March 1, 2019- What We Got Here is a Failure to Communicate

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE
Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
March 1, 2019
Volume 22  Number 9

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Colleagues:

My wife Sandra and I have been blessed with five wonderful children.  The Madejski children are a combination of scientists and thespians.  My oldest son, Greg, is the other Doctor in the family— a PhD in Biomedical Engineering at the University of Rochester.  His youngest brother, Joe, is following in his footsteps as a sophomore at the U of R.  Giovanni, our middle child, is an industrial engineer in Colorado.  My daughter Jacqueline is an actress, currently performing in Key West, and my son James is a writer, currently in London working on a film.  The engineers, but especially the artists are all film buffs and we have ongoing discussions about a number of family favorite movies.

I missed the Oscars on Sunday, but am always amused, and sometimes dismayed, when life imitates art.

The quote at the top of the page is from the movie Cool Hand Luke.  Our children didn’t require a lot of guidance growing up, but when they did I would often joke that I felt we had difficulty with communication.  I felt somewhat like Paul Newman this past week in my efforts to give care to one of my patients in a Medicare Advantage Plan.

Rationing by Inconvenience

My patient, Mr.  X., had a CT of his abdomen and pelvis to assess some abdominal symptoms.  He was found to have an incidental abnormality in one of his kidneys, and my colleague in radiology recommended an ultrasound for further delineation. The ultrasound did not provide enough information and the radiologist recommended a dedicated CT of the kidney to complete the evaluation.  My office reviewed with the radiologist the need for repeat imaging.  The patient’s Medicare Advantage insurance plan required prior authorization for non-emergent imaging studies. We submitted the request and copy of the radiology report and recommendation and were denied the additional study.  I reviewed the denial, and felt that the initial reviewer had erred and submitted an appeal, indicating that my colleague in radiology recommended additional imaging.

Second Denial

Monday, I received another denial and reviewed the rationale.  The denial letter indicated that the test was denied because the patient had a CT done recently—the initial CT that incompletely identified the abnormality.  It was not clear to me who reviewed the information (a physician— it appeared) and whether they had the full clinical picture when they refused to authorize the study.  If they did have the full picture, and denied the study, I had serious concerns about the quality of care that I could deliver to my patients enrolled in this plan.  I called the 1-800 number on the denial and was connected immediately to a very friendly woman who accepted the patient identification information and then, because I was a provider, transferred me to the provider 800 number. The phone rang, and then I received frequent, repeated messages indicating that due to high call volume, there would be a delay in response.  I left the phone on speaker and completed some of my other post clinical work.  After 10- 15 minutes I was still on hold.  I hung up and went home.

Different Day, Same Response

The next morning,   I asked my assistant to contact the plan and find a medical director to discuss the case with.  In my previous experiences with other health plans, I’ve had good success in discussing a case with a physician colleague and moving forward on behalf of the patient in a mutually satisfactory way.  The plan responded that the medical director could not override a determination of the external reviewer and would not arrange for me to discuss the situation with an in- house medical director.  I was intrigued, and dismayed.   There appeared to be a problem in this system in which a physician, advocating for the proper care of their patient, could not discuss with a physician involved in the administration of the plan, concerns regarding the care of an individual patient and the quality of the plans administration of benefits for their insured. I dialed up the pleasant supervisor of appeals who dutifully took down my concern.  I did question whether the supervisor understood my concern was not just the individual patient, but a potentially flawed process that could harm other patients.  She indicated she would review it further with one of their medical directors and get back to me.  I received a call back the next morning.  The appeals supervisor told me they had reviewed my concerns, but no physician was available to speak to me.

Pulling Rank?

 Metaphorically, there was some blood on my forehead, and some puffiness to the bridge of my nose.  We had some back and forth and I was informed my only option would be to speak to her supervisor.  Trying to maintain some humor, I indicated that I thought she was the supervisor, but found that there were a number of levels of supervisors.  In these types of situations, my inclination is to work through the system, but clearly the system was not working for my patient, and not for me.  My sense of humor was failing, and I indicated that I did not wish to speak to another supervisor, but wanted to speak with a physician working for the plan.  It appeared that we were at an impasse.  Bloodied, but unbowed, I related my displeasure and indicated that I would now pursue the matter outside of the plans process.  I mentioned that I had 20,000 or so colleagues in New York who were going to hear about my experience, and indicated that if there was a medical director who wished to call me to discuss my concerns further, it might be worth their while.

I received a call back from the Medical Director of the plan within the hour.  We agreed to speak at the end of the day.  We had a pleasant conversation about my individual patient’s situation and his explanation (and to some extent an apology) about the frustrating rules imposed on the plan and their participating physicians and patients due to Medicare regulations.  He agreed to review my concern about the quality of the review and we agreed to have further discussions about the process for appeals and to review communications policies with our MSSNY VP for Socioeconomics Regina McNally.  I look forward to further discussions to improve the care of our patients and the satisfaction of our physician members.  Hopefully, this will be to the benefit of all concerned, and I won’t end up like Luke.

P.S. Just yesterday, I did have a conversation with a medical director and I think the long story will have a satisfactory (not happy because of the hours expended) ending.

This story has a number of lessons which I think are instructive to some of the discussions we will be having over the next few months in Albany and Washington.

Medicare for All?

There are ongoing discussions about single payer in New York, and Medicare for All in Washington.  Without the ability to discuss clinical concerns with administrative physicians (who also will need to be protected from reprisal when they act on behalf of a patient) in a timely, easily accessible, collegial fashion, care will be even more disrupted than it is now. Patients and physicians will have no recourse or alternative pathway in the face of an adverse determination.   If New York is going to move towards single payer, we need to have Senator Rivera and Assemblyman Gottfried pass our Collective Negotiation Bill now, as a bridge to the future, to ensure patients can get the care they require.

Physician Wellness

Physician wellness will also be further eroded due to increasing frustration with a bureaucratic, Medicare Disadvantage for all type system.  Health plans need to review the quadruple aim and pay attention to physician satisfaction as a key quality indicator.  We need to continue to work with the AMA and our State representatives to Fix Prior Auth

All healthcare financing systems have limited resources.  Patients, their physicians and other providers have ever increasing desires for care.  This constant dynamic within the system determines what actual care occurs.  Which is worse, a bureaucratic system which rations by inconvenience and can be subverted by advocacy, or an overt system with price transparency and determination of value by the purchaser?  Which is more ethical?

It is humbling, and exciting, for each of us, to have the power of this fully operational Medical Society.  Our collective voice opens doors, and our members provide valuable input on crafting the best solutions for healthcare across the state.  Many of our patients are great, articulate advocates for their interests and problems.  MSSNY physicians can complement them well, and we are acting as our best selves when we advocate on behalf of our patients who, for many reasons (illness, stigma, impairment, and developmental issues) cannot advocate on their own behalf.

Come to Albany on Wednesday

I again invite you to join me in Albany March 6th to meet with our elected representatives and share your personal story to inform them about the issues critical to you and your patients. www.mssny.org.  We have physicians and students joining us from all corners of our great state.   It should be educational (CME provided) and fun.

Our incoming President Dr. Art Fougner has agreed to try and exceed the record number of hard boiled eggs consumed in one sitting by Cool Hand Luke!

Quod si veru est per se evident, non est opus facundia

Comments? comments@mssny.org; @mssnytweet; @TomMadejski

Thomas J. Madejski, MD
MSSNY President



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Capital Update

Will You Be Joining Us in Albany Next Wednesday?
Hundreds of physician leaders from across New York State are coming to Albany next Wednesday, March 6, to advocate for their profession and their patients. Will you be joining them?

These physicians will be meeting with their local legislators, and hearing from key health care policy leaders including the Chairs of the Health and Insurance committees in the New York State Senate and New York State Assembly.  Physicians will also be given the opportunity to ask questions of these legislators.

Please join us in Albany so that together we can advocate that the Legislature:

  • Reject State Budget proposals that would impose significant cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject State Budget proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support State Budget proposals to improve public health including raising the age for tobacco purchase, regulating Pharmaceutical Benefit managers, and enable the creation of a Maternal Mortality Review Committee;
  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana and creating a single payor health insurance structure.
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms; and
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

Advocacy Day reading materials can be found: here.

To view MSSNY’s Physicians Advocacy Webinar, please click here.

A brief informal luncheon to which members of each House are invited to speak with their constituents will follow the morning program. County medical societies will be scheduling afternoon appointments for physicians to meet with their elected representatives. If you have any questions/comments, please contact Carrie Harring at: charring@mssny.org

(DIVISION OF GOVERNMENTAL AFFAIRS)


Physicians Urged to Oppose $80/Dual Eligible Patient Cut
Physicians are urged to continue to contact their state legislators to oppose a proposal in the 2019-20 Executive Budget that would significantly cut payments that Medicaid makes to physicians to cover the Medicare Part B deductibles of their patients covered by both Medicare and Medicaid.

You can send a letter in opposition to this harmful proposal by clicking: here

You can read MSSNY’s memo of opposition to the Legislature here: memo

While the exact cut for each physician would depend on the physician’s patient mix and services provided, we estimate that the cut would be $80 per patient.  That is because the 2019 Medicare Part B deductible is $185, and studies show that on average Medicaid only pays 56% of the Medicare fee schedule in New York.

Given that there are hundreds of thousands of patients in New York who are “dually eligible”, for practices that see a large number of dual eligible patients, this will have a profound impact.  For example, if a physician’s patient mix includes 500 such dual eligible patients, which could certainly be the case for many types of specialty physicians, it would cut payments by $40,000 per year – funds that could go toward upgrading electronic health records, hiring additional staff to allow for more time with patients, upgrading facilities or other medical equipment.

In past years, physicians have had to absorb significant cuts from Medicaid for the care that they provide to their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care. Please urge your legislators know how unfair this cut is.  Please urge them to oppose balancing the state budget on the backs of dedicated community physicians seeking to deliver quality care to their patient.                                                                              (AUSTER)


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Measures Enacting Tighter Restrictions on Tobacco and E-Cigarettes Moves Forward in NYS Legislature
A series of bills to limit youth tobacco use moved out of the Assembly and Senate Health Committees this week including one that would raise the age of tobacco purchase to 21.  A.558/S.2833, sponsored by Assemblywoman Linda Rosenthal and Senator Diane Savino raises the purchase age of tobacco products from 18 to 21.  Also moving from the Health Committees was A.47/S.428, sponsored by Assemblymember Linda Rosenthal and Senator Brad Hoylman.

This measure prohibits the sale and distribution of flavored “e-liquids” for use in electronic cigarettes and electronic cigarettes containing such flavoring.  A.389/S.592, sponsored by Assemblymember Sandra Galef and Senator David Carlucci, would enact the “Tobacco-Free Pharmacies Act”, which would prohibit the sale of tobacco products in pharmacies. This measure was moved from the Assembly Health Committee; action is still pending in the Senate Health Committee. The Medical Society of the Society of the State of New York supports these measures. MSSNY also supports similar proposals that have been advanced in the Executive budget.  (CLANCY)


New York Health Act Reported from Assembly Health Committee
This week legislation to create a single payor system in New York (The New York Health Act A.5248, Gottfried) was reported from the Assembly Health committee to the Codes Committee. The bill passed the Health Committee by a vote of 17-8, with Democrat Robin Schimminger and all seven Republicans on the committee voting against the measure.

During the committee meeting there was extensive debate, including questions related to private insurance, out of state injuries, effects on Medicare recipients and costs of the bill related to a variety of factors such as pharmaceuticals and unemployment insurance. Gottfried estimated that it would take two years to start paying out claims. The current iteration of the bill adds long-term care insurance for New York State residents in addition to its goal of providing taxpayer-funded insurance coverage without premium or co-pays for all New Yorkers.

The bill has passed the Assembly four years in a row and is carried in the Senate by Health Chair Committee Gustavo Rivera. MSSNY continues to have a long standing policy position in support of a multi-payor system to achieve universal coverage and in opposition to a single payor system, but also recognizes that there is a wide array of physician perspectives on this issue.  MSSNY looks forward to continued open and honest dialogue and careful evaluation of the nuances such a far-reaching proposal related to our healthcare and insurance system to ensure that New York moves forward in a manner that assures that patients access to needed care from the physician of their choice is not impaired.

When the legislation was re-introduced a few weeks back, MSSNY President Dr. Thomas Madejski issued the following statement (Statement by Thomas Madejski, MD) that highlighted improvements to the legislation to place parameters around prior authorization requirements and provide a fairer process to negotiate payments for patient care, but also MSSNY’s ongoing strong concerns with moving away from a multi-payor insurance system. (AVELLA, AUSTER)


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Governor Signs Into Law “Red Flag” Law
Governor Andrew Cuomo this week signed into law S.2451/A. 2689, sponsored by Senator Brian Kavanagh and Assemblymember JoAnne Simon, which allows law enforcement officials, family and household members, and certain school officials to seek a court order requiring a person likely to harm themselves or others to surrender any firearms in their possession. This bill, commonly referred to as a “red flag” law, would establish an Extreme Risk Protection Orders (ERPO) which is an order of protection prohibiting a person from purchasing, possessing or attempting to purchase or possess a firearm, rifle or shotgun.    Under the measure, a police officer, a family or household member, a school administrator or his/her designee, can request a court-issued order of protection.  The bill provides grounds for the request and surrendering of the firearm.  MSSNY’s Taskforce on Firearm Safety recently recommended (and the MSSNY Council agreed) that MSSNY support the concept of “red flag” provisions.

Still awaiting the governor’s signature are a series of bills that would help ensure firearm safety.  S.2374/A.2690, sponsored by Senator Michael Gianaris and Assemblymember Amy Paulin, would establish a background check waiting period of up to 30 days.  S.2248/A.2448, sponsored by Senator Luis Sepulveda and Assemblymember Patricia Fahy, would prohibit the possession of a device (bump stock) that accelerates the rate of fire of a firearm.

Also passed by the Legislature was S.101A/A.1715, sponsored by Senator Todd Kaminsky and Assemblymember Judy Griffin that prevents K-12 schools from authorizing anyone other than a security officer, a school resource officer or a law enforcement officer from carrying a firearm on school grounds.  Senator Shelley Mayer and Assemblymember Linda Rosenthal sponsored legislation that directs the state police to devise regulations for gun buyback programs to ensure that such programs are operated consistently throughout the state.  Senator Anna Kaplan and Assemblymember Pamela Hunter were the sponsors of S.2438/A.1213, which would require out of state applicants for gun permits to allow NY permitting authorities to review out-of-state mental health records.

In March 2018, the MSSNY House of Delegates took action to support legislation that requires a waiting period and background checks prior to the purchase of all firearms, including person-to-person transfer, internet sales and interstate transactions for all firearms.  The MSSNY HOD also supported legislation that blocks the sale of any device or modification – including but not limited to bump stocks, which convert a firearm into a weapon that mimics fully-automatic operation.  MSSNY supports legislation that would ban the sale and/or ownership of high-capacity magazines or clips and high-speed, high-destruction rounds. (MSSNY Policy 260.898 and Policy 260.899). (CLANCY)


NY Health Foundation Issues Report Promoting NY’s Successful Law to Limit Patient Surprise Bills
With the United States Congress looking at legislation to address the issue of patients facing “surprise” out of network medical bills across the country, the New York State Health Foundation issued a report this week highlighting the success that New York’s 2014 law has had in reducing such bills.

While New York’s law contains a number of different components to expand network adequacy and comprehensive out of network coverage, its most notable component assures that patients are not financially responsible for medical bills for “surprise” Emergency Department and hospital out-of-network services that are above the patient’s standard in-network copayment, deductible, or coinsurance amount.  Physician payments for these services are determined through informal negotiation between the insurer and physician, with either party having the right to go to a simplified expedited independent dispute resolution (IDR) process if such negotiations for fair payment are not successful (for more information about the law, click here).  The report noted that the percent of out-of-network emergency department services that were billed decreased from 20.1% in 2013, before the law was passed, to 6.4% in 2015, after its implementation.

As Congress debates this issue, MSSNY has written to the New York Congressional delegation, urging that any legislation to be considered is consistent with New York’s comprehensive law (see MSSNY’s letter here).   New York’s comprehensive law addressing this issue has been hailed as a model for the rest of the country because of the delicate balance it struck among key health care stakeholders (such as physicians, hospitals and health insurers) to protect patients from large “surprise” medical bills, while at the same time being constructed in such a way that it did not adversely affect the ability of hospital emergency departments to have adequate on-call specialty physician care.

The NYS Health Foundation report also included some recommendations for improving New York’s law, including stronger insurer network adequacy requirements, enhanced insurer and provider disclosure of network participation, further limiting balance billing in ER out of network situations, and extending applicability to air ambulance services.  MSSNY is continuing to review the feasibility of these recommendations. (AUSTER)



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Assembly Passes Legislation to Exempt Nursing Home from E-Prescription Requirement
This week the Assembly passed Assemblyman Richard Gottfried’s bill (A1034-A) that would exempt nursing homes’ prescription of oral medication from the state requirement that all prescriptions be electronically submitted.   As was recently discussed at MSSNY’s Long-Term Care subcommittee meeting, nursing homes present unique circumstances that make compliance with the current mandate impractical. Physicians are not physically present 24 hours a day, so RNs are allowed to take orders for medication safely and without delay for the residents who need them. The physician would then sign the oral order within 48 hours. This is an extension of an already existing exemption established by the NYS Department of Health that is set to expire on 3/24/19. It would set forth in statute that a waiver from this requirement would be extended to March 2021. The bill does not yet have a Senate sponsor. (AVELLA)


DOH Announces Prevention Agenda 2019-2024 at 6th Annual Population Health Summit
On February 2nd, MSSNY staff and Dr. Geoffrey Moore (Tompkins County) participated in the 6th Annual Population Health Summit: “Becoming the Healthiest State for People of All Ages – Incorporating Health Across all Policies and Age Friendly Principles into the Prevention Agenda 2019-2024” hosted by the NYS Department of Health. The Summit sought to deepen and extend the understanding of ongoing efforts in New York State and nationally that demonstrate effective collaboration between public health, health care, and other sectors to advance population health.

The Prevention Agenda 2019-2024 will focus on preventing chronic diseases; promoting a healthy and safe environment; promoting healthy women, infants, and children; preventing mental and substance use disorders; and preventing communicable diseases. To learn more about the Prevention Agenda 2019-2024 click on this link (HARRING)


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Legislation to Help Prevent Sudden Cardiac Arrest in Student Athletes Moving in NYS Assembly
Legislation to create an educational program on sudden cardiac arrest moved out of the Assembly Health Committee this week.  A.4892/S.3269, sponsored by Assemblymember Michael Cusick and Senator Andrew Lanza, would add the development of an educational and outreach program preventing sudden cardiac arrest among student athletes to the Health Care and Wellness Education and Outreach Program that currently exists in the New York State Department of Health.

The Medical Society of the State of New York supports this measure.  Under the bill’s provisions, DOH will provide educational materials regarding sudden cardiac arrest to students and their parents and guardians. The materials would be developed in conjunction with the Commissioner of Education, the Medical Society of the State of New York, the New York Chapter of the American Academy of Pediatrics, and the American Heart Association.  They would include an explanation of sudden cardiac arrest, a description of early warning signs and an overview of options that are privately available for screening. This legislation would establish a program similar to one being used in New Jersey that requires the development of brochures that could be given to parents as well as pediatricians. (CLANCY)


Registration now open for Medical Matters: Disaster Medicine: Every Physician’s Second Specialty on March 27th at 7:30 AM
The Medical Society of the State of New York will conduct a webinar entitled Disaster Medicine: Every Physician’s Second Specialty on March 27, 2019 @ 7:30am.

Register now for:

Medical Matters: Disaster Medicine: Every Physician’s Second Specialty

Wednesday, March 27th @ 7:30am
Register here.
Faculty: Lorraine Giordano, MD, FACEP, FAADM

Educational Objectives:

Identify core preparedness competencies every physician should know

Explore essential elements of preparedness plans for staff, patients, and family

Describe available courses, resources and organizations to obtain disaster preparedness education and training. 

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. (HOFFMAN, CLANCY)


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Registration Now Open for New Veterans Matters CME Webinar March 14th
The Medical Society of the State of New York is proud to announce our newest Veterans Matters webinar scheduled for March 14th at 7:30am. This webinar is entitled Military Culture: Everything Physicians Need to Know About Veterans as Patients.  Register for this program here.

Veterans Matters: Military Culture: Everything Physicians Need to Know About Veterans as Patients

When: Thursday, March 14 2019 at 7:30am – Register here.

Faculty: Lt. Col Lance Allen Wang, & Marcelle Leis, CM Sgt. (Ret)

Educational Objectives:

  1. Describe the unique aspects of military culture and how they impact patients who are veterans.
  2. Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality.
  3. Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back into civilian life.

Additional information or assistance with registration can be obtained by contacting Melissa Hoffman at mhoffman@mssny.org or (518)465-8085                                 (HOFFMAN)

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 creditsä.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.


For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
charring@mssny.org

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MSSNY Member Event at the Westbury Manor: “Is Single Payer Legislation Coming to New York? 

Moe Auster MSSNY, Single Payer Seminar, Westbury David Podwell, MD, Single Payer Seminar, Westbury
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Response to Claim that Majority Legalization of Assisted Suicide
Dr. Thomas Madejski, the president of the Medical Society of the State of New York (MSSNY), wrote in a letter to the editor of the Albany (NY) Times Union (2/22) that MSSNY “has strong concerns with the articulation in the article ‘State’s physicians support aid in dying,’ Jan. 29, that a majority of New York doctors are in favor of physician assisted suicide.” Madejski says that “the survey from Compassion & Choices that was referenced in the article, like the 2017 Medical Society survey, is not a scientific sample representative of the nearly 100,000 New York-licensed physicians as a whole.” Madejski adds that MSSNY’s “Task Force on End of Life continues to discuss many matters related to end-of-life care and whether Medical Society’s long-standing position on physician assisted suicide should be re-evaluated.”


NY Services for Senior Citizens Strained by Record High Elderly Population
The Wall Street Journal (2/27, King, Subscription Publication) reports a study published by the Center for an Urban Future indicates that people aged 65 and older now make up 16 percent of New York’s population, a record high. This in turn is straining state and county services for senior citizens, such as home-care aides and meal delivery.


A Patient Just Sexually Harassed An Employee of My Practice: What Can I Do?
By Andrew Zwerlingftnref1″>[1]

It seems like a normal day at your medical practice until one of your female physician-employees informs you that a male patient grabbed and tried to kiss her when she was conducting a routine examination.  The patient fled the practice immediately after this event.

Putting aside the issue of whether your employee may file criminal charges against the patient – she can – an issue confronting you as the physician-owner of the practice is whether it is appropriate to discharge the offender as a patient of your practice.   As the owner of the practice, under New York law you are required to intervene when put on notice of acts of sexual harassment and assault in your workplace and may be held accountable if you fail to do so.  Here, in order to ensure the safety of your staff, one measure you can take is to discharge or terminate the patient.

Significantly, however, there are myriad components to the termination process that should be undertaken in the effort to insulate you and your practice from a claim of patient abandonment.  You should inform the patient of the termination in writing and through a method of delivery that allows you to track and confirm receipt by the patient, and also send the letter by first class mail.

In the letter you should advise the patient 1) of the reason for the termination; 2) that your practice will be available to him for urgent or emergent care only for a period of thirty (30) days while he transitions his medical care to another qualified provider; 3) that he should contact his insurance provider to assist him in identifying local medical providers to manage or arrange for any ongoing treatment he may need; and 4) that when he finds another provider, that provider may contact your practice to arrange for the transfer of the patient’s clinical records.  You may, but are not required to, provide the patient with a list of other similar providers in the area that he can contact to arrange for ongoing treatment, but cannot recommend any particular provider.  Finally, you should maintain a copy of the termination letter in your files.

[1] Andrew L. Zwerling is a Partner-Director at Garfunkel Wild P.C. with over 36 years as a trial and appellate lawyer in State and Federal courts, including his successful argument before the United States Supreme Court.  He specializes in employment law, and conducts internal investigations for clients relating to sexual harassment and other personnel issues.   His may be reached at 516-393-2581 and by email at azwerling@garfunkelwild.com.


Physicians Accepted $40M in Kickbacks from Texas Hospital, Feds Say
The federal trial for 10 defendants, including four surgeons and a pain physician, accused of participating in a $200 million healthcare fraud scheme kicked off last week, according to The Dallas Morning News.

Five things to know:

  1. The trial, which is expected to last up to two months, centers on bribes and kickbacks now-defunct Forest Park Medical Center in Dallas allegedly paid to physicians and surgeons to steer surgeries to the hospital.
  2. The scheme, which began in 2009 and ran through 2013, involved paying surgeons for referring patients to FPMC, which was out of network with payers. Instead of billing patients for out-of-network copayments, hospital executives and physicians allegedly assured patients they would pay in-network prices. Those involved in the scheme allegedly concealed the patient discounts and wrote off the difference as uncollected bad debt.
  3. There were 21 defendants charged in the scheme in 2016, 11 of whom have pleaded guilty and are expected to testify on behalf of the government at trial, according to The Dallas Morning News.
  4. The $200 million healthcare fraud scheme allegedly involved FPMC officials making $40 million in illegal payouts to surgeons and others in exchange for referrals. Although the $40 million in payments looked legitimate, they were really “bribes and kickbacks,” a government lawyer told the jury during opening arguments on Feb. 21, according to Law360.
  5. Several of the defendants have denied any wrongdoing. They claim healthcare attorneys told them the marketing agreements they entered into, which are at the center of the kickback allegations, were not illegal, according to The Dallas Morning News. (Becker’s Hospital Review, Feb. 27)

More Independent Hospitals Joining Systems Amid Financial Struggles
Modern Healthcare (2/23) reported “stand-alone hospitals’ financial situations are increasingly tenuous,” with 53.2 percent operating at a loss “for each of the past five years, which is more than twice the share of system-owned hospitals, according to an analysis of Modern Healthcare Metrics.” Among rural standalone hospital, the number increases to 60.5 percent. Meanwhile, “independent government-owned hospitals, many of them in rural areas, had an average annual operating margin of negative 16.6% and a $15.8 million operating loss in 2016 compared with a negative 7.9% operating margin and $8.4 million operating loss for their system-owned peers, according to a white paper from Healthcare Management Partners, Waller Lansden Dortch & Davis, and Taggart, Rimes & Graham.” Such financial struggles are leading independent hospitals to join larger health systems; “nearly three-quarters of all hospitals were part of multihospital systems in 2017, up from 70.4% in 2012, according to Metrics data.” (Becker’s Hospital Review, Feb. 27)


As Congress Looks at ‘Surprise’ Billing, a Review of NY’s Law
The New York State Health Foundation on Monday published a review of the state’s law regarding surprise bills, implemented in 2015, to highlight its successes and limitations.

Under the law, patients are responsible for their in-network payment only in cases when they did not give written consent to be treated by an out-of-network provider, including in emergencies. The law also created a dispute-resolution process for providers and insurers to enter binding arbitration over bills.

The law seems to have had its intended effect. The percentage of out-of-network emergency department services billed dropped from 20.1% in 2013 to 6.4% in 2015, according to a study from researchers at Yale University cited in the report.

“We found with our review that the law is working quite well,” said Sharrie McIntosh, vice president for programs at NYSHealth.


Study Underscores Cost Implications of Trend on Taxpayers and Beneficiaries
This study demonstrates that the overall trend continues and is dramatically reshaping the landscape for physicians by creating an increasingly concentrated health care system that costs more.  This is because the same services performed in the hospital outpatient setting are reimbursed by Medicare at higher rates compared to the independent physician office setting. Previous PAI-Avalere research underscored the impact of this policy as it relates to health care spending by taxpayers and patients:

  • Medicare paid $2.7 billion more for four specific cardiology, orthopedic, and gastroenterology services performed in the hospital outpatient setting than if the same services were delivered in the physician office setting from 2012 to 2015.
  • For these same services, Medicare beneficiaries faced $411 million more in out-of-pocket costs due to higher cost-sharing.

Sexual Harassment Webinar
Train the Trainers”: Impact on Healthcare System and Medical Profession

March 20, 2019
12:00pm-1:00pm

REGISTER HERE

 The issue of sexual harassment in the workplace has been the center of a staggering amount of media attention and of a surge in litigation activity. Consistent with this momentum, New York State recently mandated that all employers are required to have a sexual harassment policy containing specified criteria in place by October 9, 2018, and to conduct sexual harassment prevention training by October 2019. (New York City requirements are slated to take effect in April 2019.)

The issue of sexual harassment takes on particular significance for the healthcare industry, because there is an established nexus between disruptive behavior, which includes sexual harassment, and adverse patient outcomes and medical errors.

Sexual Harassment Train the Trainer FREE Webinar on March 20 12 noon

At this time, Garfunkel Wild will be offering a complimentary “Train the Trainers” webinar on the issue of sexual harassment.  The live webinar will be presented on March 20, 2019, from 12 noon to 1:00pm.  For those individuals who are unable to participate in the webinar at that time, MSSNY will be placing a recorded version of that webinar on the MSSNY website to facilitate access to the webinar for MSSNY members.

By the conclusion of the “Train the Trainers” webinar, you will know how to teach your employees:

  • How to identify the more subtle forms of sexual harassment.
  • The impact of sexual harassment on the quality of care and the victim.
  • Practical advice on how to diminish and prevent sexual harassment at your practice.
  • How to respond to sexual harassment in the workplace.
  • Guidelines on how to comply with statutory mandates relating to sexual harassment.

Garfunkel Wild offers individual or group training, on-site or off-site training, as well as webinar modules that can serve to satisfy this new statutory mandate for your employees. If you would like to set up a personal training, please contact Andrew L. Zwerling at 516-393-2581 or azwerling@garfunkelwild.com.


CME PROGRAMS

Two CME Programs at the HOD: Protect Your Patients and Women in Medicine
You don’t want to miss these! REGISTER NOW at sbennett@mssny.org

Thursday, April 11, 2019, 3:00 – 4:00 pm, Grand Ballroom D/E, Westchester Marriott, Tarrytown

Protect Your Patients, Your Practice, and You!*

Join us at the OMSS Annual Meeting for an interactive presentation by Garfunkel Wild on MEDICAL RECORDS, including the impact on records of the controlled substances “epidemic,” what to consider when emailing and texting, dealing with non-compliant patients, additional areas of exposure from EMRs, and what to include in a telemedicine record.

Business meeting to follow, 4:00 – 6:00, Putnam Room


Friday, April 12, 2019, 5:00 – 6:30 pm, Grand Ballroom B, Westchester Marriott, Tarrytown 

Women in Medicine: Reaching Your Potential Now!**

A panel presentation at the Women Physicians Caucus on PAY, PROMOTIONS and CAREER ADVANCEMENT in Academic Medicine, Private Practice and Organized Medicine

Gender imbalance in medicine and academic sciences still exists. Hear three women physicians who have achieved significant leadership positions describe their own pathways, provide advice on how to achieve success, and show how to overcome gender bias, gender pay gaps and system-wide barriers to career advancement. Learn how to achieve success in your career!

* The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

** The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Classified

RENTAL/LEASING SPACE

 

Office Rental 30 Central Park South.
Two fully equipped exam, two certified operating, bathrooms and consultation room.  Shared secretarial and waiting rooms. Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468drdese@gmail.com.


5th Ave Medical Office for Share
Facing Central Park in exclusive building, ground floor, separate entrance.
Perfect for psychiatrist, physiatrist, osteopath, or other.
880 5th Avenue (between 69th and 70th Sts.), New York, N.Y.
Please call 917-715-2464


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES

Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


Pediatrician BC, P/T
Seeking motivated, enthusiastic pediatrician for P/T position in solo practice in Long Island. Coverage will increase over time. Great opportunity for those seeking part time hours in an established practice.   Fax resume to 516-858-2389.


Physician Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year.

Interested? Learn more and apply today at www.98point6.com/pcc



CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Council – March 5, 2019

AGENDA
MSSNY Council Meeting
Tuesday, March 5, 2019, 1:00 p.m.
Albany Renaissance Hotel
144 State Street
Albany, NY  12207

 

A. Call to Order and Roll Call

B. APPROVAL of the Minutes of January 24, 2019

C. New Business (Informational/Action Items)

1. President’s Report:
Introduction to the New MSSNY Mobile App for the House of Delegates (verbal)
Presented by:
Mr. Stephen Sachs, MSSNY’s Website Administrator

2. Board of Trustees Report – Dr. Robert Hughes will present the report  (handout)

3. Secretary’s Report – Dr. Frank Dowling will present the report

4. MLMIC Update – Mr. Marc Craw will present the report (verbal) 

5. AMA Delegation Report – Dr. John Kennedy will present the report (verbal)

6. MSSNYPAC Report – Dr. Joseph Sellers will present the report (handout)

7. MESF Update – No written report submitted

8. Commissioners (Action Items – For Council Approval)
    Commissioner of Science & Public Health, Joshua M. Cohen, MD

  1. Resolution 2018-63 – Integrating Medical Records
  2. Resolution 2018-150 – Common Sense Prostate Cancer Screening
  3. Revisions to MSSNY Policy 125.996 Screening Programs and Interventions Most Beneficial in Improving the Overall Public Health

DReports of Officers

  1. Office of the President – Thomas J. Madejski, MD
  2. Office of the President-Elect – Arthur C. Fougner, MD
  3. Office of the Vice President – Bonnie L. Litvack, MD
  4. Office of the Treasurer – Joseph R. Sellers, MD
        Financial Statement for the period 1/01/18 to 12/31/18
  5. Office of the Secretary – Frank G. Dowling, MD
  6. Office of the Speaker – Kira A. Geraci-Ciradullo, MD

E.  Presentations

2:00 p.m.
PowerPoint – “Physician Wellness” (handout)
Presented by:
Arthur Hengerer, MD, Chair BPMC
Robert Catalano, MD, MBA Executive Secretary, OPMC
Mr. Keith Servis, OPMC Director
Mr. Stephen Boese, Executive Secretary, Board of Medicine


2:45 p.m.
PowerPoint – “Efforts to Stop Legalization of Marijuana in New York State” (handout)

Presented by:
Kevin A. Sabet, PhD. President & CEO
Smart Approaches to Marijuana (SAM)


3:45 p.m
Discussion – “Overview of the Proposal to Legalize Marijuana in New York State” (verbal)
Presented by:
Mr. Axel Bernabe, Associate Counsel for Health
Office of  New York Governor Andrew Cuomo
Mr. Jason Starr, Assistant Counsel
Office of  New York Governor Andrew Cuomo


F.
  Reports of Councilors (Informational Items)

  1. Kings & Richmond Report – Parag H. Mehta, MD
  2. Manhattan & Bronx Report – Joshua M. Cohen, MD
  3. Nassau County Report – Paul A. Pipia, MD
  4. Queens County Report – Saulius J. Skeivys, MD
  5. Suffolk County Report – Maria A. Basile, MD
  6. Third District Branch Report – Brian P. Murray, MD
  7. Fourth District Branch Report – Gregory L. Pinto, MD
  8. Fifth District Branch Report –Howard H. Huang, MD
  9. Sixth District Branch Report – Robert A. Hesson, MD
         (no report submitted)
  10. Seventh District Branch Report – Janine L. Fogarty, MD
  11. Eighth District Branch Report – Edward Kelly Bartels, MD
  12. Ninth District Branch Report –  Thomas T. Lee, MD
  13. Medical Student Section Report – Breyen Coffin
  14. Organized Medical Staff Section – Stephen F. Coccaro, MD
  15. Resident & Fellow Section Report – Justin Fuehrer, DO
  16. Young Physician Section Report – L. Carlos Zapata, MD
         (no report submitted)

G.  Commissioners (Informational Items)

1. Commissioner of Communications, Maria A. Basile, MD, MBA
  a.  Report from the Division of Communications 

2. Commissioner of Governmental Relations, Gregory Pinto, MD
  a. HIT Committee Minutes, February 1, 2019

3. Commissioner of Membership, Parag H. Mehta, MD
    a. Membership Committee Report

4.  Commissioner of Science & Public Health, Joshua M. Cohen, MD 
  1. Addiction & Psychiatric Medicine Committee Minutes, January 18, 2019
  2. Bioethics Committee Minutes, February 8, 2019
  3. Health Care Disparities Minutes, January 25, 2019
  4. HLC Committee Minutes, October 17, 2018
  5. Infectious Diseases Committee Minutes, January 17, 2019
  6.  PMFH Committee Minutes, February 7, 2019
  5. Commissioner of Socio Medical Economics, Howard H. Huang, MD
  (No written report submitted)

H. Report of the Executive Vice President, Philip Schuh, CPA, MS

I. Report of the General Counsel, Garfunkel Wild, P.C., James Derling, Esq.
   (No written report submitted)

J. Report of the Alliance, Barbara Ellman
   (No written report submitted)

K. Other Information/Announcements 

  1. AMA Surprise Bill Sign-On Letter
  2. MSSNY Surprise Bill Letter to Senator Schumer
  3. PAI Comments on HIPAA RFI
  4. MSSNY Statement on Legalization of Cannabis Public Hearing
        http://www.mssnyenews.org/press-releases/legalcannabis/#can
  5. MSSNY Statement on Revised New York Health Act Legislation
        http://www.mssnyenews.org/press-releases/health-act-  legislation/#leg   
  6. Poughkeepsie Journal Article    https://www.poughkeepsiejournal.com/story/news/2019/02/20/marijuana-legalization-ny-under-attack-cops-educators-docs/2905268002/

L. Adjournment

 

 

 

 

 

Feb. 8, 2019 – Women and Children First!

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE
Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
February 8, 2019
Volume 22  Number 6

MSSNYPAC Seal

Colleagues:

I need your help.  I need you to join me in Albany March 6th to meet with our elected officials about the health and safety of our patients Click Here to Register! New York Governor Andrew Cuomo @NYGovCuomo has proposed his budget for New York State and the NYS legislature has started budget hearings on a multitude of issues affecting the health and welfare of our patients and our profession.  These issues are currently under discussion and MSSNY has provided testimony on a number of items of concern. I’ve indicated to you in some of my previous communications the importance of building relationships with our elected officials in the markedly changed legislative environment during the new session. Our representatives and their staff need to understand the potential effects of their proposals on our patients and families and their constituents.

Our excellent MSSNY legislative staff does a great job in getting information about our greatest concerns to our elected officials. The most critical part of advancing our goals for the betterment of public health and the proper practice of medicine is direct interaction with your personal representatives.  March 6th is our best opportunity to demonstrate our care of, and care about, our patients. We have an opportunity to weigh in on reducing maternal mortality, advocating for the care of women and their infants, and to reduce the incidence of exposure to psychoactive substances to our children and young adults.  Let me assure you that the situation is fluid, and your individual effort can make a difference in the health of your patients, your satisfaction in your practice, and the health of our communities.

Please sign up to join me in Albany March 6th.  Your patients, and our profession, are counting on us.

P.S. I’d be honored if you would also join me in Albany for our MSSNY Council meeting March 5th.  Let me know if you’re coming, and any other thoughts you have.

You can follow me on twitter@tommadejski

lux, veritas, virtuslegis plenitudo charitas

Comments? comments@mssny.org; @mssnytweet; @TomMadejski

Thomas J. Madejski, MD
MSSNY President



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Capital Update

MSSNY Delivers Testimony Highlighting Positives and Negatives of New York State Budget Proposal
MSSNY Senior Vice President and Chief Legislative Counsel Moe Auster delivered testimony this week to a joint Senate-Assembly Committee regarding the healthcare portion of Governor Cuomo’s proposed 2019-20 budget. MSSNY’s testimony applauded the several positive measures included within the budget that MSSNY believes will help physicians provide better care to New Yorkers, while also highlighting a list of issues deemed problematic to the medical community and their patients.

To view MSSNY’s testimony and the several questions from legislators,  Click here.  To read MSSNY’s written testimony, Click here.

Of note, MSSNY’s testimony noted its support for NYS Executive Budget measures that would: increase the tobacco/e-cigarette purchase age to 21, provide better coverage of care for mental illness and substance abuse treatment, examine ways to prevent maternal mortality, provide stronger regulation of pharmaceutical benefit managers (PBMs) and extend the Excess Medical Malpractice Insurance program to assist physicians in affording extraordinarily expensive but needed liability insurance coverage.

MSSNY’s testimony also expressed strong concerns with proposals that would legalize the non-medicinal use of marijuana, revoking from doctors the final say in coverage for prescribing medications to their Medicaid insured patients and expansion of the types of practitioners who could treat Workers Compensation patients without addressing the numerous factors that are deterring physician participation in this program.  He particularly highlighted the physician community’s strong concerns with a proposal that would significantly cut (an estimate $80 per patient cut) the patient deductible payments that Medicaid makes to physicians who treat patients dually eligible for Medicare and Medicaid.

Mr. Auster answered a variety of questions from the legislative panel, including the physician perspectives on the legalization of non-medicinal marijuana; the regulation of pharmaceutical benefit managers, and perspectives on single payer legislation. (DIVISION OF GOVERNMENTAL AFFAIRS)


Physicians Urged to Oppose Further Dual Eligible Payment Cuts Proposed in State Budget
All physicians are urged to contact their state legislators to urge that they reject a proposal contained in the 2019-20 Executive Budget that would significantly cut the payments that Medicaid makes to physicians to cover the Medicare Part B deductibles of their “dually eligible” patients.   You can send a letter in opposition by clicking Here.

You can read MSSNY’s memo of opposition to the Legislature Here.

While the exact cut for each physician would depend on the physician’s patient mix and services provided, we estimate that the cut would be $80 per patient.  That is because the 2019 Medicare Part B deductible is $185, and studies show that on average Medicaid only pays 56% of the Medicare fee schedule in New York.

Given that there are hundreds of thousands of patients in New York who are “dually eligible”, for practices that see a large number of dual eligible patients, this will have a profound impact.  For example, if a physician’s patient mix includes 500 such dual eligible patients, which could certainly be the case for many types of specialty physicians, that amounts to a decrease of over $40,000 per year – funds that could go toward upgrading electronic health records, hiring additional staff to allow for more time with patients, upgrading facilities or other medical equipment. In past years, physicians have had to absorb significant cuts from Medicaid for the care that they provide to their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care. Please urge your legislators know how unfair this cut is.  Please urge them to oppose balancing the state

budget on the backs of dedicated community physicians seeking to deliver quality care to their patient.
(AUSTER)


Medical Liability Reform Bills Introduced in the Assembly
Assemblymembers Robin Schimminger (D-Kenmore) and Peter Abbate (D-Brooklyn) each re-introduced legislation this week aimed at reducing the exorbitant cost of medical liability insurance in New York State, and providing more fairness in the resolution of the cases.

In New York, cumulative medical liability payouts far outpace other states. A recent report by Diederich Healthcare showed that, in 2017, once again New York State had far and away the highest number of cumulative medical liability payouts. Claimants in New York were awarded nearly two times more than the state with the next highest amounts, Pennsylvania, and payments in New York far exceeded states such as California and Florida. Moreover, New York had the dubious distinction of having the highest per capita medical liability payouts in the country, about 500% greater than the State of California, which has enacted meaningful liability reforms.

Assemblyman Schimminger’s Medical Liability Reform Act (A.4897) would work to ease the extraordinary liability burden on physicians in New York through the enactment of a number of policy changes, including the following:

  • Requiring an affidavit of merit from a NY licensed physician to cut down on the filing of non-meritorious claims;
  • Placing a reasonable limit on non-economic damages (there are currently 30 states with some form of a similar cap); and
  • Requiring enhanced disclosure of identity of expert witnesses

Assemblyman Abbate’s legislation (A.5018) would require a particularized affidavit of merit to function as a comprehensive vetting of medical malpractice claims prior to commencing of a legal action. Additionally, it would require full and complete discovery of expert witnesses in medical liability actions.                            (AVELLA, AUSTER)                     


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New York State insurance exchange reports record enrollment numbers
NY State of Health’s open enrollment period ended on January 31, and at that time enrollment in both the Essential Plan and in Qualified Health Plans had increased over last year. Essential Plan enrollment stood at 790,152, up 6.9% over last year meanwhile 271,873 people had purchased Qualified Health Plans, a 7.4% increase compared to the same point last year. In contrast, enrollment dropped by 3.8% in the 39 states that use the federal marketplace. The Essential Plan provides coverage with no deductible and is either free or costs $20 monthly. A family of four earning up to $50,200 qualify and New York and Minnesota are the only two states to offer this option. According to the Kaiser Family Foundation, the monthly premium for the cheapest individual bronze Qualified Health Plan in NY averages $402 without subsidies and the cheapest gold plan averages $638 per month. NYSOH has stated that 58% of people buying plans qualify for financial assistance.      (AVELLA)


Experts Debate New York Health Act
Click here to watch a 2-hour debate of the proposed New York Health Act sponsored by the New York City Bar Association please Click here.  Participants in the program included NYS Assembly Health Committee Chair Richard Gottfried, sponsor of the legislation; Eric Linzer, President of the New York Health Plan Association; Bill Hammond, Director of Health Policy for the Empire Center for Public Policy; Dr. Oliver Fein, Chair of the NY-Metro Chapter of Physicians for a National Health Plan; and Ashley Fox, an Assistant Professor at University at Albany.                       (AUSTER)     


Workers Compensation Board Looks at Improvements to the IME Process
This week the initial meeting of the New York Workers’ Compensation Board IME Advisory Committee took place.   Among the members of the WCB expert panel was MSSNY Past-President Dr. Robert Goldberg.  The group was created pursuant to a provision of the comprehensive Workers Compensation legislation enacted in 2017 that called on the WCB to make recommendations for improving the process by which injured workers receive independent medical examinations.   In particular, the statute calls upon the Board to develop recommendations “that will ensure fairness, and highest medical quality, while improving methods of combatting fraud”For example, one of the major discussion points for the initial meeting this week was examining data that a small number of practitioners had performed an enormous number of IMEs.  The group will be meeting throughout 2019 to develop recommendations for improving the IME process with a report due to the Governor & Legislature by year end. (AUSTER)


Medical Jobs Ad

MSSNY Fights for Funding to Attract and Retain Physicians in NYS
This week MSSNY staff joined representatives from a variety of other health care advocacy groups (including HANYS, NYACP, CHCANYS, the Center for Health Workforce Studies & the Upstate NY Physician Recruiter Network) in numerous meetings with key legislative and executive staff to support increased efforts to address the shortage of physicians in underserved regions across New York State. In addition, two physicians who are Doctors Across New York (DANY) awardees joined the group and shared their stories about how DANY positively affected their lives and ability to practice in New York. Among the notable issues was the request of legislative support of funding for DANY.

DANY is a state funded program launched in 2008 that aims to train and place physicians in areas of New York State where that specialty is most needed. The goal is to ensure adequate funding, streamline the application process and to remove barriers to application. The group is also hoping for increased funding for the Empire Clinical Research Investigator Program (ECRIP) which allows doctors to spend additional time training in research.

Other priorities for the group include funding for the Diversity in Medicine Scholarship; the expansion of the Take a Look Program, which introduces medical students and residents practicing in NYC to Upstate New York and the opportunities available in medicine; and statutory implementation of required data collection for allied health workers.                                                                      (HARRING, AVELLA)


Senator Rivera Introduces Legislation to Improve Patient Access to be Treated by the Physician of Their Choice
Senator Gustavo Rivera, Chair of the New York State Senate Health Committee, introduced three bills this week that are strongly supported by MSSNY. The bills in question relate to health insurance networks and the interaction between physicians and insurance companies.

  • S3461 would require that health insurers cover services provided by out-of-network (OON) providers. OON coverage is not mandated in New York and while exchange officials have “strongly encouraged” insurers to offer this coverage, many New Yorkers do not have this option available. Additionally, many patients are restricted to limited physician networks that do not provide adequate choice of physician to receive their care.
  • S3462 would allow in limited instances independently practicing physicians in New York State to conduct some collective negotiations by creating a system under which the state would closely monitor those negotiations, and approve or disapprove such negotiations from going forward. Many areas of New York are dominated by a small number of insurers and this bill would help even the playing field between physicians and insurers.
  • S3463 would provide physicians due process protections when health insurers seek to terminate a physician from its network by failing to renew the physician’s contract. Current law prohibits a health insurance company from terminating a physician’s contract without a written explanation of the reasons for the proposed contract termination and an opportunity for a hearing by a panel comprised by three persons including a clinical peer in the same or similar specialty. These provisions, however, do not apply to situations involving the non-renewal of physician contracts. This bill would correct that disparity.                            (AVELLA)

NYS Senate Commitee to Consider Bill Mandating Patient Education for C-Section; Physician Action Urged
Senate Bill 2888/A.318, sponsored by Senator Julia Salazar and Assemblymember Amy Paulin, would require all physicians and other health care providers to provide all maternity patients with written information as to the risks associated with Cesarean section. This measure is before the Senate Women’s Issues Committee and has already passed the NY State Assembly. The Medical Society of the State of New York & ACOG are opposed to this measure as it interferes with the physician patient relationship by requiring a written communication to every single pregnant women whom the physician recommends a  C-Section. MSSNY & ACOG are concerned that a individual patient may have different risk factors and health needs.

Furthermore, the terminology of the bill is not consistent with the typical medical practice.  The Medical Society is also troubled by the proliferation here in New York State, and nationally, calling for legislation requiring educational information that physicians will need to cite that pertains to women’s health issues.  Nationally, a disproportionate number of these bills apply only to physicians when they are treating pregnant women.  Furthermore, states have gagged or coerced physician communications for politicized public health issues.

This measure mandates physicians to provide “a script” that may not comply with the latest medical evidence on Cesarean section. Physicians are urged to contact members of the Senate Women’s Issue Committee which are:  Senator Julia Salazar, Senator Betty Little, Senator Shelley Mayer, Senator Anna Kaplan, Senator Catherine Young, Senator Jen Metzger, and Senator James Gaughon. They can be reached through the main senate switchboard at (518) 455-2800 or by sending a letter through the MSSNY Grassroots Action Center at this link please Click here.                (CLANCY)   


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NYS Reproductive Health Act; Governor Discusses Aspects of the Law
The New York State Legislature passed the Reproductive Health Act and it was immediately signed into law by Governor Andrew Cuomo as Chapter 1, Laws of 2019.    The law amended the public health law by codifying the abortion procedure within New York State’s public health law and removing it from the penal law.  The same provisions found in Roe v. Wade remain in same.  The law creates a statement of purpose and says that an abortion may be performed by a licensed, certified or authorized practitioner acting within their defined scope of practice under Title 8 of the Education Law. Under the new law, an abortion can be performed:

  1. a) within 24 weeks from the commencement of pregnancy;
  2. b) at any time, where there is an absence of fetal viability; or
  3. c) at any time, when necessary to protect the patient’s life or health.

This is consistent with what previous Supreme Court decisions have held.

Gov. Andrew Cuomo this past week wrote an op-ed about the law in the NY Times including responding to comments misinterpreting what the law does.   His op-ed can be found  Here.

MSSNY has a long standing policy that opposes the criminalization of the exercise of clinical judgement in the delivery of medical care.   Moving the abortion procedure from the State Penal law to the Public Health Law is consistent with this position.   The law does not expand the current scope of practices for health care providers.  It does, however, specify that health care practitioners can perform an abortion if it is otherwise enabled by their current scope of practice as defined under the NYS Education Law. Nurse practitioners are allowed to perform a medicated abortion procedure already under their scope of practice.  However, nurse practitioners’ scope does not include “surgery” and cannot perform a surgical abortion.   The American College of Obstetricians and Gynecologists (ACOG) District II and the NYS Academy of Family Physicians (NYAFP)  supported this measure.  MSSNY will be closely monitoring the implementation of the new law to assure health care practitioners are acting within their scope. (CLANCY) 


Measles Outbreak in New York State Continues to Spread Webinars Available at MSSNY CME Website
The measles outbreak in New York State continues to spread with at least 186 confirmed cases as of last week.  There have been 124 in Rockland County and 62 cases in Brooklyn with one suspected case currently being monitored.  While New York State has a statewide vaccination rate of about 90% for Measles, the communities mainly affected by the current outbreak are only at about 60%.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December, 2018.  This webinar has now been posted to the MSSNY CME website.

Additionally, be sure to watch The Importance of Herd Immunity, another Medical Matters posting that delves into how herd immunity works and why it is integral to the elimination of vaccine-preventable diseases.  Please check both of these programs out and keep yourself informed about the ongoing measles outbreak throughout New York State and the country.  You can also listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine please Click here. (HOFFMAN, CLANCY)


“What’s Your Diagnosis? Psychological First Aid” Interactive CME webinar February 20, 2019 @7:30am – Registration now open
Be sure to register for the next Medical Matters interactive webinar, What’s Your Diagnosis? Psychological First Aid.  This program will include interactive components for participants.  You will be asked to answer questions about a case and discussion will follow.  Find out if you’re fully prepared to include psychological first aid during an emergency on February 20th at 7:30am.

Registration is open for this program please click Here.

Faculty will be Craig Katz, MD, co-vice chair of MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.

Educational Objectives:

  • Describe the basic tenets of psychological first aid (PFA)
  • Identify resources to assist patients during and after trauma
  • Describe a scenario and review questions and answers

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

(DIVISION OF GOVERNMENTAL  AFFAIRS)


Registration Now Open for New Veterans Matters CME Webinars
The Medical Society of the State of New York is proud to announce two NEW Veterans Matters webinars scheduled for February and March 2019. These webinars are: The Special Mental Health Needs of Women Veterans on Thursday, February 28th at 7:30am and Military Culture: Everything Physicians Need to Know About Veterans as Patients on March 14th at 7:30am.  Register Here

for The Special Mental Health Needs of Women Veterans, and Register Here.

for Military Culture: Everything Physicians Need to Know About Veterans as Patients.



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For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
charring@mssny.org

eNews

MSSNY, AMA and Medical Societies Fight to Assure Fair Resolution of Surprise Medical Bills Issue
Led by United States Senator William Cassidy, MD (R-LA), the US Senate has been examining proposals that would address surprise out of network medical bills faced by patients in hospitals, usually the result of being treated by an out of network specialist in the emergency department or other unanticipated care.

Many believe that this is one of the only health care issues in the current Congress that has bipartisan support.

To that end, MSSNY has written to the New York Congressional delegation, urging that any legislation to be considered is consistent with New York’s comprehensive law on the subject enacted in 2014 (see MSSNY’s letter here: http://www.mssnyenews.org/wp-content/uploads/2019/02/0349_001.pdf).   New York’s comprehensive law addressing this issue has been hailed as a model for the rest of the country because of the delicate balance it struck among key health care stakeholders (such as physicians, hospitals and health insurers) to protect patients from large “surprise” medical bills, while at the same time being constructed in such a way that it did not adversely affect the ability of hospital emergency departments to have adequate on-call specialty physician care.

In addition, MSSNY has also joined on to a federation of medicine letter to the US Congress initiated by the American Medical Association along with over 60 other national specialty societies and over 40 other state medical societies urging that the any legislation to be considered by Congress meet a series of key principles.  These principles recognize the multitude of factors that can lead to patients facing unanticipated out of network medical bills: including assuring health insurers maintain robust physician networks, assuring health insurers maintain accurate provider directories; assure patients are kept “out of the middle”, and assure that any guidelines or limits on what out-of-network providers are paid should reflect actual charge data for the same service in the same geographic area from a statistically significant and wholly independent database, and not be based on Medicare or in-network rates.

MSSNY physician leaders will be in Washington DC next week along with physician leaders across the country to visit with their respective Congressional delegations on this critical issue and other key health care issues before Congress.


What’s next for DSRIP?
State Department of Health officials said they plan to pursue an additional five-year federal waiver ahead of the expiration of the $7.4 billion Medicaid Delivery System Reform Incentive Payment program in April 2020. In the meantime, the governor’s fiscal 2020 budget proposal includes several provisions to advance the DSRIP goal of reducing avoidable hospital use by 25% compared to the state’s baseline in 2015.

So far the state’s 25 Performing Provider Systems—groups of hospitals, physicians, health centers and community organizations—have reduced unnecessary hospitalizations by 17%, said Greg Allen, director of program development and management at the state Department of Health, during a webinar budget briefing.

“Many Performing Provider Systems have been engaged in conversations in what a future DSRIP program could look like,” he said. “Clearly there’s an interest by all stakeholders in continuing the best of what’s happened here. Just about everyone agrees we should ask for renewal.”

Allen noted that several other states have had their federal waivers renewed. He said health care providers’ value-based contracts with insurers were “not quite mature enough” to finance the types of programs providers are pursuing. As part of the budget, the state Department of Health plans to promote best practices from providers that have been able to keep their patients out of the hospital, which it estimates will save $10 million for Medicaid next year. The department also plans to lower Medicaid payments to facilities that have high rates of avoidable hospitalizations. It would use the $5 million it expects in savings to invest in primary, maternity and ambulatory care. (Crains)


 


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SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
With nearly 40 newly elected legislators in Albany, the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, as well as strengthen existing relationships with this new Legislature to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 6th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click HERE to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana (proposed in the State Budget) and creating a single payor health insurance structure.
  • Reject unfair cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms.
  • Reject burdensome mandates that interfere with patient care delivery.
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. County Medical Societies will be scheduling afternoon appointments for physicians to meet with their elected representatives.                                                                       (HARRING)

If you have any questions, please contact Carrie Harring: charring@mssny.org.


NY County President Dr. Van De Walle Welcomes Legislators

Naheed-Van-De-Walle-MDThe President of the New York County Medical Society Naheed Van De Walle MD at the podium at the Legislative Breakfast held on January 27. 

The event featured a lineup of Manhattan legislators including Assembly Health Chair Dick Gottfried, US Representative Carolyn Maloney, Manhattan Borough President Gale Brewer, and Senate Health Chair Gustavo Rivera.  

Other speakers were New York City Councilman and physician Matthieu Eugene, Senator Robert Jackson and Assemblymember Harvey Epstein.  Over 70 physicians from New York County Medical Society and co-sponsoring organizations NY City Psychiatric Society and the New York Council on Child and Adolescent Psychiatry were in attendance to question legislators on everything from single payer, drug formularies, marijuana, and other important physician issues.

Presidents of all three organizations actively participated in the session. According to Dr. Van de Walle, the success of the breakfast was a product of the hard work and dedication of the organizers from all three organizations which included, Cheryl Malone, Meagan O’Tolle, Susan Tucker, Vera Fuer and other dedicated NYCMS staff such as Lisa Joseph. Although representatives from a number of organizations attended the breakfast, the initial feedback was that it was the best Legislative breakfast they had attended to date.


Anthem Tops Fourth Quarter Expectations
The Blue Cross-Blue Shield insurer Anthem topped fourth-quarter earnings expectations and unveiled a better-than-expected 2019 forecast, helped by an early start for its prescription drug coverage business. Shares of the nation’s second-largest health insurer soared after Anthem said Wednesday that it will start moving customers into its new business in this year’s second quarter, several months ahead of schedule.

The insurer has said that it expects to gain annual savings of more than $4 billion by running its own pharmacy benefit management operation, which it calls IngenioRx.

Anthem initially anticipated a 2020 start for its PBM business, which it will run with help from CVS Health Corp. But it said Wednesday that it was ending its deal with Express Scripts on March 1 due to that company’s recently completed acquisition by another insurer, Cigna Corp. Anthem Inc. covers nearly 40 million people, including those who receive private insurance or benefits from the government-run Medicaid and Medicare programs. (AP 2/7)


Determining Whether Older Medical Professionals Can Competently Perform
The New York Times (2/1) reports that some hospitals are using “mandatory screening procedures” to assess whether medical professionals older than 70 can perform competently, with many of those professionals “unenthusiastic about the idea.” The Times says mandatory screening – generally beginning at age 70 –has already begun at “the University of Virginia Health System, Temple University Hospital and UPMC in Pittsburgh.” Screening generally covers physicians as well as physician assistants, nurse practitioners, and other roles.


Researchers Find Increasing Risk of Obesity-Related Cancers
The New York Times (2/4) reports on a study published in Lancet Public Health finding that “the risk of developing obesity-related cancer is increasing in successive generations, along with increasing rates of obesity.” Investigators “studied the incidence of 30 of the most common cancers, including 12 that are obesity related, from 1995 to 2014 in people ages 25 to 84 — more than 14.6 million cases.” The investigators “found that for six of the 12 obesity-related cancers (multiple myeloma, colorectal, uterine, gallbladder, kidney and pancreatic) the risk for disease increased in adults 25 to 49, with the magnitude of the increases steeper with younger age.”


E-Cigarettes Outperform Nicotine Replacement for Smoking Cessation
Adults who smoke conventional cigarettes are more likely to quit smoking successfully when they use electronic cigarettes rather than nicotine replacement therapy (NRT) as a quit aid, according to a randomized trial in the New England Journal of Medicine. Nearly 900 U.K. adults who were looking to stop smoking were randomized to use e-cigarettes or NRT beginning on their quit date. The e-cigarette group was given a starter pack but could then use the product of their choice, while NRT participants could choose their preferred product. All participants also received at least four weekly sessions of behavioral support.

The primary outcome — the rate of abstinence at 1 year confirmed by carbon monoxide levels — favored the e-cigarette group (18% vs. 9.9% in the NRT group).

NEJM article

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Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
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Physician Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year.  Interested? Learn more and apply today at www.98point6.com/pcc


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MSSNY eNews: Visions, Myopia, or Delusions?

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE
Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
January 4, 2019
Volume 22  Number 1

MSSNYPAC Seal

Colleagues:

I hope you, your families, friends, and patients have a happy and healthy New Year.  I want to bring to your attention recent developments in the current controversy of Maintenance of Certification (MOC).

The ABMS Visions for the Future Commission released its report on principles for continuous professional development and MOC in December.  The period for public comment closes January 15.

One of the principle duties of a learned profession is self-regulation of professional duties and standards.  The nature of that regulation has evolved over the years from the profession itself to a more complicated structure to provide regulation with input from multiple stakeholders outside the profession to ensure service to the public.  Part of that evolution resulted in the establishment of Certification Boards as professional knowledge and practice became more and more specialized.

Medicine continues to debate and discuss how to best maintain and improve practice standards and the Specialty Boards have been important advocates for higher practice standards.  The dilemma for the boards and the profession is how best to move continuing professional development forward, while minimizing the burden to the profession.  Clearly, one size does not fit all, and there has been variable acceptance of maintenance of certification requirements across the specialties within the ABMS.  I was able to provide some testimony to the Visions Commission this past March, and MSSNY is reviewing the report and preparing comments.  I encourage you to review the report and send us your thoughts for inclusion in our response here.

I think most of us agree that competition is good, and can help to improve performance and satisfaction when applied to many different situations.  To that end, a group led by Dr. Paul Tierstein, a cardiologist from the Scripps Clinic in California, created the National Board of Physicians and Surgeons as an alternative for MOC, in response to some of the criticisms of the present ABMS sponsored program with regards to cost, relevance and burden of participation both in time and on physician wellness.  There have also been some concerns regarding the actions of some of specific specialty boards’ activities.  Those concerns have resulted in at least one class action lawsuit against one of the constituent specialties within the ABMS

MSSNY is committed to advocating for our patients, the betterment of public health, maintaining high standards of practice, and the well-being of the physicians of New York State.

Finding the balance that maintains and raises practice standards and patient care, while not paradoxically worsening care and reducing time spent with patients due to overly burdensome requirements is the key. Please send me your additional thoughts at comments@mssny.org. 

Quod oculus non videre mente id quod non habet

Thomas J. Madejski, MD
MSSNY President


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eNews

SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
On January 9, the New York State Legislature will welcome nearly 40 new members in Albany – the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, as well as strengthen existing relationships with this new Legislature to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 6th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click HERE to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reduce excessive health insurer prior authorization hassles that delay patient care
  • Reduce the high cost of medical liability insurance through comprehensive reforms
  • Reject burdensome mandates that interfere with patient care delivery
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders
  • Reject inappropriate scope of practice expansions of non-physician practitioners
  • Prevent big-box, store-owned medical clinics that will negatively impact community primary care delivery
  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana and creating a single payor health insurance structure.

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. County Medical Societies will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org. (HARRING)


MSSNY President Urges Caution on Single Payor Proposals
With the discussion of single payor legislation heating up in Albany, MSSNY President Dr. Thomas Madejski’s op-ed on the topic appeared in the January 1, 2019 edition of the Albany Times-Union.

Dr. Madejski noted that “One of the most appealing aspects of the NYHA is the potential to reduce administrative burdens associated with delivering patient care. Physicians increasingly report difficulties with challenging insurer-imposed prior authorizations that lead to unnecessary delays in patients receiving needed care. And physician burnout arising from these administrative burdens is a very real and pervasive issue.  However, there is concern among many physicians that budget pressures could force state bureaucrats implementing a single-payer system to impose even more burdensome prior authorization requirements. Furthermore, many physicians are concerned that these same budget pressures could create enormous pressure to constrain payments for care at a time when physicians already face immense overhead costs that exceed those in any other state.”

He went on to note that “Failure to adequately address the many questions with transitioning to a single-payer system may not be in the best interest of New Yorkers. We must make sure that, in our efforts to address the current barriers patients face in receiving care, we do not impose new ones.” (AUSTER)


President Approves Bill to Provide Funding for States to Prevent Maternal Deaths
President Donald Trump has signed into law legislation, the “Preventing Maternal Deaths Act”, to provide millions of dollars in funding to states to establish maternal mortality committees.  The bill had been passed by the US Congress in early December.   The purpose of such committees are to investigate pregnancy-related deaths and use the findings to prevent others.

In the United States, the maternal mortality rate is 26.4 deaths per 100,000 (about 700 per year). That rate increased 250% between 1987 and 2014, according to the Centers for Disease Control and Prevention (CDC). The CDC estimates that 60% of the deaths are preventable.  The maternal death rate is more than three times higher for African American women than white women in the United States, according to the CDC.

MSSNY working together with the American College of Obstetricians & Gynecologists – District II have supported legislation in the 2018 Legislative Session to establish a Maternal Mortality Review Board in New York.  The MMRB would be comprised of a multidisciplinary team of medical experts tasked with reviewing data on maternal deaths, identifying the root causes of the these events, and disseminating evidence-based best practices to prevent them in the future. The board’s primary focus will be on quality improvement rather than punishment, reviewing outcomes of care, conducting peer reviews, and collaborating on process improvements.  As a necessary component to achieving this mission, the bill contains broad confidentiality protections to the board’s proceedings to allow for open and honest dialogue and review.  However, some are advocating that the confidentiality provisions be minimized, which could seriously undermine the quality improvement goals of the MMRB.  MSSNY will again work with ACOG in 2019 to achieve passage of a MMRB in New York.


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Gov. Signs Measure to Increase Transparency of Mental Health Parity Compliance
Just before the close of 2018, Governor Cuomo signed into law legislation establishing the Mental Health and Substance Use Parity Report Act, a measure that MSSNY strongly supported in conjunction with the New York State Psychiatric Association and other patient advocacy groups. With its adoption, the NY Department of Financial Services (DFS) will be required to collect key data points and elements from health insurers in order to analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws.

We thank the hundreds of physicians who took the time to contact the Governor to urge that he sign the bill into law.  MSSNY’s letter to the Governor noted that “In light of the growing opioid epidemic, it is vitally important that the state and various public stakeholders have a resource that would help those individuals make informed choices with respect to the choice of health plan.   Moreover, the responsibility to provide such information will incentivize insurers to follow the laws that are intended to assure that patients have coverage for the care they need.”

Timothy’s Law, which works to ensure New Yorkers have access to care and treatment for mental illness and substance abuse disorders, was passed in 2006 and made permanent in 2009. This law mandated a number of provisions aimed at improving access to mental health and substance abuse care, including coverage of a variety of relevant services for children and employees of large employers and premiums and cost sharing for mental health services that are equivalent to those for physical health services. However, investigations by the New York Attorney General’s office have identified numerous instances of noncompliance, including evidence of elevated levels of denials for mental health services. This necessitated proactive evaluation of insurers and health plans to ensure compliance and provide New Yorkers with the information they need to get the best possible care.

The data collected this law will be used by the DFS to ensure compliance with Timothy’s Law and to prepare an annual Mental Health Parity report as part of the annual comprehensive DFS Consumer Guide to Health Insurance.  In a letter of support to Governor Cuomo, the American Medical Association noted that the bill “will provide important data to better compare requirements for accessing benefits that are applied to mental health and substance use disorder treatment and coverage as compared with those applied to medical/surgical benefits. The compliance report, particularly if made available to key stakeholders and open for public inspection to patient advocates, will help regulators and others identify where appropriate oversight and enforcement are necessary.” (AVELLA, AUSTER, CLANCY)


Workers Comp Board Finalizes Fee Schedule Increases to Take Effect April 1
The New York Workers Compensation Board finalized regulations providing an overall 5% increase in the medical fee schedule for care to injured workers that will be applicable April 1, 2019.  For more information, click here.

Moreover, the WCB finalized regulations to increase the physician deposition and hearing testimony fee from $400 to $450, also effective April 1.   The WCB also clarified that payment of such witness fees shall be paid by the carrier within 10 days of the testimony, and suggest physicians who have not been paid within that time frame contact the WCB for enforcement.

There are concerns with some aspects of the changes.  For example, the WCB decided to implement changes in reimbursement for electro-diagnostic testing that had been opposed by MSSNY, certain specialty societies and many physicians.  As is noted in the WCB Summary of Public Comment:

“The Board received comments objecting to the change in CPT codes resulting in reductions in reimbursement for EMG studies and EDX testing. Needle EMG tests have received proportionate increases. Surface EMGs are not recommended under the Medical Treatment Guidelines and therefore have no fee associated. Fees for NCV reflect changes to the CPT codes themselves, as created by the American Medical Association, and the method for billing, and will be reimbursed at 200% of the Medicare level, so no change has been made.”

It should also be noted that with regard to the proposed changes to physical medicine Ground Rule 2, the Summary of Public Comment stated:

“The Board received many comments disagreeing with physical medicine Ground Rule 2 – specifically, the 12 sessions/180-day limitation. In response, the Board has decided not to implement this change, so Ground Rule 2 will read as it did previously: “Physical medicine services in excess of 12 treatments or after 45 days from the first treatment, require documentation that includes physician certification of medical necessity for continued treatment, progress notes, and treatment plans. This documentation should be submitted to the insurance carrier as part of the claim.”

MSSNY will continue to push for further increases in the WC fee schedule.  While the changes are a positive step forward to better assure access to care for injured workers, these modest increases are the first positive updates in over 2 decades.  During this same time, the costs of running a medical practice increased well over 30% (as measured by the Medicare Economic Index). (AUSTER)


Six Cases of Acute Flaccid Myelitis Confirmed in New York
The Albany (NY) Times Union (12/28) reported CDC officials have confirmed six cases of acute flaccid myelitis in New York, three of which were “in New York City and three more outside the five boroughs.” Nationwide, the CDC received 336 reports of suspected AFM this year and confirmed 182 of them in 39 states as of Dec. 21. As in previous years, an uptick in cases was observed around August and peaked in September.

The increase in cases also appears to be following a biennial pattern, with 120 cases confirmed in 2014, followed by just 22 in 2015, then 149 in 2016, 35 in 2017, and now 182 in 2018.


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Lake Erie College of Osteopathic Medicine Expands to Elmira
Buffalo (NY) Business First (1/3) reports hospitals in western New York are hoping that the new Lake Erie College of Osteopathic Medicine (LECOM) campus in Elmira may bring more physicians to the area. The article explains that LECOM is based in Erie, Pennsylvania with other locations in that state as well as Florida, but LECOM is now “investing nearly $20 million in a new facility on the Elmira College campus for a medical school program.” The new location in Elmira is scheduled to open in 2020 and “will start with 120 osteopathic medical students annually, growing to 480 after four years.”


JAMA Oncology: Over 7% of Cancers in US Attributable To Excess Body Weight
The findings were published in JAMA Oncology report that a study indicates “more than seven percent of cancer cases in the United States are attributable to excess body weight.” Investigators “found that from 2011 to 2015, among people 30 and older, 4.7 percent of cancers in men and 9.6 percent of those in women were attributable to excess weight – some 37,670 cancers in men, and 74,690 in women every year.”


Study: Casts Doubt on Omega-3 for Primary Cardiovascular Disease
Many people without known cardiovascular (CV) disease take omega-3 (ω-3) fatty acid supplements (“fish oil”) to prevent adverse CV events. However, recent studies cast doubt on this practice.

In the VITAL study, about 26,000 people (mean age, 67) without CV disease were randomized to 1-g capsules of fish oil (eicosapentaenoic acid plus docosahexaenoic acid) or placebo. During mean follow-up of 5.3 years, risks for the primary endpoint (nonfatal myocardial infarction [MI], stroke, or CV-related death) and all-cause death were similar in the two groups. Although the incidence of MI was significantly lower in the ω-3 group than in the placebo group, the absolute difference was small: 1.1% vs. 1.5% during 5 years of treatment and N Engl J Med 2018 Nov 10; [e-pub]).

In the ASCEND trial, more than 15,000 people (mean age, 63) with diabetes but without CV disease were randomized to 1-g fish-oil capsules (eicosapentaenoic acid plus docosahexaenoic acid) or placebo. During mean follow-up of 7.4 years, risks for the primary endpoint (nonfatal MI, stroke, transient ischemic attack, or CV-related death) or all-cause death were similar in the two groups (NEJM JW Gen Med Oct 1 2018 and N Engl J Med 2018; 379:1540).

A meta-analysis of 10 randomized trials (78,000 total patients) showed no significant differences between ω-3 recipients and controls in risks for coronary heart disease–related death, nonfatal MI, any coronary heart disease event, or major adverse CV events overall. Subgroup analyses among participants with known coronary heart disease or diabetes yielded similar findings (JAMA Cardiol 2018; 3:225).

The two new randomized trials do not support the use of ω-3 fatty acid supplements for preventing adverse CV events in patients with no history of CV disease. Although the meta-analysis showed no evidence of benefit for secondary prevention, a recently published trial (REDUCE-IT) showed that a different ω-3, icosapent ethyl, lowered risk for adverse CV events in patients with established CV disease and elevated triglycerides; those results are summarized elsewhere.


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FREE CME PROGRAMS

Be sure to check out all of MSSNY’s Medical Matters and Emergency Preparedness FREE CME Programs
An individual in New York was recently diagnosed with Brucellosis from raw milk. Did you know that MSSNY offers an Emergency Preparedness CME program on Brucellosis, Glanders, Melioidosis and Tularemia?  Additionally, MSSNY has posted the recent Medical Matters webinar on Measles which continues to spread throughout the state. 

All of MSSNY’s timely and relevant CME programs are available at https://cme.mssny.org.  Please note that you will need to create an account there if you haven’t already.

Additional information or assistance with the website may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.


“Public Health Preparedness 101” CME webinar January 16, 2019 at 7:30am – Registration now open
The American Medical Association Code of Medical Ethics opinion 8.3 states that: “With respect to disaster, whether natural or manmade, individual physicians should take appropriate advance measures, including acquiring and maintaining appropriate knowledge and skills to ensure they are able to provide medical services when needed.”

Are you prepared for a public health emergency? And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here. Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


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Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


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Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


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Pediatrician BC, P/T
Seeking motivated, enthusiastic pediatrician for P/T position in solo practice in Long Island. Coverage will increase over time. Great opportunity for those seeking part time hours in an established practice.   Fax resume to 516-858-2389.


Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


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