October 4, 2019: MSSNYeNews – The New Reefer Madness

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

October 4, 2019

Vol. 22  Number 37



Money, it’s a gas
Grab that cash with both hands and make a stash.”
-Roger Waters

Albany’s legislative season is almost upon us and that means the full court press for legal “adult-use” cannabis will be on. Governor Cuomo said as much, stating that he would be traveling to Connecticut and New Jersey to work on creating regional symmetry when it comes to legalizing recreational marijuana.

Today, I received an email which urged legalization to produce revenues sufficient to care for the homeless – clearly a laudable goal. Hold that thought – more in a moment.

Despite the opposition from law enforcement, county health officials and PTA’s, what’s the allure? Right – Money.

Legal cannabis has meant a veritable bonanza for state governments, with an estimated over $2 billion in cannabis sales for California. This, of course, has come at a different sort of price for citizens with legalization. There are indeed health risks, especially for two groups – children and pregnant women. When marijuana is in the home, especially in edible form, kids end up in emergency departments all too often. And we are not talking about Woodstock era pot either. Today’s product is often so potent, Tommy Chong might have issues. And then there’s pregnancy. There is sufficient evidence to warrant concern on the effects of THC on the developing brain. Yet in Colorado, almost two-thirds of dispensaries called were found to recommend cannabis for nausea and vomiting during pregnancy. This is clearly more than troubling.

Oh yes, and the homeless? it turns out that Colorado locals reported a serious increase of homeless in their neighborhoods. It appears that as in Oregon, Washington and California, transients tend to migrate to places that let them smoke legally. So that money will surely come in handy.

Oh, and the black market appears to do very nicely despite ample legal supply. Also, depending on the limits for personal use, the thought of the return of the Revenuers from the days of prohibition is not idle musing. Finally, given the vape lung situation, if vaporizer product is restricted or proscribed, the black market may be quite robust indeed. And again, those gummy bear edibles are hard for children to resist either.

This promises to be an interesting session indeed.

The last word, I leave to Barrett Strong.

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

Arthur Fougner, MD
MSSNY President

MLMIC Insurance Banner Ad


Physicians Welcome to Provide Public Comments on DSRIP at 10/30 Syracuse Public Forum
The New York State Department of Health (NYSDOH) will be holding a Public Comment Day for New York’s 1115 waiver program on October 30th 2019 at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.   The open comment period will be from 11am to 2pm.  In addition to public testimony, written statements may be submitted to 1115waivers@health.ny.gov through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

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

Background on the DSRIP Program

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

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

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

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

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

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

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

Click Here to view the full letter!

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

Recently, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.  Moreover, it noted that there were a total of 2,595 IDR decisions reached, an extremely low number considering that there are over 7 million Emergency Department visits in New York every year.

While MSSNY together with physician groups across the country are working diligently to refute the lies and half-truths expressed by the insurance lobby, more physician advocacy is urgently needed. MSSNY leadership and physician advocates have been meeting with key members of Congress to advocate for passage of legislation that emulates New York’s successful model, such as H.R.3502, sponsored by Representatives Ruiz and Roe.

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

Furthermore, NY DFS Superintendent Linda Lacewell touted the success of New York’s law in a Daily News op-ed this week.  And MSSNY joined several other northeastern state medical societies in a statement urging Congress to enact the right solution to address surprise medical bills.

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

Lobby Day Banner

Physicians: When to Seek Specialist Support for Transgender Patients
Endocrine News (10/1) reports that even though “endocrinologists are fairly well versed in caring for transgender patients, primary care physicians need to better understand their roles and know when to seek the counsel and support of specialists.” In 2017, “the Endocrine Society published a Clinical Practice Guideline on the treatment of gender dysphoric/gender incongruent persons,” but “primary care physicians need to know when to seek the support of specialists.” Just this “past July, Joshua D. Safer, MD, and Vin Tangpricha, MD, PhD, of the Mount Sinai Health System and Icahn School of Medicine at Mount Sinai in New York, N.Y. and the Emory University School of Medicine and Atlanta VA Medical Center in Atlanta, Ga., respectively, published a review in Annals of Internal Medicine” that “details the specific medical issues this population faces.”

DFS Superintendent: Do Not Buy Junk Health Insurance
New York State Department of Financial Services Superintendent Linda Lacewell reminded New Yorkers to file a complaint with the state if they believe they purchased junk insurance. “We know that so-called Trumpcare — or however else these short-term plans are marketed — is nothing more than a ploy to convince Americans to buy junk insurance,” she said. “These plans often fail to cover basic services and end up making health insurance more costly for consumers, and the fact that such junk insurance is allowed for sale anywhere in the US is an unfortunate product of the current federal administration’s continual dismantling of basic protections for Americans seeking quality and affordable health care.”

End Surprise Billing Banner Ad

Judge OKs First Site in Philadelphia Where People Can Use Illegal Opioids
A judge has ruled that a Philadelphia nonprofit group’s plan to open the first site in the U.S. where people can use illegal opioids under medical supervision does not violate federal drug laws, delivering a major blow to Justice Department lawyers who have been working to block the facility.

U.S. District Judge Gerald McHugh ruled Wednesday that Safehouse’s plan to allow people to bring in their own drugs and use them in a medical facility to help combat fatal overdoses does not violate the Controlled Substances Act.

Prosecutors had contended that the plan violated a provision of the Controlled Substances Act that makes it illegal to own a property where drugs are being used — known as “the crack house statute.” But backers of Safehouse argued the law was outdated and not written to prevent the opening of a medical facility aimed at saving lives in the midst of the opioid crisis.

The decision means that America’s first supervised injection site, or what advocates call an “overdose prevention site,” can go forward. Justice Department prosecutors had sued to block the site, calling the proposal “in-your-face illegal activity.”

The ruling may pave the way for New York to open five supervised injection facilities, New York City Council Member Mark Levine said. The Cuomo administration has been slow to approve a pilot program that would establish four sites in New York City and a space in Ithaca that gives people a safe space to use drugs amid threats of prosecution from the Department of Justice. New York State Health Commissioner Howard Zucker cited those threats from the federal government in February as the reason for the holdup. The new court decision should remove that hurdle, argued Levine,
the Council’s Health Committee chairman.  (WSJ, Oct.3)

NY First State to Offer Anonymous Whistleblowers Report Govt. Misconduct
New York, on Wednesday, became the first state to offer whistleblowers an anonymous electronic platform to submit tips about government misconduct. Through a new online portal, the state attorney general’s office will oversee shielded communications with whistleblowers who submit allegations of illegal or fraudulent behavior. The system is run through the downloadable TOR browser, which protects a person’s identity and location.

A spokesperson for the attorney general said the browser prevents officials from knowing a person’s name or location unless they submit a document or other evidence that may somehow identify them. They contend the complaints filed through the portal also would not be subject to disclosure under the state’s Freedom of Information Law due to law enforcement and privacy exemptions.

However, any law enforcement exception blocking the public disclosure of a complaint could be voided in cases where an investigation is closed or leads to an arrest. The privacy exception also may not apply to complaints that target agencies or corporations, rather than individuals.

In New York, whistleblowers can also submit complaints to the attorney general’s office through an online form or traditional mail or e-mail. (Times Union, 10/2)

CPH Banner

Heads Up: Beware of Scam Calls from the “NY DEA” Demanding Information
Shirley Cosgriff, Executive Director of Broome, Delaware Otsego & Tompkins Counties alerted MSSNY that she received at least 3 phone calls asking directly for one of our physicians or one of our CRNA.  When I questioned what the call was about I was told it was the NY Licensure division of the Department of Education…They informed me that if I could provide them with the doctor’s Social Security #, License number, DEA number and date of birth, they would be able to verify if they had the correct provider that’s license was in question.

I asked if I could return their call and they gave me a phone of 804-293-0309.  I called this number back, and was told it was “NYS DEA” and I had to provide the providers information in order to talk with a representative. I questioned why they were the NY DEA, when DEA is a federal organization.

They hung up.”

From MSSNY VP of Socio-Medical Economics Division Regina McNally: “I Googled the phone number and see that it has been used in SC and Florida.  I have notified the NYSED, MSSNY leadership, the counties and our communications division.  This needs to be shared with physicians and their staff so these wicked people don’t succeed.”

Clinicians Still Waiting for 2017 Advanced APM Bonuses
About 90,000 clinicians who participated in advanced alternative payment models in 2017 are concerned that they haven’t received bonuses from the CMS. Advanced alternative payment models, also known as advanced APMs, were created under MACRA in 2015 and offer an opportunity for clinicians to receive a 5% bonus to their Medicare payments if they participate. It requires clinicians to take on significant downside risk. The CMS said it would provide the positive payment adjustment in 2019 to eligible clinicians who participated in 2017. But providers are worried the bonuses still haven’t been distributed. In a letter Tuesday to CMS Administrator Seema Verma, nine provider groups, which include the American Medical Association and the National Association of ACOs, claim the bonus payments are delayed and it’s unclear why.
(Modern Healthcare, September 17, 2019)

CMS Penalizes 2,583 Hospitals for High Readmissions: 5 Things to Know
In fiscal year 2020, CMS will penalize 2,583 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data released Sept. 30 cited in a Kaiser Health News report.

This is the eighth year of the Hospital Readmissions Reduction Program. To determine penalties for fiscal 2020, CMS examined hospitals’ 30-day readmission rates for patients who had originally been treated for the following conditions: heart failure, heart attack, pneumonia, chronic lung disease, hip and knee replacement or coronary artery bypass graft surgery. Scheduled readmissions were not counted.

CMS used patient data from July 2015 through June 2018 to determine the penalties. The agency compared each hospital’s reported readmission rate to national averages for each of the conditions to determine the penalties. (Beckers Hospital Review, Oct 1)

Here are five takeaways from the Kaiser Health News analysis:

  1. Eighty-three percent of the 3,129 hospitals evaluated received a penalty.
  2. CMS will cut payments to the penalized hospitals by as much as 3 percent for each Medicare case during fiscal 2020, which runs Oct. 1 through September 2020.
  3. Fifty-six hospitals were hit with the maximum penalty. The average penalty will be a 0.71 percent payment cut for each Medicare patient.
  4. Though 64 hospitals received the same penalty as the year prior, 1,177 hospitals received a higher penalty and 1,148 hospitals received a lower penalty.
  5. In fiscal 2020, CMS will withhold an estimated $563 million in Medicare payments to hospitals under the Hospital Readmissions Reduction Program.

Access the full Kaiser Health News article here.

Criticism re CMS’ Proposal to Require Hospitals to Disclose Negotiated Prices
Modern Healthcare (9/30) reports hospitals and health insurers are criticizing CMS’ “proposal to make hospitals publicly post payer-negotiated rates for medical services would be bad for business and patients.” The article says that “hospitals also asked the CMS to rethink reimbursement cuts to 340B hospitals and for outpatient clinic visits.”


RSVP Now for Veterans Matters: PTSD & TBI at the New York County Medical Society
The Medical Society of the State of New York and the New York County Medical Society are proud to announce Veterans Matters: PTSD & TB in Veterans scheduled for October 10th 2019 at 5:30pm at the Manhattan Eye, Ear & Throat Hospital (MEETH).  It is suggested that people arrive early for the opportunity to sign-in and grab refreshments. Early arrivers will also have the opportunity to sit in on the brief meeting of the New York County Medical Society’s Public Health Committee.

Veterans Matters: PTSD & TBI in Veterans

Where:         MEETH
                     210 East 64th St.
                     Manhattan, NY 

When:          Thursday October 10, 2019 5:30-8:15pm
Faculty:        Adolph Meyer, MD

Educational Objectives:

  • Identifying signs and symptoms of PTSD & TBI
  • Examining evidence-based treatment modalities
  • Exploring military culture and methods to overcome barriers to treatment.

RSVP to Lisa Joseph at (212) 684-46-98 or email ljoseph@nycms.org 

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

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

“Influenza 2019-2020” CME Webinar on October 16; Registration Now Open
The first of MSSNY’s 2020 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2019-2020” on Wednesday, October 16, 2019 at 7:30 a.m.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here. To view the flyer for this program, please click here.

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

Educational objectives are:

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

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. 

Scrubs Banner Ad

October 17 DOH Grand Rounds Series: Strengthening Community and Health Care Provider Resiliency to Adverse Childhood Experiences
The 2019-2020 Commissioner’s Medical Grand Rounds series, Strengthening Community and Health Care Provider Resiliency to Adverse Childhood Experiences. The session will take place Thursday, October 17th from 12 noon-2 pm. Please see the attached flyer.

Participants can join online via webcast or in-person at UHS Binghamton General Hospital in Binghamton, New York. As with all DOH Grand Rounds, the session is free of charge.

If you have any questions, contact Susannah Feinstein or Sam Meyer, Student Assistants: Office of the Commissioner at 212-417-4975 or 212-417-4341.

CDC: Vaping Illness Cases Tops 1,000



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

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


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