COVID-19 Update April 30, 2019

New York State COVID-19 Stats

NYSDOH COVID-19 Tracker – NY.gov


Notes from Governor Cuomo’s COVID-19 Briefing:

  • Hospitalizations and new cases are down.-306 new deaths yesterday – 287 in hospitals / 19 in nursing homes.
  • DATA:– Gov stressed two points about reopening:- Closely monitor the rate of transmission, keep it below 1.1.- Maintain 30% or more available hospital capacity.- The state has collaborated with the federal government to increase testing to 30,000 tests per day. The goal is 40,000.
  • TRANSIT:– NYC Subway conditions have rapidly deteriorated as a result of corvid-19.- MTA employees and NYPD officers are sick, so there are less people available to maintain the subway.- There are less people to provide outreach for homeless people.- The MTA has been cleaning the trains and buses every 72 hours.- Unfortunately, the virus can remain on surfaces for days.- Gov said that trains and buses should be disinfected every 24- The scale of work is unprecedented, but it must be done.

    – The MTA will also disinfect the Metro North and LIRR without

    service disruptions.

    – Overall ridership is down 92%.

    – The slowest hours are from 1:00 a.m. to 5:00 a.m.

  • TRACING:
    – When you get a positive case of COVID-19, you must trace by identifying who they have been in contact within the last 14 days.- Yesterday, there were 4,681 positive cases.- There are too many people to contact at once.- The state needs help tracing people- The state will collaborate with city and county health departments to find tracers- The state is also collaborating with former NYC Mayor- Bloomberg: we must use contact tracing as we relax socialdistancing protocols.

    – He announced partnerships with Johns Hopkins University,

    Vital Strategies, and Resolve to Save Lives, staffing

    organizations, and SUNY/CUNY.

    – These organizations will help with tracing training,

    recruitment, guidance, and app development.

    – Guidelines will be publicly available to provide a model for

    others and spread best practices.

    – There must be 30 contact tracers for every 100,000 cases.

    – Statewide, we will need about 6,000 tracers

    – There will be a tri-state collaboration for contact tracing.

    Q&A:
    CHILDREN:
    – Zucker: COVID-19 infects the lining of blood vessels and lungs.
    – Some kids are having strange, adverse effects to this.
    – Camps are set to open at the end of May.
    – Gov says that the federal government is not providing
    enough funding for schools, rental assistance, etc.


Physicians Offices Should Continue to Submit Requests for PPE through Local Office of Emergency Management (OEM)
Physicians’ offices should continue to submit requests for Personal Protection Equipment (PPE) through their local Office of Emergency Management. Physicians generally need to call the local Department of Health first.  Upon providing their license number and practice address they will be given the private OEM phone number or website address for requesting PPE supplies.   Physicians will need to provide information to the local OEM regarding the amount of PPE needed, license number, and practice location.  In some cases, we have been able to eliminate one step.  IT’S OFTEN A TWO-STEP PROCESS TO REQUEST PPE.

  • Here are contacts for this region:
  • In NYC, EMAIL the OEM directlysupplyrequest@oem.nyc.gov   Make sure you include doctor’s name, complete contact information, and the request.
  • In Nassau, you can go directly to the OEM website (OEM phone number is 516 573-9600)
  • In Suffolk, you can go directly to this website.
  • In Westchester, call the DOH at 1-866-588-0195, Option 2.  A DOH expert will take the request and provide the next step for reaching the OEM

New York State continues to fulfill requests for PPE and provides supplies to the local OEM when there is a request. If your practice is unable to obtain PPE through vendors and local Offices of Emergency Management fail, please let MSSNY know.  MSSNY will need the information that was provided to the local OEM so that we can provide that information back to the state.  MSSNY is in continuous contact with the NYS Department of Health to help address such situations.

For general guidance on the use of PPE in healthcare settings, please refer to CDC guidance entitled “Healthcare Supply of Personal Protective Equipment”.

MSSNY is engaging our county societies statewide to assess the level of difficulty physicians may be encountering in obtaining PPE, to determine if problems being reported are local in nature, or more widespread.

2)  Guidance on steps to take in reopening physician practices is being finalized and will be circulated shortly. 

3)  We are engaged with the Dept of Health and the OPMC on legal changes needed to support confidential peer-to-peer support for physicians during the pandemic and beyond.  Meetings are occurring this week.


HHS: FAQs Posted Regarding Second Tranche
The Department of Health and Human Services (HHS) has posted new Frequently Asked Questions regarding the second tranche of disbursement of the CARES Act Provider Relief Fund. Regarding second Tranche Please note there is conflicting information about whether a provider who has not previously received money from the first round of funding can apply for this round.  The AMA is trying to clarify this and other questions with HHS.


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Paycheck Protection Program (PPP) Update
Have you applied for the PPP small business forgivable loan program yet?  According to SBA.gov as of 5:00 PM yesterday more than 960,000 loans had been approved totaling greater than $90 billion. The total number of lenders involved in processing these transactions has been 5,300 so far. Last week Congress approved an additional $310 billion for the program.

Yesterday, the SBA notified borrowers and lenders that certain provisions would be put in place to favor lending from smaller institutions. The text of the notice:

Paycheck Protection Program (PPP) Lending Operations Update – Wednesday, April 29, 2020

SBA and Treasury value all lenders and their small business customers.

To ensure access to the PPP loan program for the smallest lenders and their small business customers, starting at 4 p.m. yesterday EDT through 11:59 p.m. EDT, SBA systems will only accept loans from lending institutions with asset sizes less than $1 billion.

Please note, lending institutions with asset sizes less than $1 billion will still be able to submit PPP loans outside of this time frame. Please also note that lenders with asset sizes greater than $1 billion will be able to submit loans outside of today’s 4:00 PM -11:59 PM EDT reserved processing time.

Today this reserved processing time applies to April 29, 2020. SBA and Treasury will evaluate whether to create a similar reserved time again in the future.

SBA and Treasury continue to monitor loan system performance and will continue to provide frequent updates to the lending community.


Governor Issues Executive Order to Resume Elective Surgery in 35 Counties, but Only in Hospitals
The Governor issued an Executive Order on April 29 to lift the prohibition on elective surgery in 35 upstate counties based upon meeting certain criteria, but only for hospitals in those counties.  There was an arbitrary exclusion of Ambulatory Surgery Centers and Office-Based surgery locations in these counties from resuming elective surgery.  With many patients facing significant health care issues including pain that require surgical intervention, there is no good reason to exclude these care facilities from the resumption of these elective procedures.  For the benefit of patients, physicians are urged to contact the Governor to lift this restriction by sending a letter from here.

The counties in which hospitals are now eligible are: Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Delaware, Dutchess, Essex, Franklin, Fulton, Genesee, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Niagara, Oneida, Onondaga, Ontario, Orleans, Oswego, Putnam, Saratoga, Schoharie, Schuyler, St. Lawrence, Steuben, Sullivan, Tompkins, Ulster, Wayne, Wyoming and Yates.


NIH Announces $1.5 billion, ‘Shark Tank’-like Initiative to Accelerate Covid-19 testing
The NIH yesterday announced a $1.5 billion initiative aimed at speeding up the availability of diagnostics for Covid-19. The hope is that this endeavor will lead to “millions of tests” being deployed per week by late summer or fall. The initiative will rely on a “national Covid-19 testing challenge,” in which researchers and inventors across the country will compete for a share of $500 million in a “Shark Tank”-style competition to move their proposed inventions forward. The National Institute of Biomedical Imaging and Bioengineering’s director Bruce Tromberg tells STAT’s Lev Facher that the agency, which will be coordinating the initiative, expects to select roughly five winners who will be paired with manufacturers who will mass-produce the new diagnostics.


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NIH: Critical Study of COVID-19 Drug Shows Patients Respond to Treatment
Preliminary data released yesterday from a closely watched, government-run trial of Gilead’s remdesivir showed it was effective in Covid-19 patients. Those who were given remdesivir recovered four days faster than those who were given placebo. The decrease in mortality rate compared to placebo was not statistically significant. Anthony Fauci, the director of NIAID, which is conducting the study, said the data are a “very important proof of concept,” but cautioned they were not a “knockout.”

The preliminary results come after days of conflicting results on remdesivir’s efficacy against Covid-19: While early results from Gilead’s separate trial of the drug in severe Covid-19 patients showed promise, data from a trial in China showed no added benefit. NIAID’s trial results are critical because the drug was tested in a large number of patients and neither the patients nor physicians knew who was getting the drug, which controlled for any unconscious biases. And following NIAID’s preliminary data, the FDA is exploring an emergency use authorization for remdesivir, according to The Wall Street Journal.


 

 

COVID-19 Update April 17, 2019

I hear empty trains a’comin
They’re rollin round the bend
And I ain’t seen a steakhouse
Since I don’t know when.
I’m stuck in COVID prison
And time keeps draggin’ on
But the news scroll keeps a rollin’
On and on and on.
(Apologies to Johnny Cash)

John Donne famously wrote “No man is an island unto himself.” Mr. Donne clearly had not experienced social distancing. Humans are by nature social beings. This trait enabled our distant ancestors to obtain food while avoid being food. We enjoy going to parties, to shows, to restaurants, to sporting events, and yes, even to Grand Rounds. The current pandemic has stolen that all from us. We can no longer attend weddings. We cannot hold funerals for our dead. We can no longer congregate in parks nor play pick-up basketball. Tech can provide some relief, some illusion of sociability but that small comfort is both illusory and fleeting.

In the days when medicine was far more art than science, the most powerful weapon in that black bag was the therapeutic touch. Attending at the bedside to comfort the sick and dying was integral to the calling. Without curative therapies, all physicians really had to offer were moments of humanity. The virus has even deprived us of these moments. Surviving the virus, we have lost much of our humanity.

Now, we may be over the worst. Some curves have flattened. Others are on the downslope. Early reports of treatments are lighting up the financial markets. Our leaders are talking about and planning the recovery phase – society’s parole. This too will no doubt have its glitches, but we should be optimistic and begin to plan. We should realize that nothing will go back to the way things were and, in fact, many should never go back to the way things were. Hearings will be held. Books will be written. Talking heads will drone on.

Let me suggest one principle to help us find our way. We have flattened the curve. We must work to flatten the bureaucracy. Let’s do it together.

Let’s all find those Blue Skies.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


Visit covid19tracker.health.ny.gov to See the Latest NY Data
New York reported 12,822 statewide deaths as of Friday morning, including 630 more fatalities in the past day of New Yorkers who have tested positive for COVID-19. As of Thursday, the state reported 8,893 deaths of New York City residents. As of Thursday, 17,035 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here. 


Gov. Cuomo: What You Need to Know

  • “New York on PAUSE” will be extended until May 15th. This action is taken in consultation with other regional states. Non-essential workers must continue to stay home and social distancing rules remain in place. We will re-evaluate after this additional closure period. I know this is hard, but we must stay the course.
  • Cuomo outlined a blueprint to get New Yorkers back to work and ease social isolation without triggering a renewed spread of the virus.The blueprint operates under one overarching principle — do no harm. As part of the strategy to reopen, we will strengthen the healthcare system; use diagnostic testing, antibody testing and contact tracing to limit the spread of the virus; and implement a phased return to a “new normal” — which will include evaluating risk by industry, starting with the most essential businesses that present the lowest risk, rethinking the workplace to make it safer, and implementing protocols for response if a worker develops COVID-19 symptoms. Real the full plan here.
  • New Yorkers MUST wear masks or face coverings on public transportation systems and while taking private transportation or riding in for-hire vehicles.Additionally, all operators of public systems, private carriers and for-hire vehicles must always wear a mask or face covering while working. These directives expand on the Executive Order announced yesterday requiring everyone in New York to wear a mask or a face covering when out in public and in situations where social distancing cannot be maintained. The order will go into effect on TODAY at 8 PM.
  • The number of hospitalizations continue to fall but we are not out of the woods yet. Yesterday, total hospitalizations fell to 17,735, the third straight day of declines. However, infections remain high and the virus is still spreading. Visit health.ny.gov to see the latest data.


For more information, click here.


Urge the NY Congressional Delegation to Support Additional Stimulus to Assist Physician Practices
All physicians are urged to contact Senators Schumer and Gillibrand, as well as their respective US Representative, to urge that they fight for needed funding to assist physician practices across the state of New York to be able to keep their doors for their patients, as Congress discusses the creation of a fourth stimulus bill.  A letter can be sent from here.


MSSNY Survey Results re COVID-19 Impact on Their Practices
This week, MSSNY issued a press release announcing the results of a physician survey that showed that, like many businesses across the state, New York physicians have faced a devastating impact on their practices as a result of the coronavirus outbreak.  The survey results were reported in several media outlets including the Syracuse Post-Standard , Buffalo News and Crain’s Health Pulse.

The survey results make clear that while the CARES Act funding pools (including the SBA funding and other health care distribution pools) provided some funding to make up these enormous deficits, it is not nearly enough to ensure the survival of many physician practices across the State of New York.  MSSNY President Dr. Art Fougner thanked the New York Congressional delegation for their efforts to fight for relief funds for New Yorkers, but also noted how is imperative they fight in the next relief package to preserve the viability of New York’s health care system, including physician practices. This is not only critically important for doctors and their patients, but also for their hundreds of thousands of dedicated employees—many of whom have been laid off or furloughed during this crisis.

Among the key findings of the MSSNY survey were that: 83% of respondents have had a reduction of more than 50% in the volume of patients visiting their practices; 80% have suffered a loss of revenue of more than 50% since the outbreak of COVID19; and more than a quarter have had to layoff, or furlough, more than 50% of their staff.

In addition to fighting for an expansion of the small business loan/grant funding pool, the grassroots letter also urges funding for tuition relief and loan forgiveness for physicians, residents and medical students treating patients on the front lines.


DHHS Stimulus Payment
Please note that physicians who received a deposit into their bank account from HHSPAYMENT, must attest to the Terms and Conditions within 30 days of receipt and advise whether they accept or reject the payment. The following link will “walk” physicians through this attestation process: https://covid19.linkhealth.com/#/step/1


Please Continue to Let MSSNY Know if Your Hospital or Office Cannot Receive Adequate PPE
Pursuant to Executive Order 202.16 issued this past Monday, all businesses must provide face coverings, at their expense, for all their employees who are in direct contact with the public.  However, we continue to hear concerns from physicians that, in some hospitals, physicians and other health care staff are not receiving the personal protective equipment (PPE) they need when delivering patient care.

MSSNY has been sharing these reports with the New York State Department of Health for further investigation.  It is our hope that with the new Executive Order, and a briefing notice from the Greater New York Hospital Association and the Healthcare Association of New York State to their members calling for compliance with this requirement, that these concerns will be addressed.  However, please let us know (mauster@mssny.org) if these concerns continue, and we will continue to bring them to the attention of the NYSDOH.


New Clarifications on Emergency Funds
As you know, concerns were raised Friday when the initial HHS Emergency Fund grants were released that, in agreeing to the terms and conditions of the grants, physicians were being required to attest that they diagnose, treat, or test patients for COVID-19. The AMA brought these concerns to the Secretary’s office and HHS committed to posting some clarifying language. HHS has now modified some of the language to make its meaning clearer, as follows, stating that every patient is a possible case of COVID-19.

The website now includes the following statement:

If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

​Also, the second provision of the Terms and Conditions has been changed to no longer say providers attest to “currently” taking care of patients, just that they did so after 1/31/2020:

The Recipient certifies that it billed Medicare in 2019; provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19; is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked.


NEJM: Clinical Characteristics of COVID-19 in New York City
NYC physicians published a paper today in NEJM.


Garfunkel Wild Webinar: Employer’s Practical Guide to Facing Day-To-Day Coronavirus Challenges on April 20, 2020 | 12:00 pm – 1:00 pm
In the last several weeks, myriad laws and protocols have been issued by Federal and local governments in response to the outbreak of the global COVID-19 virus and to dissipate the profound economic and health and safety impacts of the virus. Examples of this are the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, which are part of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security Act (CARES Act).

At this juncture, while most employers are familiar with the eligibility requirements and magnitude of the leave benefits under these new statutes, they are lacking practical information and guidance on how to implement these requirements.  The webinar will address such issues as:

  • How to deal with COVID-related health issues in the workplace
  • What measures can employers take to determine if employees coming into the workplace have COVID-19 or related symptoms?
  • Can employers tell their employees if a co-worker contracts COVID-19?
  • What types of accommodations must an employer consider related to COVID-19?

Planning for your PPP Loan

  • Can employers furlough employees until the PPP loan comes in?
  • How can employers apply for a PPP loan?
  • How can employers deal with reductions in force and salary reductions in light of a PPP Loan?

Addressing Unemployment Insurance Issues

  • How do the new federal unemployment provisions work?
  • What is the interplay between State and Federal Standards?
  • What are the rates of unemployment under the new rules?
  • What to do with employees who don’t want to return to work?

REGISTER NOW


COVID-19 & Healthcare Professionals: What the Latest CDC Data Shows
Federal data released this week showed that healthcare professionals account for 9,282 of the 315,531 COVID-19 cases nationwide, their median age is 42, and 73 percent of them are female. The tally came from the CDC April 14 and was representative of laboratory-confirmed COVID-19 cases voluntarily reported to the agency from 50 states, four U.S. territories and affiliated islands and the District of Columbia, from Feb. 12 to April 9.


Dr. Erick Eiting’s Video Diary from the ED Featured on ABCNY7
Dr. Erick Eiting, an Emergency Room physician at Mt. Sinai Beth Israel, is featured in a short film about last Friday’s night shift at the hospital treating COVID-19 patients.
Dr. Eiting, a MSSNY member since he left medical school, is currently Vice Chair of Preventive Medicine Family Health Committee, a Member of Task Force on End of Life Care, and Co-Vice Chair of Committee to Eliminate Health Disparities.


Staten Island Launched 10,000 Calls’ to Help Curb Spread of Coronavirus
Borough President James Oddo announced that his office has teamed up with several healthcare organizations on Staten Island, including Richmond County Medical Society (RCMS), Community Health Action of Staten Island (CHASI) and New York Chapter of the American College of Physicians (NY ACP) to launch “10,000 Calls.”

The initiative is meant to tackle the coronavirus pandemic through local physicians conducting outreach to patients, or their caregivers in order to provide a quick “wellbeing/social check-in” phone call. Patients who are 65 years old or older, who are more susceptible to the coronavirus, will be prioritized by physicians.

The Initiative gives physician offices and their staff questions to ask patients, and/or their caregivers, that are related to critical areas of the coronavirus outbreak.

Physician staff members will ask patients questions about their overall health and whether they have any pressing health concerns. Staff members will also ask patients about whether they need medication assistance, have concerns related to the pandemic and will offer concrete help related to social support during the pandemic.


 

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CME COURSES

COVID-19 Resources and Free CME Available from MSSNY
The MSSNY website has myriad resources available in response to the current pandemic.  Go to www.mssny.org and click on the COVID-19 Update link or the banner with COVID-19 Resources for Physicians to find out more.

You can also go to https://cme.mssny.org and get free CME credits for the Medical Matters and Emergency Preparedness courses posted there.  Courses of relevance to the current pandemic include, but are not limited to:

Medical Matters Courses:

  • Psychosocial Dimensions of Infectious Outbreaks
  • Coronaviruses 2020: COVID-19 An Evolving Story
  • Disaster Medicine Every Physician’s Second Specialty
  • Doctor Are You Ready?
  • The Importance of Resilience After a Disaster
  • Principles of Isolation and Quarantine: Epidemiology as a Decision Maker
  • Public Health Preparedness 101
  • Virtual Drill: Incident Command System & Crisis Communications

Emergency Preparedness:

  • Physician’s Electronic Emergency Preparedness Toolkit (Modules 1-4)

Resources:

  • Psychological Impact of Disaster and Terrorism Reference Card

Please note, if you do not already have an account there, you will need to create one, this is separate from MSSNY’s home page.

You are also encouraged to listen to the podcasts MSSNY has produced about COVID-19 by clicking on the links below:


April 29, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open
“COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid”

Register now for MSSNY’s next webinar related to the COVID-19 pandemic, Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid on April 29th at 7:30am. Faculty for this program is William Valenti, MD and Craig Katz, MD.

Registration is now open for this webinar! 

Educational objectives are:

  • Explore the role of office-based physicians during the COVID-19 pandemic
  • Describe surge preparedness procedures for infectious disease outbreaks
  • Identify wellness and resiliency strategies to use during infectious outbreaks

To view the companion pieces to this webinar, be sure to go to https://cme.mssny.org and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020 and Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020.

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

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.


Pain Management, Palliative Care and Addiction Online Programs Now Available at MSSNY CME Website
The Medical Society of the State of New York updated 2020 Pain Management, Palliative Care and Addiction modules are now available on-line here.

These modules are being offered free of charge to all MSSNY members.  Physicians who are new users to the MSSNY CME site will be required to register as a new user.

These online programs cover all eight topics required in the New York State statute:

  • New York State and federal requirements for prescribing controlled substances
  • Pain management
  • Appropriate prescribing
  • Managing acute pain
  • Palliative medicine
  • Prevention, screening and signs of addiction
  • Responses to abuse and addiction
  • End of life care

MSSNY developed the program with the NYS Office of Alcoholism and Substance Abuse Services (OASAS).  MSSNY is listed as an accrediting organization by the NYS DOH Bureau of Narcotic Enforcement. 

These courses are entitled:

  • PM, PC & A 2020: Understanding the Current Legal Landscape in New York State
  • PM, PC & A 2020: When to Consider Opioid Therapy for Chronic Non-Cancer Pain and in Palliative Care
  • PM, PC & A 2020: Patients with Opioid Use Disorders 

Additional information or technical support may be obtained by contacting cme@mssny.org

Attestation Process for Mandatory Prescribers
Prescribers must attest to the completion of the pain management, palliative care and addiction course work or training by July 1, 2017, and again every three years thereafter. The prescriber should only attest after completion of at least three hours of course work or training covering all eight topics.

A prescriber with a Health Commerce System (HCS) account will attest online using the Narcotic Education Attestation Tracker (NEAT) application. Complete the steps to access the NEAT (Narcotic Education Attestation Tracker) application in the NYS Health Commerce System (HCS):

  1. Log into the HCS at https://commerce.health.state.ny.us
  2. . Under “My Content” click on “All Applications”
  3. Click on “N”
  4. Scroll down to NEAT (Narcotic Education Attestation Tracker) and double click to open the application. You may also click on the “+” sign to add this application under “My Applications” on the left side of the Home screen.

Complete the steps to ATTEST to the completion of the education requirement.

Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll-free at 1-866-811-7957. They may then complete the form and return it by mail to the address provided in the form.

Further information may be obtained by contacting BNE at 1-866-811-7957 or narcotic@health.ny.gov

Or at https://www.health.ny.gov/professionals/narcotic/mandatory_prescriber_education/


This Week’s Legislative Podcast


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MSSNYeNews: December 6, 2019 – Progressive or Regressive

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
December 6, 2019

Vol. 22  Number 45


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Colleagues:

NY State faces a significant budget deficit as 2020 approaches. Assembly Speaker Heastie knows it. Senate Leader Stewart Cousins knows it. Governor Cuomo knows it. This promises to be a Dickensian winter of discontent. Our Medical Society stands as it has always stood – ready to help.

One contentious area has been medical liability. Our governor at his birthday event announced that NY is the most progressive state in the country as he recounted a litany of accomplishments. However, what he failed to mention is that in the arena of medical liability, NY is the most regressive state in the country. NY pays out annually more than the next two highest states put together. NY’s liability environment is so toxic that in the 1980’s, in order to keep physicians’ practicing, NY began providing an excess layer of malpractice insurance.

Our state government perennially rails against waste, fraud, and abuse in the Medicaid system. Yet Albany refuses to address the obvious waste, fraud and abuse that is our medical liability system. By enacting even modest reforms, hundreds of millions of hard-earned taxpayer dollars could be reclaimed by the Medicaid system by disincentivizing the defensive practices that do nothing to enhance patient care.

Albany wants to fight climate change yet continues to drop lumps of coal into New Yorkers’ stockings every year. I say we embrace climate change – let’s change Albany’s medical liability climate once and for all.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


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It’s Crunch Time – Please Make Sure Congress Doesn’t Let the Insurance Industry Write the  “Surprise Bill” Solution
As Congress reaches a critical juncture about whether to act on legislation to address “surprise” out of network medical bills, it is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution that protects patients’ access to needed care, and does not grant huge new powers to the health insurance industry.  By clicking here, you can send a letter, and tweet at your legislators.

This week U.S. Rep Joe Morelle (D-Rochester) authored an op-ed in The Hill that made the case for federal legislation to address surprise medical bills based on New York’s model using an independent dispute resolution mechanism, and in opposition to an approach that would base payment on an insurer-determined median in-network payment.

Also this week, MSSNY sent a letter to the Congressional delegation to address some of the inaccurate statements about the impact of New York’s law. In particular, we highlighted that the New York DFS has commented on multiple occasions that there has been no adverse premium impact of New York’s surprise bill law.  In the May report from Georgetown University analyzing New York’s law, it was noted that “state regulators report that there has not been, as yet, an indication of an inflationary effect in insurers’ annual premium rate filings.”.

Moreover, in a webinar hosted by Yale University professor Zach Cooper with NYDFS staff, it was noted that New York’s law “at least in the first years, was helping to save money”, and that it has “never been raised by any of the plans…as any significant cost driver in making premiums go up.”

It is clear why.  The balance in New York’s law results in a dynamic where the dispute resolution is rarely used.  From 2015 to 2018, there were just over 2,500 decisions, as compared to the over 7 million visits to New York emergency departments each year.   A recent DFS report found that the law saved consumers over $400 million and reduced out-of-network billing by 34%.

Even the health insurance industry has praised New York’s approach.  In a recent statement in support of legislation to extend New York’s law to out of network hospitals, the New York Health Plan Association (which includes representatives of the largest insurance companies in the country) commented that “The existing Independent Dispute Resolution process has worked well to ensure reimbursements for emergency services are fair and reasonable while holding individuals harmless.

Large market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not let Congress make this worse.  Please contact your Senators and Representatives today!


Listen to this Podcast to Hear Why You Need to Be in Albany on March 4
Please plan to be in Albany on March 4, 2020 for Physician Advocacy Day to hear from key health care policy leaders and to meet with your local legislators!  To register, click here.

Want to learn more about why you should come to the State Capitol.  Listen here to a 15-minute podcast featuring Suffolk County Medical Society President Dr. Richard Schoor, Suffolk County Medical Society Executive Director Dr. Aaron Kumar, and MSSNY Senior Vice-President Moe Auster discussing the importance of physician advocacy, including participating in the Albany Lobby Day.


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Dutchess County Medical Society Physician Leader Praises Goal, Raises Concerns at Legislative Single Payor Hearing
On November 25, Poughkeepsie orthopedic surgeon and Dutchess County Medical Society Past President Dr. William Barrick delivered testimony to New York State Senate and Assembly Health Committee members at a Kingston hearing examining a proposal to create a single payor health care system in New York State.  Dr. Barrick’s testimony at the hearing can be viewed here, at the 7:32 mark.

Dr. Barrick’s testimony praised the goals of the New York Health Act legislation to reduce insurance hassles and expand coverage while also raising the significant challenges inherent in implementing such a massive system.  At one point, his testimony elicited a comment from Senate Health Committee Chair Gustavo Rivera regarding what the fee schedule of this system would likely be if this legislation were to be enacted, to which Senator Rivera characterized as “above Medicare”.

Dr. Barrick’s comments regarding possible prior authorization requirements prompted Assembly Health Committee Chair Richard Gottfried to praise MSSNY and the New York County Medical Society for engaging in a constructive dialogue, including highlighting specific areas of concern in the far-reaching proposal.  As a result, changes were made to the legislation including limiting prior authorization requirements and providing stronger collective negotiation rights for physicians. Dr. Barrick also raised the importance of liability reform as an essential component if legislation were enacted to create a single payor system.

MSSNY President Dr. Art Fougner previously testified at a May hearing in Albany, and New York County Medical Society Past-President Dr. Scot Glasberg testified at a Bronx hearing on this topic.


Data Exchange Incentive Program (DEIP) Step-By-Step
The Data Exchange Incentive Program (DEIP) offers a one-time incentive to help providers offset the cost of connecting to the SHIN-NY via a Qualified Entity (QE). Click here to view a  DEIP step-by-step document that will help physicians know what to expect regarding the DEIP process and timeline.


Hospital Groups Sue HHS to Block Price Transparency Rule
Four organizations representing hospitals and health systems across the nation sued HHS Dec. 4, challenging a final rule that requires hospitals to disclose the rates they negotiate with insurers beginning in 2021.

The American Hospital Association, the Association of American Medical Colleges, the Children’s Hospital Association, and the Federation of American Hospitals filed the lawsuit in the U.S. District Court for the District of Columbia. The groups argue that HHS lacks statutory authority to require public disclosure of individually negotiated rates between commercial insurers and hospitals. The lawsuit further alleges that the rule violates the First Amendment because it requires “highly confidential” negotiated rates to be disclosed.

“America’s hospitals and health systems stand with patients and are dedicated to ensuring they have the information needed to make informed health care decisions, including what their expected out-of-pocket costs will be,” Rick Pollack, president and CEO of the AHA, said in a press release. “Instead of giving patients relevant information about costs, this rule will lead to widespread confusion and even more consolidation in the commercial health insurance industry. We stand ready to work with CMS and other stakeholders to advance real solutions for patients.”

Under the final rule, issued Nov. 15, hospitals will be required to disclose the standard charges, including payer-specific negotiated rates, for all items and services. Hospitals that fail to publish the negotiated rates online could be fined up to $300 a day.
(Becker’s Hospital Review, 12/5)


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FDA Raises New CBD Concerns
FDA in a Consumer Update revised last week raised new safety concerns about products containing cannabidiol (CBD), particularly CBD-containing foods. In addition, FDA last week sent warning letters to 15 Companies that the Agency said are illegally marketing CBD Products.


HHS Moves to Provide HIV Prevention Drug to the Uninsured
HHS today launched a program to provide HIV prevention or PrEP drugs to an estimated 200,000 uninsured people at risk of HIV.

Officials intend to use Truvada that will be donated by Gilead Sciences in an annual arrangement through 2030. HHS Secretary Alex Azar said the department will cover the costs of dispensing the treatment through next March. After that, CVS, Rite Aid and Walgreens will donate pharmacy dispensing services.

The announcement comes nearly a year after President Donald Trump in his State of the Union address vowed to eliminate domestic HIV transmissions by 2030.

HHS has requested $291 million from Congress to support Trump’s plan. Both the House and Senate have committed to the HIV strategy, and Azar said officials are working to wrap funding into a short-term spending patch if fiscal 2020 appropriations measures aren’t finalized.

“We do need this money to get this moving,” Azar said.


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Deaths from Alcohol-Related Liver Disease at Highest Levels Since 1999
According to Reuters (11/29), CDC data revealed that “U.S. deaths from alcohol-related liver disease (ALD) are at their highest levels since 1999 and have risen every year since 2006 in nearly every racial, ethnic and age group.”

After analyzing “causes of death for people aged 25 and older in the two decades since 1997,” investigators “found that 2017 had the highest rates of death from ALD, at 13.1 per 100,000 deaths in men and 5.6 per 100,000 in women,” which “compares to 1999 ALD mortality rates of 10.6 per 100,000 in men and 3.3 per 100,000 in women.” In particular, “mortality rates and recent increases in ALD diagnoses were…pronounced among middle-aged adults, Native Americans and non-Hispanic whites,” the study found. The findings were published online in the American Journal of Gastroenterology.


Health Foundation of Western/Central NY’s Health Leadership Program
The Health Foundation for Western and Central New York is now accepting applications from leaders in western and central New York who are interested in participating in Cohort 10 of the Health Leadership Fellows Program. The Fellows program is designed for executives and leaders from health-related non-profit organizations, safety net organizations and public agencies that address the needs of older adults and young children impacted by poverty.

Applications can be submitted online here.

The deadline to apply for the Health Leadership Fellows Program is Friday, April 3, 2020. Interviews will be held throughout the spring, and the program will begin in November 2020. For those interested in learning more about the program, the Health Foundation will hold the following informational webinar sessions. Log-in information for the webinars will be posted on the Fellows web page at a later date.

  • February 13, 2020 at 2 pm
  • March 10, 2020 at 11 am

More than 300 leaders in western and central New York have graduated from Health Leadership Fellows since the program began. Taking what they have learned from the expert faculty, residential sessions, leadership assessments and coaching sessions, fellows have used new information, relationships and ideas to improve health care for people in our regions.

Questions? Visit the Health Leadership Fellows page on our site, check out our FAQ sheet or email Fellows Program Director Nancy Blaschak at nblaschak@hfwcny.org.


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California Surgeon: Prison Time for Role in $580M Billing Fraud
An orthopedic surgeon was sentenced to 30 months in federal prison Nov. 22 for his role in a healthcare fraud scheme that resulted in the submission of more than $580 million in fraudulent claims, mostly to California’s worker compensation system, according to the Department of Justice.

Daniel Capen, MD, was sentenced more than a year after pleading guilty to conspiracy to commit honest services fraud and soliciting and receiving kickbacks for healthcare referrals. He was one of 17 defendants charged in relation to the government’s investigation into kickbacks physicians received for patient referrals for spinal surgeries performed at Pacific Hospital in Long Beach, Calif.

Dr. Capen received at least $5 million in kickbacks for referring surgeries to Pacific Hospital and for referring services to organizations affiliated with the hospital. He allegedly accounted for $142 million of Pacific Hospital’s claims to insurers between 1998 and 2013, according to the Justice Department.

In addition to the prison term, Dr. Capen was ordered to forfeit $5 million to the federal government and pay a $500,000 fine. Becker’s Hospital. Review

Subject: Continuous Recruitment for NYS DUR Board Membership


Fed Legislation: States Must Maintain a DUR program and Establish a DUR Board The NYS Medicaid DUR Board provides recommendations to the Department of Health associated with establishing clinical standards for Medicaid’s pharmacy program. The composition of the DUR Board can be found on pages 1 & 2 of the Bylaws: https://www.health.ny.gov/health_care/medicaid/program/dur/docs/bylaws.pdf

Responsibilities of the DURB include:

  • The establishment and implementation of medical standards and criteria for the retrospective and prospective DUR program.
  • The development, selection, application, and assessment of educational interventions for physicians, pharmacists and recipients that improve care.
  • The collaboration with managed care organizations to address drug utilization concerns and to implement consistent management strategies across the fee-for-service and managed care pharmacy benefits.
  • The review of therapeutic classes subject to the Preferred Drug Program.

CVs associated with interest in becoming a DUR Board member are accepted continuously and can be submitted to the DUR Board mailbox at dur@health.ny.gov. If no vacancies exist, CVs will be kept on file for consideration once a position becomes available. Questions on membership and candidacy can be directed to the DUR Board Member Liaison, Robert Sheehan, at dur@health.ny.gov or 518-486-3209.

For more information about the NYS Medicaid DUR Board please visit: https://www.health.ny.gov/health_care/medicaid/program/dur/


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WORKERS COMP

Important News About WC Authorization/Re-Registration

Back in November 2017, MSSNY notified members that the WCB was updating its directory in 2018 and all WC authorized physicians had to re-register –

New Health Care Provider Registration Coming Soon

The Workers’ Compensation Board (Board) has initiated a registration process to update and maintain a current list of medical providers who are authorized to treat injured workers. The goal of this process is to enable an injured worker to easily and accurately identify Board-authorized medical providers.

Registering

You will be notified in November when registration opens for Board-authorized medical providers. Authorized providers are asked to register with the Board and update their office address(es) and contact information by January 15, 2018. This registration process will be an ongoing initiative every two to three years.

Medical providers who have not registered by January 15, 2018 will:

  • be removed from the public directory of Board authorized providers, and
  • become ineligible for the Board’s disputed bill process.

Creating an Account in the New York State Health Commerce System (HCS)

The Board will use the existing New York State Health Commerce System (HCS) for this registration process. For the initial registration and for future updates to your practice information, you will need to have an HCS account. If you don’t already have one, you can view directions to create an account on the New York State Department of Health website.

Q. If a WC physician did not re-register with the WCB to update the physician directory, what happened?
A. The physician was dropped from the directory of authorized WC physicians.

Q. What will occur moving forward?
A. Anyone who did not re-register with the WCB since 2018 will be dropped from WC authorization on or about 1/1/20. If a WC authorized physician doesn’t register by 1/30/20 their authorization status will be terminated.

Q. What if a physician wants to keep his/her WC authorization status?
A. Please have the doctors complete the registration process, click the link provided:
http://www.wcb.ny.gov/content/main/hcpp/Health_Provider_Registration_Instructions.pdf

Back in November 2017, MSSNY notified members that the WCB was updating its directory in 2018 and all WC authorized physicians had to re-register –


CME

MSSNY Podcast: DPT Vaccine
According to the CDC Provisional Pertussis Surveillance Report, there were 345 confirmed cases of pertussis in New York State in 2018.  There is currently a case in Montgomery County, and in October 2019 Jefferson County had an outbreak.  If pertussis is present in a community, it is possible for fully vaccinated people of any age the contract this highly contagious disease.  Be sure to learn more by listening to MSSNY’s podcast on the Tetanus, Diphtheria & Pertussis vaccine here.

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RENTAL/LEASING SPACE


Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email robin.roy@corcoran.com for information and showings.

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
_______________________________________


Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net


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Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                 Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*             Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                  Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                     Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Wyoming               Wyoming Correctional Facility (waterfalls, family farms, natural beauty)

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Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: November 22, 2019 – California Dreamin’

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 22, 2019

Vol. 22  Number 44


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Colleagues:

The AMA Interim Meeting in San Diego was interesting. A major issue discussed concerned Scope – NOT the mouthwash. The meeting highlighted the confusion that often arises among patients as to the credentials of the person who is treating them.

Table of doctorshttps://www.ama-assn.org/media/26936/download

For example, 88% of those surveyed were clear that an Obstetrician-Gynecologist is a physician, 12% either thought an Ob-Gyn was not a physician or were unsure. About one in five thought a Nurse Anesthetist was a physician. More folks than not thought Optometrists were physicians.

Therefore, in NY, we have the requirement to wear identifiers to reduce the confusion. However, there are Doctors of Nursing with PhD degrees. Therefore, they are doctors but not physicians. No wonder patients get confused.

To be clear, we all need each other. Patients clearly fare best when their care is team-based. There should be no room for either – or. No remonstration, no finger pointing allowed. However, when I learn that a physician is being bullied so as not to give a vanilla presentation on the differences in education and training among the various healthcare professionals who treat patients in the area, I am deeply troubled.

To that end, MSSNY has set up an ad hoc Scope of Practice committee.

In the end, it’s the patient who counts.

Please let us end the confusion.

There is a “physician” and then there is “not exactly”.

All the leaves are brown and the sky is gray
I’ve been for a walk on a winter’s day
If I didn’t go, I could leave today
California dreamin’ on such a winter’s day

-John and Michelle Phillips

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


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Please Take Our Survey Re Prior Authorization —A Major Physician Concern
MSSNY has worked together with numerous physicians and patient advocacy groups in support of multiple pieces of legislation to reduce physicians’ administrative burden to ensure that their patients can receive the medications they need. Please click here to complete the survey.

Our success includes a recent law that gives physicians greater authority to override a health insurer “step therapy” or “fail first” prescription medication protocol in certain circumstances.

However, MSSNY continues to work for additional laws that reduce the need for unnecessary and repetitive prior authorizations that take time away from patient care delivery.

Please take just a few minutes to complete the survey.


Physicians: Urge Governor to Sign Legislation to Permit Partial Filling of Opioid Prescriptions
Please urge Governor Cuomo to sign into law legislation (A.3918/S.1813) presented for his consideration this week that would permit a physician to stagger a patient’s short-term opioid prescription, so as to prevent the accumulation of unused opioids in patient medicine cabinets.  You can send a letter from here: https://p2a.co/YRf6CsU.  Specifically, the legislation would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each “partial fill” would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households.

The Governor has until November 30 to decide whether to veto or sign. MSSNY President Dr. Art Fougner issued a statement this week calling on the Governor to sign this bill into law, noting that “We know that one way opioid abuse starts is by persons other than the patient accessing unused medications left in medicine cabinets or other parts of a patient’s home.  By enabling the staggered filling of the prescription, this measure will help to reduce the amount of pain medicines left unused. This will limit the risk of these medications being diverted.”


New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
As recently reported, Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted.   The law was designed to respond to reports of medical students being asked to perform such exams, without express patient consent, as part of their medical training in teaching hospitals. Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance  of  a  pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized  to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

·   the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;

·   the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has  already given oral or written consent; or

·   the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

It would also make violation of such provision an element of physician misconduct. Several other states have passed similar laws expressly banning this practice without clinical justification. MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care.  The American College of Obstetricians & Gynecologists have issued an ethical opinion that “Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery”. The law takes effect on April 4, 2020.


It’s Crunch Time – Please Make Sure Congress Doesn’t Let the Insurance Industry Write the “Surprise Bill” Solution
With just a few weeks left in the year, Congress is continuing to have extensive discussions about legislation to address “surprise” out of network medical bills.  It is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution to this issue that protects patients’ access to needed care, and does not grant huge new powers to the health insurance industry.  By clicking here https://p2a.co/klWfpHT, you can send a letter, and tweet at your legislators.

Please remind them of the successes of New York’s law.  In September, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.   According to a May Georgetown University report, there has not been any adverse premium impact attributable to our law.  

At the same time, please remind them of the grave concerns have been raised about insurance company friendly legislation (H.R.3630 Pallone/Walden, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.  When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.   

Large market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not let Congress make this worse.  Please contact your Senators and Representatives today!  https://p2a.co/klWfpHT


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NYDOHMH Confirms Second Vaping-Related Death
The AP (11/20) reports New York’s Department of Health “has declared the state’s second death linked to a vaping-associated illness.” Gov. Andrew Cuomo “said on Wednesday that the person who died was a man in his 30′s from Manhattan with a reported history of using e-cigarettes and vapor products.” The first death, on Oct. 4, “was of a 17-year-old boy from the Bronx.”

New York AG files suit against Juul

New York Attorney General Tish James filed suit against e-cigarette maker Juul Tuesday alleging the company marketed to underage users and misrepresented the product as a healthier alternative to traditional cigarettes. In the 38-page complaint, the AG’s office says that Juul engaged in “deceptive business practices when marketing and advertising its products, and illegally sold its products to minors through its websites and in third-party retail stores throughout the state.”

“There can be no doubt that JUUL’s aggressive advertising has significantly contributed to the public health crisis that has left youth in New York and across the country addicted to its products,” James said in a statement. “By glamorizing vaping, while at the same time downplaying the nicotine found in vaping products, JUUL is putting countless New Yorkers at risk.”

The suit makes it illegal to sell nicotine products to minors. About 220,000 of the 1 million e-cigarette users across the state are under the age of 18, according to an estimate from the state health department. The federal government has reported 2,172 cases of vaping-related illness — though many cases have been tied to vitamin E acetate found in THC cartridges — and 42 deaths as of Nov. 13.


Canada May Have Found New Vaping Complication: Popcorn Lung
Canadian physicians may have identified a new type of lung injury linked to vaping. In CMAJ, they report a potential case of vaping-associated bronchiolitis obliterans, a form of which is known as “popcorn lung.”

Previously, a number of workers in factories making microwave popcorn developed “popcorn lung” after inhaling the flavoring chemical diacetyl, which is also used in e-liquids.

An otherwise healthy, 17-year-old male with a history of heavy, daily vaping presented with cough, dyspnea, and fever. Tests for infectious agents were negative. Computed tomography revealed a diffuse tree-in-bud pattern, which differs from what has been observed in patients with e-cigarette, or vaping, product use associated lung injury (EVALI).

The patient developed refractory hypercapnia and required extracorporeal membrane oxygenation, but he improved with corticosteroids. He was hospitalized for 47 days and still had impaired lung function at 4 months.

Separately, a correspondence in the New England Journal of Medicine describes autopsy findings from a young man who died from untreated EVALI.

CMAJ article https://www.cmaj.ca/content/early/2019/11/20/cmaj.191402CMAJ editorial (https://www.cmaj.ca/content/cmaj/early/2019/11/20/cmaj.191503.full.pdf

NEJM correspondence on pathology of vaping-related lung illness https://www.nejm.org/doi/full/10.1056/NEJMc1914980?query=pfw&jwd=000012759862&jspc=%20


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Three LI Children Contract Polio-Like Disease Acute Flaccid Myelitis
Newsday (NY) (11/17) reports on the “rare polio-like disease” acute flaccid myelitis “that has struck at least three Long Island children since a nationwide outbreak began in 2014.” The CDC “has confirmed nearly 600 cases of the disease – mostly in young children – since it began tracking cases in 2014.”


Survey: Women More Likely to be Warned Away from Surgery Careers
Findings were published in Annals of Surgery regarding a recent survey that “punishing hours and concerns about having little time to marry and have children deter both male and female medical students from choosing careers in surgery, but more women say they’ve been warned away from the field because of their gender.” Researchers “sent surveys to roughly 720 students at Harvard Medical School.” Among the 261 who responded, “similar proportions of both genders intended to become surgeons – roughly one in four men and one in five women.”


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Plan Legal Challenge against Health-Pricing Disclosure Rule
The Wall Street Journal (11/20) reports that the hospital industry is planning a legal challenge to block the Trump Administration’s new health-pricing disclosure rule, which would require the disclosure of secret rates negotiated by hospitals with insurers for all services.


CMS Flags Nursing Home Citations
CMS on its Nursing Home Compare website has added a new icon—a red circle with a white stop hand in the center—to ratings for 760 facilities, indicating that the facilities have been cited for an incident of abuse, neglect, or exploitation. Consumer advocates have applauded the move, but some in the nursing home industry say the alerts are misleading. (Wall Street Journal, 11/19)


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Incontinence is Increasingly Common Though Few Seek Care
The Wall Street Journal (11/17, Subscription Publication) reported on incontinence and efforts to improve bladder health, adding that according to the Urology Care Foundation one-third of Americans 40 or over have urinary incontinence at least some of the time, though many do not seek care.


Hard-to-Use EHRs Tied to Physician Burnout
Physicians who find their electronic health records (EHRs) difficult to use are more likely to report symptoms of burnout, according to a study in Mayo Clinic Proceedings.

Nearly 900 physicians answered a questionnaire about burnout and completed the System Usability Scale (SUS), a 10-item survey assessing how usable they found their EHR (see second link below). SUS scores range from 0 to 100, with higher scores denoting better usability.

Overall, the mean SUS score was 45.9, which is considered “not acceptable.” Additionally, nearly half the cohort reported at least one burnout symptom. SUS scores were associated with burnout in a dose-dependent manner. After multivariable adjustment, the odds of burnout were 3% lower with each 1-point increase in SUS score.

Dr. Patrice Harris, president of the American Medical Association, said in a statement: “The findings will not come as a surprise to anyone who practices medicine. … It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function — helping physicians care for their patients.” Mayo Clinic Proceedings article; System Usability Scale;


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Survey: Practices Spend One Staff Day Each Week on Provider Directory Upkeep
Modern Healthcare (11/14) reports a new Council for Affordable Quality Healthcare survey reveals “maintaining provider directories is an expensive, time-consuming task that takes up the equivalent of one staff day per week for physician practices.” The not-for-profit health plan alliance “found directory maintenance costs practices nationwide $2.76 billion annually, or $999 per practice per month.”

Additionally, “the cost to practices rises in accordance with the number of providers and plan contracts,” and “practices with more than 25 providers spent an average of about $2,500 per month maintaining provider directories, while those with fewer than five providers spent $319 per month on average.” In its report of the results, CAQH suggests “a seemingly simple solution: health plans adopting a single, streamlined platform where practices can enter, update and review their practice information and share it with multiple plans at once.”


Young Physicians at Interim AMA Meeting

Young Physicians at Interim AMA Meeting. (from left) Charles Lopresto, DO; Ryan Schlobach, MD (in rear); then Ray Lorenzoni, MD (in rear); Carlos Zapata, MD; Anita Ravi, MD; Jocelyn Young, DO; Daniel Choi, MD; and Carlo Milani, MD


WORKERS COMP

Go Live Date Approaching for NY Workers’ Compensation Formulary
The New York Workers’ Compensation Board Drug Formulary (NY WC Formulary) becomes effective on December 5, 2019 for all new prescriptions. Starting that day, all new prescriptions for injured workers in New York State must be listed within the NY WC Formulary unless an alternative medication has been approved through the NYS Workers’ Compensation Board’s new prior authorization process. The new electronic prior authorization process will soon be available through the Board’s Medical Portal; please watch for the notification.

Please visit the Board’s Drug Formulary Overview webpage for:

  • An overview of the NY WC Formulary and the prior authorization process
  • The latest version of the NY WC Formulary (effective 11/5/19)
  • A video overview for Medical Providers
  • A Quick Guide to the NY WC Formulary
  • An NY WC Formulary Dashboard Guide for Medical Providers

Information and resources related to requesting prior authorization through the Board’s Medical Portal, can be found on the Board’s Medical Portal Overview webpage.

For more information or assistance: http://www.wcb.ny.gov/content/main/hcpp/DrugFormulary/overview.jsp


CMS

The CY 2020 MPFS is Now Available
The CY 2020 Medicare Physician Fee Schedule (MPFS) is now available. You can view the new fees using the Fee Schedule Lookup tool page on the NGSMedicare.com website.


Webinars

MSSNY hosted a webinar, “How to Maximize Success and Maintain Control & Ownership of Your Physician Group,” featuring Roy Bejarano, Co-Founder & CEO of Scale Physician Group, and Andrew Blustein, Partner/Director and Vice Chair of Garfunkel Wild, P.C. on November 12, 2019.

Roy shared the lessons and best practices learned from his experience working with over 1,200 physicians across the country and Andrew facilitated Q&A during the presentation. Listen to the replay for Scale’s insights on the benefits of scale, barriers to building sustainable growth, and how to approach a private equity transaction for physician groups.


Classified

RENTAL/LEASING SPACE


Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email robin.roy@corcoran.com for information and showings.

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
_______________________________________


Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net


NYS Corrections Logo

Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                 Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*             Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                  Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                     Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Wyoming               Wyoming Correctional Facility (waterfalls, family farms, natural beauty)

NYS Corrections Personnel Ad

Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: November 15, 2019 – Collateral Damage

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 15, 2019

Vol. 22  Number 43


MSSNYPAC Seal


Colleagues:

This past week, I learned that pharmacies in the Bronx were either out of stock of opioids or on “back order.” This seemed hard to believe but one neurologist recounted his experience in trying to find a pharmacy carrying Percocet for his patient with severe paroxysms of sympathetic nerve pain. In exploring further, he had obtained a memo from a health organization suggesting that opioid manufacturers were loathe to ship supply to NY State because of the opioid excise tax recently enacted.

This particular organization suggested that the medications would be obtainable via a rather circuitous route via their own central distribution center.

This, of course, would be little help for this particular patient or for many who legitimately need narcotic analgesia. Despite the opioid crisis, pain relief is still a quality metric and pain is still the “fifth vital sign.” Measures in place, however well-intended, have put patients and physicians in a bind. Pain must be relieved but the relief is often difficult to obtain. And when the analgesics in question are out of reach, is it so hard to consider that patients might seek alternative means to relieve that pain?

Therefore never send to know for whom the bell tolls.
It tolls for thee.
John Donne

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


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We Need Your Data
At November’s MSSNY Council meeting, Dr. Sana Block expressed concerns on behalf of physicians who are finding it difficult for patients to obtain medically needed prescriptions for pain.  He explained that pharmacies are not filling prescriptions for opioids when needed for patients with chronic pain.  Other Councilors stated that they have experienced difficulty for patients obtaining pain medications following surgery.  Anecdotal information is fine; but, to bring this to the attention of powers that might be able to address this problem, we need your data.

To help us help you, please download the MSSNY Hassle Factor Form.  Complete the form, letting us know if you have experienced difficulty in obtaining medically needed pain meds for you patients.

In Section C of the form, please indicate the name of the pharmacy.  If you have experienced problems with multiple pharmacies, please use multiple forms.  In addition, please identify the nature of the problem, such as the drug is out of stock; the pharmacy recommends a different drug, etc.  The completed form can be emailed to RxHassles@mssny.org or faxed to: 516-282-7093 or 516 282-7099 or 516-282-7098.


It’s Crunch Time – Please Make Sure Congress Adopts a Fair Solution to Surprise Medical Bills
 With just 6 weeks left in the year, Congress is continuing to have extensive discussions about legislation to address “surprise” out of network medical bills.  It is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution to this issue that protects patients’ access to needed care, and does not grant huge new powers to already market dominant insurers.  By clicking here, you can send a letter, and tweet at your legislators.

Please remind them of the successes of New York’s law.  In September, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.   According to a May Georgetown University report, there has not been any adverse premium impact attributable to our law.

At the same time, please remind them of the grave concerns that have been raised about insurance company friendly legislation (H.R.3630 Pallone/Walden, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.  When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not give them any more power.  Please contact your Senators and Representatives today!

Cartoon illustration issues with surprise billing


Physician Action on Key Health Care Legislation Needed
As of today, there were still 375 bills that passed both houses in 2019 that were awaiting delivery to the Governor.  But with just 6 weeks left in the year, the flurry of bill signings/vetoes has begun.  This week, MSSNY sent letters to the Governor in support of legislation to extend for 2 years the “nursing home exception” to mandatory e-prescribing (A.1034-A/S.4183) and to permit ophthalmologists to delegate administration of eye drops to assistants (S.4469-B/A.3822-D).

Physicians can quickly and easily send a letter to the Governor here on the following bills:

  • Protect Against Insurer Mid-year Formulary Changes– would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year.  Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please urge the Governor to sign this bill into law.
  • Support Partial Prescription Fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
  • Oppose Liability Expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please urge the Governor to veto these bills.

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NYeC: Shin-NY Reduced Healthcare Costs by Over $160 Million Annually
According to a recent preliminary analysis conducted by New York eHealth Collaborative (NYeC) use of the Statewide Health Information Network for New York (SHIN-NY) is reducing unnecessary healthcare spending in New York by $160-$195 million annually, which includes significant savings to Medicaid and Medicare.  To see NYEC’s white paper on this analysis click here.

The results of the analysis indicate that the savings are based on the current size and use of the network, using methodology developed by the Department of Health and Human Services’ (HHS) Office of the National Coordinator (ONC) for purposes with recent related federal proposals.

The report noted that, “The approximated savings and value are based and consistent with results of existing peer reviewed academic studies pointing to the value of using HIE generally. HIE has been associated with 50% reduction in rates of hospital readmission, 26% reduction in the rate of emergency department admissions, 35% reduction in the repeat of repeat imaging procedures and 10% lower 30-day readmission rate among Medicare fee-for-service beneficiaries”

The SHIN-NY is a statewide network that facilitates secure and confidential electronic sharing of patient data across the healthcare system to improve outcomes. It is comprised of and connects regional health information networks (RHIOs) that allow participating healthcare professionals, with patient consent, to quickly access and share comprehensive patient health information and medical records. Statewide, 100 percent of hospitals and over 100,000 healthcare professionals are connected to the SHIN-NY, which facilitates the exchange of health information (HIE) for patients across the state.

MSSNY representatives have been in regular communication with NYeC staff to work towards enhanced physician participation in their local RHIOs and the SHIN-NY.  They have touted HIT as a fundamental tool in positively impacting patient care and outcomes, but also have raised concerns that this technology, for many physicians, is not easily compatible with patient care delivery.  Physicians should be aware of programs such as the Data Exchange Incentive Program (DEIP) that helps subsidize the cost of connecting to your local RHIO.


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New York Is 1st State to Publicize Hospitals with C. Auris Cases
New York health officials on Nov. 13 published a list of healthcare organizations that have treated patients for the deadly fungus Candida auris, making it the first state to share this information with the public, reports The New York Times.

The list includes 64 hospitals, 103 long-term care homes, three hospice units and one long-term care hospital. It does not detail how many cases occurred at each organization.

The New York State DOH released the list in response to a rapid increase in C. auris cases. Health officials said the information is intended to boost transparency for consumers and motivate hospitals to stop C. auris from spreading further, according to NYT. The CDC has reported 836 cases of C. auris nationwide as of Aug. 31. Of these, 388 have occurred in New York.

To view the state’s full list of healthcare organizations reporting C. auris cases, click here. (Becker’s Hospital Review, Nov. 14)


Vaping Illness Leads to Lung Transplant at Henry Ford Health System
Henry Ford Health System this week announced that it performed what the health system believes is the first ever double-lung transplant for a patient with a vaping-related illness. Hassan Nemeh, who led the surgical team at Henry Ford, said the patient’s lungs were unlike anything he had seen in his 20-year career, noting that the 17-year-old patient’s lungs were scarred, rigid, inflamed, marked with dead spots. (New York Times, 11/12)


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Hospital Safety Grades
The Leapfrog Group last week released its Fall Leapfrog Hospital Safety Grades, giving about one-third of hospitals an “A,” but giving more than 40% of hospitals a “C” or lower. Leapfrog also published an infographic that looked at the rates of avoidable deaths at hospitals for each grade. (Source: HealthLeaders Media, 11/7)


CDC: Five Leading Causes of Death
U.S. residents living in rural areas of the country were more likely to die from preventable causes than those living in urban areas from 2010 to 2017, according to a CDC Morbidity and Mortality Weekly Report released last week. Overall, the researchers found heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke ranked as the five leading causes of death in the United States in 2017.


Survey Finds Many PCPs Don’t Discuss How Hair Care Can Be a Barrier to Exercise for Some Black Women
Findings published in the Journal of the American Board of Family Medicine suggests “primary care providers often don’t realize that hair care can be a barrier to regular exercise for some black women.” A survey of primary care physicians “found an overwhelming majority talk to their female African American patients about the importance of exercise. But three-quarters said they don’t talk with these patients about hair care, which can be a barrier to vigorous workouts.”


Families May Feel Better About End-Of-Life Care in ICU if Granted Simple Wishes
Researchers found in a small study that “families of dying patients may feel better about end-of-life care in the ICU if they are granted simple wishes, like letting the patient taste a favorite meal or use a blanket from home.” The findings were published in the Annals of Internal Medicine


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Hospital Price Transparency Rule Could Come Before Year’s End
CMS could release a rule by the end of 2019 on a proposal that hospitals disclose payer-specific negotiated rates, a White House adviser said. CMS is delaying action on the price transparency proposal, excluding it from the 2020 Medicare Outpatient Prospective Payment System final rule released Nov. 2.

The proposal, which CMS released July 29, includes provisions in a price transparency executive order signed this year by President Donald Trump. It would require hospitals to publish all “standard charges,” including the hospital’s gross charges and negotiated rates with payers for an item or service, online in a machine-readable format.

Under the rule, hospitals also would be required to publish the rates they negotiate with insurers for 300 services consumers are likely to shop for in a searchable and consumer-friendly manner. Hospitals that do not comply would be penalized.

The proposal builds on a current federal rule that requires hospitals to publish a list of their standard charges on the internet, but excludes negotiated rates with payers.

The American Hospital Association has come out against the proposal, saying it is “the wrong approach” and “would introduce confusion and fuel anticompetitive behavior among commercial health insurers.” Federal contends the proposal could significantly reduce healthcare costs. (Becker’s Hospital CFO Report Nov.11)


(E/M) Visit Frequently Asked Questions (FAQs) Physician Fee Schedule (PFS)
This document addresses Frequently Asked Questions (FAQs) regarding documentation and payment for evaluation and management (E/M) visits under the Medicare Physician Fee Schedule (PFS).

  1. What parts of the history can be documented by ancillary staff or the beneficiary starting in CY 2019?

The CY 2019 PFS final rule expanded current policy for office/outpatient E/M visits starting January 1, 2019 to provide that any part of the chief complaint (CC) or history that is recorded in the medical record by ancillary staff or the beneficiary does not need to be re-documented by the billing practitioner. Instead, when the information is already documented, the billing practitioner can review the information, update or supplement it as necessary, and indicate in the medical record that she or she has done so.

This is an optional approach for the billing practitioner, and applies to the chief complaint (CC) and any other part of the history (History of Present Illness (HPI), Past Family Social History (PFSH), or Review of Systems (ROS)) for new and established office/outpatient E/M visits.

To clarify terminology, we are using the term “history” broadly in the same way that the 1995 and 1997 E/M documentation guidelines use this term in describing the CC, ROS and PFSH as “components of history that can be listed separately or included in the description of HPI.” This policy does not address (and we believe never has addressed) who can independently take/perform histories or what part(s) of history they can take, but rather addresses who can document information included in a history and what supplemental documentation should be provided by the billing practitioner if someone else has already recorded the information in the medical record.


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Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line!
Revalidate before your due date to avoid a hold on your Medicare payments and deactivation of your Medicare billing privileges.

There are several ways to find your revalidation due date:

Generally, the due date will remain with the provider/supplier throughout subsequent revalidation cycles. So you will not have to wonder about the due date the next time you need to revalidate.

NOTE: Unsolicited applications received seven months prior to the revalidation due date will be returned to the provider.

Need assistance? Providers and suppliers can register for our provider enrollment webinars by either using the following links, Part A/Part B or by visiting the NGSMedicare.com website. The webinars below can be found under the Education Tab by selecting Webinars, Teleconference and Events.

  • Provider Enrollment Revalidation Overview
  • Getting Access to PECOS
  • Submitting Revalidation via PECOS Application
  • Submitting Revalidation via CMS-855A Paper Application for a Part A providers
  • Submitting Revalidation via CMS-855B Paper Application for a Part B providers
  • Submitting Revalidation via CMS-855I Paper Application for a Part B providers
  • Let’s Chat about Provider Enrollment Revalidation

PECOS: View and Manage Reassignments through Group Enrollment

Webinars

“When is the Flu not the Flu?” CME Webinar on November 20; Registration Now Open
Flu season is upon us, but there are myriad other illnesses that present similarly.  Be sure to brush up on these by signing up for Medical Matters: When is the Flu not the Flu? on November 20th at 7:30am.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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.


Classified

RENTAL/LEASING SPACE


Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email robin.roy@corcoran.com for information and showings.

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
_______________________________________


Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net


NYS Corrections Logo

Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*              Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                 Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                      Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

NYS Corrections Personnel Ad

Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: November 8, 2019 – Stop Digging

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 8, 2019

Vol. 22  Number 42


MSSNYPAC Seal


Colleagues:

How did things ever get so far? This is the existential question confronting physicians every day. One of the key reasons why so many physicians report burnout or even depression is the feeling of a loss of professional autonomy. Sadly, the only group of professionals licensed to practice medicine have so little control in the way they actually practice. We are burdened by data entry, billing, coding, keeping up with new unfunded mandates, and all the while seeing their practices barely making payroll or even taking out second mortgages to keep their offices open. As said previously, it’s not about profitability anymore but about viability.

There’s an old saying – when you find yourself in a deep hole, stop digging. Going along to get along is no longer working. It’s time for a change – but how? Here’s one suggestion. Stop digging. It’s time to say, as Roberto Duran famously said, “No mas.” The decline in fortune did not start yesterday. This did not happen overnight. Therefore, the road back will not be a short one. But we must start. It will, for sure, be a long and arduous journey. But we must start. There will be bumps along the road but we must start. As the infamous Chairman put it, “A journey of a thousand miles begins with but a single step.”

So let’s take that single step. Get together. Get active. Support your fellow physicians. We need all the help we can get.

Stop digging.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

To all physicians who served in the United States Armed Forces,
 we salute you and thank you for your service!


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Congress Finalizes 2020 Medicare Payment Rule and 2021 E&M Changes with Potentially Significant Redistributive Effects
On November 1, 2019, CMS released its 2020 Medicare Revisions to Payment Policies under Physician Fee Schedule and Other Changes to Part B Payment Policies final rule.  For a brief summary from the American Medical Association as to the highlights of the nearly 2,500 page rule, click here.

Among the highlights:

  • The Medicare Physician Fee Schedule conversion factor will be $36.09 (CY 2019 conversion factor was $36.04), which reflects a budget neutrality adjustment for reductions in relative values for individual services in 2020.
  • Geographic Adjustment Factor (GAF) Increases. Each of the 5 New York Medicare payment locality will receive a slight GAF bump for 2020 and 2021, as follows
    • Manhattan +1.3% for 2020; +2.6% for 2021
    • NYC Suburbs/Long Island +1.5% for 2020; +2.9% for 2021
    • Poughkeepsie/Northern NYC Suburbs +1.7% for 2020; +3.4% for 2021
    • Queens +1.6% for 2020; +3.3% for 2021
    • Upstate NY +0.2% for 2020; +0.4% for 2021.
  • Effective January 1, 2021, CMS will adopt the CPT guidelines to report office visits based on either medical decision making or physician time. With CMS adopting the RUC work recommendations for the office visit codes, the work value increases represent $3 billion in redistributed spending, resulting in a 3% reduction in the conversion factor.   Moreover, CMS adopted the RUC physician time recommendations. Coupled with the work value increases and some modifications in direct practice costs, these changes lead to an additional $2 billion in redistributed spending, resulting in an additional 2% across-the-board reduction.
  • CMS departed from the RUC recommendations in two ways that further intensify the specialty redistribution impact. CMS will implement an add-on payment for office visits for primary care and patients with serious or complex conditions. This proposal redistributes an additional $2.6 billion, resulting in an additional 3% reduction to the Medicare conversion factor.

CMS states that although they have no specialty restrictions on reporting new code GPC1X, they assume that the following specialties will report this add-on code with 100% of their office visits, essentially making this a bonus payment for: family medicine, general practice, internal medicine, pediatrics, geriatrics, nurse practitioner, physician assistant, endocrinology, rheumatology, hematology/oncology, urology, neurology, obstetrics/gynecology, allergy/immunology, otolaryngology, interventional pain management, cardiology, nephrology, infectious disease, psychiatry, and pulmonary disease.

It is estimated that the add-on payment for GPCIX will be approximately $18 per visit.  Therefore, while each of these specialties are expected to see sizable increases in 2021, those expected to see sizable decreases as a result of E&M changes include: anesthesiology (-7%); cardiac surgery (-8%); colon & rectal surgery (-4%); emergency medicine (-7%); gastroenterology (-4%); general surgery (-4%);  neurosurgery (-6%); ophthalmology (-10%); plastic surgery (-5%); radiology (-8%); thoracic surgery (-7%) and vascular surgery (-5%)


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Council Notes — November 7, 2019
Nancy Nankivil, AMA Director of Practice Transformation, and Kyra Cappelucci, AMA Project Administrator, Practice Transformation, presented Practice Transformation Initiative: Solutions for Increasing Joy in Medicine. The AMA has partnered with the Physicians Foundation and several state medical societies to create a practice transformation framework to reduce physician burnout by furthering research focused on evidence-based interventions; collaborate and learn from health systems committed to assessing clinician satisfaction and its correlation to workflow design; and to foster a network or organizations implementing evidence-based solutions, sharing best practices and driving change to improve the joy in medicine.

Council approved the following:

  • MSSNY will become involved in the AMA/Physician Foundation’s Practice Transformation Initiative and will seek appropriate resources for this endeavor.
  • Approval of 2020 Legislative Program
  • MSSNY will file a FOIL request for all documents from the New York Department of Health regarding ZocDoc’s business model exempted from application of NYS Education 6530 laws.

ZocDoc changed its business model to charge practices a per-patient booking fee effective April 1, 2019. The NY DOH indicated that ZocDoc can move forward with the model despite concerns of violations with referral fees; some NY DOH emails regarding ZocDoc have been redacted in a Freedom of Information Law (FOIL) request.

  • MSSNY will seek legislation to create a physician-led healthcare cooperative in New York as one pathway for achieving legally permissible state supervised collective negotiation rights for physicians.
  • Strategies to Improve NYS Immunization Rates in Children: MSSNY will urge that New York State provide incentives to parents/guardians who vaccinate their children as a strategy to improve vaccine uptake in school-aged children and advocate that New York State develop programs to pay stipends to community health workers as a strategy to improve vaccine uptake in school-aged children.
  • Healthcare Cooperative Act: MSSNY will seek legislation to create a physician-led healthcare cooperative in New York as one pathway for achieving legally permissible state supervised collective negotiation rights for physicians.
  • Physician Owned Distributorships: MSSNY supports the concept of Physician Owned Distributorships (PODs), provided that they are operated consistently with generally accepted principles of physician ethical conduct (such as the AMA Code of Medical Ethics), including assuring that patients and other potential contractors are sufficiently notified of the physician’s financial interest in such POD.
  • Study of State and National Health Service Corps Needs: MSSNY will advocate for the expansion of the Doctors Across New York Physician Loan Repayment Program, support the development of State funded loan forgiveness and repayment programs for physicians, and advocate for scholarships/grants for medical students who plan to work in the state.
  • Manpower Assistance for Medical Students: MSSNY supports the concept of continuing federal manpower financial assistance, including grants and long term, low interest loans for medical students.
  • Patient-Driven Groupings Model (PDGM): MSSNY will work with the AMA to monitor implementation of the PDGM methodology to determine whether this new program will impose additional administrative burdens on physicians and/or impede patients from receiving needed home care services. Should it be determined that this new model is creating these issues, these concerns will be conveyed to CMS and Congress for remediation.

Complaints Re Pharmacies Not Honoring Scripts: WE NEED YOUR DATA
At yesterday’s MSSNY Council, Dr. Sana Block expressed concerns on behalf of physicians who are finding it difficult for patients to obtain medically needed prescriptions for pain.  He explained that pharmacies are not filling prescriptions for opioids when needed for patients with chronic pain.  Other Councilors stated that they have experienced difficulty for patients obtaining pain medications following surgery.  Anecdotal information is fine; but, to bring this to the attention of powers that might be able to address this problem, we need your data.  To help us help you, please download the MSSNY Hassle Factor Form. Complete the form, letting us know if you have experienced difficulty in obtaining medically needed pain meds for your patients.

In Section C of the form, please indicate the name of the pharmacy.  If you have experienced problems with multiple pharmacies, please use multiple forms.  In addition, please identify the nature of the problem, such as the drug is out of stock; the pharmacy recommends a different drug, etc.  The completed form can be emailed to comments@mssny.org or faxed to: 516-282-7093 or 516 282-7099 or 516-282-7098.


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Gov. Signs Law: Death Certificates to Specify Opioid-Involved Overdose
Following Governor Cuomo’s press release on November 5, 2019, the EDRS Team would like to reinforce the importance of complete and accurate Cause of Death data on all death certificates, including those deaths related to opioid overdose. See the Governor’s press release here. Capturing this data assists State and federal government agencies analyze and pinpoint community impacts and work toward combatting epidemics, such as the opioid crisis.

The EDRS Team would like to take this opportunity to let you know about the recently launched self-paced online course, Mastering the Cause of Death in the 21st Century, for physicians, medical examiners, coroners, and other medical certifiers. This course provides medical data providers with tips to get the best cause of death determination, including opioid related deaths. Participants may be eligible for AMA PRA credit for completing this course and its final assessment.

According to the state Department of Health’s Opioid Annual Data Report for 2018, the rate of opioid-overdose deaths in 2016 was 15.1 per 100,000 people, about three times higher than it was in 2010.

The new law takes effect immediately. Participants may register now by visiting  https://lms.udutu.com/LMSPortal/Account/LogOn?OrgCode=EDRS and using the organization code:  EDRS and select Create New Learner Account.  If you have additional questions related to the new drug specificity requirements or the EDRS implementation, call (518) 408-0243 or kira.cramer@health.ny.gov.  For more information on registration for the course, contact Zina Adams at zina.adams@health.ny.gov or 518-474-4317. Please see the flyer here.


MSSNY President Delivers Testimony to NY State Senate on Potential Harms of Electronic Cigarettes and Vaping
MSSNY President Dr. Arthur Fougner, MD, provided testimony to the New York State Senate public hearing held to examine the safety and potential harms of electronic cigarettes and vaping, especially among school-aged youth. (View full testimony here: 1Hr and 5 mins)

Dr. Fougner praised Governor Cuomo and the New York State Health Department for its emergency executive action to ban the sale of flavored e-cigarettes in the state (http://www.mssnyenews.org/press-releases/mssny-supports-call-to-ban-menthol-flavored-e-cigarettes/).  He also noted MSSNY’s long-standing support for legislation to ban flavored tobacco products, menthol and e-cigarettes and formally codify these provisions into law.

Specifically he noted that, “While evidence exists that adult smokers who completely substitute vaping for traditional smoking reduce their exposure to many of the toxic chemicals and carcinogens present in combustible tobacco cigarettes, e-cigarettes are not risk-free and are not approved by the Food and Drug Administration (FDA) as a quit-smoking aid. The bottom line is neither smoking nor vaping is safe, and people who do not smoke or vape should not begin to do so.” 

Dr. Fougner also urged strong caution regarding proposals to legalize the recreational use of marijuana since it appears from a number of sources that the vast majority of cases of vape-related lung illness are linked to the vaping of THC. Since the FDA has launched an ongoing investigation, he urged that “any proposed adult-use cannabis program, especially with a vaporizer product, be put on hold until completion of that investigation.”


Stolen Flash Drive: U of Rochester Med Center Pays $3M HIPAA Settlement
The University of Rochester Medical Center has agreed to pay $3 million to HHS’ Office for Civil Rights to settle potential HIPAA violations, according to a Nov. 5 news release. In 2013, URMC filed a data breach report with the OCR stating that an unencrypted flash drive had been stolen. Following the notice that patients’ protected health information could have been exposed, the OCR offered technical assistance to URMC.

Then in 2017, URMC disclosed that an unencrypted laptop had been stolen. An OCR investigation found URMC failed to conduct enterprise-wide risk analysis, implement security measures sufficient to reduce risk and vulnerabilities to a reasonable and appropriate level, utilize device and media controls, and employ a mechanism to encrypt and decrypt electronic protected health information.

“Because theft and loss are constant threats, failing to encrypt mobile devices needlessly puts patient health information at risk,” said Roger Severino, OCR director. “When covered entities are warned of their deficiencies, but fail to fix the problem, they will be held fully responsible.”

Along with paying the $3 million settlement, URMC will also undergo a corrective action plan, including two years of HIPAA-compliance monitoring.


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JAMA: People Turning To Social Media Platforms for STD Diagnosis
The Reddit community r/STDs “encourages its more than 10,000 members to share stories, concerns and questions about sexually transmitted diseases – and according to a study published Tuesday, they have increasingly done so.”

The study, published in the Journal of the American Medical Association, found that “the number of posts significantly increased over time, from just eight in 2010 to 3,375 in 2018.” Investigators “focused on a random sampling of 500 posts” and found over “half – 58 percent – asked the site’s members for a diagnosis,” while “nearly a third of those included photos of the apparent STD in question.”

Medscape reports investigators conclude, “requests for crowd-diagnoses were frequent, with most receiving a reply within hours, and many of these requests were for second opinions after obtaining an original diagnosis from a health care professional.”


Workers Comp

Workers’ Compensation Formulary
The NYS Workers Compensation Board Drug Formulary (NY WC Formulary) becomes effective in four weeks (12/5/19) for new prescriptions.

Training materials related to the NY WC Formulary, as well as an updated version of the NY WC Formulary (effective 11/5/19), can be found on our webpage:

Drug Formulary Overview

Information and resources related to the Board’s Medical Portal, which is used to access the prior authorization system, could be found on the Medical Portal Overview webpage. For more information or assistance Visit http://www.wcb.ny.gov/content/ebiz/drugformulary; General Formulary questions:

Subscribe for email notifications at http://www.wcb.ny.gov/notify


 

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CDC

CDC: Preventing Adverse Childhood Experiences Can Reduce Chronic Disease Experiencing traumatic things as a child puts you at risk for lifelong health effects, according to a body of research. The CDC’s new report confirms this, finding that Americans who had experienced adverse childhood experiences or ACEs, were at higher risk of dying from five of the top 10 leading causes of death.

And those who’d been through more bad experiences — such as abuse or neglect, witnessing violence at home or growing up in a family with mental health or substance abuse problems — were at an even higher risk. According to the agency, women and minorities—like African Americans, American Indians, and Alaskan Natives—were more likely to experience four or more kinds of harm while they were kids. The conclusions were drawn from surveys taken by adults between 2015 and 2017.


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Webinars

How to Maximize Success & Maintain Full Control & Ownership of Your Practice
MSSNY invites you to tune in on Tuesday, November 12 from 7PM-8PM for a webinar featuring Roy Bejarano, Co-Founder & CEO of Scale Physician Group, and Andrew Blustein, Partner/Director and Vice Chair of Garfunkel Wild, P.C. Scale Physician Group provides expert non-clinical advisory and management services to independent and private equity owned physician groups, empowering physician leaders to build modern healthcare delivery platforms that yield better results.

Roy will share the lessons and best practices learned from his experience working with over 1,200 physicians across the country. Andrew will introduce Roy and facilitate a Q&A session following the presentation. Special thanks to Garfunkel Wild, P.C., who serves as MSSNY’s General Counsel, for bringing us this program. Access the flyer here.


“When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Flu season is upon us, but there are myriad other illnesses that present similarly.  Be sure to brush up on these by signing up for Medical Matters: When is the Flu not the Flu? on November 20th at 7:30am.

William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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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MSSNY President-Elect Dr. Bonnie Litvack Delivers Testimony to NY Senate on Veterans Mental Health
President-Elect Dr. Bonnie Litvack, MD provided testimony to the New York State Senate Committee on Mental Health and Developmental Disabilities at its public hearing to examine veterans’ mental health.

Dr. Litvack spoke about MSSNY’s “Veterans Matters” educational program which is a part of the Veterans Mental Health Training Initiative (VMHTI) that is funded through an appropriation in the New York State budget.  She noted that the program seeks to insure our veterans can receive the care they need and deserve in New York State. She thanked the committee for their foresight in fighting for continued funding for the program.

Dr. Litvack highlighted that roughly 1.64 million troops were deployed in Operation Enduring Freedom and Iraqi Freedom and had prolonged exposure to combat which took a toll on veterans psychologically.  Additionally she noted that “11% of New York State veterans began serving after 9/11 and this group in New York State is expected to reach 22% by 2025”. Dr. Litvack quoted a 2010 RAND survey on NYS veterans which found that 22% of post 9/11 veterans have a probable mental health diagnosis, 16% screened positive for depression and PTSD.

Dr. Litvack spoke briefly about the VMHTI program which looks to educate the community and healthcare providers on veteran specific mental health issues which includes; PTSD, depression, suicide, traumatic brain injury. Dr. Litvack emphasized the importance of asking individuals whether or not they are veterans in order to help them connect to various organizations that can help them. Dr. Litvack concluded by stating that the program is both timely and critical, emphasizing that the healthcare community needs to be educated on the importance of mental health as it relates to veterans.

MSSNY faculty have participated in numerous presentations at institutions and county medical society meetings all across the State of New York.  Please contact Mhoffman@mssny.org if you would like to have a presentation at your hospital or next county medical Society meeting.

Dr. Litvak at State Senate

MSSNY President-Elect Dr. Bonnie Litvack testified this week before the Senate Mental Health Committee regarding MSSNY’s Veterans mental health training initiative

 

Classified

RENTAL/LEASING SPACE


Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email robin.roy@corcoran.com for information and showings.

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
_______________________________________


Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net


NYS Corrections Logo

Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*              Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                 Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                      Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

NYS Corrections Personnel Ad

Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Council November 7, 2019

AGENDA
MSSNY Council Meeting
Thursday, November 7, 2019, 9:00 a.m.
Courtyard Marriott, Westbury Long Island
1800 Privado Road
Westbury, NY  11590

A.  Call to Order and Roll Call

B.  APPROVAL of the Council Minutes of September 19, 2019

C.  New Business (All Action & Informational Items)

    1. President’s Report
      a.  Presidential Appointments to the 2020 Nominating Committee
                 (For Council Approval)
            b. New Eighth District Councilor, Mark Jajkowski, MD (For Council Approval)

2.  Board of Trustees Report – Dr. Sam Unterricht will present the report (handout)

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

4.  MLMIC Update  –  Dr. John Lombardo will present a verbal report

5.  AMA Delegation Report – Dr. John Kennedy will present a verbal report

6.  MSSNYPAC Report – Dr. Thomas Lee will present the report (handout)

7.  MESF Update – Dr. Thomas Madejski (nothing to report at this time)

8.  County Federation Report – Dr. Aaron Kumar will present the report

9. Commissioners/Councilors (Action Items – (For Council Approval)
    Commissioner of Governmental Relations, Fregery Pinto, MS, Commissioner
1. Legislative & Physician Advocacy Committee, Paul A. Pipia, MD, Chair
(For Council Approval)

a. 2020 Legislative Program
b. Resolution 70 – Physician Fees and Single Payer
c. Resolution 72 – Healthcare Cooperative Act
d. Resolution 117 – Parental Alienation Syndrome in Custody Cases
e. Resolution 122 – Physician-Owned Distributorships
f. Resolution 201 – Study of State and National Health Service
 Corp Needs

2.  Long-Term Care Subcommittee Resolution (For Council Approval)
     a. Patient-Driven Groupings Model (PDGM)

3. Commissioner of Science & Public Health, Joshua Cohen, MD, Commissioner

  a. Committee on Infectious Diseases
  Resolution 166 – Strategies to Improve NYS Immunizations Rates in Children
Presented by Dr. Cohen/Dr. Fogarty/ Pat Clancy (For Council Approval)

b. Quality Improvement and Patient Safety Committee & Physician Wellness and Resiliency Committee
    Joint Resolution Supporting MSSNY Involvement in AMA’s Practice Transformation
Presented by Dr. Charles Rothberg, Co-Chair, Physician Wellness Committee
(For Council Approval)

10.  Presentation – Physician Wellness
Presented by:
Ms.  Nancy Nankivil, Director, AMA’s Practice Transformation
Ms. Kyra Cappelucci, Project Administrator, Practice Transformation at
American Medical Association

D. Reports of Officers (Verbal Reports)

1. Office of the President – Arthur C. Fougner, MD
2. Office of the President-Elect – Bonnie L. Litvack, MD
3. Office of the Vice-President – Joseph R. Sellers, MD
4. Office of the Treasurer – Mark J. Adams, MD – Financial Statement for the
period 1/1/19 to 9/30/19 (For Council Approval)
5. Office of the Speaker – William R. Latreille, Jr., MD

E.  Reports of Councilors (Informational)

  1. Kings & Richmond Report – Adolph B. Meyer, MD
  2. Manhattan & Bronx Report – Joshua M. Cohen, MD
    ACTION ITEM – Investigation of Impact of ZocDoc’s
    Business Practice on Violation of Public Accommodation Laws
    (For Council Approval)
  3. Nassau County Report – Paul A. Pipia, MD
  4. Queens County Report – Saulius J. Skeivys, MD
  5. Suffolk County Report – Linda S. Efferen, MD
  6. Third District Branch Report – Brian P. Murray, MD
  7. Fourth District Branch Report – Gregory Pinto, MD
  8. Fifth District Branch Report – Howard H. Huang, MD
  9. Sixth District Branch Report – Robert A. Hesson, MD
  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 – Peter Joo
  14. Organized Medical Staff Section – Stephen F. Coccaro, MD
    (no report submitted)
  15. Resident & Fellow Section Report – Catherine E. Steger, DO
    (no report submitted)
  16. Young Physician Section Report – L. Carlos Zapata, MD
    (no report submitted)

F. Commissioners (Informational Items)
1.   Commissioner of Communications, Maria A. Basile, MD, MBA
      Report from the Division of Communications

2.    Commissioner of Continuing Medical Education, Mark J. Adams, MD
       Report from the Office of CME

3. Commissioner of Governmental Relations, Gregory Pinto, MD
   a. HIT Committee Minutes, October 3, 2019
b. Long Term Care Minutes, September 26, 2019
c. Quality Improvement & Patient Safety Minutes,
September 25, 2019

 4. Commissioner of Membership, Parag H. Mehta, M
           PowerPoint Presentation – “Harnessing the Science of Persuasion” (handout)

 5. Commissioner of Science & Public Health, Joshua M. Cohen, MD
a.  Addiction and Psychiatric Medicine Minutes, October 4, 2019
b.  Bioethics Minutes, September 27, 2019
c.  End of Life Care Minutes, September 13, 2019
d.  Heart, Lung & Cancer Minutes, October 16, 2019
e.  Infectious Diseases Minutes, October 17, 2019
f.   Preventive Medicine & Family Health Minutes, October 10, 2019
g.  Physician Wellness & Resilience Minutes, October 18, 2019

   6. Commissioner of Socio Medical Economics, Howard H. Huang, MD
          (No written report submitted)

G.  Report of the Executive Vice President, Philip Schuh, CPA, MS
1. Membership Dues Revenue Schedule
2. Group Institutional Dues Comparison Report

H. Report of the General Counsel,
     Barry Cepelewicz, MD, Esq. Garfunkel Wild, P.C.
     (No written report submitted)

I. Report of the Alliance, Helena Mirza, Co-President
    Alliance Report

J. Other Information/Announcements

  1. Firearms Safety Letter to Michael Dowling, Northwell
  2. Surprise Bill Sign-On Letters
  3. Prior Authorization(PA) Sign-On Letter
  4. American Board of Internal Medicine Letter
  5. Physician Wellness Letter to Commissioner Zucker
  6. Scope of Practice Sign-on Letter
  7. 2020 PFS Final Rule Summary

K. Adjournment

 

 

 

 

MSSNY eNews: October 11, 2019 – R-E-S-P-E-C-T

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 11, 2019

Vol. 22  Number 38


MSSNYPAC Seal


Colleagues:

The term “provider” has bothered me for a long time. And it should bother you as well.  ACP President Dr. Robert McLean posted Defining our identity does not include the ‘P word’ for his September President’s message. The central theme is a reminder that the practice of Medicine is a profession.  Physicians have a unique relationship with patients that is considerably more than the “Cable Guy” who comes to install your TV service. Dr. McClean writes:

… Such a fundamentally unique and sacrosanct relationship as that between patient and physician is not merely “providing” a health service. And that is why the term “health care provider” is so inappropriate. The patient-physician relationship does not consist of simple transactions where we provide and patients consume. That marketplace terminology implies that health care can be conceptualized as just another commodity.

The primacy of this relationship has been eroded with the commoditization of aspects of the health care delivery system. 

Dr. McClean is not the only physician upset by “provider creep.” Washington pediatrician, Dr. Niran Al-Agba goes one step further, writing in the Kitsap Sun: The sneaky cynicism of calling your doctor a ‘provider’. She traces the history of provider as a pejorative back to 1930’s Germany:

… According to Dr. Saenger, who wrote Jewish Pediatricians in Nazi Germany: Victims of Persecution, “the 1937 issue of the Reichs Medizinal Kalender, a directory of doctors, the remaining Jewish doctors in Germany were stigmatized by a colon placed before their names. Their medical licenses were revoked in 1938. They could no longer call themselves ‘Arzt’ or ‘doctor.’ They were degraded to the term ‘Behandler’ or freely translated, ‘provider.’  

She continues:

Insulting any person on the basis of their race, ethnicity or gender is morally wrong. Using the word “provider” to describe a physician is and will always be insulting, personally and professionally; it is demeaning and devalues the education and degree conferred upon every physician. Why are physicians forced to suffer repeated use of this derogatory professional insult? And why have physicians as one professional body not risen up in anger at this injustice? 

While I would not equate those who call physicians “the P word” with the Third Reich, people should realize that Provider is insulting and demeans our noble profession.

Dr. McClean concludes:

And by the way, this terminology issue was raised through the ACP Board of Governors way back in 2008. Hence, it has been ACP policy since 2009 to eliminate use of the term “provider” and “prescriber” in lieu of “physician” in all publications and communications. Pass it on. 

I would add that this has been MSSNY policy since 2011:

Professionalism in Terminology 207.956

The leadership and staff of the Medical Society of the State of New York shall not in written or spoken word, use the term “provider” in referring to physicians

With that, I give you the inimitable Aretha Franklin.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



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eNews

DFS Proposes Regulation to Ensure Patients Have More Detailed Notice of New York’s Surprise Bill Law
New York Department of Financial Services (DFS) Superintendent Linda Lacewell announced this week a proposed regulation to assure patients that receive a claim for the services from a non-participating physician or a non-participating referred healthcare provider receive notice from their health plan and non-par treating physician about the protections of New York “surprise bill” law.  This action follows a recent report of a Long Island patient on “CBS This Morning” who received surprise bills totaling hundreds of thousands of dollars that weren’t covered by his healthcare plan.

“We are taking this action to strengthen the law so that New Yorkers have all the information they need to avoid surprise medical bills,” said Superintendent Lacewell. “After hearing about − and resolving – a recent issue, we know that if it could happen to one consumer; it could happen to others.”

The proposed regulation would require health plans that receive a claim for the services of a non-participating physician or a non-participating referred healthcare provider that could result in a surprise bill to provide additional notice to the insured consumer.

The notice would advise that the insured consumer may receive a surprise bill based on the claim and would include a description of surprise bills and the New York Out-of-Network Law’s Independent Dispute Resolution (IDR) process for surprise bills, as well as instructions on how to submit a dispute, a copy of an assignment of benefits form, and the healthcare plan’s designated addresses for submitting the form. The notice would be included on or with the explanation of benefits.

Additionally, the proposed regulation requires health plans that determine that services billed by a healthcare provider as emergency services are not emergency services to notify the consumer that the consumers may receive a surprise bill for such services and that consumers may be protected from any such surprise bill.  The notice would include the healthcare plan’s contact information as well.  If a health plan receives an assignment of benefits form and determines that a disputed bill is not a surprise bill, they would be required to notify the consumer in writing of the procedures for filing a grievance or appeal and provide information on how to file a complaint with DFS.

It is also important to note that the proposed regulation would require non-participating physicians who bill consumers for emergency services or a surprise bill to inform the consumer of the IDR process, along with providing the claim form and assignment of benefits form which non-participating physicians already must send with surprise bills.

Click here to view a full copy of the proposed amendment, which will be published in the October 23, 2019 State Register and subject to a 30-day notice and public comment period.


MSSNY President, Dr. Fougner, Comments in Crain’s re Surprise-Billing Amendment Proposes More Requirements for Insurers and Physician
Dr. Arthur Fougner, president of the Medical Society of the State of New York, said that the society is “supportive of efforts to assure patients are notified by insurers of the limitations of their coverage, and the protections available to them under our surprise bill law,” in a statement provided to Crain’s. “We are continuing to review the new proposal and will seek to provide feedback to DFS regarding the contents of the proposed disclosure form.”


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Urge the Governor to Support Formulary Protection Legislation!
MSSNY joined AARP and over thirty various health and consumer organizations in sending a letter to urge Governor Andrew Cuomo to approve S.2849/A.2969 that would protect health plan members from increases in out-of-pocket prescription drug costs in the middle of a contract year.

In a press release by AARP, Dr. Arthur Fougner, President of MSSNY said: “MSSNY strongly urges that this formulary protection bill be signed into law as it would provide significant protection from the adverse consequences many patients face as a result of non-medical switching of prescription drugs. If a treatment is working, it should not be changed due to financial constraints. In medicine as in sports, you don’t change a winning game; it’s unreasonable to force patients to change a successful course of treatment for any reason other than medical need.”

MSSNY encourages physicians, as well as their families, friends and other sympathetic individuals to send these letters to their lawmakers.

Protect your patient’s prescriptions! Urge the governor to sign formulary protection bill into law by clicking here.

Click Here to view the full letter!


Medical Society Raises Concerns About Trump’s Order on Medicare
Although the Medical Society of the State of New York supports the goal of President Donald Trump’s executive order on Medicare, it is concerned with several policy directions the order advances, according to a statement issued Tuesday by Dr. Art Fougner, president of the society.

“In particular, we are concerned with the apparent goal to expand the Medicare managed-care program, which likely could include efforts to disincentivize continued or new enrollment in the Medicare fee-for-service program,” Fougner said. “This is especially problematic in light of multiple instances in recent years where Medicare managed-care plans dropped huge numbers of physicians from their Medicare Advantage networks. This, in turn, significantly reduces care options for our patients.”

The society also takes issue with proposals to expand “already cumbersome Medicare value-based payment programs,” Fougner said. Specifically, many smaller physician practices have reported challenges with the Medicare Merit-based Incentive Payment System, such as burnout from spending more time on health-tech systems than on treating patients “to meet well-intended but often overreaching value programs.”

Additionally, Fougner said that some proposals in the order seem to focus on expanding the scope of other types of health practitioners. The combined care of a team headed by a physician is what is best for patients, he said.

Trump’s executive order states that it is focused on empowering patients to “select and access the right care, at the right time, in the right place, from the right provider.” Another focus is to help the fiscal sustainability of the Medicare program through alternative payment methodologies linked to value, increased choice and lower regulatory burdens for providers.

Dr. Fougner said, “We look forward to working with medical associations across the country to work with the administration toward preserving and strengthening the Medicare program so that our seniors continue to have timely access to the quality care they need and deserve.” (Crain’s Health Pulse Oct 8)


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Physicians – Beware of Fake Letters Claiming to be from NYS Board for Medicine
Please should be aware that the New York State Board for Medicine has advised of a scam where physicians have received a bogus letter claiming to be from the “NY State Education Department, Office of the Professions” indicating that their license has been suspended for “Illegal Drug Trafficking Under Section 33(c) of The Aviation Drug Trafficking Control Act of 1984”.

The Board for Medicine has advised MSSNY that, should any physician receive such a letter, that they be aware that they would not receive such a letter from the NYS Board for Medicine or NYSED.


New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted. Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance of a pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

  • the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;
  • the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has already given oral or written consent; or
  • the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

Several other states have passed similar laws expressly banning this practice without clinical justification. MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care.


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Bronx Teen Is First to Die in New York from Vaping
A teenager from The Bronx became the first New Yorker to die from vaping last week, state officials said Tuesday. The 17-year-old boy treated at Montefiore Hospital is among nearly two dozen people across the nation whose deaths have been linked to the use of electronic cigarettes, officials said.

“Parents have to know, young people have to know: You are playing with your life when you play with this stuff,” Gov. Andrew Cuomo said at an unrelated news conference at his Manhattan office.

The boy was first treated for a “vaping-associated respiratory illness” early last month and was hospitalized again in late September before his Oct. 4 death, according to the Democratic governor’s office. The teen’s death was reported Tuesday to the state Department of Health, which is investigating the case, officials said.

The boy may be the 20th person in the United States to die from a vaping-related illness amid an outbreak of lung ailments linked to the habit.

The U.S. Centers for Disease Control and Prevention had confirmed 18 vaping deaths in 15 states as of Oct. 1, and another was reported in Massachusetts on Monday.

Some 110 people across the Empire State — including 21 in New York City — have come down with serious lung illnesses after using at least one vape product, according to the state health department. Officials have attributed most of those cases to black-market cannabis vape devices rather than nicotine-based e-cigarettes sold in stores.

The spate of sicknesses nonetheless spurred state authorities to ban flavored e-cigarettes, but a pending lawsuit blocked the measure from taking effect last week.


Poll: New Yorkers Back Ban on E-Cigs
A majority of New Yorkers support Gov. Andrew Cuomo’s emergency ban on flavored e-cigarettes and think vaping is a serious public health problem, according to a poll published Monday.

The Siena College Research Institute found that 78% of the more than 800 New Yorkers surveyed believe e-cigarette use and vaping represent either a very serious or somewhat serious public health problem. Nearly two-thirds (61%) of New Yorkers support banning flavored e-cigarettes, and 52% support banning the sale of all e-cigarette and vaping devices.

The poll found that 12% of New Yorkers vape on a regular basis.

The poll—which has a margin of error of 4.3 percentage points—was conducted between Sept. 22 and Oct. 1. That means the final results came in two days before a state court temporarily blocked Cuomo’s prohibition on flavored e-cigarettes in response to a lawsuit from the industry.

Health Commissioner Howard Zucker vowed after the court’s decision that the state will use “every tool at our disposal to address this crisis.” More than 1,000 people have been diagnosed with vaping-related illnesses in the U.S., with 18 reported deaths, according to data from the U.S. Centers for Disease Control and Prevention.


 

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Physicians Welcome to Provide Public Comments on DSRIP at 10/25 NYC and 10/30 Syracuse Public Forums
The New York State Department of Health (NYSDOH) will be holding Public Comment Days for New York’s 1115 waiver program on:

  • October 25th 2019 at Baruch College, 55 Lexington Ave. (Corner of 24th St. & Lexington Ave.), Room 14–220 (14thFloor), New York, NY 10010.
  • October 30th 2019 at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.

The open comment period for both forums will be from 11am to 2pm.  In addition to public testimony, written statements may be submitted to 1115waivers@health.ny.gov through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

Specifically, the NYS Health Department is seeking from the federal government a continuation of DSRIP for the 1-year balance of the 1115 waiver ending on March 31, 2021 and to extend an additional 3 years from April 2021 to March 31, 2024.   Click Here to view the Amendment Proposal.

Background on the DSRIP Program

The roughly $6 billion Delivery System Reform Incentive Payment (DSRIP) program provides incentives for Medicaid providers to create and sustain an integrated, high-performing health care delivery system that can effectively and efficiently meet the needs of Medicaid beneficiaries and low-income uninsured individuals in their local communities by improving the quality of care, improving the health of populations and reducing costs.

The DSRIP program promotes community-level collaboration and aims to reduce avoidable hospital use by 25% over the 5-year demonstration period. A total of 25 Performing Provider System (PPS) were established in different regions of the State to implement innovative projects across three domains: system transformation, clinical improvement and population health improvement (New York’s Prevention Agenda).

While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as community physician practices, some have raised concerns that not enough funding has been made available to physicians who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.


Hassle Factor Form Now in Easy-to-Use PDF Format
MSSNY’s Hassle Factor Form has been updated.  The updated PDF version of the form can be found at the following this link.

Anyone can access the form by clicking on the drop-down box of RESOURCES from the MSSNY home page – www.mssny.org.  Then, scroll down to Payer Relations (SME).  Now, scroll to Hassle Factor Form and click.  This is a more user friendly form.

The County Medical Societies can send it to their members and add it to their websites.  The PDF version can be used by the county medical societies to gather data/information from the membership for interacting with DFS.



Doctor Sues Kaiser Permanente over Opioid-Related Patient Satisfaction Scores
An emergency medicine physician filed a lawsuit Sept. 18 against Kaiser Permanente over its patient satisfaction scoring methodology, which she alleges incentivized overprescribing of opioids and hurt her career at the Oakland, Calif.-based health system, The News Tribune reports.

Eryn Alpert, MD, worked at Kaiser Permanente from 2012 to December 2017, when she was fired. The lawsuit alleges her dismissal stemmed from her failure to accept patient satisfaction scoring tools. It alleges these tools were structured to incentivize physicians to prescribe opioids, even when medically unnecessary. The lawsuit said this pressure was greater in the emergency department, where patients often went seeking prescriptions and would leave poor reviews if they didn’t receive them, according to the report.

In the lawsuit, Dr. Alpert alleges her resistance to prescribing unnecessary opioids created a high standard deviation in her patient scores, which in turn prevented her from gaining shareholder status three years in a row, according to the report.


CME

“Influenza 2019-2020” CME Webinar on October 16; Registration Now Open
Are you prepared for flu season?
The first of MSSNY’s 2020 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2019-2020” on Wednesday, October 16, 2019 at 7:30 a.m.

William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

  • Educational objectives are:
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
  • Describe clinical and laboratory diagnostic features and treatment specific to each flu season
  • Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated

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

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.


“When Is the Flu Not the Flu?” CME Webinar on November 20 at 7:30am; Registration Now Open
.  This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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.


Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm
The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2nd from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432.  Please click here to register.

Program schedule:

7:30—8:20 am:           Registration and Breakfast

8:20—8:30am:            Welcome and Opening Remarks

8:30—9:30am:            Health Matters for Women: Endometriosis *
 Faculty: Lisa Eng, DO

9:30—10:30am:         Ovarian Cancer and Genetic Risk **
Faculty: David Fishman, MD

10:30—11:30am:       Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis *
Faculty: Florence Shum, MD

11:30—12:30pm:       Genetic Profiling of Breast Cancer and Its implication for Staging, Prognosis and Treatment **
Faculty: Louis Auguste, MD

* 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 each of these live activities 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 Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.  

The Academy of Medicine of Queens County designates each of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä.  Physicians should only claim credit commensurate with the extent of their participation in the activity. 


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CMS

HHS Issues Opioid Tapering Guidance for Clinicians
The Department of Health and Human Services today released a guide to help clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation of long-term opioid therapy for chronic pain. Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the guide reviews issues to consider when changing a patient’s chronic pain therapy. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction,” said Adm. Brett Giroir, M.D., HHS assistant secretary for health.


NGS Notice : Errors Causing Incorrect Part A and Part B Claim Denials
Date Reported: 10/9/2019
Status: Open
Provider Type(s) Impacted: Part A, Part B, HH+H
Description of Issue

National Government Services (NGS), along with all Medicare Administrative Contractors (MACs), is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. NGS is informing providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. This is causing claims to incorrectly deny based on invalid beneficiary entitlement.
National Government Services Action

NGS is actively pursuing a solution to this issue which will be shared with providers as soon as possible.
Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.
Proposed Resolution/Fix Date TBD


Seal of Italian Medical SocietyCalling All Physicians of Italian Heritage: Join Morgagni Medical Society
The Morgagni Medical society of New York is comprised of physicians of Italian heritage, who meet for social, educational and professional meetings in NYC quarterly. It is a nonprofit 501c3 organization, and sponsors a medical school scholarship in conjunction with the Columbus Citizen’s Foundation. Interesting people and speakers, exceptional dinners, opera night, exclusive club and venue events.

Members can march with their families in the NYC Columbus day parade. New members, both of Italian descent as well as Italophiles, have a great opportunity to share culture and profession. Check out www.Morgagnimedicalsociety.com, email Morgagni.society@gmail.com for information and join today!


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RENTAL/LEASING SPACE



Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY eNews: Watching the Detectives – September 20, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
September 20, 2019

Vol. 22  Number 35


MSSNYPAC Seal


Colleagues:

On Monday, MSSNY applauded Gov. Cuomo’s emergency executive action to ban the sale of flavored e-cigarettes in the state. Flavored vaping products like “cotton candy” and “Captain Crunch” are obviously targeted to entice teens to vape. The health of our children is at stake. It’s time to address this head on before it affects an entire generation.

Vape Lung, VALI (Vaping-Associated Lung injury), Allergic Pneumonitis, Lipoid Pneumonia – these are all names for an acute and sometimes fatal lung injury which leaped into our lexicon as summer was coming to an end.  Seven deaths and over 400 cases have been reported thus far in 36 states and the US Virgin Islands. Presentation is often fulminant, yet cases with slower onset have been reported. While clinical presentation resembles lipoid pneumonia, imaging is not typical for that disorder. Reports have been associated with street level THC products.

NY’s Department of Health issued an update on September 5th:

As of September 5, 2019, the Department has received 34 reports from New York State physicians of severe pulmonary illness among patients ranging from 15 to 46 years of age who were using at least one cannabis-containing vape product before they became ill. However, all patients reported recent use of various vape products.

Laboratory test results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. At least one vitamin E acetate containing vape product has been linked to each patient who submitted a product for testing.

At our meeting with NY State’s Commissioner of Health Dr. Howard Zucker on Tuesday, we were assured the Wadsworth Laboratory had not isolated any vitamin E acetate in any of NY’s Dispensary Medical Cannabis product.

Other investigators are not so sure Vitamin E is the only etiologic factor in vape lung, suggesting some patients have not fit the street pot Vitamin E pattern.

Curiously, the cases appear to be limited to the US and its territories. For example, Canada, despite its proximity, has reported no cases. There have been no cases thus far in the UK as well. The UK had banned certain flavored nicotine vaporizer oils because they contained diacetyl which had been linked to lung disease. Michigan and now New York have banned flavored e-cigs. We can only hope this makes a dent in the incidence of these cases.

Eerily reminiscent of the 1980’s Tylenol murders, the FDA has launched a criminal investigation. (See story below.)

For now, the take home message from WarGames applies – “The only winning move is not to play.”

We’ll all be watching the detectives.

Late-breaking news: Governor Andrew M. Cuomo and State Department of Health Commissioner Dr. Howard Zucker today re-issued a warning to New Yorkers to continue to refrain from using e-cigarette or vaping products as the number of vaping-associated illnesses sharply increases both nationally and in New York State. https://www.governor.ny.gov/news/governor-cuomo-and-health-commissioner-zucker-issue-renewed-warning-vaping-associated-illnesses

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



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FDA Launches Criminal Probe as Vaping-Related Illnesses Top 500
In an update on the vaping crisis, federal health officials said today that, as of September 17, the number of confirmed and probable cases of lung injury associated with e-cigarettes and vaping products has climbed to 530 in 38 states and one territory, prompting the FDA to launch a criminal investigation into the possible causes.

“Sadly,” seven patients from six states have died as a result of their illness and “we do expect others,” Anne Schuchat, MD, principal deputy director, US Centers for Disease Control and Prevention (CDC), told reporters in a telebriefing.

She said the CDC will update case counts every Thursday going forward.

Earlier this week, the CDC activated its emergency operations center to help coordinate the investigation into the growing number of cases of severe lung illnesses linked to e-cigarette use.

The exact cause of vaping-related lung illness remains elusive. This investigation is “dynamic and complex and I wish we had more answers,” Schuchat said. “States are classifying cases and reporting them to CDC on a regular basis.”

She emphasized that “no consistent e-cigarette or vaping product, substance, additive, or brand has been identified in all cases; nor has any one product or substance been conclusively linked to lung injury.” Many patients reported using multiple types of products, some containing tetrahydrocannabinol (THC), THC plus nicotine, or nicotine only.

Based on available data, Schuchat said three quarters of the cases are males, two thirds are in people 18-34 years of age, 16% are younger than 18 years of age, and 17% are age 35 years or older. In all, more than half of the cases are under 25 years of age. Patients typically have reported cough, shortness of breath, and/or chest pain, gastrointestinal symptoms (nausea, vomiting, or diarrhea) as well as fatigue and fever.

The CDC continues to recommend that people consider not using e-cigarette products while investigations are ongoing.


Council Notes—September 19, 2019
Council approved the following:

  • MSSNY will recommend that the AMA seek legislation to ban anti-assignment provisions in health insurance plans and to support legislation requiring health insurers to issue payment directly to the physician when the patient or patient representative signs an agreement that permits payment directly to the physician.
  • MSSNY will advocate for increased payment for office based afterhours CPT Codes.
  • MSSNY will advocate for legislation and regulation requiring ALL credentialed physicians (employed and voluntary) be equally included on their hospital websites and Find-a-Doctor sites of the hospitals and other health care facilities and will recommend the AMA do the same.
  • MSSNY commends the Governor and the DOH Commissioner for their action to protect patients by banning sale of flavored e-cigarettes; recommends a moratorium on dispensing of vaporized products to new certificate holders for medical marijuana until data on long term safety is available; recommends rescheduling marijuana to Schedule II; and recommends funding in the State Budget for study of efficacy and harms of the current medical marijuana program.
  • MSSNY will create a Scope of Practice Ad Hoc Committee with the following members: Rose Berkun, MD, Co-Chair; Lisa Eng, DO, Co-Chair; Inderpal Chhabra, MD; Atul Kumar Gupta, MD; Richard Wissler, MD.
  • MSSNY will adopt the Accreditation Council for Continuing Medical Education (ACCME) Menu of New Criteria for Accreditation with Commendation. This year marks the end of a transition period in which CME providers had a choice between demonstrating the old commendation criteria and the new.  Additionally, MSSNY will adopt the revised CME Annual-Reporting Requirements for MSSNY-accredited CME providers.

Bills Signings Ramping Up – Physician Action Needed!
As of today, there were still 617 bills that passed both houses in 2019 that were awaiting delivery to the governor. In the past week alone, 59 bills were chaptered into law – the flurry of bill signings has begun. Of those 617, there are a few that stand out as priorities for MSSNY. When these bills arrive at the governor’s desk, he has to decide whether to sign them into law or to veto them and as such there is still a strong opportunity to influence the decision-making process.

Physicians can quickly and easily send a letter to the Governor here on these issues by using the MSSNY Grassroots Advocacy Center at http://tiny.cc/MSSNYGAC (direct links to these priority items are listed below). Please take a moment to voice your support/concerns on these very important issues!

  • Mid-year formulary changes – would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year.  Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please reach out to the governor and let him know how helpful this bill would be by clicking here.
  • Partial prescription fills – would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
  • Malpractice expansion – two bills passed the legislature that will further tip the scales in lawsuits against physicians and others, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please let the governor know how destructive these bills would be by clicking here.


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Please Continue the Fight for a Fair Solution to Surprise Medical Bills; NY Law a Great Success
Please continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair federal legislative solution to the issue of surprise medical bills.  By clicking here, you can send a letter, make a tweet and make a phone call to your elected officials. It only takes a few minutes and contains all of the details necessary to get our point across.

This week, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.  Moreover, it noted that there were a total of 2,595 IDR decisions reached.  With regard to IDR for out of network hospital “surprise” bills, 815 IDR decisions were rendered. Health plans prevailed in 13% of the cases, while physicians prevailed in 48% of the cases. There were split decisions in 39% of the cases.   With regard to IDR for out of network emergency care services, 43% of decisions were in favor of the health plan, 24% were in favor of the provider, and 33% were split between the health plan and provider.

While MSSNY together with physician groups across the country are working diligently to refute the lies and half-truths expressed by the insurance lobby, more physician advocacy is urgently needed. MSSNY leadership and physician advocates have been meeting with key members of Congress to advocate for passage of legislation that emulates New York’s successful model, such as H.R.3502, sponsored by Representatives Ruiz and Roe. At the same time, grave concerns have been raised about the alternative being pushed by insurance companies (H.R.3630, sponsored by Representative Pallone, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.

When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not give them any more power.  Please contact your Senators and Representatives today!


New York’s Opioid Tax Creating Concerns
Fortune (9/16) reports that New York “became the first state to place an excise tax on opioids sold to or within the state,” with supporters expecting “the tax to generate $100 million in revenue for the state, which Gov. Andrew Cuomo and his administration have said will be plowed into helping victims of the opioid crisis.”

The idea behind the tax “was to punish pharmaceutical companies for their role in the opioid epidemic,” but “the tax, which went into effect July 1, has already set off a ripple effect across the entire supply chain, as manufacturers and distributors have either stopped shipping to the state altogether or passed the tax onto each other.” Additionally, regarding the fear of social costs, health officials are concerned “the tax could drive patients to seek out opioids on the black market.”

If you have patients who are having difficulty obtaining their opioid prescriptions, MSSNY wants to hear from you so that we can ascertain how widespread this problem is. Please email mauster@mssny.org with any information you have regarding this situation.


Weill Cornell: Free for Students Who Qualify
On Monday, Weill Cornell Medicine in New York City, announced that all students who qualify for financial aid will get a full ride: All costs will be covered by scholarships, including tuition, room and board, books and other educational expenses. “Student debt has been in the national discussion for a long time, and we have been planning, strategizing and raising money,” said Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine and provost for medical affairs at Cornell University. “It’s the right time to offer debt-free medical education.”

In 2017, Columbia University announced a new endowment that it said would eliminate the need for medical students to take out loans for tuition; the neediest would also have living expenses covered. The David Geffen School of Medicine at the University of California, Los Angeles, offers full rides to about 20 percent of its entering classes, though the awards are based on merit, not need. In August 2018, the New York University School of Medicine said it would cover tuition for all its current and future students.

Of Weill Cornell’s 373 students, 52 percent qualify for need-based aid. A single year at the school — which sits in one of America’s most expensive ZIP codes, on the Upper East Side of Manhattan — costs more than $90,000, according to Weill Cornell. With need-based grants for the last academic year averaging about $38,000, students often relied on federal loans to bridge the difference. The average debt for a graduate of the program this year was $156,851. (NYT Sept.16)


Zocdoc Gets Federal OK to Book Medicare and Medicaid Visits
Zocdoc would not violate the federal anti-kickback statue by charging physicians for each Medicare or Medicaid beneficiary who books an appointment through its website, according to an advisory opinion issued by the U.S. Department of Health and Human Services’ Office of the Inspector General.

The opinion does not mention Zocdoc by name but Dr. Oliver Kharraz, Zocdoc’s CEO, wrote a blog post sharing the opinion. Kharraz said Zocdoc will restore access to its appointment-booking service for all Medicare beneficiaries and Medicaid beneficiaries in certain states including New York on Sept. 18. Zocdoc began charging doctors per new patient booking earlier this year, frustrating New York doctors who had grown accustomed to paying a flat monthly fee for access to the services. At that time, it restricted Medicare and Medicaid beneficiaries from using the service to book appointments to avoid running afoul of federal law.

It has now received guidance from the state Attorney General, state Department of Health and HHS that its pricing policy wouldn’t violate the law with certain caveats. (Crain’s Sept.17)


Most Not Screening Patients for All Five Social Needs Recommended by Feds
Researchers found that “most U.S. physician practices and hospitals are screening patients for at least one social need, but only a small percentage are screening for all five social needs recommended by the federal government.” The five social needs are: Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence.

The findings were published in JAMA.


CME

Sign Up for the Morning Briefing on October 17 in Binghamton
Strengthening Community and Health Care Provider

Resiliency to Adverse Childhood Experiences

Thursday, October 17, 2019 • 12 – 2 pm
UHS Binghamton General Hospital
Russell Community Room
10-42 Mitchell Avenue
Binghamton, NY 13903

The session will also be archived on the Department of Health website. The event is free of charge and available to all interested providers throughout New York State. Participants are eligible for 2.0 CME credits. Flyer.


MLMIC Presentation: Hot Topics in Healthcare: LIVE CME EVENT
Presenters:  MLMIC and MAGNACARE

When:           Tuesday, September 24, 2019
Time:             9:00 AM to 12:30 PM

Where:          Long Island Marriott, 101 James Doolittle Blvd. Uniondale, NY 11553 

Register online at www.mlmic.com/exclusive or e-mail your full name to pjorge@mlmic.com


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CMS

The Deadline to Submit a MIPS Targeted Review Request is 2 Weeks Away
If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are now available for review on the Quality Payment Program website. The MIPS payment adjustment you will receive in 2020 is based on your final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2020.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request for CMS to review their performance feedback and final score calculation through a process called targeted review. The deadline to submit your request is September 30, 2019 at 8:00 PM (EDT) – which is just 2 weeks away.

When to Request a Targeted Review

If you believe an error has been made in your 2020 MIPS payment adjustment factor(s) calculation, you can request a targeted review until September 30, 2019 at 8:00 PM (EDT). The following are examples of circumstances in which you may wish to request a targeted review:

Errors or data quality issues for the measures and activities you submitted

Eligibility and special status issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)

Being erroneously excluded from the APM participation list and not being scored under the APM scoring standard

Note: This is not a comprehensive list of circumstances. CMS encourages you to contact the Quality Payment Program if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted. We’ll help you to determine if you need to submit a targeted review request.

How to Request a Targeted Review

You can access your MIPS final score and performance feedback and request a targeted review by going to the Quality Payment Program website


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Classified

RENTAL/LEASING SPACE

Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room



Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643


Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing
: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/



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.


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


Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


 


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY eNews: September 13, 2019 – MSSNY Responds to Washington Post OpEd

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
September 13, 2019

Vol. 22  Number 34


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Colleagues:

The following letter to the editor was submitted to the Washington Post on September 6, 2019.

To the Editor:

Physicians agree with the goal of legislation before Congress to protect patients from “surprise” medical bills.  It is unfortunate Dr. Ezekiel (Re “No One Likes Surprise Medical Bills…”, 9/5/19) failed to recognize the need for a balanced solution. Instead, he promotes the interests of the health insurance industry.

In 2014, New York physicians worked with state regulators and patient groups to enact a law protecting patients from surprise medical bills and established a balanced approach to determine fair payment.  When an insurer and physician cannot agree, the solution is decided through a low cost, simplified dispute resolution system. The arbitrator chooses the side that is more reasonable based upon a number of factors.  New York’s system has discouraged unreasonable billing and encourages negotiated compromises between physicians and insurers.

Importantly, New York’s law also addressed a key factor often leading to surprise medical bills – new rules to protect against narrow insurer networks. Legislation before Congress (HR 3502-Ruiz-Roe) would emulate New York’s acclaimed system.  It would take patients out of the middle while employing a simplified dispute resolution system.

We are very concerned with Congressional approaches that give insurers unilateral control to determine payment for surprise bills. It would undoubtedly be manipulated by market-dominant insurers to reduce their physician networks.  Worse, it could produce shortages in hospital emergency departments, a concern New York sought to prevent.

This is a serious problem that requires a thoughtful solution—not a one-sided giveaway to the insurance industry.

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



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eNews

Assemblyman Walter Mosley Campaign Event

Dr. Moore, Council Leader Cumbo, Dr. Sweeney at the Assemblyman Walter Mosley Campaign Event

Dr. Donald Moore, Council Leader Laurie Cumbo, Dr. Monica Sweeney

Drs. Moore, Sweeney and Assemblyman Mosley at the Walter Mosley Campaign Event

Drs. Donald Moore, Monica Sweeney, and Assemblyman Walter Mosley


New York War on E-Cigarettes Breaks Out
Local state and now federal officials have declared war on e-cigarettes amid an outbreak of respiratory illnesses tied to vaping, but with little data to go on, it’s unclear regulatory efforts will stymie the health problems that have captured the public’s attention. In New York, the health complications from vaping are associated with cannabis oil, Health Commissioner Howard Zucker said, during a press conference Monday where Gov. Andrew Cuomo called for legislation banning flavored pods. Cannabis oil, and other recreational marijuana products, remain black-market items and would not be affected by curbing the availability of over-the-counter e-cigarettes and flavored pods.  (Politico New York Health Sept. 12)


NYCDOHMH: Nearly 15% of Middle School Students Used E Cigs
The New York City Health Department “revealed alarming new information Tuesday about the use of electronic cigarettes among New York adolescents and teens, and pushed the city to crack down on the device’s availability to the youth.” Last year, “about 13,000 middle school students, roughly 6.7%, reported using e-cigarettes and 29,000 students, about 14.4%, said they had tried them. Health Commissioner Dr. Oxiris Barbot said the numbers are concerning, particularly in light of recent studies that have shown that e-cig use leads to long term health problems.”


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DFS: Insurance Cannot Be Canceled for Carrying a Script for Naxalone
The state’s top insurance regulator said on September 6 that it’s illegal for insurance companies to deny life, disability income or long-term care insurance to applicants based solely on whether they carry a prescription for naloxone, a drug that reverses opioid overdoses.

The updated guidance from the state Department of Financial Services comes four months after Gov. Andrew Cuomo directed an investigation into reports that nurses and other first responders were being denied life insurance because they had a prescription for the drug known by the brand name Narcan.

Many had prescriptions as a preventative measure — in case they encountered someone in the field who overdosed and needed to be revived. But the department’s investigation found that insurers’ underwriting practices and guidelines did not distinguish between circumstances where an applicant had naloxone for their own use, or when they had naloxone for encounters with other individuals at risk of overdose.

The distinction is important, at least with insurance law, because companies are prohibited from discriminating against people of the same class and of “equal expectation of life” when approving coverage and setting rates. Carrying naloxone to prevent your own overdose could be seen as an indicator of shorter life expectancy, but carrying it to protect others would not.

“In the midst of a national opioid crisis, it is common sense for our nurses and first responders who work every day to keep New Yorkers safe to carry naloxone,” Cuomo said. “Denying them insurance coverage for doing their job to save lives is unacceptable, and today we correct this discriminatory practice.”

And it’s not just medical professionals who have taken to carrying it. Family members and friends of people struggling with addiction are also increasingly seeking prescriptions for naloxone as a way to keep their loved ones safe. In some cases, a prescription is not needed if individuals request it from a pharmacist or other official who has a “standing order” to dispense it without a prescription.

In guidance published, however, Deputy Superintendent for Insurance James Regalbuto instructed any insurer who has improperly denied coverage to “immediately reach out” to the rejected applicants to provide them with an opportunity to reapply for coverage. He also instructed insurers to “correct or remove” any record or report that may have been made to a third-party consumer reporting agency regarding an improper insurance denial.

First responders who have been denied coverage should contact the Department of Financial Services via its consumer complaint website (www.dfs.ny.gov/complaint) or by phone at 212-480-6400 or toll-free at 1-800-342-3736.


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FDA Experts Warn Medical Devices Are Vulnerable to Hacking, Errors
Experts attending a meeting of the FDA’s Patient Engagement Advisory Committee on Sept. 10 warned medical devices like insulin pumps and pacemakers can be prone to hacking and errors. At least two speakers at the meeting “described how easy it was to hack their own medical devices by reverse-engineering them.” Committee members also “repeatedly said that many devices and the instructions that come with them are cumbersome and difficult to understand.” One attendee also stated that the “fact that it is impossible to predict which types of cybersecurity risks can affect a given medical device can make it more difficult for healthcare providers to have meaningful conversations about risks and benefits.” Medscape (9/12)


Webinars

Health Matters for Women: Endometriosis

REGISTRATION NOW OPEN

The Medical Society of the State of New York will host a live continuing medical education (CME) webinar on women’s health topics entitled “Health Matters for Women: Endometriosison Friday, September 20th, 2019 from 7:30 AM to 8:30 AM.

To register for “Health Matters for Women: Endometriosis, please click here.  The faculty will be Lisa Eng, DO.   The educational objectives are: 1) Review potential causes of pelvic pain and discuss how to identify endometriosis. 2) Discuss the benefits and risks as well as the efficacy and limitations of available medical therapies for long-term treatment of endometriosis. 3) Discuss implementation of individualized endometriosis treatment plans and options.

For assistance in registering or any other questions, please contact Melissa Hoffman at mhoffman@mssny.org or call (518) 465-8085.

The Medical Society for 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 credit TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.



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CMS

CMS-1500 Resources: Video Available and Q&A Webinars Next Week
The Workers’ Compensation Board is offering new resources to assist in the transition to Form CMS-1500, which will streamline medical billing and reduce the paperwork requirements currently in the workers’ compensation system. To help you prepare, the Board has developed a training video to show health care providers, and all others who will be using Form CMS-1500, how to use the form and the required narrative reports to bill for their services to workers ‘compensation patients.

Next week, the Board is also holding two follow-up Q&A webinars so that you can get answers to any questions you may have after viewing the training video and reading the CMS-1500 FAQ’s on the Board’s website.

With that in mind, we encourage you to view the training video before attending one of the webinars. As you view the training video, take note of questions that come up so that you’ll be prepared for the Q&A webinar. This will enable you to take full advantage of both resources.

To view the training video, follow this link: CMS-1500 Training Video

The webinars will be held next week on:

In the meantime, please see CMS-1500 Initiative and the CMS-1500 FAQ for information. Please direct questions to CMS1500@wcb.ny.gov

Revalidate before your due date to avoid a hold on your Medicare payments and deactivation of your Medicare billing privileges.

There are several ways to find your revalidation due date:

Centers for Medicare & Medicaid Services (CMS) Revalidation List Tool

Search by National Provider Identifier (NPI) or name.

A due date of “TBD” (to be determined) means a revalidation due date has not been assigned by CMS.

You can access the YouTube video, “How to use the CMS Medicare Revalidation Tool

Revalidation notice mailed by National Government Services

Mailed in yellow envelope

Internet-Based Provider Enrollment, Chain and Ownership System (PECOS)

Sign in with user ID and password.

Generally, the due date will remain with the provider/supplier throughout subsequent revalidation cycles. So you will not have to wonder about the due date the next time you need to revalidate.

NOTE: Unsolicited applications received seven months prior to the revalidation due date will be returned to the provider.

Need assistance? Providers and suppliers can register for our provider enrollment webinars by either using the following links, Part A/Part B or by visiting the NGSMedicare.com website. The webinars below can be found under the Education Tab by selecting Webinars, Teleconference and Events.

Provider Enrollment Revalidation Overview
Getting Connected to PECOS
Submitting Revalidation via PECOS Application
Submitting Revalidation via CMS-855A Paper Application for a Part A providers
Submitting Revalidation via CMS-855B Paper Application for a Part B providers
Submitting Revalidation via CMS-855I Paper Application for a Part B providers
Let’s Chat about Provider Enrollment Revalidation
PECOS: View and Manage Reassignments through Group Enrollment


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Conferences / Events

Public Health Impact of Legalizing Cannabis
You are invited to join the New York State Public Health Association and the New York State Association of County Health Officials for the “Public Health Impact of Legalizing Cannabis.” Program content will address implications for public health, cannabis policy and health equity resulting from a legalized program. As New York State considers the passage of policy to establish an adult-use cannabis program, it is imperative that public health stakeholders unite to prepare for potential implications and learn about policy, regulatory and governance aspects related to legalization.

When:     17 Oct. 2019
TIME:      8:30 AM – 4:00 PM
WHERE: Hilton Westchester

Hear from nationally-recognized experts in partnership with your colleagues in the public health sector. Throughout this meeting, there will be plenty of opportunities for networking with professionals representing local health departments; academia; clinical care settings; community-based organizations and others who value the health and safety of communities in New York. For more information and to register, please click here.


2019 AIM: Advocacy in Medicine Conference

Sunday, September 22, 2019

Time:     8:30AM-4:00PM

Venue:   New York Academy of Medicine, 1216 Fifth Avenue &103rd Street, NYC             

Cost : Free for medical students and health professionals with current ID; advance online registration is required. REGISTER

The second annual Advocacy in Medicine (AIM) Conference will bring together healthcare advocates and trainees from various local academic institutions interested in health advocacy for full day of talks, interactive panels, breakout sessions and networking. The conference opens with keynote speakers addressing the role of physician advocacy followed by an interactive Q&A panel discussion with physicians on advocacy, activism, and their personal career trajectories. The afternoon will be dedicated to small workgroups with the opportunity to focus on skill-building and topic-focused content.


4th Annual U of Buffalo DoctHERS Symposium; A Time of Urgency: Health Care Leaders Needed

When: Saturday, September 21, 2019

Time    8:00 am – 12:00 pm

Where: The Westin Buffalo, 250 Delaware Avenue, Buffalo, NY 14202

Join us for a morning of networking, empowerment, and education about
leadership development for women in health care professions.

Cost: $25 for General Alumni and Non-Alumni Guests; free for Students/Residents

More Details: The Jacobs School of Medicine and Biomedical Sciences’ Medical Alumni Association is proud to present the 4th Annual DoctHERS Symposium, featuring keynote speaker Dr. Susan R. Bailey, President-Elect, American Medical Association. We hope you will join us for a morning of networking, information, enrichment and resources for pay, promotions and equity in the workplace and support for females in the healthcare profession. MSSNYPAC Co-Chair Rose Berkun, MD is Chair of the event.

For more information on schedule and speaker biographies, please visit www.medicine.buffalo.edu/docthersnow


Classified

RENTAL/LEASING SPACE

Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room



Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643


Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing
: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/



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.


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.

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PHYSICIAN OPPORTUNITIES


Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


 


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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