July 19, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
July 19, 2019

Vol. 22  Number 27


MSSNYPAC Seal


Colleagues:

Congress is continuing to work on legislation that aims to deal with “surprise bills.” Keep your eyes peeled to your email inbox for updates. I realize this may seem tiresome but if the wrong legislation is passed, the Uniteds and Aetnas of the world may get handed the ability to set benchmark payments for everyone. Believe me, it won’t be pretty. Attention is soon moving to the House Ways and Means, where we have a shot. NY Reps Tom Suozzi (downstate) and Brian Higgins (western NY) are on Ways and Means and are also cosponsors of HR 3502 which would set up an independent arbitration system similar to NY’s to resolve disputes. Please take a moment and Call Rep Suozzi 202-225-3335 and Rep Higgins 202-226-0347, asking them to oppose HR 3630 and support the bill they co-sponsor— HR3502.

Perhaps contemplating the alternative should Congress get it wrong will get you to dial that much faster.

Now, please allow me to digress.

This weekend marks the 50th anniversary of that “one small step for man, one giant leap for mankind” as the first humans walked on another galactic body. Just three years before in 2016 was another 50th anniversary – that of arguably the most famous split infinitive of all time – as the voyages of the Starship Enterprise embarked on its five-year mission. This now celebrated Science Fiction series made the Science Fact of the moon mission all the more incredible. July 20, 1969 was the day the Impossible became Possible.

Space has been the dream of all humanity from the day the first sentient primate climbed down out of that tree, looked up, saw the night sky and wondered what was out there. Now, folks from all over the world are preparing to return to space. There will no doubt be missteps as there have been in the past – Apollo One and Challenger come to mind – but in the not too distant future, we will once again see explorers, as Ronald Reagan put it in another, more somber context, slip “the surly bonds of earth to touch the face of God.”

Oh, when I look back now
That summer seemed to last forever
And if I had the choice
Yeah, I’d always wanna be there
Those were the best days of my life

Oh, yeah
Back in the summer of sixty-nine

–Bryan Adams, Summer of Sixty-Nine

Arthur Fougner, MD
MSSNY President 

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


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eNews

US House Committee Advances Surprise Billing Legislation Opposed by Physician Community
This week the US House Energy and Commerce Committee reported out by voice vote surprise billing legislation (HR 3630) strongly opposed by MSSNY and other medical associations. The legislation would limit out of network payment for surprise hospital bills to a median in-network rate, for which MSSNY and the medical community has raised strong concerns that it would give enormous new powers to already market dominant health insurers.  An amendment to HR 3630 offered by Rep. Dr. Raul Ruiz MD (D-CA) and Rep. Dr. Larry Bucshon MD (R-IN) was adopted to add an appeals provision.  Appeals would be restricted to complex cases with a payment above $1,250 (indexed to inflation).

Arbitrators would be permitted to consider median contracted in-network rate, provider’s level of training, experience, quality and outcomes measurements and acuity of care/services rendered.  In order to hold down the budget score of the amendment, the arbitrator would be prohibited from considering billed charges.

The AMA has reported that the addition of an appeals process, while imperfect, represents progress on this issue, noting that there will be opportunities with two other House committees (Ways &Means/Education& Labor) to make further improvements on this and other elements in the legislation both before and during floor action in the House and Senate. While this legislation would protect New York’s law for state regulated health insurance products, it would establish this insurer determined default rate for plans governed by ERISA.

Amendments were also adopted by the E&C Committee for HHS and the GAO to conduct studies to assess impact of the legislation on access to providers, network adequacy, premiums and patient out of pocket costs. In addition, a requirement to conduct an audit of at least 25 health plans to assure that in-network median rates are being properly calculated was also adopted.

MSSNY will continue to work with the federation of medicine to fight for a law that is consistent with New York’s acclaimed approach, rather than bills such as HR 3630, which is essentially a gift to the health insurance industry wrapped in a consumer protection package. We thank the many physicians have who have contacted their respective members of Congress, and urge physicians to continue doing so by clicking here.


Physician Action Needed on Bills Awaiting Governor’s Signature
Bills that passed during the 2019 session must now be sent to the governor in order to be enacted into law. There are still a few outstanding pieces of legislation that passed both houses this year that MSSNY has taken strong positions on, and as such it is incumbent upon MSSNY members to take a moment to let the governor know where we stand on these issues. There is power in numbers; the more physicians that reach out to the governor, the louder our message will be heard.

Physicians can quickly and easily send a letter to the Governor here on these issues:

  • 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.
  • 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.



Gov. Signs Law Raising Tobacco Sales from Age 18 to 21
This week Governor Cuomo signed into law legislation (A.558/S.2833) that would raise the statewide tobacco purchase age from 18 to 21, legislation long supported by MSSNY.  The new law will take effect on November 13, 2019.  MSSNY President Dr. Art Fougner offered the following statement praising the Governor and legislators for taking this action:

“This major public health advancement will help to prevent a generation of New Yorkers from becoming addicted to smoking by delaying children and young adults’ access to tobacco products.  Data shows the earlier a child begins to smoke the more severe the addiction is likely to be and 90% of all smokers begin before age 20.   This new law will reduce the likelihood they ever start smoking and therefore create a healthier state. We thank Governor Cuomo for signing this legislation into law, and Assemblywoman Rosenthal and Senator Savion for advancing this important legislation”


New York Insurer Opens Office in Hospital
CDPHP, a New York health insurer, opened a branch inside Ellis Medicine in Schenectady, N.Y., to connect patients directly with insurance staff if they have questions during treatment and post-discharge, according to the Albany Business Review.

The idea came to CDPHP’s CEO, John Bennett, MD, after a recent hospitalization revealed some of the difficulties patients face when navigating the healthcare system. CDPHP opened its office July 16, which is staffed with representatives tasked with answering questions about what insurance will pay for at Ellis Medicine, among other discussions.

Ellis Medicine CEO Paul Milton told the Albany Business Review he expects to see improved patient satisfaction and readmission rates among CDPHP members because of the partnership. In addition, since Ellis Medicine houses CDPHP’s first hospital office, CDPHP members may seek out the hospital for care. Read the full article here.


 

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Private Equity Investing Heavily in Physician Practices
Private equity is a big mover in the long-term care continuum, especially in the home care and hospice spaces where the platforms are looking to build growth through acquisition-heavy strategies, Providing’s Kyle Daly told Bloomberg Law  (June 17).

Involvement by BDT Capital Partners and Gryphon Investors in deals in the physical therapy space demonstrated private equity’s continued interest in expanding its presence in key markets through add-on acquisitions, Daly said.

Private equity also is investing heavily in physician practices, Hirschman said. Radiology remains a hot practice area for consolidation, he said.

Private investors have shown the most interest in ophthalmology, gastroenterology, ear-nose-and-throat, obstetrics-gynecology, and orthopedics practices, Hirschman said. This is because those specialties have the greatest potential to increase revenues and profits through additional investments in new and expanded ancillary services, like ambulatory surgical centers, he said.


40% of Physicians Refuse New Patients Who Use Opioids for Chronic Pain
Researchers found that more than 40% of physicians refuse “to take on new patients who need opioids to control pain.” The study surveyed 194 primary care clinics in Michigan. The findings were published in JAMA.


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Our State Fair is a Great State Fair…Don’t Miss it from August 21 to September 5!
Once again the Onondaga County Medical Society will staff the Medical Society of the State of New York/New York State Society of Anesthesiologists booth at the state fair. Medical Society physician members are encouraged to volunteer to work the booth during a time slot. This is a great opportunity to perform public health outreach, and to promote your practice or organization at the NYS Fair, free of charge. Those who work at the booth will receive free admission tickets and free parking (on a limited basis). Feel free to bring handouts about your practice or other timely medical information to share with fair goers. Please let us know if you have any ideas for exhibits, testing, etc., that you feel will be informative and help advance a positive image of the medical profession.

Contact us for available time slots remaining for the 13-day fair, which runs from Wednesday, August 21 – Monday, September 2, 2019 (Labor Day). You can work as little as two hours or the entire day if you’d like. We need only one physician-member group per time slot. This is being updated daily. Time availability is on a first-come, first-served basis.  Contact Patty Corasaniti at (315) 424-8118, or send email to corasaniti@oncms.org for more information.


American Medical Women’s Association Hosts Congress July 25 in Brooklyn
The American Medical Women’s Association will be hosting the Centennial Congress of the Medical Women’s International Association MEDICAL WOMEN: AMBASSADORS OF CHANGE IN A CHALLENGING GLOBAL WORLD from July 25-28, 2019 at the Brooklyn Bridge Marriott Hotel (333 Adams Street, Brooklyn). Keynote speaker Gloria Steinem, author/co-founder of MS. Magazine and New York Magazine will address the audience of more than 1000 female physicians on Friday, July 26, 2019 at 11AM.

The hashtag for the 3-day conference is #MWIA100.  The Centennial Congress will feature discussions on Digital Health, Innovation & Genomics, Gender Specific Medicine, Gender Equity, Global Health, Work-Life Balance, Violence Against Women, Obesity: A Global Health Crisis, Sex & Gender Specific Medicine, and Sexual Harassment, among other professional tracks and topics.To register for the Conference, please follow this link. For more information, please contact: Charlotte Tomic, 917-882-5243; charlotte@tomiccommunications.com.


Frances Foy, Wife of Ret’d MSSNY EVP, Don Foy, Mother of Former Westchester EVP Brian Foy, Died on July 7; Services in St. Augustine FL on Friday, August 2
Frances M. Foy, age 82, of St. Augustine, FL, passed away on July 7, 2019 at her home with family at her side. She was the mother of four children; grandmother of nine; and great grandmother of two. Frances met her husband, Donald, in California where she was a former TWA flight attendant. They were married for nearly 59 years.  A memorial mass will be held at 9:00 am on Friday, August 2, 2019 at St. Anastasia Catholic Church in St. Augustine, FL.


 

 

Classified

RENTAL/LEASING SPACE

Photo of Park Ave building facade
Prestigious Park Ave Office Near Lenox Hill Hospital for Sale
2,400 sq/ft on two levels with a separate 6×12 ft. storage closet. Fireplace in waiting room and consult room. Perfect for plastic surgeons, cosmetic dermatologists or other. $2,950,000 Call for details and appoint to view. 212-570-6060



 

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


For Lease – Buffalo Area Urgent Care / Primary Care Clinic
Next door to only grocery store in town: Sav-a-Lot 4+ exam rooms, X-Ray room, Lab, Offices, etc. 3300 Sq Ft. – Fully built-out facility  ADA compliant Dunkirk New York
View full listing https://reporting.loopnet.com/report/3008dc65-60b8-4476-ab01-df4ffa2bc628.Contact geoff_jenkins@hotmail.com / (917) 825-4542


Upper East Side Medical Office Space for Rent Part–Time
Beautiful, newly renovated medical office on the Upper East Side between Lexington and Park Ave. Full service building with 2 entrances, conveniently located near all public transportation. Office includes 2 consult rooms, 3 exam rooms, treatment area, 2 bathrooms, kitchenette and reception area with waiting room. The office is available on a part-time basis. Please call 212-288-2278 or e-mail eastsidemedical@usa.net for further information.
Upper East Side Office lobby and receptions area


Park Avenue Office Share-3 Days Per Week
Tasteful, bright, well-maintained medical office in prestigious building on Park Avenue at 94th Street.  Large waiting room and reception area, consultation room and 2 exam rooms available 3 days per week. Room for an
assistant or clerical help 5 days per week. Please emailabgmdpc@gmail.com or call 987-5000


Medical Office Space for Rent!
Beautiful Newly Renovated Medical Office on the Upper East Side between Madison and Park Avenue! Conveniently located near all public transportation and Mount Sinai Hospital. Consult and Exam room available for rent part time or full time (see pictures). Please call 212-860-0300 or email
carnegiehill0062@gmail.com <for further information.
Pictures of office space for rent on Madison Ave




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.


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


  

 


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

PHYSICIAN OPPORTUNITIES

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.

 


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: July 12, 2019 – Oppose Disastrous Surprise Med Bill Now

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
July 12, 2019

Vol. 22  Number 26


MSSNYPAC Seal

 


Colleagues:

Congress, Don’t Harm Patients With The Wrong Surprise Medical Bills Solution
by Dustin Corcoran and Phil Schuh

Dustin Corcoran is chief executive officer of the California Medical Association, and Phil Schuh, CPA, is executive vice president and chief financial officer of the Medical Society of the State of New York.

Former Supreme Court Justice Louis Brandeis said in the early 1930s that states are laboratories of democracy that can experiment with various policies without harming the rest of the country. Now that more than 10 states have enacted laws to end surprise medical bills, Congress is discussing various policies that work toward the same goal.

Everyone agrees patients need to be held harmless from surprise medical bills to prevent financial hardship. What hasn’t been resolved is how the anticipated federal law will direct insurers and physicians to resolve billing disputes and enter into fair contracts. As Congress continues to consider this question, the experiences of California and New York offer important lessons that can ensure patients don’t inadvertently lose access to essential medical services in an emergency as they gain important new financial protections from surprise bills.

California’s law instituted a government-mandated benchmark to resolve disputes, championed by the health insurance industry. Instead of promoting fairness, the benchmark has become an artificial ceiling.

It fails to consider the actual cost of medical services and has emboldened insurers to avoid entering into contracts with doctors, meaning even more physicians will remain outside of insurers’ networks. Experience has shown this creates a huge hardship for patients and is precisely what surprise medical bills legislation is supposed to solve.

With more doctors forced out of network, patients will encounter more difficulty finding an in-network doctor. When they seek care out of network, it will substantially increase their deductibles and out-of-pocket costs.

Importantly, fewer hospital-based physicians, such as surgeons, obstetricians and anesthesiologists, will be able to serve patients in emergencies, a direct result of empowering insurance companies to decide how disputes should be settled. It’s not an exaggeration to assume that California’s approach will eventually destroy access to emergency and “on-call” safety net physicians.

The difference between life and death in some emergencies is a matter of minutes. Patients need to know that the right physician specialist will be there to treat them.

Contrast this cautionary tale with the overwhelmingly positive results attributed to New York’s surprise medical bills law. It should be the basis for federal legislation because consumers are no longer financially responsible for payment; complaints have plummeted; premiums have grown more slowly in New York than the rest of the country; physicians’ out-of-network charges are down 13 percent; and out-of-network billing is down 34 percent, according to a recent Georgetown University analysis. In other words, New York has prevented the serious problems that arise in a marketplace, like California’s, that’s unduly dominated by insurers.

Most importantly, the New York law ensures patients can continue to see the doctors they need in an emergency because arbitration is deterring disputes from ever reaching that point. When they do, outcomes are grounded in fair, transparent and independent data, in stark contrast to California’s arbitrary, insurer-championed approach that’s adding to the ranks of out-of-network doctors and diminishing access to essential emergency physicians.

As Congress continues to debate federal legislation to end surprise medical bills, the approach it ultimately adopts to resolve insurer-physician disputes could be the difference between a health care system where insurance coverage includes an adequate number of in-network physicians to protect patients and a system that empowers even bigger, more powerful insurance companies to encourage health care consolidation that decreases access to doctors and raises prices.

As leaders of two of the nation’s largest medical societies, we know from experience that federal surprise medical bills legislation needs to look like New York’s law, which is why Congress should support the House of Representatives’ bipartisan Protecting Patients from Surprise Medical Bills Act introduced by Reps. Raul Ruiz, MD (D-Calif.), and Phil Roe, M.D. (R-Tenn.). The Senate Health, Education, Labor and Pensions Committee’s legislation, which uses the so-called “median in-network” rate, another government-mandated benchmark, is far too much like California’s law, which experience shows has been devastating for patients and physicians.

Arthur Fougner, MD
MSSNY President 

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


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eNews

Physicians Urged to Contact Schumer, Gillibrand and Members of Congress to Oppose Disastrous Surprise Medical Bill Legislation
Please do not let the US Congress make it even harder for physicians to be able to negotiate fairly with market dominant health insurers, and force even more physicians into employment arrangements.   Physicians are urged to continue to contact Senators Schumer and Gillibrand, as well as their respective US Representative, to oppose disastrous legislation that would mandate out of network payment at insurer determined in-network levels, and in support of legislation to align with New York’s approach to surprise medical bills.  A letter can be sent from here.

While these bills would protect New York’s law for state regulated health insurance products, it would establish this insurer determined default rate for plans governed by ERISA.

This week, the US Energy& Commerce Health Subcommittee reported to the full Committee legislation (HR 3630) that would tie out-of-network payments for surprise medical bills to an insurer determined in-network payment level.  Legislation (S.1895) with a similar “default rate” remedy for these surprise bills was also recently advanced from the US Senate Health, Education, Labor and Pensions (HELP) Committee.  Both bills ignore New York’s successful approach that resolves these disputes through a simplified independent dispute resolution system based upon “baseball arbitration” that includes consideration of regional charges for health care services.

MSSNY President Dr. Art Fougner issued a statement noting that “New York’s physicians are extremely concerned about the impact to patient care of a bill before the US House Energy& Commerce Health Subcommittee…that would further enable abusive health insurer practices by establishing an insurer determined “default rate” for surprise medical bills (HR 3630). New York’s physicians very much agree with the goal of the legislation to protect patients from facing these bills, but disagree strongly with the solution being offered by Rep. Frank Pallone and Rep. Greg Walden, Chair and Ranking Member of the E&C Committee…”

Instead, MSSNY has supported legislation (HR 3502) that had been introduced by Representative Raul Ruiz, MD (D-CA) and Representative Phil Roe, MD (R-TN) based on New York’s model that has the support of a number of New Yorkers, including Representatives Clarke (D-Brooklyn), Higgins (D-Buffalo), Lowey (D-Westchester), Maloney (D-Westchester), Morelle (D-Rochester), Rice (D-Long Island), Stefanik (R-North Country), Suozzi (D-Long Island) and Velasquez (D-NYC).  While this legislation has some drafting errors that need to be fixed, it most closely follows New York’s approach.

MSSNY has been working closely with other state medical associations, national specialty associations, the Physicians Advocacy Institute and the AMA to oppose the health insurance industry gift that is S.1895 and HR 3630, and to instead support legislation that aligns with New York’s approach.  MSSNY’s letter to Senators Alexander and Murray expressing strong concerns with S.1895 can be found here.


Physician Action Needed on Bills Awaiting Governor’s Signature
While the legislative session may be over, there is still ample opportunity to influence the policy-making process. Many bills that passed both houses of the legislature have yet to be sent to the Governor for his signature or veto. Please take just a few minutes to send letters to the Governor from MSSNY’s Grassroots Action Center in support or opposition of the following issues:

  • Mid-year formulary changes (MSSNY supports)– 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 (MSSNY supports) – 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 would help to address patients’ pain control needs while also reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here. 
  • Malpractice expansion (MSSNY opposes) – two bills passed the legislature that will further tip the scales in liability actions against physicians and others, adding costs and potentially increasing liability premiums while doing nothing to help reform our current broken system.

The first would require a non-settling co-defendant in a tort action, where another co-defendant has settled, to make a “blind gamble” prior to trial (instead of after) whether to reduce the overall jury determined amount by the settlement amount or the settling defendant’s equitable share, instead of after a jury verdict has been reached.

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 that these bills would unnecessary costs to an already broken system by clicking here.


Hospital Association Urges Support for Bill to Repeal Medicaid DSH Cuts
Ahead of an important congressional hearing, the Greater New York Hospital Association is urging its members to express support for a bill that repeals impending Medicaid disproportionate share hospital cuts. The House Energy and Commerce Health Subcommittee will consider the bill. If approved, House leaders have said they would like the full chamber to vote on the bill before the end of the month.

MSSNY weighed in on surprise billing ahead of Thursday’s hearing.

“New York’s physicians very much agree with the goal of the legislation to protect patients from facing these bills but disagree strongly with the solution being offered by Rep. Frank Pallone and Rep. Greg Walden, chair and ranking member of the [Energy and Commerce Health Subcommittee],” said Dr. Art Fougner, president of the medical society, in a statement.

“Their proposal would greatly limit the ability of physicians to negotiate patient-care terms fairly with already market-dominant insurance companies. It would also make it much harder for hospitals to ensure needed on-call specialty care in their emergency departments. Moreover, it could have a particularly significant adverse impact on rural and smaller hospitals.

Kenneth Raske, president of the association, wrote in a letter to members Wednesday stating, “Eliminating Medicaid DSH cuts is GNYHA’s top federal priority, and we worked closely with Rep. Engel on getting this amendment included,” Raske wrote.

Safety-net hospitals that serve high numbers of low-income and uninsured patients operate on tight margins, Engel recently said of his efforts to repeal Medicaid DSH cuts. “If Medicaid DSH cuts were implemented, it would have a devastating impact on these critical facilities, potentially leading many to close their doors.” (Crains July 11)


RFK Jr. and NY Families Sue State for Ending Religious Exemptions to Vaccines
Attorneys Michael Sussman and Robert F. Kennedy Jr. filed a lawsuit Wednesday in the New York State Supreme Court that questions the constitutionality of the vaccination exemption changes, which took effect on June 13. The challenge, filed on behalf of 55 New York families who had lawful religious exemptions, requests that the court “enjoin the enactment of the repeal temporarily, preliminarily and permanently.” Kennedy, chief legal counsel for Children’s Health Defense, argued that it’s “unconstitutional for the state to deprive people of such important rights when religious animus has played a key role.”

Sussman, an attorney with Goshen-based Sussman & Associates, further argued that “to deprive families of the rights to freedom of religious expression, parental rights and the right to either a public or private education, the state must demonstrate a ‘compelling state interest’ that the state has failed to prove here.” Under New York Department of Health guidance issued in response to the new law, children attending daycare or public, private or parochial school who had a religious exemption were required to receive the first age appropriate dose in each immunization series by June 28. Parents and guardians must show that they have scheduled appointments for all required follow-up doses by July 14 for their children to remain in school or daycare. (Politico, July 10)



Female Physicians Paid Less Than Males
Female primary care providers are paid an average of 25% less than their male counterparts in the United States, according to Medscape‘s Female Physician Compensation Report released last week. The report noted that, overall, male physicians were more likely than female physicians to say they felt fairly compensated.


FCC Approves New Telehealth Pilot Program, Issues Proposed Rulemaking
The Federal Communications Commission voted unanimously to approve a notice of proposed rulemaking to establish a new $100 million “Connected Care Pilot Program” to support telehealth for low-income Americans, including veterans and those living in rural areas. “The future of health care is connected care, and this is the future that I want the FCC to support,” said FCC Chairman Ajit Pai.

The AHA has said the program is a critical next step toward delivering affordable telehealth services to those Americans who need it the most, and in September shared comments and recommendations with the FCC on its notice of inquiry about the program. Among other areas, FCC’s proposed rule seeks comments on who should participate in the pilot, including eligible health care providers and broadband service providers; the goals of the pilot; and the project application submission and evaluation. FCC will accept comments for 30 days after the rule is published in the Federal Register.


Federal Judge Blocks Rule Mandating Drug Prices in TV Ads
A federal judge on Monday blocked a rule that would have required pharmaceutical companies to disclose the prices of their drugs in television ads, according to media reports.

The rule, set to go into effect on Jul. 9, would have mandated cost disclosure for any drug covered by Medicare or Medicaid that has a list price above $35 for a month’s supply or the usual course of treatment. In June, three drug companies filed a lawsuit against the regulation, and on Monday, Judge Amit P. Mehta ruled that the Department of Health and Human Services had “exceeded its regulatory authority” in requiring such disclosure, the New York Times reports.

For now, TV ads will stay as they are. An HHS spokesperson said that “the administration … was consulting with the Justice Department on what to do next,” according to the Times.  Physician’s First Watch coverage of lawsuit


Doctors Without Borders Information Session in Queens
Every day, Doctors Without Borders/ Médecins Sans Frontières aid workers from around the world to provide assistance to people whose survival is threatened by violence, neglect, or catastrophe—treating those most in need regardless of political, religious, or economic interest. Whether an emergency involves armed conflicts or epidemics, malnutrition or natural disasters, Doctors Without Borders is committed to bringing quality medical care to people caught in crisis.

On Wednesday, July 31st, medical and non-medical professionals are invited to an evening presentation in Queens to learn more about joining Doctors Without Borders’ pool of dedicated aid workers. This is your opportunity to meet the recruitment team and learn about how you can join the pool of dedicated aid workers. The organization is currently recruiting for a variety of medical and non-medical positions.

Where:
Sunnyside Community Services
Seminar Room
43-31 39th St.
Sunnyside, Queens 11104

When:
July 31st, 2019, 7-8:30 pm

Register here.


Primary Care First Seriously Ill Population Webinar: Scheduling Update
In an effort to share model details and to include Center for Medicare and Medicaid Innovation leadership, the upcoming webinar on the Primary Care First Seriously Ill Population (SIP) payment option will now be held at the following date and time:

Wednesday, July 24th at 12:00 PM EDT

We apologize for any inconvenience and appreciate your continued interest in Primary Care First. Webinar slides will be available for download on the Primary Care First webpage shortly after the event.

Please forward the registration link below to colleagues who may be interested in learning more about the Seriously Ill Population payment model option of Primary Care First.

Register to attend here.

If you registered for the event on July 10th, then you do not need to re-register for the event as the link you received is still valid.

For additional information about Primary Care First, please visit the model webpage here.

Questions or Feedback?

If you have questions or feedback, please email PrimaryCareApply@telligen.com.


Thanks from Anti-Recreational Marijuana Group
The following letter of gratitude from Kevin Sabot, PhD, President of Smart Approaches to Marijuana (SAM), was sent to MSSNY’s Moe Auster thanking him for MSSNY’s support regarding our opposition to the legalization of recreational marijuana and convincing the legislature from legalizing recreational marijuana during this year’s legislative session.


 

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Classified

RENTAL/LEASING SPACE

Photo of Park Ave building facade
Prestigious Park Ave Office Near Lenox Hill Hospital for Sale
2,400 sq/ft on two levels with a separate 6×12 ft. storage closet. Fireplace in waiting room and consult room. Perfect for plastic surgeons, cosmetic dermatologists or other. $2,950,000 Call for details and appoint to view. 212-570-6060

 


 

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


For Lease – Buffalo Area Urgent Care / Primary Care Clinic
Next door to only grocery store in town: Sav-a-Lot 4+ exam rooms, X-Ray room, Lab, Offices, etc. 3300 Sq Ft. – Fully built-out facility  ADA compliant Dunkirk New York
View full listing https://reporting.loopnet.com/report/3008dc65-60b8-4476-ab01-df4ffa2bc628.Contact geoff_jenkins@hotmail.com / (917) 825-4542


Upper East Side Medical Office Space for Rent Part–Time
Beautiful, newly renovated medical office on the Upper East Side between Lexington and Park Ave. Full service building with 2 entrances, conveniently located near all public transportation. Office includes 2 consult rooms, 3 exam rooms, treatment area, 2 bathrooms, kitchenette and reception area with waiting room. The office is available on a part-time basis. Please call 212-288-2278 or e-mail eastsidemedical@usa.net for further information.
Upper East Side Office lobby and receptions area


Park Avenue Office Share-3 Days Per Week
Tasteful, bright, well-maintained medical office in prestigious building on Park Avenue at 94th Street.  Large waiting room and reception area, consultation room and 2 exam rooms available 3 days per week. Room for an
assistant or clerical help 5 days per week. Please emailabgmdpc@gmail.com or call 987-5000


Medical Office Space for Rent!
Beautiful Newly Renovated Medical Office on the Upper East Side between Madison and Park Avenue! Conveniently located near all public transportation and Mount Sinai Hospital. Consult and Exam room available for rent part time or full time (see pictures). Please call 212-860-0300 or email
carnegiehill0062@gmail.com <for further information.
Pictures of office space for rent on Madison Ave




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.


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


  

 


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

PHYSICIAN OPPORTUNITIES

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.


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: June 28, 2019 – Surprise Bills Go National

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
June 28, 2019

Vol. 22  Number 25


MSSNYPAC Seal

 


Colleagues:

We’ve all seen Geico’s humorous “Surprising” ad campaign. Unanticipated or “Surprise Bills” are not so funny. This situation most often occurs when a patient seeks services from a participating physician or hospital but then requires services not covered by the patient’s insurance plan. Consequently, the patient receives a surprise bill, often a significant amount. Everyone agrees this issue is problematic. The real issue becomes how to deal with it. Caution: this may get wonky.

New York State took the lead on this issue with the nation’s first surprise bill law, Article 6 of Financial Services Law: Emergency Medical Services and Surprise Bills. Most importantly, this law removed the patient from this troubling billing situation, leaving the dispute now between payer and provider. The out of network provider bills the plan for the services. If the claim cannot be resolved, the plan pays “an amount the health care plan determines is reasonable for the health care services rendered, except for the insured’s copayment, coinsurance or deductible” and the dispute may now go for independent resolution much like baseball arbitration – the arbitrator decides which number – the physician’s charge or the plan’s proposed payment is more appropriate.  One of the factors utilized by independent resolution is the usual and customary charge for that service.

History

Let’s back up for some history. In 2009, a settlement was reached between then NY State Attorney General Andrew Cuomo and UnitedHealth Group over using Ingenix, a wholly-owned subsidiary of United, as the resource for “usual, customary, and reasonable” pay rates. This settlement established FAIR Health. For NY, FAIR Health is now the resource for UCR.

NY’s law works. No, make that NY’s law works well. Arbitration decisions have gone 50 – 50. Surprise Bill complaints have dwindled down to a trickle. So NY’s law should be the model for the nation, right? Well … not so fast. Congress is now dealing with this issue as well other vexing pricing problems. Because of this, the insurers are now getting another bite at this apple. Proposed legislation would similarly remove the patient from any dispute but would establish the In Network payment as the standard. This is troubling for several reasons not the least of which is that that rate most commonly is felt to be a “low ball” payment. For this reason, many specialty care physicians had chosen not to participate with the plan in the first place.  Perhaps even more often, health insurers chose to not contract with these physicians because they were trying to limit their networks.  Heck, if this were going to be the case, why do the plans fight so bitterly against “any willing provider” clauses and insist on narrowing networks?

Why would Congress choose to reward the health insurance industry for this abusive behavior?

Proposed Solution

Another proposed solution is an All Payer Database. (I warned you this would get wonky.) Turns out the APD often excludes information about many employer-provided ERISA plans which tend to be the highest payers and are therefore more heavily weighted toward lower payers such as Medicaid. Perhaps we should call them Some Payer Databases. NY uses FAIR Health. The nation should do the same.

This issue is important because it involves all physicians – employed and independent, in-network and out-of-network. Employed physicians depend on the success of independent doctors the same as in network doctors depend on the success of their out of network colleagues.  What is being debated ultimately becomes a ceiling and the insurers know this. They are mobilizing all resources for this issue. We need to do the same. The wrong national law may undo much of what NY has successfully accomplished. You have received and will continue to receive MSSNY alerts on this issue. Please answer the call. We need all hands on deck. Please send a letter to your Representative, and Senators Schumer and Gillibrand here.

 

Arthur Fougner, MD
MSSNY President 

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


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eNews

Physicians Urged to Contact Schumer, Gillibrand and Members of Congress to Oppose Disastrous Surprise Medical Bill Legislation

All physicians are urged to contact Senators Schumer and Gillibrand, as well as their respective US Representative, to oppose disastrous legislation that would mandate out of network payment at insurer determined in-network levels, and in support of legislation to align with New York’s approach to surprise medical bills.  A letter can be sent from here.

This week the Senate Health, Education, Labor and Pensions (HELP) Committee advanced by a 20-3 vote S. 1895, the Lower Health Care Costs Act.  The surprise billing provisions of the bill are problematic because they would tie out-of-network payments to average in-network rates in situations where a patient did not have the opportunity to choose an in-network provision.  It also omits the independent payment arbitration process that has been supported by the AMA and state medical associations, and has been a successful model for New York.  Senator Dr. William Cassidy (R-LA) made strong comments against the surprise billing section in S.1895, noting that is it skewed heavily in favor of insurance companies.  He warned that letting insurance companies set rates will have dire consequence for rural and critical access hospitals that are already closing due to inadequate payments and it will exacerbate health care market consolidation problems.  Senators Hassan, Romney and Murkowski were also outspoken, expressing concerns with the contracted in-network rate benchmark and speaking in favor of including of an independent dispute resolution mechanism.

Separately, Congressman Ruiz, MD (D-CA) and a significant number of cosponsors from both sides of the aisle, including Representatives Morelle (D-Rochester), Stefanik (R-North Country) and Clarke (D-Brooklyn) from New York, introduced surprise billing legislation in the House that is based on New York model’s.

MSSNY has been working closely with other state medical associations, national specialty association, the Physicians Advocacy Institute and the AMA to oppose the health insurance industry gift that is S.1895, and to instead support legislation that aligns with New York’s approach.  MSSNY’s letter to Senators Alexander and Murray expressing strong concerns with S.1895 can be found here.


Physician Action Needed – Urge Governor Cuomo to Veto Liability Expansion Bills
Physicians are urged to contact the Governor to urge that he veto 2 bills passed at the end of the Legislative Session over the objections of many groups that could have the effect of driving up liability costs and creating an even more toxic malpractice adjudication system. Please take a minute to go to http://tiny.cc/VetoLiabilityBills and send a letter to Governor Cuomo urging him to veto these two bills and instead act to help bring down these costs through comprehensive reform.

S.6081/A.2372 will add costs to the system by requiring non-settling co-defendants in a tort action to choose whether to reduce their liability exposure by the stated settlement amount of a co-defendant or the settling co-defendant’s allocated percentage of fault prior to the first opening statement of the trial.  It would force these defendants into making a “blind gamble” and would enable in many cases the total payout to a plaintiff to actual exceed a jury’s award. There is little justification to this proposal other than increasing lawyer fees.

S.6552/A.2373 will also add new costs to the system, again with little justification. The bill 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.

These bills have also been opposed by hospital associations and the insurance industry.

These bills would exacerbate an already onerous system. New York was recently granted the dubious distinction of having by far and away the highest cumulative medical liability payouts in the country. Of course, this is not the first time that our state has been “honored” with this distinction. In New York we pay out nearly two times as much as in the state with the next highest amount. We also pay out the highest amount per capita.

Yet instead of trying to address this problem, these two bills would make this problem even worse.

It is imperative that the Governor and legislators take action to ensure that physicians and hospitals remain available to deliver the quality and timely care our patients expect and deserve to receive. A critical element to this is acting to reduce the choking costs of medical liability insurance and stopping one-sided proposals that will undoubtedly raise these costs. We urge the Governor to work towards comprehensive reform to enable a comprehensive supply of physicians across New York, rather than enabling cynical attempts to increase lawyer fees at the expense of patient care.

URGE A VETO OF ONEROUS LIABILITY EXPANSION BILLS! CLICK HERE

 



Two NY Healthcare Groups Lose EHR Access Following Ransomware Attacks
Both Olean (N.Y.) Medical Group and Seneca Nation Health System in Salamanca, N.Y., have lost access to their computer and EHR systems following recent cyberattacks on the organizations, Olean Times Herald reports.

OMG, which serves around 40,000 patients, said that no patient records or information were compromised as a result of the ransomware attack, according to the publication. The medical group has been completing patient charting by paper since the organization’s computer systems and EHR were infected with the ransomware June 11, OMG CEO Christine Strade told Becker’s Hospital Review.

The hacker demanded “a significant amount of money,” in exchange for access to the systems’ files, which OMG did pay, Ms. Strade confirmed. The group is working to restore all the encrypted files.

Seneca, which is not affiliated with OMG, also maintained security of patients’ protected health information following the attack on its health system, according to a statement from Mark Halftown, acting CEO, published to the health system’s website. He added that while access to patients’ electronic charts and the hospital’s scheduling system is currently down, Seneca is still seeing patients.

“We are working feverishly to rebuild our system and we apologize for any inconvenience,” Mr. Halftown wrote.

OMG hired Kivu, a cybersecurity forensic group, to investigate the attack, according to the report. After its review, the forensic group determined numerous attacks, which mostly came from Eastern Europe and Africa, against OMG had been stopped by the medical group’s security system prior to the breach.

It is not clear whether the ransomware attacks on both organizations originated from the same hacker. (Becker’s Hospital Review June 20)


Opioid Prescriptions Tied to Higher Overdose Risk among Family Members
People whose family members have opioid prescriptions face increased risk for opioid overdose themselves, according to a case-control study in JAMA Internal Medicine.

Using claims data from 2004 to 2015, researchers matched roughly 2300 people with opioid overdose to 9200 controls without overdose. Having a family member with a prior opioid prescription was associated with nearly triple the odds of overdose. Additionally, the overdose odds increased when more opioids were prescribed. Children aged 0 to 12 years had a fourfold increase in overdose risk when a family member had a prescription, but risk was increased across most age groups.

The authors conclude: “Interventions may focus on opioid dispensing limits, encouraging patients to properly dispose of prescription opioids after use, enhancing patient and public education, and using secure medication storage boxes to limit the risk of opioid overdose among other household family members. Treating and preventing opioid overdose events at the family level, as well as expanding access to opioid antagonists, should also be considered.”

JAMA Internal Medicine article; Background: Physician’s First Watch coverage of parental opioid use and suicide attempts among offspring

 


 

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Lawsuit Filed in North Dakota Claims State Law Forces Physicians to Lie
The AP (6/25) reports a federal lawsuit filed by the only abortion clinic in North Dakota claims state law “forces doctors to lie, including one measure passed this year requiring physicians to tell women that they may reverse a so-called medication abortion if they have second thoughts.” The suit was filed by “the Center for Reproductive Rights on behalf of the Red River Women’s Clinic and the American Medical Association” and “also targets an existing law requiring doctors to tell patients that abortion terminates ‘the life of a whole, separate, unique, living human being.’” The suit “asks a judge to block enforcement.” AMA President Patrice A. Harris, M.D., told the AP, “The AMA will step in when there is any interference with our ability to talk to our patients about legal, evidence-based medical procedures.” Dr. Harris also “said AMA lawyers are monitoring abortion laws in all states and decided North Dakota’s was the next case to be ‘actively involved in.’”

For more information on this lawsuit, see the AMA’s press release

Vaccine Panel Downgrades Pneumonia Shot Recommendation for Seniors
The AP (6/26) reports the Advisory Committee on Immunization Practices “said routine vaccination with Pfizer’s Prevnar 13 [pneumococcal vaccine] shot was no longer necessary for all healthy people 65 and older.” The panel’s recommendation will likely be adopted by the Centers for Disease Control and Prevention. Vaccine injury claims are rare, federal data show

Research Offers Clue to Lyme Arthritis Found in Patients’ Inflamed Joints
“A small but significant number of people with Lyme disease continue to suffer from symptoms long after finishing an antibiotic treatment,” and “the mystery of why may have come closer to being solved with a study…that found that bits of the Lyme bacteria can persist in patients’ inflamed joints even after taking antibiotics.” Investigators “examining synovial fluid from those inflamed joints also found antibodies to the persisting molecules, called peptidoglycans, that come from the outer covering of the Lyme bacteria, according to the study.” The findings were published in the Proceedings of the National Academy of Sciences. https://www.pnas.org/content/early/2019/06/11/1904170116

 


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Classified

RENTAL/LEASING SPACE

Prestigious Park Ave Office Near Lenox Hill Hospital for Sale
2,400 sq/ft on two levels with a separate 6×12 ft. storage closet. Fireplace in waiting room and consult room. Perfect for plastic surgeons, cosmetic dermatologists or other. $2,950,000 Call for details and appoint to view. 212-570-6060


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


For Lease – Buffalo Area Urgent Care / Primary Care Clinic
Next door to only grocery store in town: Sav-a-Lot 4+ exam rooms, X-Ray room, Lab, Offices, etc. 3300 Sq Ft. – Fully built-out facility  ADA compliant Dunkirk New York

View full listing https://reporting.loopnet.com/report/3008dc65-60b8-4476-ab01-df4ffa2bc628.

Contact geoff_jenkins@hotmail.com / (917) 825-4542

 


Upper East Side Medical Office Space for Rent Part–Time
Beautiful, newly renovated medical office on the Upper East Side between Lexington and Park Ave. Full service building with 2 entrances, conveniently located near all public transportation. Office includes 2 consult rooms, 3 exam rooms, treatment area, 2 bathrooms, kitchenette and reception area with waiting room. The office is available on a part-time basis. Please call 212-288-2278 or e-mail eastsidemedical@usa.net for further information.
Upper East Side Office lobby and receptions area



Park Avenue Office Share-3 Days Per Week
Tasteful, bright, well-maintained medical office in prestigious building on Park Avenue at 94th Street.  Large waiting room and reception area, consultation room and 2 exam rooms available 3 days per week. Room for an
assistant or clerical help 5 days per week. Please email abgmdpc@gmail.com or call 987-5000


Medical Office Space for Rent!
Beautiful Newly Renovated Medical Office on the Upper East Side between Madison and Park Avenue! Conveniently located near all public transportation and Mount Sinai Hospital. Consult and Exam room available for rent part time or full time (see pictures). Please call 212-860-0300 or email
carnegiehill0062@gmail.com for further information.
Pictures of office space for rent on Madison Ave


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.


 

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

  

 


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


PHYSICIAN OPPORTUNITIES

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.


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 – June 14, 2019 – Circle of Life

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE<
Arthur Fougner, MD
MSSNY President

MSSNY eNews
June 14, 2019

Vol. 22  Number 23


MSSNYPAC Seal

 


Colleagues:

Yesterday, the New York State Legislature passed a measure that will assure that the only acceptable exception to New York’s vaccination requirements is when there are medical contraindications.  Governor Andrew Cuomo has already signed this measure.  The Medical Society would like to thank all the physicians who took the time to write a letter, make a phone call and take other steps to educate their legislators about the critical importance of this legislation for protecting our public health.  MSSNY would also like to thank the many patient and public health advocacy organizations who also took the time to advocate to their legislators for this needed change.

Most importantly, we thank Assemblymember Jeff Dinowitz, Senator Brad Hoylman and our superior MSSNY legislative staff, especially Moe Auster and Pat Clancy, for their dogged advocacy in support of this legislation!  Their steadfastness commitment to the measure and to the public health ensures that ALL of New York State children will be protected from vaccine preventable diseases.

AMA Annual Meeting

Returning from the 2019 AMA Annual House of Delegates, I got in a cab, returned home, picked up my car and drove off to the Northwell Ob-Gyn Resident Graduation Party on Long Island. En route to the affair, I checked off potential topics for this week’s epistle and it dawned on me that the graduating house staff IS the topic. They are the fledglings leaving the nest and flying toward their collective future. Yet are they truly prepared for the world of copays, deductibles, contracts, prior authorizations and medical liability?

There are those in academia who feel that there will be time enough to address these concerns. I am not one of those academics. What is often missing in medical school and postgraduate medical education is advocacy. Yet there is hope for at the AMA meeting, I encountered many medical students, residents and fellows who were eager to familiarize themselves with the issues that would either soon confront them or were engulfing them now. Full of youthful exuberance, they embrace the concerns of medicine with an enthusiastic optimism unencumbered by the vicissitudes of life. Here was the opportunity for continual dialogue, continual reality check, learning the art of negotiation and compromise. And yes, sometimes we all agreed to disagree yet continue to engage.

Sadly, I noted that several health systems in our state were not represented. This is a pity for these students and young physicians are the future. Without the opportunity for mentoring by those who have walked these paths before them, they are thus free to repeat our missteps. We are the ones who must provide the GPS for their careers.

In “The Last Samurai”, Katsumoto says to Algren: “The way of the Samurai is not necessary anymore.”

Algren replies: “Necessary? What could be more necessary?”

Similarly, in these troubled times, what could be more necessary than our Medical Society? And Advocacy is our most important product.

It’s the circle of life
And it moves us all
Through despair and hope
Through faith and love

Till we find our place
On the path unwinding

“Circle of Love,” Tim Rice, lyricist for The Lion King

Arthur Fougner, MD
MSSNY President 

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


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Podcast SymbolThis Week’s Podcast of MSSNY’s Legislative Priorities

Capital Update

Legislature & Governor Pass Bill to Assure Medical Exemptions Only For Immunization
In a significant move to change public health policy, the New York State Legislature passed a measure that would assure that the only acceptable exception to New York’s vaccination requirements is when there are medical contraindications.   Governor Andrew Cuomo has already signed the bill into law.  The bill is effective immediately, and contains provisions that allow a school age child, who has begun the immunization process to attend school in Fall 2019.  The law becomes fully effective in June 2020.  The measure, A.2371A and S.2994A, was sponsored by Assemblymember Jeffery Dinowitz and Senator Brad Hoylman.  The measure, which the MSSNY strongly supported, passed the Assembly by a vote of 84-61 and the New York State Senate by 36-26.   A copy of the voting record is at click here.

MSSNY led a group of specialty societies, patient and public health advocates to ensure that there was strong support for the bill and helped to activate many physicians, nurses, parents, and other public health organizations in support of the measure.  MSSNY wishes to thank Assemblymember Dinowitz and Senator Hoylman for their dogged advocacy in support of this legislation and for their commitment to public health.   MSSNY recognizes that it will be important to educate the public about the benefits about immunization over the next several months.

There were 33 organizations that joined with the Medical Society in support of the bill:

American Academy of Pediatrics, NYS District II, Chapters 1, 2 & 3, American Nurses Association – New York (ANA-NY),  Associated Medical Schools of New York, Autism Science Foundation, Citizen Committee for Children of New York, Inc., Children’s Defense Fund-New York, Erie County Department of Health, Ithaca Is Immunized, Kimberly Coffey Foundation, Nurses Who Vaccinate, March of Dimes, Meningitis B Action Project,  Nurse Practitioner Association of NYS, NY American College of Emergency Physicians, the NY Chapter American College of Surgeons, NY State Society of Dermatology and Dermatologic Surgery, NYS Society of Orthopaedic Surgeons, NYS Psychiatric Association, NY Chapter American College of Physicians, NYS Academy of Family Physicians, NYS Association of County Health Officials (NYSACHO), NY Occupational and Environmental Medical Association (NYOEMA), NYS Society of Plastic Surgeons,NYS Neurosurgical Society, NYS Ophthalmological Society, NYS Society of Otolaryngology-Head and Neck Surgery, NYS Public Health Association, NYS Society of Anesthesiologists, Inc., The New York State Radiological Society, Schuyler Center For Analysis and Advocacy, The Children’s Agenda, Tompkins County Department of Health and the Tompkins Board of Health.                      (CLANCY) 


All Physicians Urged to Contact Their Legislators to Prevent Huge Increases in Liability Premiums
All physicians are urged to contact their legislators to oppose bills being aggressively pushed  by trial lawyers in the Session’s final days that would drive huge increases in physicians’ and hospitals’ already outrageously high liability premiums, and make it even more difficult for physicians and hospitals to be available to deliver needed patient care.   Physicians are urged to call their local legislators and send a letter clicking here: These bills include:

  • 4006/A.5612, which would greatly expand the possible damages awardable in a wrongful death action. While estimates vary, one actuarial estimate indicated that passage of this legislation could further increase premiums by nearly 50%, which translates to tens of thousands of dollars in new costs for many physicians and could make it impossible for many physicians to stay in practice in New York.
  • 6194/A.2370, which would limit a physician’s ability to defend themselves in liability actions by prohibiting their defense counsel from conducting an interview with the plaintiff’s treating physician.
  • 6081/A.2372, which would require a non-settling co-defendant in a tort action to choose whether to reduce his/her liability exposure by the stated settlement amount or the settling tortfeasor’s equitable share prior to the first opening statement of the trial.

Medical liability payouts in New York State continue to be far out of proportion with the rest of country. A recently released report showed that New York State had far and away the highest number of cumulative medical liability payouts of any state, and that this cumulative number had increased by 11% from 2017 to 2018. Claimants in New York were awarded nearly two times more than the state with the next highest amounts, Pennsylvania, and payments in New York far exceeded states such as California and Florida. Moreover, New York had the highest per capita medical liability payment as well, averaging over $35 per New York resident, more than 20% higher than the second highest state, New Jersey.

Given the extraordinary costs of medical liability insurance that many physicians must pay, combined with the enormous changes in health care delivery and payment that is placing huge new financial pressures on physician practices and hospitals, MSSNY is urging legislators to consider long overdue needed comprehensive reforms, not stand alone pieces of legislation that will harm patient access to care.    (AUSTER)


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Efforts to Legalize Recreational Marijuana Continue as Legislature Nears End; Physician Action Urged
With momentum growing in the New York State Legislature to act on the commercialization of the recreational use of marijuana, physicians are urged to continue to contact their legislators to oppose legislation here  A.1617B/S.1527B sponsored by Assembly Majority Leader Crystal Peoples-Stokes and Senator Liz Krueger, was recently amended.  The Assembly bill is in the Assembly Codes Committee and the Senate bill is in the Senate Finance Committee.  The Medical Society of the State of New York continues to oppose the legalization of recreational/adult use marijuana and continues to work with other advocacy groups that oppose this measure. In particular, MSSNY is concerned with the adverse public health consequences that have occurred in other states that have legalized marijuana.

Additionally, the measure changes the medical use of marijuana and takes the program out of the Department of Health and under the Office of Cannabis.  The measure eliminates “serious condition” and eliminates the list of conditions for certifying patients.   It also would allow any “practitioner” who is authorized to prescribe controlled substances with the state to certify a patient for marijuana. Training requirements for the medical components under the bill have been reduced to two hours.     The measure would also authorize “smoking” as a modality of treatment in the medical component and for recreational use.   (CLANCY,AUSTER)


Opioid Measures Moving in Both Houses
There are several measures that relate to opioid prescribing that are moving forward in the New York State Legislature that would have an impact on prescribing practices for physicians.  The bills are listed below:

  • 8256/S.5867A, sponsored by Assemblymember Richard Gottfried and Senator Gustavo Rivera, has moved from the Assembly Health Committee to the Assembly Rules Committee. This legislation would amend the public health law to require health practitioners before prescribing an opioid medication to consider discussing with the patient and refer or prescribe alternative services such as chiropractic, massage therapy or behavioral therapy. The Medical Society is concerned that this legislation will create confusing requirements for prescribers that will simply deter more physicians from prescribing pain medications for those patients that truly need them.  The Medical Society of the State of New York is opposed to this measure.
  • 5603/S.5150, sponsored by Assemblymember Edward Braunstein and Senator Peter Harckham, has moved to the Assembly Ways and Means Committee and is pending in the Senate Health Committee. This legislation would amend the public health law to require require that prescribers, who prescribe opioids for the first time, also co-prescribe an opioid antagonist with the prescription. MSSNY is concerned that this legislation could potentially create fear within patients that they would be stigmatized as drug addicts.  This fear may very well carry over to the patient’s use of opioids in general – leading those patients to suffer intense pain because of the fear of “addiction”.
  • 7285A/S. 4277A, sponsored by Assemblymember Linda Rosenthal and Senator Peter Harckham, has passed the Senate and is pending in the Assembly Health Committee. This legislation would amend the public health law to require health practitioners who prescribe an opioid or other Schedule II Controlled Substance to discuss with the patient the risks of being prescribed a CSII drug. The measure ignores the principle of informed consent—which essentially means that if a patient needs treatment, the physician gives the patient the information to make an informed decision. This process of understanding the risks and benefits of treatment is known as informed consent.  Additionally, this is duplicative of requirements that currently exist under the ISTOP law, whereby, after the physician prescribes the medication, the pharmacist is required to again inform the patient about the risks of taking a controlled substance.

Physicians are urged to call their member of the New York State Assembly and Senate and to urge them to vote no on these measures. (CLANCY, AUSTER)



Physician Advocacy Needed to Support Important Health Insurance Reforms
With just one week left until the scheduled end of 2019’s legislative session it is vital to continue advocating for legislation to assure patients are more able to receive the timely quality care and medications they need. Physicians may advocate via clicking the links below or calling their legislator’s office. You can call the switchboard and ask to be directed to their office (Senate 518-455-2800, Assembly 518-455-4100). Find your legislator here.

Mid-year formulary changes – Surprisingly, current law does not restrict insurance companies from making substantial changes to their formularies mid-year. This is an egregious practice when you consider the fact that your patients choose insurance plans based on the coverage presented to them – and they generally are not able to switch plans mid-year. Senator Breslin and Assemblymember Peoples-Stokes have introduced legislation (S.2849/A.2969) that would prevent mid-year formulary changes so that patients do not experience removal of a drug or changes in tiering when there is no similarly effective option.  This bill is on the verge of becoming law as it is on the floor calendar in both houses.  However it is being fiercely opposed by health insurers.  Please urge your Assemblymember and Senator to join on as a co-sponsor and support the bill here.

Network due process – There is currently a glaring loophole in New York’s laws that allow insurance companies to terminate physicians by non-renewal without cause or recourse. While they are required to notify physicians when contracts are terminated and physicians are then afforded the opportunity for a hearing, these protections don’t extend to non-renewal. Senator Rivera and Assemblymember Lavine’s bill (S.3463/A.2835) would provide physicians with proper due process upon non-renewal and would enhance the current hearing process by allowing the subject of the hearing (the physician) to choose one of the three members of the panel.  The bill is on the floor of both Houses.

Collective negotiations – Negotiating patient care terms with insurance companies is extremely difficult given many insurers’ overwhelming market share, so we strongly support legislation introduced by Senator Rivera and Assemblymember Gottfried (S.3462/A.2393) that would allow independently physicians to collectively negotiate with insurance companies in certain situations. The bill has been reported out of the Assembly Health Committee and awaits a vote in Ways & Means. Its Senate companion is currently in in the Senate Health Committee. Please urge your Assemblymember and Senator to join on as a co-sponsor and support the bill http://tiny.cc/mssnycollectivenegotation      (AVELLA/AUSTER)


Physician Advocacy Urged to Prevent Congressional Attempts to Undermine New York “Surprise Bill” Law
With several US House and Senate leaders releasing proposals to address the issue of “surprise” out of network medical bills faced by patients, physicians are urged to send a letter (please click here) urging their member of Congress to fight for a law that is consistent with New York’s approach.  Physician advocacy is essential due to a multitude of proposals before Congress that could seriously undermine New York’s proven model and further diminish the ability of physicians to fairly negotiate patient care terms with market dominant health insurers.

Specifically, MSSNY and other physician advocacy organizations have praised a proposal advanced by Representative Joe Morelle (D-Rochester) together with Representative Dr. Phil Roe (R-TN) and Dr. Raul Ruiz (D-CA), that seeks to mirror New York’s law, which uses a “baseball arbitration” Independent Dispute Resolution (IDR) system to determine payment for out of network medical care, and uses charge data collected by an independent database as a leading benchmark to guide the IDR.  MSSNY Board of Trustees member Dr. Andrew Kleinman also recently participated in a meeting with the House Doctors Caucus to educate legislators about New York’s approach.

However, several other proposals have been advanced that would require an insurer determined in-network based default rate for out of network surprise medical bills.  This would give enormous new powers to already market dominant insurers, and fails to recognize the insurance industry’s fault in creating this problem due to their narrow networks.  MSSNY has written to New York’s Congressional delegation praising the approach set forth by Representatives Morelle, Roe and Ruiz, and raising strong concerns with other proposals.

Specifically, New York’s letter raised concerns with the insurance industry’s own notorious history in establishing benchmarks for out of network payment, and the history of then-Attorney General Cuomo’s investigation which found that by using a flawed and conflicted database to determine reimbursement rates for out-of-network care, insurers were increasing profits at the expense of patients and physicians. Moreover, it was noted that New York’s law struck a tenuous balance among various health care stakeholders that protected patients from surprise medical bills and assured that hospital emergency departments had access to needed on-call specialty care.

MSSNY has been working with several other state medical associations and national specialty societies in its advocacy to Congress.  Please see here for a short “Fact Sheet” developed by the Physicians Advocacy Institute that sets forth key principles for Congress to consider in this debate: Fact Sheet   (AUSTER)


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Workers Compensation Board Adopts Regulations to Implement Prescription Medication Formulary
The New York Workers’ Compensation Board (WCB) recently announced it had adopted regulations to implement a prescription drug formulary for injured workers’ medication needs.  To read the final adopted regulation, formulary and summary documents, click here.

Comprehensive Workers Compensation reform legislation enacted by the State Legislature in 2017 directed the WCB to develop and implement a formulary.  The proposed regulation and formulary (Formulary) sets forth a listing of medications that may be prescribed for injured worker patient care needs without prior authorization during the first 30 days after the worker’s injury (Phase A), as well as a listing of medications that may be prescribed and dispensed, up to a 90- day supply, without obtaining Prior Authorization after 30 days following an accident or injury (Phase B).

The regulation also notes that drugs listed as “Perioperative Formulary drugs” may be prescribed without Prior Authorization when prescribed four days before and four days after the patient goes into the hospital, clinic, or doctor’s office for surgery; with the day of surgery being day zero.  When prior authorization is needed for certain medications, the proposed rules require the carrier, employer, or PBM to approve, partially approve or deny a PA request within 4 calendar days of submission by the physician or other care provider.

The regulation also sets forth that new prescriptions must be prescribed pursuant to the Formulary within 6 months of the effective date of the Formulary (December 2019), and that refills and renewals must be prescribed pursuant to the

Formulary within 12 months of the effective date of the Formulary (June 2020). (AUSTER)


Please Complete NYeC Survey to Gauge Physician Hassles with EHR Implementation and Use
MSSNY, in conjunction with other physician associations, has been working with the New York e-Health Collaborative (NYeC) on ways to reduce the hassles associated with the implementation and use of electric health record (EHR) systems. To that end, they have developed a survey for physicians to complete gauging the challenges of EHR use, including connecting to and using medical information from your local Regional Health Information Organization (RHIO) to enhance patient care delivery.

Please take just a few minutes to complete the survey here. (AUSTER)                                                                   


                                                 


pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
charring@mssny.org
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Zocdoc Update
Recently, MSSNY expressed concerns with Zocdoc based on physicians expressing discontent with the verbiage of “Dr. XXX has no appointments on Zocdoc right now.”  The site then lists other {Specialists} nearby.  Many physicians viewed this as Zocdoc steering patients away from their practice to practices that have an agreement with Zocdoc.  We asked Zocdoc to reconsider their language.

In an effort of cooperation and in an attempt to address our stated concerns, Zocdoc advised that they are going to adjust the language on these pages as a show of good faith to MSSNY and its members. Zocdoc asked their Product team to update the language to read as follows: “Dr. [NAME] does not participate in Zocdoc to offer online booking at this time.”  This should resolve our specific concern and MSSNY is appreciative of Zocdoc’s consideration.


Our State Fair is a Great State Fair…Don’t Miss It!
Once again the Onondaga County Medical Society will staff the Medical Society of the State of New York/New York State Society of Anesthesiologists booth at the state fair. Medical Society physician members are encouraged to volunteer to work the booth during a time slot. This is a great opportunity to perform public health outreach, and to promote your practice or organization at the NYS Fair, free of charge. Those who work at the booth will receive free admission tickets and free parking (on a limited basis). Feel free to bring handouts about your practice or other timely medical information to share with fairgoers. Please let us know if you have any ideas for exhibits, testing, etc., that you feel will be informative and help advance a positive image of the medical profession.

Contact us for available time slots remaining for the 13-day fair, which runs from Wednesday, August 21 – Monday, September 2, 2019 (Labor Day). You can work as little as two hours or the entire day if you’d like. We need only one physician-member group per time slot. This is being updated daily. Time availability is on a first-come, first-served basis Contact Patty Corasaniti at (315) 424-8118, or send email to corasaniti@oncms.org for more information.


Major City Physician Group Calls for Two-Year Extension of DSRIP Money
Dr. Ramon Tallaj, chairman of Somos Community Care, said Tuesday that the Cuomo administration should work to secure federal funding to continue the Delivery System Reform Incentive Payment program. The DSRIP program provided $7.4 billion for health care providers across the state to implement projects that would lower unnecessary trips to the hospital by 25% over five years. The program is set to end by April.

“We need to extend this for two more years. We have to find together a way to do that,” Tallaj said Tuesday after speaking at a conference hosted by Somos at the New York Academy of Medicine in Manhattan. “We need to be sure the Medicaid money is available to the state to do this transformation.”

Somos Community Care is a network of more than 2,500 physicians who care for more than 700,000 patients in New York City. It is one of 25 Performing Provider Systems, or groups of medical providers that have collaborated on projects to keep patients healthy and out of the hospital. Those projects include increasing care management and integrating medical and behavioral health care.

The money for DSRIP came from an amendment to New York’s 1115 waiver through which the federal government provided New York more than $8 billion. That allowed the state to reinvest some of the $17 billion it had saved through initiatives developed by its Medicaid Redesign Team. To secure additional funding, the state will need to a new amendment to its 1115 waiver, a labor-intensive process that will test New York’s ability to work with the Trump administration. But New York could renew some money from its DSRIP program. Certain parts of DSRIP, known as the state supplemental programs, are distributed through Medicaid managed-care plans and represented more than $1.5 billion in the first five years of the program. The state could allocate a continuation of that money in the next state budget.

Not all leaders in the health care industry think that DSRIP 2.0 is the answer to funding future collaboration among providers and social service organizations. (Crain’s Health Pulse)


NYC DOHMH Conducting Survey on Closure of Pain Clinics
The NYC Department of Health and Mental Hygiene (DOHMH) is involved in emergency preparedness planning in case of the event of a pain clinic closure or other emergency within New York City.  Pain clinic closures in other parts of New York State have led to serious public health consequences.   It is essential to have contingency plans in place in NYC to avoid abrupt interruption of treatment for patients with chronic pain, some of whom receive opioid therapy, and to assure continuity of care.  Physician response to this survey will inform DOHMH’s work and optimize all available resources to protect the health of New Yorkers.

AMA Meeting Highlights

  • AMA And Single-Payer 

The AMA remained opposed Tuesday to proposals for the U.S. to establish a single-payer health care system. At its annual House of Delegates meeting, it voted 53% to 47% against adopting an amendment to remove its formal opposition. The vote follows days of debate between leadership and a group of medical students.

  • AMA: Mature Minors Should Be Able to Provide Informed Consent for Vaccinations

Members voted to express support for “state policies that would allow minors to override their parent’s objections to vaccinations.” AMA board member S. Bobby Mukkamala, M.D., said in a news release, “The prevalence of unvaccinated pediatric patients is troubling to physicians. Many children go unvaccinated as anti-vaccine related messages and advertisements target parents with misinformation. Allowing mature minors to provide informed consent to vaccinations will ensure these patients can access this type of preventive care.”

  • AMA Delegates Vote In Favor of Ethics Council Report On Aid-In-Dying, Physician-Assisted Suicide

Members approved “a report from the AMA’s Council on Ethical and Judicial Affairs (CEJA), which was issued in response to resolutions at the 2016 and 2017 annual meetings that asked the council to ‘study the issue of aid-in-dying with consideration of data collected from the states that currently authorize aid-in-dying, and input from some of the physicians who have provided medical aid-in-dying to qualified patients.’” In the report, “the council had noted that arguments for and against participating in aid-in-dying or physician-assisted suicide were ‘fundamentally unchanged’ since the council’s earlier report on the issue in 1991.” The report also said, “In the council’s view, despite its negative connotations, the term ‘physician-assisted suicide’ describes the practice with the greatest precision.”


Dr. Underwood, Urologist from Buffalo, Elected to AMA Board of Trustees

Dr. Underwood

Willie Underwood, III, M.D., M.Sc., M.P.H., a urologist based in Buffalo was elected to the AMA’s to its Board of Trustees. Dr. Underwood has been an active leader in organized medicine for many years; he has chaired the AMA Council on Legislation and the AMA Resident and Fellow Section, served as president of the Erie County New York Medical Society, and he is an AMA Delegate from the American Urological Association (AUA).

Dr. Underwood is a board-certified urologic surgeon specializing in prostate cancer who has been practicing in the state of New York for the past 11 years. He oversees research focusing on methods to improve early detection and treatment of prostate cancer. In all his advocacy work he is proudest of getting prostate cancer early detection legislation successfully passed in Michigan and Maryland. Dr. Underwood earned his M.D. and M.Sc. from SUNY Upstate Medical University and his M.P.H. from the University of Michigan.


Physician Wellness Committee: 2016 Survey Has Sparked More Attention
Michael Privitera MD, Co-Chair of MSSNY’s Committee for Physician Wellness and Resilience, announced that another publication has come out of the MSSNY Burnout survey we did in the fall of 2016 in collaboration with Federation of State Medical Boards. “Physician Burnout and Mental Health Care Barriers when Reporting on Applications” has been accepted in Journal of Legal Medicine. It expounds upon how asking physicians questions on their state license applications and renewals about previous mental health care is such a large deterrent for physicians getting the care they need and how this backfires in efforts to protect the public.

Dr. Privitera stated, “I am particularly pleased about taking these issues seriously on a national level. There is the terrible perfect storm of an endless list of increasing expectations on physicians and medical students without any single agency overseeing the total expectations of the job. This scenario is then mixed with a culture of silence and endurance prevalent in medical culture that makes them less likely to be aware of how impossible the job has become. It’s not a fair fight  like other challenges in which they have prevailed, so it is important to try to recognize this and  reach out to get help.”


CMS

NGS Medicare Part B Claims Update

Top Reasons for Returning Claims

  • Item 1a Insured ID Number – blank or not valid format
  • Item 21 Diagnosis – No diagnosis code report
  • Item 24b Place of Service – No place of service reported
  • Item 32 – Service Facility location – Blank
  • Item 33a Missing NPI – missing or invalid format reported

JK Timeliness Jan Feb Mar Apr May
JK Claims 977 829 814 2,681 1,627

MIPS 2019: Not Too Late to Avert Future Medicare Pay Penalties
MIPS-eligible physicians who don’t report data may be subject to a 7% Medicare pay penalty in 2021. AMA resources offer help to avoid that outcome

Eligible physicians who fail to report data under Medicare’s 2019 Quality Payment Program (QPP) will be subject to a 7% penalty in 2021. That penalty will rise to 9% the following year.

To avoid such penalties, physicians need to score a minimum of 30 points in this year’s iteration of the QPP’s Merit-based Incentive Payment System (MIPS). The AMA’s expert resources outline what’s new this year under MIPS and how you can avoid potential future pay cuts.

The AMA offers extensive resources to help physicians understand MIPS, including:

Those physicians seeking a positive payment adjustment to their Medicare rates (potentially up to 7%) should have already started collecting data for the MIPS Quality performance category as of Jan. 1. Physicians, however, looking to avoid penalties and receive a neutral Medicare pay adjustment can still do so by collecting 90 days’ worth of data relevant to the MIPS Promoting Interoperability (PI) and Improvement Activities (IA) categories. The latest date to begin collecting data is Oct. 1.


Join CMS for a Public Webinar on Quality Measurement
CMS is pleased to invite the public to attend its upcoming webinar titled Measuring Quality to Improve Quality: Strengths and Challenges of Clinical Quality Measurement. The webinar will provide an engaging and informative overview of key concepts that go into its quality measures. Additionally, the presentation will review current CMS quality measures, explain how they are used, and how they fit into CMS’s quality goals, including the Meaningful Measures initiative. The webinar will be offered twice in June, on Tuesday, June 25th, from 2:00-3:00pm EST (Register here) and Thursday, June 27th, from 2:00-3:00pm EST (Register here). Please register in advance if you can attend as space will be limited. We request that you please only register for events you plan to attend. We hope you can join us and look forward to your questions! For questions, please contact MMSSupport@battelle.org.


Classified

RENTAL/LEASING SPACE


For Lease – Buffalo Area  Urgent Care / Primary Care Clinic
Next door to only grocery store in town: Sav-a-Lot 4+ exam rooms, X-Ray room, Lab, Offices, etc. 3300 Sq Ft. – Fully built-out facility  ADA compliant Dunkirk New York

View full listing https://reporting.loopnet.com/report/3008dc65-60b8-4476-ab01-df4ffa2bc628.

Contact geoff_jenkins@hotmail.com / (917) 825-4542


Upper East Side Medical Office Space for Rent Part–Time
Beautiful, newly renovated medical office on the Upper East Side between Lexington and Park Ave. Full service building with 2 entrances, conveniently located near all public transportation. Office includes 2 consult rooms, 3 exam rooms, treatment area, 2 bathrooms, kitchenette and reception area with waiting room. The office is available on a part-time basis. Please call 212-288-2278 or e-mail eastsidemedical@usa.net for further information.
Upper East Side Office lobby and receptions area



Park Avenue Office Share-3 Days Per Week
Tasteful, bright, well-maintained medical office in prestigious building on Park Avenue at 94th Street.  Large waiting room and reception area, consultation room and 2 exam rooms available 3 days per week. Room for an assistant or clerical help 5 days per week. Please email abgmdpc@gmail.com or call 987-5000


Medical Office Space for Rent!
Beautiful Newly Renovated Medical Office on the Upper East Side between Madison and Park Avenue! Conveniently located near all public transportation and Mount Sinai Hospital. Consult and Exam room available for rent part time or full time (see pictures). Please call 212-860-0300 or email carnegiehill0062@gmail.com for further information.
Pictures of office space for rent on Madison Ave

 


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.


 

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


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

PHYSICIAN OPPORTUNITIES

Multi-Specialty Medical Office Looking To Bring On More Doctors
New York Medicine Doctors Center is a multi-specialty Medical Agency networking some of the best medical professionals and specialists in the New York Tri-State area. Our offices currently serve both Manhattan and Queens, providing a variety of advanced technological on site testing, imaging, and services for the most rapid results.

We are actively looking to bring on board an array of Doctors specializing in Primary Care, Gynecology, Gastroenterology, ENT, Urology, Podiatry, and Dermatology.

As we continue to broaden our medical services in both locations, we also provide individualized on-boarding contracts with health benefits, tailored in-house marketing and advertising, practice management assistance, and in house team of administration dedicated in serving any and all concerns whether it be credentialing or equipment related tasks.

If you are interested in joining our growing network, please do not hesitate to contact us

at 718-360-9550 or 212-931-8533. Our direct email is drshusterman@gmail.com

Primary Contact: Oksana


 

 


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 – May 10, 2019 – NY State of Fear

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE<
Arthur Fougner, MD
MSSNY President

MSSNY eNews
MAy 10, 2019

Vol. 22  Number 18


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Colleagues:

Fear is the Mind Killer.”
-Bene Gesserit (from Dune by Frank Herbert)

The 21st Century is not turning out the way I expected. How it could happen that a disease once declared eradicated by the CDC in 2000, now plagues our state? With over 600 cases in NY State, there seems no end to this outbreak. Schools have been closed, families are now under quarantine. Any day, I expect to pick up the paper and learn that someone, like the Israeli flight attendant, is now in an intensive care unit somewhere on life support.

Where once NY enjoyed almost universal vaccination, today there are over 200 schools where less than two thirds of the children are immunized. This is truly disturbing.  You see, there are those who cannot be vaccinated – those infants 6 months of age or younger, those with cancer or transplants on immunosuppression therapy, patients with HIV or autoimmune disease, pregnant women, or those allergic to any of the ingredients in the vaccine. To minimize the likelihood of exposure, the rest of the community needs to be immunized. This is the concept of herd immunity. Today, our herd has been culled.

So what’s going on here? Some might point to religion. Yet there is no major religion that proscribes vaccination. Moreover, religion has been with us since the day that homo sapiens took their first steps. Religion was certainly around while measles was being eradicated through a vigorous vaccination campaign.

So what is different now?

What’s different now is the pervasive state of fear created by a relatively small group who spread the notion that the vaccines are more terrifying than the diseases they are designed to control. We all know who they are. They are powerful, they are media savvy and their influence has spread throughout all sectors of our society, promulgating the false gospel that vaccination causes such afflictions as autism. That notion, which first emerged 20 years ago, has been thoroughly discredited but facts do not deter this cult. Take the two recent Danish studies of over half a million children. These found no significant difference in autism rates between those vaccinated and those not. In fact, the vaccinated group actually had a slightly LOWER incidence of autism.

So we must take this challenge head on and protect those who cannot protect themselves. Re-establish Community Immunity. Remember the words of a former NY governor, President and victim of a now vaccine-preventable disease: “The only thing we have to fear is fear itself.”

Arthur Fougner, MD
MSSNY President 

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

Dr. Fougner and Dr. Sellers at Measles Conference

Vaccinations: Only Medical Exemptions.
MSSNY Vice President Dr. Joseph Sellers and MSSNY President Dr. Art Fougner at a press conference on Tuesday, May 8. Speaking to NYS legislators, Dr. Fougner said, “An important first step is ensuring that medical exemptions are the ONLY exemptions allowable.”


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Capital Update

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This Week’s Podcast of MSSNY’s Legislative Priorities


MSSNY Participates in Congressional Discussion on Addressing Surprise Medical Bills
MSSNY Past-President Dr. Andrew Kleinman was one of the key participants in a meeting this week in Washington DC with the US House of Representatives’ Doctors Caucus to highlight New York’s acclaimed “surprise medical bill” law as a model for Congress to follow as it develops similar legislation for the country.  Dr. Kleinman highlighted that New York’s comprehensive law protected patients and struck a balance among the concerns of physicians, hospitals and health insurers to help preserve needed on-call specialty care availability in hospital emergency departments.

He noted New York’s law not only addressed surprise out of network bills directly, but also addressed other “root causes” of  surprise medical bills, such as inadequate and inaccurate physician networks and inadequate out of network coverage. He also highlighted the expeditious and relatively inexpensive cost of New York’s independent dispute resolution system for resolving surprise out of network bills.  Dr. Kleinman was extensively involved in efforts to help develop and advance New York’s law.

Other participants in the meeting included the American Medical Association, the American Association of Neurological Surgeons, the American College of Emergency Physicians, and the Federation of American Hospitals.  Dr. Kleinman also met with key health policy staff for several other key US Senators developing legislation on this issue, including Senate Minority Charles Schumer (D-NY) and Senator Dr. William Cassidy (R-LA).    

This week, President Trump held a press conference urging action to address surprise medical bills. The AMA released a statement following the press conference agreeing with the goal to protect patients from surprise bills but raising concerns with aspects of the President’s statement.  Read the AMA statement here.

Physicians are urged to send a letter to Senators Schumer and Gillibrand, as well as their respective member of Congress here  to urge that any proposal addressing surprise medical bills be consistent with New York’s law.                      (AUSTER)


Medical Organizations, Public Health and Patient Advocacy Groups Hold Press Conference; Urge Legislators to Enact Medical Exemption
The Medical Society of the State of New York and 27 other medical organizations, public health and patient advocacy groups are urging the New York State Legislature to pass A.2371/S.2984 which ensures that medical reasons are the only exception to vaccination requirements.  MSSNY President Dr. Art Fougner, Vice-President Dr. Joseph Sellers and Assistant Treasurer Dr. Parag Mehta joined many other physicians and patient advocates this week in a press conference urging support for the legislation.  The press conference generated significant media attention. The legislation is sponsored by Assemblymember Dinowitz and Senator Hoylman and is in the Assembly and Senate Health Committees.

Following the press conference, the groups met with various members of the legislature urging their support of the measure; those meetings will continue this week.  It is important to note that many anti-vaccine advocates are expected at the Capitol next week to discuss their views with legislators.  Therefore, it is critically important that all physicians reach out o their legislators and urge passage of A.2371/S.2984.

The measure must go through the Assembly Health Committee and MSSNY’s focus has been on the following individuals:  Assemblymembers Gottfired, Abinanti, Ashby, Barron, Bichotte, Braunstein, K. Byrne, M. Byrnes, Cahall, Cymbrowitz, Dinowitz, Galed, Garbarino, Gunther, Hevesi, Jaffee, Kim, D. McDonought, Paulin, Ra, Raia, Rosenthal, Sayegh, Schimminger, Solages, P. Steck.  You can call the Asssembly at 518-455-4100 and ask to be transferred to their offices.  You may also send a letter to these legislators urging support of A.2371 and S.2984 by going to MSSNY Grassroots Action Center (GAC) here.

With the number of confirmed measles cases exceeding 700, groups are urging passage to ensure that measles – a vaccine preventable disease – does not gain a sustained foothold in New York and across the nation.

The following groups have joined onto a memo in support and many attended this week’s press conference:  American Academy of Pediatrics, NYS District II, Chapters 1, 2 & 3, American Nurses Association – New York (ANA-NY), Associated Medical Schools of New York, Autism Science Foundation, Citizen Committee for Children of New York, Inc., Children’s Defense Fund-New York, Erie County Department of Health,  Ithaca Is Immunized, Kimberly Coffey Foundation, Nurses Who Vaccinate, March of Dimes, Meningitis B Action Project, Medical Society of the State of New York, Nurse Practitioner Association New York State, New York American College of Emergency Physicians, NY Chapter American College of Physicians, NYS Academy of Family Physicians, NYS Association of County Health Officials (NYSACHO), NY Occupational and Environmental Medical Association (NYOEMA) , NY State Neurological Society, NY State Neurosurgical Society, NYS Ophthalmological Society, NYS Society of Otolaryngology-Head and Neck Surgery, NYS Public Health Association, New York State Society of Anesthesiologists, Inc., The New York State Radiological Society, Schuyler Center For Analysis and Advocacy, The Children’s Agenda and the Tompkins County Department of Health.                                  (CLANCY)



Collective Negotiations Bill Advances in the Assembly
Please urge your legislators to support Assemblymember Gottfried’s bill A.2393, which would help to even the playing field between physicians and insurance companies.  A letter can be sent here.

This bill was reported out of the Health committee on 4/30 and has now been reported out of the Codes committee. It currently awaits a vote in the Assembly Ways and Means Committee. If enacted into law it would allow independently practicing physicians to communicate and negotiate collectively with health care plans in limited instances (when health plans have an undue advantage negotiating the terms of contracts with health care providers). Physicians are currently unable to do so due to federal antitrust law. However, a longstanding US Supreme Court precedent enables States to permit these negotiations via the State Action Doctrine.

Passage of this legislation would help to enable physicians to negotiate in order to limit burdensome prior authorization procedures and unfair network participation rules. It also contains protections to help ensure that negotiations do not impair access to patient care by prohibiting collective slowdowns/strikes and would ensure strict oversight of these negotiations by the Department of Health.

The bill, which is also sponsored by Senator Rivera (S.3462) is currently in the Senate Health Committee.             (AVELLA)     


Bill Requiring Physicians to Maintain Excessive Documentation of Discussion of Risks of Prescribing Opioids Moves to Senate Floor; Action Needed!
Physicians are urged to contact their legislators in opposition to legislation (S.4277-A/A.7285-A) which would require physicians and health practitioners who prescribe an opioid or other Schedule II Controlled Substance to discuss with patients’ the risks prior to prescribing the medications. The Medical Society is opposed to this measure and encourages

physicians to send a letter to their legislator at the MSSNY Grassroots Action Center (GAC) here. The bill has moved to the Senate floor and can be voted on at any time.      Specifically the legislation would require physicians to discuss (and by extension document that such discussions took place) the following: a) the risks of addiction and overdose associated with opioid medications, b) the reason why the prescription is necessary, c) alternative treatments that may be available and d) the risks associated with the use of these medications. Moreover it would require the physician each year to counsel the patient on the risks of overdose and the availability of an opioid antagonist.

While the legislation is well intended, it ignores existing Public Health Law that essentially requires the patient’s informed consent. This means that when a patient needs treatment, the physician must give the patient information regarding risks so that they can make an informed decision.

Additionally, this is duplicative of requirements that currently exist under other laws that mandate that after a physician prescribes the medication, the pharmacist is required to again inform the patient about the risks of taking a controlled substance. Moreover, for their patients who are on opioid medications longer than 90 days, physicians are required to have a written treatment plan that includes discussing with patients the risks of these medications and possible alternatives to these medications.  MSSNY is also concerned that such requirements will further discourage physicians from prescribing pain medications for patients who need them – already a growing concern – and could potentially scare patients who truly need pain medication away from taking this medication. (CLANCY,AUSTER)



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Action Needed on Prior Authorization Reform Bill
Prior authorizations continue to be a major roadblock to care and cause endless hassles for physicians and their staff. The burdens caused by excessive and often unjustified prior authorization requirements take away from the time that physicians can spend with their patients and lead to far too many hours being spent on paperwork. Further, surveys continue to demonstrate that a significant number of patients have experienced adverse outcomes due to prior authorizations, either due to the time that insurance companies take to process them or because of improper or unfair denials.

Senator Breslin and Assemblymember Gottfried have introduced an “omnibus bill” (S.2847/A.3038) that would help in reducing prior authorization burdens, updating UR standards and patient protections for prescription drugs.  MSSNY has been working with several specialty societies and patient advocacy groups, including the New York Bleeding Disorders Coalition, on advocacy in support of the legislation.

The bill has picked up additional co-sponsors in both houses this year. It is currently awaiting action in the Senate Health Committee and the Assembly Insurance Committee. Please urge your Assemblymember and Senator to join on as a co-sponsor here(AVELLA)


Single Payer Hearing Scheduled for May 28 in Albany
Health Committee Chairs Senator Rivera and Assemblymember Gottfried will host a hearing on the Proposed New York Health Act on May 28, 2019 in Albany. It will be the first of a series of hearings throughout NY regarding the proposed legislation, which would create a single payor system in New York. MSSNY President Arthur Fougner, MD will be providing testimony on behalf of MSSNY.

The hearing will take place at 10am in Hearing Room A in the Legislative Office Building. Oral testimony will be limited to 10 minutes per participant. More information, including the form that must be submitted by those who wish to testify, can be found here.          (AVELLA)


Uniform Credentialing Bill on Senate Health Committee Agenda
Senate Bill S.4335, sponsored by Senator Salazar, is on the Senate Health Committee’s agenda for Tuesday, May 14. The bill would require the creation and use of uniform credentialing and re-credentialing forms for physicians and other providers to use for the purposes of applying for and being maintained on a health care plan’s network. While many insurance companies now use CAQH’s standard form, not all use it exclusively. As a result, physicians and their staff – who are already overburdened with paperwork and bureaucratic tasks – must sometimes file multiple different forms that serve the same purpose.

It would also require the creation of a standard referral form that a primary care physician may use to facilitate care for a patient from a specialist physician. Similar to the credentialing forms, health care plans may have their own referral forms that are substantially similar, but different enough so that the physician must use each plan’s form instead of a single form. A uniform referral form would alleviate further unnecessary administrative hassles that physicians face in attempting to facilitate appropriate care for their patients.

Assemblymember Gottfried’s companion bill A.3077 passed the Assembly on 3/26.        (AVELLA)


Patient Formulary Protection Bill Ready for Senate Vote
Senator Breslin’s S.2849, which would prohibit a health care plan from making prescription drug formulary changes during the contract year, is currently on the floor of the Senate. While patients are locked into an insurance plan for the contract year – and often choose their plan based on their prescription co-pays and prescription formularies – insurance companies are able to modify their formulary and often move drugs into a higher cost-sharing tier mid-contract. This legislation would ensure that patients are able to access the drugs they need without unexpected cost increases mid-year.  MSSNY has been working with several patient advocacy groups in support of this legislation.

This is the first year that the bill has advanced out of committee in the Senate. Its companion bill, which is sponsored by Assemblymember People-Stokes (A.2969), has passed the Assembly every year since 2015 and is currently in the Assembly Insurance Committee awaiting movement. Please urge your legislator to support this bill by clicking here. (AVELLA)


CMS to Require Pharma Companies to Include List Price during TV Commercials
CMS will now require TV commercials for prescription drugs covered by Medicare or Medicaid to include the list price (Wholesale Acquisition Cost) if the price is greater than or equal to $35 per month or the usual course of therapy. Currently, drug companies are only required to disclose a drug’s potential major side effects. The final rule is effective 60 days after its May 10, 2019 publication in the Federal Register (July 9, 2019).

Per HHS, the 10 most commonly advertised drugs have list prices ranging from $488 to $16,938 per month (or usual course of therapy).  HHS estimates that prescription drug spending in the United States was about $457 billion in 2015, or 16.7 percent of overall personal health care services. Further, over $4.2 billion was spent on prescription drug television advertising.

The stated intent of this rule change is to incentivize lower list prices and ensuring that beneficiaries are provided all of the information that they need to make informed decisions, minimizing their out-of-pocket costs. 47% of Americans are insured through high-deductible health plans and all seniors on Medicare Part D must pay coinsurance and often a deductible as well. The list price is also what a patient would pay if a drug is not on their insurance formulary.    (AVELLA)  


Measles Outbreak in New York State Continues to Spread
Webinar Available at MSSNY CME Website

The number of measles cases in New York State continues to rise with approximately 665 of the 706 confirmed cases nationwide occurring in New York State (423 in New York City, 206 in Rockland, 23 in Orange, 10 in Westchester, 2 in Sullivan, 1 in Suffolk and 1 in Greene counties) as of May 1st.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December, 2018.  This webinar has now been posted to the MSSNY CME website. You can also view MSSNY’s latest Medical Matters webinar entitled “What’s Your Diagnosis? Infectious Diseases” which involves a patient with a fever and a rash.  Please check these out and keep yourself informed about the growing measles outbreak throughout New York State.  You can also listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine here         (HOFFMAN, CLANCY)


Be Sure to Listen to MSSNY’s Latest Podcast
MSSNY proudly announces our latest podcast entitled Military Culture: Forging an Alliance with Veteran Patients.  Dr. Frank Dowling, MSSNY Secretary, discusses the unique aspects of military culture with Marcelle Leis, CMS (Ret.) USAF/ANG and Lance Allen Want, Lt. Col. (Ret.) USA.  Listen here.                                                                   (HOFFMAN)


Registration Now Open for Medical Matters Webinar on May 15, 2019 @ 7:30am
The Medical Society of the State of New York will host its final Medical Matters webinar of 2019, The Importance of Resilience After a Disaster on May 15th @ 7:30am.  Encouraging post traumatic growth is an essential part of recovery from any type of disaster.  Learn more about how best to encourage resilience behaviors in patients.

The Importance of Resilience After a DisasterRegister here.:

When:  Wednesday, May 15 2019 at 7:30am

Faculty: Craig Katz, MD

Educational Objectives:

  • Define resilience and post traumatic growth
  • Describe how best to measure resilience and post traumatic growth
  • Explore resilience behaviors and how to encourage them in your patients

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. Physician should only claim credit commensurate with the extent of their participation in the activity. (HOFFMAN)


Registration Now Open for Veterans Matters CME Webinar on June 5th
Register now for MSSNY’s next Veterans Matters webinar June 5th at 7:30am. This webinar is entitled Substance Use Disorders in Veterans.  Register for this program here

Veterans Matters: Substance Use Disorders in Veterans

When:  Wednesday June 5 2019 at 7:30am

Faculty: Frank Dowling, MD

Educational Objectives

  • Define Substance Use Disorders (SUDs), symptoms, warning signs, comorbidities
  • Explore evidence-based intervention and treatment options for SUDs among veterans
  • Identify barriers to diagnosis and treatment and methods to overcome them

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

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


pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
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Empire, Westchester Medical Center Locked in Contract Dispute
Empire BlueCross BlueShield has notified its members that Westchester Medical Center Health Network will become out-of-network on June 1 unless the two sides reach an agreement. The health network’s contract with Empire expired April 1, but discussions have continued during a two-month “cooling off” period.

“We have a strong desire for Westchester Medical Center to be in-network, but we have to provide affordable products,” Alan Murray, Empire’s CEO, told Crain’s. “That’s a constant balance we’re challenged with.”

The hospitals affected are Westchester Medical Center and Maria Fareri Children’s Hospital in Valhalla; Bon Secours Community Hospital in Port Jervis, Orange County; Good Samaritan Hospital in Suffern, Rockland County; St. Anthony Community Hospital in Warwick, Orange County; and MidHudson Regional Hospital in Poughkeepsie, Dutchess County.

The insurer told members that Empire would cover WMCHealth facilities as in-network during emergencies, when services have been previously authorized or where another provider is not within 30 miles of a patient’s home. Crains May 7.


Mayor Unveils NYC Care Card for Uninsured; Will Hire Seven Doctors in Bronx
The city’s public hospital system is hiring seven doctors for Lincoln Hospital in the Bronx to prepare for what officials hope will be an influx of patients this summer who will take advantage of NYC Care, the de Blasio administration’s latest health program.

The city’s effort to connect people without insurance to primary care at NYC Health + Hospitals will officially start Aug. 1 in the Bronx. The mayor’s office expects 10,000 people to sign up for NYC Care within the first six months of the program. The patients will have 24/7 access to a customer-service line and hospital-based pharmacies.

The $100 million NYC Care program does not provide participants with access to medical care at any private doctor, hospital or pharmacy. It will charge sliding-scale payments based on an individual’s income and encourage people to enroll in MetroPlus if they earn too much to qualify. The card includes a member ID number, the name of an individual’s primary-care physician and a customer-service phone number.

People are eligible if they have lived in the city for at least six months and do not have an affordable insurance option or are ineligible for insurance. Of course, NYC Health + Hospitals always has welcomed any patient whether or not they have insurance. The difference is the priority of connecting uninsured patients to primary care before they go to a city emergency room with a crisis. The city will spend $25 million bringing the program to the Bronx, which also includes ramp-up costs, said City Hall spokesperson Marcy Miranda.


NY Improves Its Readiness for Health Emergencies
New York has continued to improve its readiness for health emergencies, according to the 2019 National Health Security Preparedness Index, released by the Robert Wood Johnson Foundation. The state improved its readiness in all areas between 2013 and 2018, the index found. It also bested the national average of 6.7—on a 10-point scale—scoring 6.9. Specifically, New York scored particularly well in community planning and engagement, increasing nearly 21%, to 5.8. The national average was 5.2 last year.

New York also posted its highest score in health security surveillance, 9.2, compared with a national average of 8.3. Health security surveillance is defined by the index as the ability to detect and monitor health threats and identify where they start and spread to contain them rapidly.

The state also exceeded the national average in readiness in environmental and occupational health last year at 6.7, compared with 5.9. New York’s lowest score was in health care delivery—the ability to provide care during and after emergencies—at 4.7. The national average was 4.9. The state also scored significantly below the national average in incident and information management, at 8.2, compared with 8.7. This metric is the ability to deploy people, supplies and funds to locations where they are most effective in protecting health, according to the index.

The index was originally developed by the Centers for Disease Control and Prevention. It is now funded by the Robert Wood Johnson Foundation and involves the collaboration of more than 30 organizations.


Yelp to List NYC and Long Island Maternity Care Metrics on Hospital Pages
As of May 8, Yelp started displaying information about the quality of maternity care at about 50 hospitals in New York City and Long Island through a partnership with the Northeast Business Group on Health. The Yelp pages for hospitals will indicate whether the facilities are above average, average or below average in their rates of Cesarean-section deliveries in low-risk pregnancies, newborns being fed only breast milk before discharge, the administering of an episiotomy and vaginal births among women who’ve had a previous C-section.

The data come from expectny.com, a project of the Northeast Business Group on Health, which provides maternity-care statistics from New York State and patient-safety organization Leapfrog Group. Its work was supported by a grant from the New York State Health Foundation. The ratings include a link to expectny.com where users can get more information about why it has rated hospitals on these measures. A 2017 report from researchers at the Manhattan Institute found Yelp ratings were correlated with better-quality hospitals in New York State. In the analysis, hospitals with lower rates of avoidable readmission were considered higher quality. Crains NY May 8 

“Do I Really Need An Employee Handbook? Absolutely!”
Creating an employee handbook can seem like a daunting task for an employer. Some employers have few, if any, written policies in place when they begin the process. Others may have adopted individual written policies in the past with little, if any, consideration given to how the policies can or should fit together in a handbook. Questions abound over what policies must or should be included, or over how often the handbook should be updated.

Despite such issues, there is no question that every employer should have a handbook in place.  A properly drafted employee handbook can be a critical risk management tool, communication tool and cost containment tool.  Specifically, a handbook informs employees and supervisors of the rules and policies of the workplace in a uniform way, and provides for clarity concerning expectations and standards that must be followed and adhered to by employees.  A handbook is a primary tool for placing employees on notice of an employer’s policies, expectations and benefits.

Moreover, employers can refer to provisions of an employee manual for purposes of establishing legitimate and lawful reasons for taking an adverse employment action against an employee.  Furthermore, a handbook informs the employees of their rights and benefits in a clear consistent manner and of grievance procedures to ensure that complaints are handled appropriately and effectively.  The prospect of supervisors enforcing rules consistently is enhanced by the existence of a handbook.

Finally, a properly drafted handbook can reduce the risks of litigation or provide a defense in should a lawsuit arise.  This is because its existence can show an employer’s intended consistent treatment of employees, the plaintiff-employee’s violation of the workplace rules, and that a plaintiff-employee’s claim for benefits is baseless given the express language of the handbook.

[1]Madelin T. Zwerling is an attorney at Garfunkel Wild, P.C., which she joined in 2011, and a member of the Employment Law Practice Group, which provides legal advice on a full range of employment matters.  She may be reached at mzwerling@garfunkelwild.com or (516) 393-2510.


New Rule Requires Drug Price Disclosure in TV Ads
The HHS finalized a rule on Wednesday that will require drugmakers to post the list prices of their products in TV ads. The policy applies to all drugs covered by Medicare that cost $35 or more per month or over the course of treatment. The rule takes effect 60 days after it is published in the federal register. The drug industry might challenge the rule.

“We’re moving from a system where patients are left in the dark to where patients are put in the driver’s seat,” Alex Azar, secretary of health and human services, said in a speech.

The rule makes drug companies more accountable to New York consumers, said Eric Linzer, president and CEO of the state Health Plan Association.

“While breakthrough medications provide tremendous clinical benefits to patients there’s really little understanding of how drug manufacturers establish their prices,” he said.


Severe Alcohol-Related Liver Disease Rising, Possibly Due to Binge Drinking
Severe alcohol-related liver disease is on the rise,” (which) may be due to heavy binge drinking, especially in young adults,” experts posit. For the study, investigators “turned to data from 2001 to 2016 from the National Health and Nutrition Examination Survey (NHANES).” The researchers then discovered that “while there has been little change in the rate of people developing alcoholic fatty liver disease, there appears to be an increase in those who are at greater risk of cirrhosis, liver cancer and death.” The findings of the 34,423-person study were published May 7 in a research letter in JAMA.


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RENTAL/LEASING SPACE


Medical Office Space for Rent!
Beautiful Newly Renovated Medical Office on the Upper East Side between Madison and Park Avenue! Conveniently located near all public transportation and Mount Sinai Hospital. Consult and Exam room available for rent part time or full time (see pictures). Please call 212-860-0300 or email carnegiehill0062@gmail.com for further information.
Pictures of office space for rent on Madison Ave


Park Avenue Medical Office for Sale
On Park Ave, for sale is a large medical office, in a beautiful full service co-op with two entrances, one of which is an impressive doorman in lobby entrance.The office has high ceilings, easily adaptable to any specialty and priced to sell. Three good size rooms easily converted to five exams, plus consult, bathroom, reception and large waiting room. Outstanding location. A must see. View floorplan http://ow.ly/kKOI30o6MjI. Call Jeff Tanenbaum,  646-234-2226 or email jtanenbaum@halstead.com for showings and more information.


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.


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


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


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

PHYSICIAN OPPORTUNITIES

Multi-Specialty Medical Office Looking To Bring On More Doctors
New York Medicine Doctors Center is a multi-specialty Medical Agency networking some of the best medical professionals and specialists in the New York Tri-State area. Our offices currently serve both Manhattan and Queens, providing a variety of advanced technological on site testing, imaging, and services for the most rapid results.

We are actively looking to bring on board an array of Doctors specializing in Primary Care, Gynecology, Gastroenterology, ENT, Urology, Podiatry, and Dermatology.

As we continue to broaden our medical services in both locations, we also provide individualized on-boarding contracts with health benefits, tailored in-house marketing and advertising, practice management assistance, and in house team of administration dedicated in serving any and all concerns whether it be credentialing or equipment related tasks.

If you are interested in joining our growing network, please do not hesitate to contact us

at 718-360-9550 or 212-931-8533. Our direct email is drshusterman@gmail.com

Primary Contact: Oksana


Seeking Executive Director of the Onondaga County Medical Society
Concept:
 An exciting opportunity for the right person to provide leadership for physicians Salary: Commensurate with experience Job Description: Direct day-to-day operations of the Onondaga County Medical Society Some evening meetings, travel required. RequirementsExperience with leading political advocacy; political sophistication. Must know how to interface with government officials. Good networking and communication skills. Conversant with budgets and finance. Excellent media relations skills, including electronic, social media, and written communications. Familiar with medical issues and comfortable discussing them. Education: BA/BS required.  MPH or MBA desirable. We expect innovation and project initiation. The Executive Director will receive a contract that increases remuneration commensurate with membership growth. Application Instructions: Please direct your application to: Dr. Brian Johnson, johnsonb@upstate.edu.


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 April 14, 2019

  AGENDA
Council Meeting – HOD
Sunday, April 14, 2019
                         Westchester Marriott, Tarrytown, NY                    

A. Call to Order and Roll Call

B. APPROVAL of the Council Minutes of March 5, 2019

C. New Business           

President’s Report:

Please welcome our MSSNY Officers, Councilors, Trustees, County Execs,
and MSSNY Staff
  1. APPROVAL – 2019/2020 Meeting Schedule
  2. APPROVAL – 2019/2020 Committee Appointments
     (Future changes only)

D.  Treasurer’s Report – Mark J. Adams, MD
Financial Statements
1/1/19 – 2/28/19 and 1/1/18 – 12/31/18

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

1. Membership Dues Schedule
2. Group Institutional Dues Report

F. Report of the General Counsel, Garfunkel Wild, Barry Cepelewicz, MD, Esq.
APPROVAL Bylaws of the MSSNY Medical Student Section

G. Commissioner of Socio Medical Economics, Howard H. Huang, MD
Interspecialty Committee Minutes, February 28, 2019

H. Commissioner of Communications, Maria A. Basile, MD
 Social Media for Physicians

I.  Reports of Councilors
1. Seventh District Branch Report – Janine L. Fogarty, MD
2. Ninth District Branch Report – Thomas T. Lee, MD
3. Nassau County Report 
Paul A. Pipia, MD
4. Suffolk County Report – Linda S. Efferen, MD
5. Kings and Richmond Report Parag H. Mehta, MD
6. Manhattan and the Bronx Report – Joshua M. Cohen, MD

 J. Adjournment

March 29, 2019 – March Madness

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


MSSNY eNews
March 29, 2019
Volume 22  Number 13

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Colleagues:

Happy Doctor’s Day, tomorrow, March 30! 

On behalf of MSSNY, I want to thank you for your devotion to your patients and our profession.  Your commitment to caring for your patients helps to improve our communities and our society in general.

It’s been a busy week.  I had hoped to spend a little time watching my favorite NCAA teams, the Syracuse Orange, and the University at Buffalo Bulls charge into the Sweet Sixteen of the NCAA Basketball tournament.  Alas, it was not meant to be.  Both suffered crushing defeats accompanied by much wailing and gnashing of teeth by me and the other diehard fans in the Madejski family room.

Marijuana and Science

Proposals to legalize the recreational use of Marijuana continues to be an issue of statewide and national concern.  I have received comments from a few readers questioning why we are spending time on this issue.  I’ve responded to them individually, but thought it might be worth reviewing where we’ve been and where we are going.  To begin with, we are very sympathetic to the goals of many seeking legalization regarding the unfair and arbitrary application of current laws. We agree with the concept of decriminalization.  However, we are spending time on this issue because MSSNY (and the AMA) policy is based on science and advocates for the best care of our patients, and prevention of reasonably avoidable harms to our citizens.  We are very concerned that the push for legalization of recreational marijuana has been funded by an evolving industry that has been given a pass on proper testing of their pharmacological products with regards to usual standards of efficacy and clarification of risk. We are watching Big Tobacco attempt to morph into Big Marijuana before our eyes and create a new generation of users of an addictive product.  This industry has also draped itself in specious arguments that wider access and use will result in a panacea for multiple disease states and economic benefits to state governments.  The emerging data from states that have legalized recreational marijuana is disturbing at best.  Harms are clear, benefits less so.  Most physicians understand the importance of dealing with this complicated substance in a scientific fashion.  Potential harms could be avoided by obtaining better data on the benefits and risks of both medicinal and recreational use. I also want to make clear that we are in favor of decriminalizing marijuana.

New York should use the data from the ongoing state experiments to inform our policy creation in New York with regards to a product with well-defined harms.  Importantly, this means we need to change federal law to reschedule marijuana to allow more, higher quality research to answer the many questions about medicinal and recreational use.

Again, this need to be based on science, not anecdote.

New York is not alone in dealing with this question.  While, there is a furious, well-funded push by the marijuana/ tobacco industry to push recreational marijuana through before our society wakes up to the potential harms, we have our own allies. We have been working with county health officials, PTAs, school administrators, and substance abuse councilors who share our concerns.

If you will forgive my Hamilton reference, we don’t have Laurens, Mulligan and Marquis de Lafayette, but we have reached out to our friends in New Jersey, Connecticut and Delaware .Thanks to Dr. Poole, Dr. Gruss and Dr. Dahlke for their leadership and courage.

New Jersey was scheduled to pass a bill for recreational marijuana this week.  The vote wasn’t taken, in part due to the advocacy of the Medical Society of New Jersey in concert with MSSNY and our allies.  We are hopeful that New York has taken legalization out of its soon to be finalized State Budget, but one never knows until the last Budget bill is passed. Connecticut remains under pressure for a revenue fix which, if based on marijuana as opposed to tolls, will have much greater financial and societal costs down the road.

It is our duty to speak as physicians to evaluate the available information, seek out the answers to the known unknowns, and then speak out on behalf of our patients, fellow citizens, and ourselves. Thanks to all for your contributions to the conversation.

Together we are stronger!

Quicumque damnantur praeteritis memoria repetere

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

Thomas J. Madejski, MD
MSSNY President


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Capital Update

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Legislature, Governor Trying to Finalize State Budget
At press time, while several of the Budget bills were printed, there were still multiple outstanding issues that were complicating a final agreement between the Assembly, Senate and Governor for a State Budget due by April 1. Here is a quick synopsis of some of the top issues being advocated by your Medical Society.

LEGALIZING RECREATIONAL MARIJUANA – Reports were that the legalization of “adult use” or “recreational” marijuana use was not going to be in the final State Budget, as had been urged by MSSNY and several other groups.

EXCESS INSURANCE – Reports were that the historical funding the Excess Medical Malpractice Insurance Program that had been proposed in the Governor’s Budget and supported by MSSNY was to be included in the final Budget.

MEDICAID – There has not been a final determination on several Medicaid proposals, including the proposed $80/patient Medicaid cut for deductibles for patients covered by Medicare and Medicaid that the Assembly and Senate had rejected in its one-House Budgets and strongly opposed by MSSNY.

BEHAVIORAL HEALTH PARITY – There is momentum towards strengthening New York laws that assure comprehensive health insurance coverage for mental health conditions and substance abuse services.   MSSNY working together with the NYS Psychiatric Association supported these proposals. These include provisions that would remove prior authorization for MAT, and strengthening New York’s “gag” laws that provide important legal protections to physicians and other health care providers who file complaints with state agencies about potential insurer violations.

WORKERS’ COMP (see related article)–  The Legislature and Governor reached agreement on a modified proposal that expands the use of certain health care providers in WC that also seeks to address some carrier-imposed barriers to patient care and preserves the historical peer review role played by the county medical societies. MSSNY had raised concerns with this proposal.

OPIOID TAX – Reports were that a revised $100 million tax on opioid manufacturers and distributors would be included in the final Budget.  Earlier this week, MSSNY, the NYS Academy of Family Physicians and the NY Chapter of the American College of Emergency Physicians joined patients, pharmacists and several legislators to raise concerns with the aspect of this proposal that would permit the cost to be passed on to pharmacies, hospitals and, in some cases, patients.

PUBLIC HEALTH– Last week the Senate and Assembly passed legislation to create a Maternal Mortality Review Board (A.3276, Joyner/S.1819, Rivera) instead of acting on the Governor’s Budget proposal. MSSNY supported this proposal.

Instead of including in the State Budget, the Senate has advanced to the floor legislation (S.2833, Savino) to raise the age of tobacco/e-cigarette sales from 18-21. The Assembly recently passed identical legislation on this issue (A.558, Rosenthal). MSSNY supported this proposal.

PBMs – There was progress being made towards the inclusion of language in the State Budget to increase the transparency of financial arrangements made Pharmaceutical Benefit Managers (PBMs), and its connection to health insurer formulary and tier development.

Please stay tuned for further updates.
(DIVISION OF GOVERNMENTAL AFFAIRS)


State Budget to Include Workers Compensation Package
With a new medical fee schedule to begin Monday, April 1 that will provide long-overdue increases to physicians treating their patients covered by Workers’ Compensation (WC), the Legislature and Governor agreed to a WC package of reform in one of the State Budget bills (– pp.16-32) that would expand the types of practitioners who can treat and be reimbursed for treating injured worker patients while at the same time seeking to reduce some of the carrier-imposed barriers to injured workers receiving needed medical care and treatment.

The bill would expressly permit injured workers to receive treatment by Nurse Practitioners (NPs), Social Workers, Physician Assistants (PAs), acupuncturists, Physical Therapists (PTs) and Occupational Therapists (OTs) acting within their statutory defined scopes of practice.  For example, this means that a NP will no longer need to be employed by a physician to provide care to an injured worker.

MSSNY raised concerns during these negotiations regarding the lack of express requirement for some of these professionals to coordinate with a specialized physician for the care of injured workers.  However, that concern was not fully addressed.  We note that the bill would prohibit these newly listed health care professionals from performing Independent Medical Examinations.  It would also specify that Acupuncture, PT and OT care could only be provided pursuant to a referral from a physician, podiatrist or NP, and that the report of a PA, PT, OT or acupuncturist could not be used as evidence to determine that a particular injury or illness is work-related.

Importantly, the bill also contains provisions designed to reduce delays in injured workers receiving needed treatment, and physicians being paid for delivering this care:

  • With regard to the list of pre-authorized procedures required to be maintained by the WCB, a new provision is added to specify that the purpose of this pre-authorized procedures list is for “expediting authorization of treatment of injured  workers” and that it “shall not prohibit varied treatment when the treating  provider  demonstrates  the appropriateness and medical necessity of such treatment.”
  • Expressly prohibiting an employer,  carrier, or third-party  administrator  from attempting to interfere with the selection by the  injured  employee  of an authorized medical provider, including attempting to direct that the injured employee seek treatment from a specific provider or type of provider selected by the employer,  carrier, or third-party administrator.
  • Eliminating the 3-arbitrator panels for review of disputed medical bills, so that every dispute would only need to be reviewed by a single arbitrator in the same profession as the professional bringing the dispute (the arbitrator can continue to be a physician recommended by MSSNY).

Moreover, unlike some previous versions, the budget provision preserves the historical role of the county medical societies to provide to the WCB peer review of physician applications to participate in the Workers’ Compensation program.  It also preserves language that permits a county medical society to designate another county medical society to perform this function on its behalf.  While it reduces from 60 to 45 days the time to review these applications and to make a recommendation to the WCB, it starts the clock upon receipt of a “completed and signed” participation application. The new provisions will take effect January 1, 2020.  There will likely be follow up communications from the WCB regarding how these provisions will be implemented.                                                                      (AUSTER, AVELLA)


Women Matters HOD Seminar


NY State Education and Health Departments Meet with MSSNY on Student Health Form, Progress Being Made
Progress is being made on efforts to reduce some of the hassles physicians have identified with the new student health form. Staff from the New York State Education Department (SED) and the Department of Health met this week with MSSNY physicians and physicians representing the NY Chapter of the American Academy of Pediatrics to discuss revising this form.   This was the second meeting of MSSNY and AAP NY with SED on the school health form.  At this meeting information was provided by staff from SED and DOH indicated that both departments were amenable to the following:

  • All school health forms data would need to be in the same order (yet to be determined), thereby allowing various EHR systems to generate the form instead of having to force a mandated form into the EHR system. There was also discussion about MSSNY and AAP reaching out to physicians about whether their systems would allow for formatting in the designated order.
  • The use of ICD codes would be optional, but would remain on the form
  • An explanation of the heart rate and respiratory rate to recognize congenital heart disease would be placed in the SED cover sheet explaining how the form is to be filled out
  • The last lead level at ages 1 and 2 and whether it was greater than 10 would be identified if known
  • There was also discussion about another school year delay in use of the form until a cover sheet and a final format for the form has been agreed upon.
  • There will be an implementation plan once format and cover sheet is agreed upon.

In 2016, the Board of Regents adopted amendments to the form that required physicians and other providers to use.  However, physicians indicated that the revised form was problematic for complying with their EHR systems.   In September, MSSNY and AAP physicians were able to delay implementation of the form for the 2018-19 school year and SED issued the following letter to schools:  http://www.p12.nysed.gov/sss/documents/HealthRequirements.pdf
Joseph Sellers, MD, incoming Vice President for the Medical Society, moderated the meeting and Gail Schonfeld, MD, from the NYS Chapter of the American Academy of Pediatrics was also in attendance.  Dr. Schonfeld has been working closing with SED to make the health form compatible to EHR systems.   Additional meetings are planned  over the next several months. (CLANCY, AUSTER)


Assembly Passes Measure to Standardize Credentialing and Referrals
Assemblymember Richard Gottfried’s A.3077 passed the Assembly on Tuesday and Senator Julia Salazar’s companion S.4335 is currently in the Senate Health Committee awaiting action. If enacted, the policy would require the creation and use of uniform credentialing, re-credentialing and referral forms for physicians and other providers to use for the purposes of applying for and being maintained on a health care plan’s provider panel and hospital’s staff. The intent of this legislation, which is supported by MSSNY, is to streamline administrative processes, reducing the time physicians and their staff spend on the paperwork and administrative tasks necessary to obtain and maintain participation in an insurer’s network and to refer patients to a specialist.

During credentialing, physicians present documentation of their professional privileges, licensure, evidence of malpractice insurance and malpractice history to such health care plan or hospital for their review.  While many use a shared system, there are still situations where insurers use different forms and methods for credentialing and referrals. A uniform method, created with collaboration from all stakeholders would reduce redundancies and would alleviate some of the cumbersome burdens on physicians and their staff.

For more information, you can watch the Assembly debate at the 01:49:49 mark here.      (AVELLA)


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SED Issues Emergency Regulations to Allow Nurses to Provide Immunizations Under a Non-Patient Specific Script Due to Measles Outbreak
In light of the measles outbreak in New York State, the State Education Department has issued emergency regulations giving nurses authority to provide immunizations pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner.  The nurse needs to be certified in CPR and ensure that anaphylactic agents, syringes and needles are available at the location whether the immunizing agents are being administered.   Currently there a two major measles outbreaks in New York State communities with very low vaccination rates. Thus, it is critical to make such vaccines available to as many children and infants as possible to protect them from this disease. According to the CDC, measles is a highly contagious virus.  The emergency regulations expand access to seasonal influenza and measles vaccines for infants, children and adults effective beginning with the current influenza season and measles outbreaks.

The amendment will authorize more registered professional nurses to immunize infants, children and adults against additional infectious diseases, in accordance with current recommendations from the United States Centers for Disease Control and Prevention (CDC). The emergency rule is set to expire on June 9, 2019 but it is anticipated that the amendment will be presented to the Board of Regents at its regular July meeting for adoption into the normal regulatory process.  A copy of the emergency regulations can be found on page 12 here.                                                                                (CLANCY)


New York AG’s Office Releases Report Detailing Health Care Bureau Intervention in 2018
The New York Attorney General’s Health Care Bureau released a report summarizing the results of its Health Care hotline from 2018.  Specifically, the report noted that the hotline handled nearly 2,000 consumer complaints and another 2,400 were referred to other agencies with appropriate jurisdiction.

Among the notable cases in the report where AG intervention led to a positive result for the patient:

  • A reversal of an insurer Medical Necessity denial for coverage for an Amyotrophic Lateral Sclerosis (“ALS”) medication;
  • A reversal of a denial of coverage for an anti-cancer drug;
  • A Health Plan incorrectly processed coverage for fertility treatments as an Out-of-Network Benefit.
  • A health plan error delays payment for Emergency Surgery.
  • A health plan delay in updating credentials leads to incorrect claim processing
  • An In-Network Ambulance provider improperly bills a consumer
  • A physician improperly coded a “preventive” colonoscopy as “diagnostic”.

Specifically, the report noted that, among the complaints:

  • 41% were related to Provider billing;
  • 15% were related to health plan claim processing/payment complaints, which include health plan mistakes in preparing, processing, or paying claims;
  • 13% were related to health plan denials of care or coverage, such as denials based on the treatment not being “medically necessary” or the care provided not being a covered benefit;
  • 10% were related to misleading advertising and other business deceptions;
  • 9% were related to problems obtaining and keeping health insurance coverage, including helping 216 consumers in having their health insurance coverage re-instated;

6% were related to problems accessing prescription medications.                       (AUSTER)   


Expedited Partner Therapy Bill Passes Both Houses
The New York State Legislature has passed a measure supported by MSSNY that would allow for expedited partner therapy (EPT) for sexually transmitted infections.    A. 2988/S.1799, sponsored by Assemblywoman Rodneyse Bichotte and Senator Gustavo Rivera, would allow EPT when the Centers for Disease Control and Prevention recommend it for the sexual partner or partners of someone having been diagnosed with a sexually transmitted infection.   EPT is currently used for the treatment of Chlamydia Trachomatis and gonorrhea.   EPT has been shown to be highly effective in decreasing infections rates with STIs.  In 2013, the Medical Society of the State of New York House of Delegates passed policy supporting the use of EPT.   The measure will now go to Governor Andrew Cuomo for his approval. (CLANCY)


Association Health Plan Ruling Struck Down in Federal Court
Federal District Court Judge John D. Bates issued a decision this week that struck down a United States Labor Department rule that would have expanded access to Association Health Plans (AHPs) – insurance plans for covering the employees of independent employers that would not be required to conform to ACA mandates, such as essential benefits coverage requirements and annual and lifetime limits. MSSNY and the American Medical Association had joined the New York Attorney General as an amicus to the successful lawsuit that was filed by a group of attorneys general representing 11 states plus Washington, DC. The lawsuit contended that the administration’s ruling violated Affordable Care Act (ACA) and Employee Retirement Income Security Act (ERISA) provisions.

In December, MSSNY President Dr. Thomas Madejski had given the following statement supporting the concept of the AHP rule while also raising strong concerns: “MSSNY supports efforts to expand the availability of health insurance through a wide variety of options, including through increased options for employers to band together to obtain insurance coverage for their employees.  However, we are concerned that these AHP plans authorized in the federal proposal would not be subject to state regulation and enforcement, which could make it difficult to ensure that patients receive coverage for the care they need and physicians to be timely paid for providing this care.”                       (AVELLA, AUSTER)


Measles Outbreak in New York State Continues: Measles Educational Programs Available Online at MSSNY CME Website
The measles outbreak in New York State continues to be one of the worst in recent history.  There have been extreme measures taken in Rockland County where, according to the New York Times, only an estimated 72.9% of the population is vaccinated.  Since October of 2018, there have been 214 confirmed measles cases in the lower Hudson Valley and New York City.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December.  This webinar is available at the MSSNY CME website.  Also be sure to check out The Importance of Herd Immunity, another Medical Matters program that is pertinent to the current measles outbreak.  Please check it out and keep yourself informed about the ongoing measles outbreak in New York State.  You can also have patients listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine at: Click here.                                   (HOFFMAN)


MSSNY CME WEBINAR
Health Matters for Women on Endometriosis Webinar To Be Held April 23. 

The Medical Society of the State of New York is proud to announce a live continuing medical education (CME) webinar on a women’s health topic entitled “Health Matters for Women: Endometriosis” on Tuesday, April 23rd, 2019 from 7:30 AM to 8:30 AM for all physicians and other health care providers. To pre-register for “Health Matters for Women: Endometriosis,” please click here.

Tuesday, April 23rd, 2019
Faculty: Lisa Eng, DO

Educational Objectives:

  • Review potential causes of pelvic pain and discuss how to identify endometriosis
  • Discuss the benefits and risks as well as the efficacy and limitations of available medical therapies for long-term treatment of endometriosis
  • Discuss implementation of individualized endometriosis treatment plans and options

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.

(ULUKAYA)                                                                                   


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CME at MSSNY 2019 House of Delegates
MSSNY is proudly offering the following CME seminars at the 2019 House of Delegates in Tarrytown on Thursday April 11th and Friday April 12th:

Thursday April 11th 1:00-2:00pm:

Medical Matters: What’s Your Diagnosis? Infectious DiseasesRegister here

Faculty: William Valenti, MD

Educational Objectives:

Identify the modes of transmission of infectious agents

Discuss presumptive treatment of infectious diseases in advance of diagnostic testing results

Describe two scenarios and review questions and answers 

Thursday April 11th 2:00-3:00pm:

Veterans Matters: The Special Mental Health Needs of Women VeteransRegister here

Faculty: Malene Ingram, MD, Lt. Col. US Army Reserves

Educational Objectives:

Review how the increased role of women in the military has impacted their mental health

Describe mental health concerns unique to women veterans and how to identify and treat them

Identify the barriers that women veterans face in getting the specific care they need

Friday April 12th 1:00-2:00pm

Health Matters for Women: Myalgic Encephalomyelitis and FibromyalgiaRegister here

Faculty: Florence Shum, DO

Educational Objectives:

Review potential causes of chronic diffused pain and fatigue

Discuss how to accurately diagnose fibromyalgia and myalgic encephalomyelitis

Discuss treatment options for fibromyalgia and myalgic encephalomyelitis

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

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

Friday April 12th 2:00-4:00pm

Improving Maternal Mortality Trends in New York State – Seminar and Panel Discussion – Register here

Faculty: Linda Clark, MD, Lisa Eng, MD, Kenyani Davis, MD & Lauren Tobias, Director, Division of Family Health, NYS DOH

Educational Objectives:

Review maternal mortality trends in NYS

Examine racial disparities around maternal morbidity and mortality

Identify potential practice models to improve patient outcomes 

Friday April 12th 4:00 – 6:00 PM

Physician Wellness: Moving from Resilience to System Culture ChangeRegister here

Faculty: Arthur Hengerer, MD, Maria Basile, MD, Brian White, MD

Educational Objectives:

Understand the impact of organizational attempts to address physician stress

Envision large-scale changes in our health care system that can protect against physician burnout

Participate in needs assessment for institutional intervention strategies

Review survey tools to help measure the health of medical staffs

Identify and prioritize actionable strategies for institutional wellness

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 2.0 AMA/PRA Category 1 creditsä.  Physician should only claim credit commensurate with the extent of their participation in the activity.

Registration Now Open for Medical Matters webinar on April 17, 2019 @ 7:30am

What’s Your Diagnosis? Infectious DiseasesRegister here

Be sure to register for the next Medical Matters interactive webinar, What’s Your Diagnosis? Infectious Diseases  This program will include interactive components for participants.  You will be asked to answer questions about a case and discussion will follow.  Find out if you’re fully prepared to diagnose and treat an infectious disease.

Faculty: William Valenti, MD

Educational Objectives:

Identify the modes of transmission of infectious agents

Discuss presumptive treatment of infectious diseases in advance of diagnostic testing results

Describe two scenarios and review questions and answers

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

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


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NYS DOH Launches Prevention Agenda Website for 2019-2024
The NYS Department of Health has launched its prevention agenda for 2019-2024 and has announced the creation of a new website.  The Prevention Agenda 2019-2024 is the state’s health improvement plan and it is designed to improve the health of New Yorkers.  The Prevention Agenda was developed in cooperation with various stakeholders, including the Medical Society of the State of New York.   This is the third cycle for this statewide plan and MSSNY has been involved since 2008.   The agenda includes five major health areas that include:  1) Prevention of Chronic Diseases 2) Promotion of Healthy and Safe Environment 3) Promotion of Health Women, Infants and Children 4) Promotion of Well-being and Prevention of Mental and Substance Use Disorders 5) Prevention of Communicable Diseases.  A copy of the plan is here and a copy of the goals are here.

MSSNY physicians are encouraged to contact their county health department to determine what the local health goals are the localities and to discuss way that they may engage patients to help improve health.   The DOH Prevention agenda website is here.           (CLANCY)


Senate Finance Committee Moves Purchase Age For Tobacco to the Senate Floor
The NYS Senate Finance Committee has approved and move to the Senate Floor legislation that would increase the purchase age for tobacco products from 18 to 21 years of age.  The measure, S. 2833/A.558, sponsored by Senator Diane Savino and Assemblywoman Linda Rosenthal, has already passed the NYS Assembly.  Governor Andrew Cuomo has also made passage of increasing the purchase age to 21 a priority within in the context of his state budget.  The Medical Society of the State of New York supports this measure.                                                                                                                 (CLANCY)


 

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

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

eNews


 

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Zocdoc Pricing Change; DOH Says Change is Not Illegal nor is It Fee Splitting
At the request of MSSNY, our General Counsel, Garfunkel Wild, P.C., met with the New York State Department of Health (DOH) to discuss DOH’s opinion concerning Zocdoc’s new pricing model scheduled to go into effect on April 1, 2019.

DOH had issued an opinion that Zocdoc’s change in pricing model from charging  customers a flat annual fee, to a reduced annual fee with per booking fees based on physician specialty, does not constitute an illegal referral business or fee splitting under New York law. After that meeting, DOH advised Garfunkel Wild that DOH’s opinion is still valid.

Zocdoc previously advised that it was also seeking guidance on its new pricing model from the federal government. To date, Zocdoc has not advised us that it has received such guidance.

However, Zocdoc had previously advised that it has modified its electronic scheduling platform to not accept appointment requests from patients who self-identify as Medicare or Medicaid beneficiaries. Whether to participate with Zocdoc under its new pricing model remains a business decision for physicians and their practices.  Any MSSNY member who requires specific guidance or has questions should contact MSSNY for further information.


Anthem Accused of Sending Checks to Patients to Force Providers in Network
San Clemente, Calif.-based Sovereign Health is suing Anthem and its Blue Cross entities for sending more than $1.3 million in payments to patients that is allegedly owed to facilities that treated them, according to CNN.

Three things to know:

  1. The lawsuit alleges Anthem is sending payments directly to patients after they seek out-of-network care to pressure providers into joining its network and accepting lower reimbursement, according to the report.
  2. The patients are supposed to send the money to providers, but some patients don’t. Arthur Caplan, PhD, director of medical ethics for New York University’s School of Medicine, told CNN it is “insane” to send reimbursement directly to patients. “I’m enormously surprised that anyone would think this is a doable approach,” he said.
  3. In court filings, Anthem does not dispute that checks are given to patients in some cases for out-of-network care. The insurer argues Sovereign Health’s lawsuit should be dismissed for lack of legal standing. The insurer also argues previous court decisions determined anti-assignment clauses that allow for payments to patients are legal, according to CNN. Becker’s Hospital Review 3/4)

Access the full CNN article here.


AMA: No Meaningful Progress on Prior Authorization
The majority of health plans aren’t “making meaningful progress” on prior authorization reforms, according to a physician survey released by the American Medical Association.

The survey took place in December 2018 and included responses from 1,000 physicians on their experience with prior authorization.
Five key takeaways from the survey:

  1. Just 8 percent of physicians said they work with a health plan that allows some providers to be exempt from prior authorization requirements.
  2. Phone and fax are still the most commonly used methods for prior authorization, according to the physicians. Only 21 percent of physicians said their EHR system completes electronic prior authorization for prescription medications.
  3. Most physicians (88 percent) said the number of drugs that require prior authorization has increased. Eighty-six percent said the same about the number of services requiring prior approval.
  4. Nearly 7 in 10 physicians said they find it difficult to determine if a prescription or medical service requires prior authorization.
  5. Eighty-five percent of physicians said prior approval processes interfere with care continuity.

Register Today for MLMIC’s Risk Management Program – April 11th in Tarrytown
April 11, 2019 at 9:00am
Westchester Marriott Hotel
670 White Plains Road
Tarrytown, NY 10591

MLMIC is pleased to invite you to attend its Risk Management Program on Thursday morning, April 11, 2019, at the Westchester Marriott Hotel in Tarrytown, New York. The program will run from 9:00 a.m. to 12:45 p.m.

This year’s program will address several topics including Top Risks of the Office Practice Setting, Effective Coordination of Hospitalist Care, and High Exposure Liability Cases.

Attendance at this complimentary educational event will enable physicians to earn 3.75 AMA PRA Category 1 CME Credits and provide the opportunity to complete a second component of the program online, at their convenience, to:

  • Earn additional CME credits;
  • Secure a 5% premium credit on their primary insurance policy, and
  • Qualify for participation in the “free” Section 18 excess medical malpractice insurance program.

There is no charge to attend however, pre-registration is required.

REGISTER ONLINE TODAY
Click on the link below to register
www.mlmic.com/2019RMProgram


A Conversation with Assemblyman David Buchwald Friday, April 12 3-5pm in Tarrytown
All are welcome to come learn about the importance of getting involved in physician grassroots advocacy and effective messaging from local Assemblymember David Buchwald representing parts of Westchester County. Assemblymember Buchwald worked to bring ethics reform to Albany through amending the NYS Constitution to include pension forfeiture for public officials convicted of corruption.  Experienced politically active physicians will discuss the many tools MSSNY offers physicians to assist them in engaging in strategic community and state-wide advocacy efforts on behalf of their patients and for the profession of medicine in New York State.  For as long as you will be a physician, local community involvement and grassroots advocacy on behalf of your patients and your profession will be essential.  Event is free to MSSNYPAC members. Download flyer.  Join online at www.mssnypac.org/contribute or donate at the event. RSVP to mssnypac@mssny.org.


CVS Asks 60 Drugmakers to Suspend Drug Price Hikes
CVS Health sent letters to 60 drugmakers asking them not to increase the net costs of their drugs in response to a proposed rule that would overhaul the rebate system, according to an Inside Drug Pricing news report. HHS proposed a rule Jan. 31 that would eliminate rebates — the discounts drugmakers pay to pharmacy benefit managers. The rebate ban, which is expected to be finalized before health plans’ deadline to submit 2020 Medicare bids in three months, would cut profits for PBMs and health insurers.

The ban also would make it hard for insurers to accurately set Medicare Part D premiums.

Medicare plans rely on drugmakers’ existing prices to design plans for the upcoming year, and they would need to redesign those plans if drugmakers increased drug prices.

Rebates also been have been used to keep insurance premiums low, but if rebates are instead passed along to patients at the pharmacy counter, patient premiums could go up.

HHS officials said health plans will do all they can to keep these increases as small as possible.

“In the best possible scenario, this would give the Part D Plans just 26 days to adjust their bids in response to any final rule,” CVS said in a letter to drugmakers, according to Inside Drug Pricing. “We require assurances that, regardless of the issuance of any final rule, you will, at a minimum, honor the financial value of your current offer and continue to provide to the Part D plans the same or lower net effective drug price for calendar year 2020.”


Sign Up for CME Courses at the Westchester Marriott April 11-12
The following is a list of CME courses that will be presented at the Westchester Marriott

You don’t want to miss these! REGISTER NOW at sbennett@mssny.org

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

Protect Your Patients, Your Practice, and You!*

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

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

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

Women in Medicine: Reaching Your Potential Now!**

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

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

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

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

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

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


Calling All IMGs! Symposium on April 18 at Jacobi Medical Center in the Bronx
Essen Health Care will host an IMG Symposium on April 18 from 5-8 pm at Jacobi Medical Center in the Bronx. MSSNY member Parag Mehta, MD, Senior Vice Chairman, Department of Medicine at NYP Brooklyn Methodist Hospital will speak about Pre-Residency Preparation. Other topics include Residency Application and Interview Tips, Primary Care Pathway and Externship Opportunities. RSVP at internship@essenmd.com or by calling 646.876.0141. Click here for more information on the symposium.


MSSNY Officer/ Psychiatrist Speaks About Negative Consequences of Marijuana
WNYC-FM New York (3/25) reported on its website that while New York’s Democrat leaders are pushing to legalize marijuana, opposition appears to be growing. Critics of legalization concede that how the drug is “policed and prosecuted” should change, but also argue that proponents of legalization are ignoring the risks of the drug. For example, Dr. Frank Dowling, a psychiatrist in Long Island, and MSSNY Secretary said, “The consensus is that using marijuana regularly does alter areas of the brain that are involved in cognition and thought processes in memory and learning. And the long-term usage, especially as a teen or young adult, can lead to long-term cognitive issues, even if someone stops using later on in life.”


CMS Annual Survey for Medicare Contractors
CMS is once again conducting their annual survey of Medicare Administrative Contractors (MAC) performance and requesting feedback from the provider community we serve through the MAC Satisfaction Indicator (MSI).The MAC Satisfaction Indicator (MSI) is the best way to share your opinions of our service directly with the CMS. This survey should only take 10 minutes of your time and helps us understand how we can better serve you. To take the survey, click on the URL below:

Jurisdiction K (JK) providers may access the survey by clicking here:

2019 Jurisdiction K MSI Survey


Dr. Anthony P. Santomauro, 89, Former Chief Surgeon at Kenmore Mercy Hospital
Dr. Anthony Patrick Santomauro, retired chief surgeon at Kenmore Mercy Hospital, died March 2 in New Smyrna Beach, Fla., where he had lived for the past 20 years. He was 89. Born in Buffalo, the son of longtime Buffalo restaurateur Anthony V. Santomauro, he was a 1947 graduate of Amherst High School. He earned a bachelor’s degree from Denison University in Ohio and his medical degree from the University at Buffalo.

A vascular surgeon, Dr. Santomauro joined the staff at Kenmore Mercy Hospital in 1963 and retired with emeritus status in 1995. He was president of the hospital’s medical staff in 1977. He also practiced at DeGraff Memorial Hospital in North Tonawanda.

Active in the Medical State Society of New York, he was a former member of its executive board and for seven years was an MSSNY delegate to the American Medical Association. He had been an officer in the MSSNY Political Action Committee since 1993 and served for 14 years as chairman. He was past president of the Erie County Medical Society and the Buffalo Surgical Society.  Survivors include four daughters, Melissa Rush, Mary Pilat, Karen Albert and Susan; a son, James A; 14 grandchildren; and six great-grandchildren. Another daughter, Leslie Ann, died in November. A memorial service will be held at 10 a.m. May 11 in the UB Newman Center, 495 Skinnersville Road, Amherst.


Classified

RENTAL/LEASING SPACE


Bronx Physician’s Office for Sale or Lease
Physician’s running office fully equipped for sale or lease. Effective immediately, retiring, Bronx, near Einstein Hospital, near subway. Call 914-882 3797 / shiva381@yahoo.com


Park Avenue Medical Office for Sale
On Park Ave, for sale is a large medical office, in a beautiful full service co-op with two entrances, one of which is an impressive doorman in lobby entrance.The office has high ceilings, easily adaptable to any specialty and priced to sell. Three good size rooms easily converted to five exams, plus consult, bathroom, reception and large waiting room. Outstanding location. A must see. View floorplan http://ow.ly/kKOI30o6MjI. Call Jeff Tanenbaum,  646-234-2226 or email jtanenbaum@halstead.com for showings and more information.


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.


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


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


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

PHYSICIAN OPPORTUNITIES

Seeking Executive Director of the Onondaga County Medical Society
Concept:
 An exciting opportunity for the right person to provide leadership for physicians Salary: Commensurate with experience Job Description: Direct day-to-day operations of the Onondaga County Medical Society Some evening meetings, travel required. RequirementsExperience with leading political advocacy; political sophistication. Must know how to interface with government officials. Good networking and communication skills. Conversant with budgets and finance. Excellent media relations skills, including electronic, social media, and written communications. Familiar with medical issues and comfortable discussing them. Education: BA/BS required.  MPH or MBA desirable. We expect innovation and project initiation. The Executive Director will receive a contract that increases remuneration commensurate with membership growth. Application Instructions: Please direct your application to: Dr. Brian Johnson, johnsonb@upstate.edu.


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


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


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

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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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

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


MSSNY eNews
March 1, 2019
Volume 22  Number 9

MSSNYPAC Seal

Colleagues:

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

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

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

Rationing by Inconvenience

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

Second Denial

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

Different Day, Same Response

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

Pulling Rank?

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

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

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

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

Medicare for All?

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

Physician Wellness

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

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

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

Come to Albany on Wednesday

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

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

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

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

Thomas J. Madejski, MD
MSSNY President



MLMIC Insurance Banner


Capital Update

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

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

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

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

Advocacy Day reading materials can be found: here.

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

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

(DIVISION OF GOVERNMENTAL AFFAIRS)


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

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

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

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

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

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


State Lobby Day Banner


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

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


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

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

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

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


Medical Jobs Ad

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

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

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

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


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

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

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

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



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


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

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


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

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


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

Register now for:

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

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

Educational Objectives:

Identify core preparedness competencies every physician should know

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

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

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

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


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

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

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

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

Educational Objectives:

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

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

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

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


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

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

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eNews

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

Moe Auster MSSNY, Single Payer Seminar, Westbury David Podwell, MD, Single Payer Seminar, Westbury
Single Payer Seminar, Westbury Single Payer Seminar, Westbury

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


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


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

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

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

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

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

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


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

Five things to know:

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

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


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

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

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

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


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

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

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

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

REGISTER HERE

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

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

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

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

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

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

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


CME PROGRAMS

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

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

Protect Your Patients, Your Practice, and You!*

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

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


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

Women in Medicine: Reaching Your Potential Now!**

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

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

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

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

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

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


Classified

RENTAL/LEASING SPACE

 

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


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


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


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


PHYSICIAN OPPORTUNITIES

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


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


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

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



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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Council – March 5, 2019

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

 

A. Call to Order and Roll Call

B. APPROVAL of the Minutes of January 24, 2019

C. New Business (Informational/Action Items)

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

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

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

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

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

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

7. MESF Update – No written report submitted

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

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

DReports of Officers

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

E.  Presentations

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


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

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


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


F.
  Reports of Councilors (Informational Items)

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

G.  Commissioners (Informational Items)

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

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

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

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

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

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

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

K. Other Information/Announcements 

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

L. Adjournment

 

 

 

 

 

Feb. 8, 2019 – Women and Children First!

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


MSSNY eNews
February 8, 2019
Volume 22  Number 6

MSSNYPAC Seal

Colleagues:

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

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

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

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

You can follow me on twitter@tommadejski

lux, veritas, virtuslegis plenitudo charitas

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Thomas J. Madejski, MD
MSSNY President



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Capital Update

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

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

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

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

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


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

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

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

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

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


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

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

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

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

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


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


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


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


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

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

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


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

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

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

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

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


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

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

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

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

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


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

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


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

Registration is open for this program please click Here.

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

Educational Objectives:

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

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

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

(DIVISION OF GOVERNMENTAL  AFFAIRS)


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

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

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



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

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

eNews

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

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

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

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

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


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

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

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

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


 


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

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

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

Join us to urge your legislators to:

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

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

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


NY County President Dr. Van De Walle Welcomes Legislators

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

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

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

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


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

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

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


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


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


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

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

NEJM article

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