Tag: eNews

MSSNY eNews: NYU’s Bold Step

 

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

Thomas J. Madejski, MD
MSSNY President

MSSNY eNews
August 24, 2018
Volume 20  Number 31
MSSNYPAC

Dear Colleagues:

When NYU School of Medicine announced last week that it will offer full tuition scholarships to all new, current and future students, it signaled a potential game-changer for the future of medical education in this country.

NYU Medical School students will graduate and move into residency with the ability to choose a path based on their passion—which might include research, family medicine or pediatrics—rather than choosing a more lucrative specialty in order to pay back loans. NYU will also benefit from an increasingly competitive applicant pool.  Hopefully, this will translate into new research initiatives and improved access and health outcomes for patients in the years ahead.

Presently, some residents may choose a specialty based on future income potential because of their massive loan debt. I don’t think that is a consideration for most students when they enter school, but has to be part of the equation for choosing a specialty as the bills pile up. According to the Association of American Medical Colleges, three out of four medical school graduates in 2017 graduated in debt—with the median amount at $192,000.

MSSNY and the American Medical Association both have concerns about the indebtedness of medical school graduates affecting their choice of specialty, as well as practice location.  While it is reasonable to postulate that reduced or no tuition will free medical students to follow their passion, the impact of loan forgiveness programs to date is less than compelling.

I practice in a rural, underserved area in upstate New York.  While New York State and the Federal government have a number of programs to entice physicians to practice in underserved areas, it is unusual to have a participant in those programs stay long term.

Studies that look at the long term effects of loan forgiveness are challenged to demonstrate any long term positive effect.  Having some of these gifted clinicians practicing in underserved areas is good for the community but, as demonstrated  by the decline in practitioners and small hospitals in rural areas in upstate New York, has not had a long lasting impact.  Nonetheless, every one of these physicians who stays long term is critical to maintain access and improve the health of their community.

The NYU initiative is a bold step in the right direction towards solving the long-standing issue of onerous and out-of-control medical school debt. Personally, I am skeptical that it will have a major effect on specialty choice as debt is just one of many factors in choice of specialty.  Will it help to improve access to care and health of our communities?  Is the $600 million cost of the program money well spent?  How will other medical schools respond to the NYU initiative?

Please share your thoughts and comments with me at comments@mssny.org.


Thomas J. Madejski, MD 
MSSNY President

eNews

MSSNY Testifies in Support of Transaction to Bolster Financial Stability of MLMIC
MSSNY Executive Vice-President Phil Schuh testified in support of MLMIC’s acquisition by Berkshire Hathaway, during a New York Department of Financial Services hearing this week examining the proposed transaction.  Mr. Schuh noted that “MLMIC’s alliance with Berkshire Hathaway will fortify its finances and enable MLMIC to continue its mission to assure physicians, dentists and hospitals have access to quality medical malpractice insurance coverage and risk management services long into the future”.

If the proposed transaction were to be approved, MLMIC policyholders between July 15, 2013 and July 14, 2016 would be eligible to receive approximately 1.9 times the amount paid in premiums over that time period.

Mr. Schuh’s testimony also urged that DFS assure that there is a strict deadline for release of the funds following the closure of the transaction after approval. Specifically, he urged that there be a prompt resolution to situations where a Policy Administrator (such as a health system or physician group) believes it has a legal right to payments otherwise due to the physician policyholder because it had paid premiums on behalf of that physician policyholder.  He noted that “some physicians have expressed concerns that entities with enormous resources at their disposal could coerce a physician to give up their statutory right to these proceeds because of the fear of excessive litigation costs.   He suggested that DFS impose a condition on the conversion approval “to assure a strict deadline for release of the funds from escrow following the closure of the transaction, whereby the funds will be awarded to the policyholder at the conclusion of such period if the process for resolving the dispute has not yet been completed.”


Governor Urged to Sign Legislation to Require Greater Transparency of Insurer Compliance with Mental Health & SUD Parity Laws
Physicians are urged to send a letter to the Governor requesting that he sign into law legislation (S.1156-C, Ortt/A.3694-C, Gunther) which directs the NY Department of Financial Services (DFS) to collect certain key data points and elements from health insurers in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws. A letter can be sent from here.

MSSNY, working together with the New York State Psychiatric Association and other specialty societies, had strongly supported this legislation as it passed the Legislature nearly unanimously.  While many physicians weighed in with their legislators in support earlier this year, advocacy should now be directed to the Governor’s office in support of this important measure.

If signed into law by the Governor, the information collected would be analyzed and used for the preparation of a parity compliance report that would be contained within in the annual “Consumer Guide to Health Insurers” issued by the DFS. Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, recent Attorney General settlements note that there continue to be patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services.  The goal of the legislation is to better ensure compliance with these laws.


Photos from the MSSNY Booth at the Great New York State Fair
The Great New York State Fair is now underway in Syracuse (August 22-September 3). Come Visit the MSSNY booth in the Hall of Health outside gate #2!

 

Karen Jonas from Central New York Care Collaborative (left)
and Dr. Joseph Maldonado (right) 

Dr. David Page checks blood pressure at the MSSNY Booth


Attention: Guide to Timely Filing is Now Available
The “Guide to Timely Billing” presentation being used by the Department of Health for its August webinar series has been posted to emedny.org. Click here to view the PDF. For more information, contact 1-800-343-9000 or emednyalert@csra.com

Emblem Notified Its Network of A New Policy on July 19 re Modifier 25
The “Guide to Timely Billing” presentation being used by the Department of Health for its August webinar series has been posted to emedny.org. Click here to view the PDF. For more information, contact 1-800-343-9000 or emednyalert@csra.com.

Modifier 25 with Evaluation and Management Services Reported with Procedures

Date Issued: 7/19/2018

Modifier 25 is used to describe a significant, separately identifiable evaluation and management (E/M) service that was performed at the same time as a procedure.

Beginning October 30, 2018, our current coding policy will apply to GHI plans regarding E/M services billed with modifier 25 within 28 days of a previous face-to-face service. The E/M service will be denied when both of the following apply:

  • The E/M service (92002-92004, 92012-92014, 99201-99380, 99441-99499) is billed with modifier 25 on the same day as a procedure with a 0-day, 10-day, or 90-day postoperative period.
  • The patient has had a face-to-face service with the same provider for the same condition as the E/M service, and the 0-day, 10-day or 90-day procedure within the previous 28 days.


Face-to-face service codes included in this medical policy: 10021-36410, 36420-44680, 44800-69990, 90935-90993, 92002-92371, 92502-92504, 92511, 95831-95852, 96365-96379, 96405-96406, 96440, 96450, 96542-96999, 97597-97755, 97802-98943, 99100-99170, 99201-99285, 99291-99337, 99341-99357

After members questioned MSSNY about the veracity of this policy change, MSSNY questioned the plan.  Their Medical Director responded, as follows:

“As per the definition of Modifier 25, if there is a significant separate and distinct problem, not associated with a procedure performed or during the global period for a prior procedure, then the physician should appeal the determination by providing the appropriate documentation that substantiates the additional billing.”

                                                                    Regina McNally, MSSNY VP Socio-Med


New York Ranks Second Among States in Healthcare Spending
The Poughkeepsie (NY) Journal (8/22, Robinson) reports New York spent $57.6 billion, or about $3,000 per person, on healthcare in 2015, the second-highest total in the nation, behind New Mexico, according to a new study. The biggest driver of healthcare costs is Medicaid, accounting for about 80 percent of annual state health costs. More than six million New Yorkers are enrolled in the program, approximately one third of the state’s population. The state’s healthcare spending, however, “doesn’t appear to be translating into better quality,” as it “recently was ranked the 17th best health care system in the country based on cost, accessibility and medical outcomes.”

 

NEW MEMBER BENEFIT

Join MSSNY’s Member Perks Program and Enjoy $4,500 in Savings!
MSSNY is pleased to announce our newest member benefit!  Our new Abenity App provides members with exclusive perks and over $4,500 in savings on everything from restaurants, City Pass, AMC movie tickets, theme parks, hotels, car rentals, mortgage savings, auto care and much more!

Popular Features Include:

  • Nearby Offers: Use our show and save mobile coupons to quickly access savings on the go.
  • eTickets On Demand: Save up to 40% with no hidden fees.
  • Showtimes: Find movies, watch trailers, and save up to 40% at a theater near you.
  • Monthly Giveaways: Win cash, movie tickets, electronics and more with our monthly contests.

And, with over 302,000 available discounts across 10,000 cities in the United States and Canada, you’ll never be far from savings!

REGISTER & LOG IN:

    • Click on the following link: http://mssny.abenity.com
    • Create a unique user name and password
    • Visit the App Store and download the Abenity App
    • Begin Saving!

 

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RENTAL/LEASING SPACE

 

Rare Find — Great Office Share
Wonderful office share in terrific location at great price. 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) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

Upper East Side Plastic Surgery Office Available for Rent Part Time
Located in posh Carriage House off Park Avenue with fully certified operative suite (AAAASF). OR can be rented separately.  OR Packages available for multiple case use. Please contact 212-628-7600between 11am and 6pm for further information.

Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with director@manhattanspine.com www.manhattanmd.com

Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical office, shared your office space, buy 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

Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated.  The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services.  The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee.  The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review.  The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff.  The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.

Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, 

or by email to resume@health.state.ny.us with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.

Physicians Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology startup 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 compensated for their participation, which requires only a few hours annually.

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

Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews: April 6, 2018 – Difficult NYS Budget Passes

 

Thomas J. Madejski, MD MSSNY President

PRESIDENT’S MESSAGE
Thomas J. Madejski, MD
MSSNY President
April 6, 2018
Volume 18
Number 13

Dear Colleagues:

Nearly 75 percent of practices do not like the technology they use for the most part. This is according the 2017 Annual Physicians Practice Technology Survey, which looks at the usage of technology at the practice level from more than 500 (mostly independent) practices across the country.

According to the survey, only 12.6 percent of practices have used telemedicine. About six years ago, one of the physician executives of United Healthcare gave a presentation regarding telemedicine to the MSSNY Council. When the Power Point concluded the Councilors were silent. Then, the outrage flowed freely with several physicians commenting that telemedicine violated every code of ethics including the Hippocratic Oath.

Well, telemedicine is here to stay and many physicians are interested in integrating it into their practices as a patient convenience, especially in rural areas. MSSNY has been working with telemedicine expert Peter Caplan for two years as a source for our physicians who are interested in adopting this technology into their practice.

Mr. Caplan’s Telemedicine Resource Guide was created to assist MSSNY members in navigating the telemedicine service industry. Its purpose is to provide physicians with information about companies that either:

  • Recruit physicians to be part of a regional/national provider network offering direct-to-consumer tele-consults (a monthly subscription vs. fee-per-call or a hybrid of both models) that are available as part of an employer health plan or as an independent, standalone service paid by the individual employee
  • Sell practice-based turnkey solutions (hardware, software, network connectivity, videoconferencing services, peripheral devices and vital sign monitors) used by physicians offering a customized and branded telemedicine program to their own patients. Click here for the Telemedicine Resource Guide (Excel)

If we can better understand and integrate the use of telemedicine as part of a patient management strategy to improve care, increase access to treatment, reduce transportation costs, and more effectively engage patients who are not able to get to a physician’s practice location, we will have created real value for patients and their physicians.

MSSNY’s Telemedicine Task Force continues to review options for our members to consider for the addition of telemedicine into their practices to enhance patient care.  I think it is critical we continue to review the evolving landscape of telemedicine options to the benefit of our patients.  We also need to review what type of care is not appropriate for a telemedicine program and ensure the safety of patients.

Proper integration of telemedicine will enhance the care of our patients and limit the intrusion of non-physician retailers like CVS and WalMart and their potential interference in the physician patient relationship.

I’d appreciate your thoughts.  Send your comments to csouthard@mssny.org

Thomas J. Madejski, MD 
MSSNY President

 

HIT MLMIC Symposium

eNews

State Legislature Completes Passage of Difficult Budget that Rejects Several Items Opposed by MSSNY
As reported last week, the New York State Legislature recently completed passage of a $168 Billion State Budget that closed a $4.4 Billion Budget deficit.    Importantly, the final adopted State Budget rejected numerous proposals of great concern that MSSNY together with specialty societies and other allies had been advocating against, including:

  • Independent practice authority for CRNAs
  • Authorization for corporate-owned retail clinics;
  • Steep Medicaid cuts to the Patient-Centered Medical Home program;
  • Elimination of “Prescriber prevails” protections for prescriptions for patients covered by Medicaid;
  • Overbroad state powers to penalize physicians and other health care providers for Medicaid billing errors
  • Authorization for patient drug management protocols between Nurse Practitioners and pharmacists.  Instead, there was a 2-year extension of the current Collaborative Drug Therapy pilot program (between physicians and pharmacists) that MSSNY supports;
  • Authorizations for EMTs to provide non-emergency care in patient homes without any express coordination requirement with that patient’s treating physician;
  • Provisions which would have reduced from 7 days to 3 days the length of an initial prescription for acute pain.  The final bill did include a requirement, consistent with CDC Chronic pain guidelines, for a prescriber to have a written treatment plan that follows generally accepted professional or government guidelines for a patient on opioid medications longer than 90 days or past the time of normal tissue healing;
  • Significant expansion of the DOH’s Commissioner’s power to investigate physician misconduct, including provisions that would have a) greatly reduced the time to respond to document requests and b) expanded the power to search and seize records and equipment.  The final bill did include a provision to permit the Commissioner to summarily suspend a physician who is both been charged with a felony crime and believed to be an imminent danger to the public as determined by the Commissioner;

At the same time, the final Budget included the following items supported by MSSNY:

  • Continued funding for the Excess Medical Malpractice Insurance Program at the historical level.
  • A new $150,000 allocation for the MSSNY’s Veterans Mental Health Initiative;
  • Reducing some of the insurance barriers to substance abuse treatment
  • Consistent with policy recently adopted at the MSSNY Council, prohibiting PBMs from disclosing to patients drug cost options that may be less than what is specified in their insurance
  • Continued historical funding and a 5-year extension of the MSSNY Committee for Physicians Health until 2023.

Thank you to all the physicians who took the time to make phone calls, send letters, or meet with their local legislators over the last few months to advocate on all these issues.  Certainly, our success on these fronts is in large part due to these extensive grassroots efforts.  However, we can’t exhale just yet – many of these proposals will continue to be raised during the remainder of the legislative session.

 

DEA Warns Public of Extortion Scam by DEA Special Agent Impersonators
The Drug Enforcement Administration is warning the public about criminals posing as DEA Special Agents or other law enforcement personnel as part of an international extortion scheme.

The criminals call the victims (who in most cases previously purchased drugs over the internet or by telephone) and identify themselves as DEA agents or law enforcement officials from other agencies. The impersonators inform their victims that purchasing drugs over the internet or by telephone is illegal, and that enforcement action will be taken against them unless they pay a fine. In most cases, the impersonators instruct their victims to pay the “fine” via wire transfer to a designated location, usually overseas. If victims refuse to send money, the impersonators often threaten to arrest them or search their property. Some victims who purchased their drugs using a credit card also reported fraudulent use of their credit cards.

Impersonating a federal agent is a violation of federal law. The public should be aware that no DEA agent will ever contact members of the public by telephone to demand money or any other form of payment.

The DEA reminds the public to use caution when purchasing controlled substance pharmaceuticals by telephone or through the Internet. It is illegal to purchase controlled substance pharmaceuticals online or by telephone unless very stringent requirements are met. And, all pharmacies that dispense controlled substance pharmaceuticals by means of the internet must be registered with DEA. By ordering any pharmaceutical medications online or by telephone from unknown entities, members of the public risk receiving unsafe, counterfeit, and/or ineffective drugs from criminals who operate outside the law. In addition, personal and financial information could be compromised.

Anyone receiving a telephone call from a person purporting to be a DEA special agent or other law enforcement official seeking money should refuse the demand and report the threat using the online form below. Please include all fields, including, most importantly, a call back number so that a DEA investigator can contact you for additional information. Online reporting will greatly assist DEA in investigating and stopping this criminal activity.

 

Complimentary Webinar by MSSNY Counsel Garfunkel Wild: How to Handle Medicare and Medicaid Overpayments

Friday, April 20, 201812:00 PM – 1:00 PM EST

Providers who identify Medicaid or Medicare overpayments have a legal obligation to timely report, return and explain the overpayments.  Knowing how to appropriately handle Medicare and Medicaid overpayments is both necessary and an essential part of an effective compliance program.

 This complimentary webinar will:

  • Educate providers on the applicable laws
  • Discuss the various mechanisms that exist for returning overpayments to the government
  • Provide practical ideas for how best to report, return and explain identified overpayments

Click Here To Register

After registering, you will receive a confirmation email containing information about joining the webinar.

SYMPOSIUM

Register Now For 2018 NY HIT Symposium on Sat. April 28 in Brooklyn

When: Saturday, April 28, 2018 8:30 a.m. – 3:00 p.m.
Where: Brooklyn Borough Hall
209 Joralemon St.
Brooklyn, NY 11201

Please join us as we examine potential risk management issues with EHR technology.

  • Liability pitfalls in EHR documentation
  • Fraud risks in documenting encounters
  • Privacy, security, and confidentiality in EHR technology


The HIT Symposium is designed for physicians in all specialties.

Click here to register.

Supported by MLMIC and MSSNY

CME

“Current Concepts in Concussion for Pediatric and Adult Patients” CME Webinar on April 12, 2018, Registration Now Open
The Medical Society of the State of New York will hold a free Continuing Medical Education (CME) webinar on the “Current Concepts in Concussion for Pediatric & Adult Patients” on Thursday, April 12th at 12:30pm.

Register for this webinar here.

Faculty: Deborah Light, MD & John Pugh, MD, PhD

Educational Objectives:

  • Identify signs and symptoms indicative of concussion as well as red flags that indicate alternate or more severe pathology;
  • Outline an appropriate management plan for a patient presenting with concussion including a return to “normal life” protocol;
  • Describe methods for the primary and secondary prevention of concussion;
  • Identify patients who would benefit from referral to a concussion specialist


“Plague & Q Fever” CME Webinar on April 18, 2018; Registration Now Open
Upcoming in MSSNY’s Medical Matters continuing medical education (CME) webinar series is: “Plague & Q Fever”.  This webinar will take place on Wednesday, April 18, 2018 at 7:30 a.m. Faculty for this program is Kira Geraci-Ciardullo, MD, MPH.

Register for this webinar here.

Educational objectives are:

  • Describe the epidemiology of Plague and Q Fever
  • Describe the transmission of Plague and Q Fever
  • Describe the diagnosis and treatment of Plague and Q Fever
  • Explain the use of Yersinia pestis and Coxiella burnetii as a biologic weapons(s)
  • Identify infection control procedures
  • Identify resources for reporting

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

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

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

Bolstering Small-Practice “Medical Home” Capabilities
Small independent primary care providers are a vital lifeline for New Yorkers, providing services to many diverse and often disadvantaged communities. While they make up approximately 40 percent of all primary care providers in New York City and State, these practices are at risk of falling behind in the race toward medical home recognition and value-based purchasing.

Understanding that challenge, UHF brought together more than 30 experts last year to discuss the potential for shared services among small practices-a way to pool resources for practice transformation and eventual value-based purchasing (VBP). The results of that convening and subsequent efforts are now being finalized, with an anticipated release this spring.

Part of UHF’s partnership with the New York City Department of Health and Mental Hygiene and the New York City Population Health Improvement Program, the roundtable discussion solicited expert feedback on a white paper entitled New York City Population Health Improvement Program (PHIP) Small Primary Care Practice Project, Draft Interim Report, which was provided to participants in advance for their review and comment.

That report reviewed:

  • Findings from a series of focus groups of small-practice providers in New York City, describing a specific set of capacities the practices felt they needed to operate as medical homes and participate in VBP contracts, but could not afford on their own. Providers reported willingness to consider sharing services with other small practices if those services were affordable and provided by a trusted organization with a track record of competence;
  • Findings from a series of interviews with organizations in New York State that are providing a range of services to small practices, describing the types of services offered and how they are organized, deployed, and supported.

The conversation reinforced the findings of this qualitative research, particularly related to the core competencies of medical homes and preparation for value based payment. Of particular value were discussions on the scope of the shared service “bundle” that was envisioned, with discussants recommending that it include support in two priority areas with which many small practices often struggle:

  • The adoption and best use of electronic medical records, and
  • Practice management consultation and support on operational issues and on compliance with complex and changing requirements related to billing and coding.


The Draft Interim Report and roundtable findings served as the foundation for subsequent quantitative work describing the legal and regulatory issues involved in establishing a shared service program, and modeling the economics of such a venture.

The final report will bring together both the qualitative and quantitative reports findings of the project.

More Info: Can Small Physician Practices Survive? (JAMA April 3, 2018) 

 

Crain’s Reports MSSNY’s HOD Gun Safety Resolution
New York Business (3/28, Lewis) reports, “The Medical Society of the State of New York is endorsing a set of proposed gun-control measures through a resolution that was passed at its annual House of Delegates meeting over the weekend.” MSSNY supports “bans on high-capacity magazines and bump stocks, legislation requiring a background check and waiting period before someone can purchase a gun, and the ability of the Centers for Disease Control and Prevention to conduct public health research on gun violence.” Dr. Thomas Madejski, the president of MSSNY, said that MSSNY members disagree about how restricted gun ownership should be. Madejski also said that there have been difficulties implementing the New York SAFE Act, which “requires mental health practitioners to report when a patient is likely to harm himself or others.”


Correction re Third Party Payers Being Billed
On March 30, it was reported that Resolution 261, which required that all 3rd party payers be billed before any patient is billed, was adopted.  This was incorrect.  The House voted NOT adopt this resolution.  We apologize for any confusion.

 

CVS Health Sued for Revealing HIV Status of 6000 Patients in Ohio
CVS Health is being sued for allegedly revealing the HIV status of 6,000 patients in Ohio.

A federal lawsuit claims CVS mailed letters last year that showed the status of participants in the state’s HIV drug assistance program through the envelopes’ glassine window.

The complaint, which was filed March 21 in federal court in Ohio, also names Fiserv, the company that CVS hired to mail the letters. On the envelopes used by Fiserv, the patients’ HIV status could be seen through the clear window, just above their name and address, the documents states. The letters included the patients’ new benefits cards and information about a mail prescription program.

The attorneys claim that CVS failed to announce the breach of privacy data and did not contact all the patients whose status was revealed. In a statement to CNN, CVS Health said the envelope window was intended to show a reference code for the assistance program and not the recipient’s health status. “CVS Health places the highest priority on protecting the privacy of those we serve, and we take our responsibility to safeguard confidential information very seriously,” the statement said. “As soon as we learned of this incident, we immediately took steps to eliminate the reference code to the plan name in any future mailings.”

 

Surgeon General Releases Advisory on Naloxone
Naloxone is already carried by many first responders, such as EMTs and police officers. The Surgeon General is now recommending that more individuals, including family, friends and those who are personally at risk for an opioid overdose, also keep the drug on hand.MSSNY endorses the surgeon general’s call for more availability/use of naloxone. MSSNY quickly endorsed the bill/law that passed a few years ago calling for more widespread availability of Naloxone including without a patient specific script.  Naloxone is available in pharmacies throughout NY State.  With endorsement by MSSNY and other groups, the bill passed quickly and as a result, thousands of lives have been saved in NY by overdose reversals.  MSSNY appreciates and supports the Surgeon General’s call for more widespread availability and use.


FDA Orders Recall of Powdered Kratom Products Due To Salmonella
The Food and Drug Administration “ordered a mandatory recall of” Triangle Pharmanaturals’ “powdered kratom products because salmonella was found in the herbal supplement.” The agency “said the company did not cooperate with the agency’s request for a voluntary recall.” The Wall Street Journal (4/3) reported that FDA said that the recall was the first of its kind under the Food Safety Modernization Act of 2011.

Physician Medicine and Drug Procedure Codes and Fee Schedule Updated
The Physician Medicine and Drugs Procedure Codes and Fee Schedule have been updated for 2018. For details, click here. 

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RENTAL/LEASING SPACE

Beautiful NYC Medical Office — Long-term Share
Bright, big consultation room and one or two exam rooms in large,  tastefully furnished office in first-rate building. 58th Street between Park and Lexington. Near transportation.  Smaller, windowed consultation room and exam room also available. Rent by the day or week, beginning June 1 or sooner. $180 per day or $5500 per months. Perfect for internist, rheumatologist, physical medicine, ob-gyn and others. Superb front desk and office management available, along with many amenities including internet, ultrasound, EMG, kitchen, optional C-arm. Call Carol: 917-856-6402.

Medical Office to Sublet – Sheepshead Bay, Brooklyn
Sublet available 2-3 days per week. Features 3 exam rooms, consultation room, x-ray and waiting room. Reasonable rent. Call 917-971-1691

For Rent – Medical Office 715 W 170 Street New York
Ground floor just completed build out 4 exam rooms with sinks and wall cabinets
Waiting and reception areas, windows throughout.
Street and private entrances, two bathrooms and storage/lab/staff room.
One block to bus and two blocks to Presbyterian Medical Center and subway.
$1900-$7900/ month for one to 4 exam rooms.
Drdese@gmail.com or 917.8618273

For Share – Plastic Surgeon’s Office Facing Central Park Ground Floor Lobby Entrance/Private exit
One to three exam rooms, consult/private office and procedure room for full or part time use.
Elegant, modern and spacious secretarial, waiting and two exam rooms.
Accredited operating rooms and recovery rooms on site.
One block to bus and 20 feet to subways.
$1275-$3750/day monthly for one to three exam rooms.
Drdese@gmail.com or 917.861.8273

Office Space – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3
bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org

Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com.  

PHYSICIAN OPPORTUNITIES

General or Vascular Surgeon Needed
Busy Vein Center in Brooklyn and Staten Island, NY is looking for a General or Vascular Surgeon,Previous experience in vein procedures is helpful but not necessary. Full-time or part-time  schedules available. For additional information please Call Muhammad Shoaib at 718-435-1777 or send resumes to shoaib@varicosecenter.com info@varicosecenter.com varicosecenter.com

Patient Navigation and Patient Advocacy Services for Your Patients
Barbara A. Brody & Associates, LTD., founded in 1992, is a private “Value–Added” resource for practices and patients. Barbara A. Brody, MPA analyses medical insurance policies, long–term care policies, and insurance billing (physicians, healthcare facilities and pharmaceutical plans). We provide an understanding of the details of Medicare, Group and Individual policies to your patients and, in return, to you and your staff.  We can help your patients with long–term claim filing and medical financial management too.  We help your patients figure out their insurance so you don’t have to.  Contact us at (212) 517–5100 or www.barbarabrody.com

Family Practice Physician – Schenectady/Amsterdam, NY
Hometown Health Centers is a Federally Qualified Community Health Center in the Upstate, Schenectady and Amsterdam, NY areas. Bi-lingual in English/Spanish is a plus.  Excellent total compensation package.  No hospital rounding. Flexible and part-time schedules available.  Sign-on bonus. For additional information please send inquiries or resumes to jobs@hhchc.org. www.hometownhealthcenters.org

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

 

Capital Update: May 25, 2017


PRESIDENT’S MESSAGE
Charles Rothberg, MD		 May 25, 2017
Volume 17
Number 20

As End of Session Nears, Now is the Time to Act to Prevent Enactment of Disastrous Liability Expansion Bill
MSSNY is urging all physicians to take action (click here) to oppose bills moving in the Legislature that could drastically increase the cost of medical liability insurance.  There are only a few weeks left of the 2017 Legislative Session.  Next week, the Legislature will be in their home districts for Memorial Day weekend and the observance of Shavuot.  It is the perfect time to contact your legislators in their district office.

The timing of these bills could not be worse.  We now have multiple malpractice insurance companies operating in New York State that appear to be in serious financial jeopardy which can ill-afford to absorb the substantial costs of a brand new cause of action. Moreover there is a great uncertainty in the NY healthcare delivery system as a result of legislation before Congress that could profoundly restructure Medicaid spending.    Please urge you elected officials to oppose the following bills:   

  • Expanding the Medical Liability Lawsuits (A.3339/S.4080) – would substantially lengthen the statute of limitations for medical malpractice actions and lead to enormous increases in the cost of liability insurance for physicians and hospitals.  If enacted this bill could increase your liability premiums by 15%.
  • Expansion of Medical Liability Damages (A.1386/ S.411) – would greatly expand the categories of damages which a plaintiff may recover in a wrongful death action.  Actuarial studies have predicted that this bill could increase liability premiums by over 50%.
  • Third Party Defendant (A.1500 / S. 412) – would permit a plaintiff to bypass the defendant he or she sued to collect a judgment from a third party defendant who or which had been sued by the defendant for contribution or indemnification as a result of the underlying action.
  • Prohibiting Ex-Parte Interviews of Plaintiff’s Treating Physician (S.243/A.1404) – would prohibit a physician’s defense counsel in a medical liability action from conducting an interview with the plaintiff’s treating physician. This bill would present significant issues for physicians in a medical liability action by limiting the opportunity to fully examine the plaintiff’s health condition to evaluate the merit of the plaintiff’s claim.    (DIVISION OF GOVERMENTAL AFFAIRS)


Please Urge Your Legislators to Enact Legislation to Permit Collective Negotiations and Expand Patient Choice of Physicians
With just a few weeks left in the Legislative Session, physicians are urged to contact their legislators to ask them to support legislation strongly supported by MSSNY to address prior authorization hassles imposed by health insurance companies, increase coverage for patients, and to limit the ability of health insurers to narrow their networks.  These bills include:

  • 3943 (Hannon)/A.2704 (Lavine) – would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract.  The bill has passed the Assembly and was recently reported to the Senate floor. Please send a letter in support here. 
  • S.3663 (Hannon)/A.4472 (Gottfried) – would permit independently practicing physicians to collectively negotiate patient care terms with market dominant health insurers under close state supervision.  In addition to the ability to push back against exorbitant administrative hassles imposed by insurers, it would also help to protect physicians to have a stronger option to remain in independent practice. The bills have advanced to the Senate Finance Committee, and the Assembly Ways and Means Committee.  Please send a letter to your legislators .in support here.
  • 5675 (Hannon)/A.7671 (Rosenthal) – would require health insurers to make out of network coverage options available through the New York Health Insurance Exchange. Currently, there are no out of network coverage options in the Exchange in downstate New York, despite Exchange officials strongly encouraging the offering of these options by insurers.  The bills are in the Senate Health and Assembly Insurance Committee. Please send a letter to your legislators in support here.(DIVISION OF GOVERNMENTAL)



Physicians Should Avail Themselves of New NYSDOH Website to Enable Expedited Search of Health Plan Networks
The New York State Department of Health, together with the NY State of Health, this week announced the launch of the NYS Provider & Health Plan Look-Up, an online tool that consumers can use to research those health insurance plans with which a physician (and other health care practitioners) participates.  It also lists practice locations for each physician.  Previously, a consumer would have to go to the website of each health insurance company to determine if a physician participated with a particular plan.

Physicians should take the opportunity to go to the website to see with which health plans they are listed to participate to determine if there are inaccuracies in their listings, and please let MSSNY know so we can let DOH officials know.  According to a recent MSSNY survey, over 50% of responding physicians indicated that they were inappropriately listed as a participating provider on a health insurer’s website.  MSSNY has previously expressed concerns to the Legislature and state agency officials that inaccurate health insurer network listings may mask situations where an insurer has an inadequate physician network.

According to the DOH press release, the NYS Provider & Health Plan Look-Up will initially include information on the health care providers that participate with plans offered on the NY State of Health Marketplace, including Qualified Health Plans, the Essential Plan, Child Health Plus and Medicaid Managed Care. The tool also includes information about provider networks for other Medicaid managed care programs including Managed Long Term Care (MLTC), Health and Recovery Plans (HARPs) and Fully Integrated Dual Advantage (FIDA) Plans. The website will be regularly updated using data submitted by health plans. The website will be updated later this year to add provider network data for commercial insurance products.  (AUSTER)


Legislation About Educating Athletes About Sudden Cardiac Arrest Advances In NYS Legislature
Assembly Bill 6538/Senate Bill 3149, sponsored by Assemblymember Michael Cusick and Senator Andrew Lanza has passed the New York State Assembly and is on the Senate calendar for a vote.   This measure requires that the New York State Department of Health develop educational materials for students, their parents and guardians, regarding sudden cardiac arrest. 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.

The materials would include an explanation of sudden cardiac arrest, a description of early warning signs, and an overview of options that are presently available for screening. Sudden death in young athletes is a rare but tragic event. The possibility that young, well-trained athletes at the high school, college, or professional level could die suddenly seems incomprehensible. It is a dramatic and tragic event that devastates families and the community. Physical exertion associated with competitive sports and other physical athletic activities can exacerbate a pre-existing condition and can result in an untimely death of a student.  The State of New Jersey currently has a similar program where brochures are sent home to parents and guardians. This legislation would establish a similar program by developing brochures that could be given to parents as well as pediatricians to distribute. (CLANCY)


Special Election Results
This week, Democratic candidate Brian Benjamin won the open 30th Senate District (New York County) seat to replace Democrat Bill Perkins who won a seat on the New York City Council.   On Long Island, Democrat Christine Pellegrino defeated Republican Thomas Gargiulo in the 9th Assembly District.  Pellegrino, an elementary school teacher, filled the seat vacated by Republican Joseph Saladino to serve as Oyster Bay Town supervisor.  Pellegrino won by a margin of 58 percent of the vote over Gargiulo, who got 42 percent in a seat that historically has been a Republican seat.   (BELMONT)


CBO Release Scoring of AHCA Proposal; AMA Sends Recommendations for Improvements to US Senate
The Congressional Budget Office released a document this week noting the American Health Care Act recently passed by the US House and under consideration by the US Senate would  “reduce federal deficits by $119 billion over the coming decade but  increase the number of people who are uninsured by 23 million by 2026”.  Also this week, the American Medical Association sent a letter to US Senate Finance Committee Chair Orrin Hatch this week to provide recommendations to improve the AHCA.  The comments focused primarily on premium affordability, insurance market stabilization, and the Medicaid safety net—topics that are generally consistent with the scope of a budget reconciliation bill. Among the AMA’s recommendations:

  • Continue to Fund the cost-sharing reductions (CSRs) for 2017 and 2018.
  • Provide young adults (ages 19-30) with enhanced tax credits—e.g., $50 per month—while maintaining the current premium tax credit structure which is inversely related to income;
  • Fix the ACA’s “family glitch,” which denies premium and cost-sharing subsidies to purchase coverage on health insurance exchanges to families facing high-cost employer-sponsored insurance when one family member has access to affordable employee-only coverage, ignoring the cost of family coverage;
  • To address problems of high deductibles and cost-sharing for individuals with incomes above 250% FPL,  consider modestly funding HSAs.  Many individuals eligible for premium tax credits, but not cost-sharing subsidies, are having difficulties in affording the cost-sharing requirements in the plans they have enrolled;
  • Create demonstration projects to allow individuals eligible for cost-sharing subsidies—who forego these subsidies by enrolling in a bronze plan—to have access to a pre-funded HSA in an amount determined to be equivalent to the cost-sharing subsidy they would have received if they had enrolled in a silver plan.
  • Lower the cap on premiums for the second lowest cost silver plan for the highest incomes eligible for premium tax credits (for example, from 9.69 percent to 8.5 percent of household income), and lower premium caps for lower incomes accordingly. Lowering premiums for individuals eligible for premium tax credits would serve as a greater incentive to this population becoming and remaining insured.
  • Protecting the Medicaid Expansion, or assure that any changes to the Medicaid program must ensure that those who have benefited continue to have the ability to obtain quality, affordable coverage. (AUSTER)


CMS Delays Medicare Bundled Payment Programs Until January 2018
The Centers for Medicare & Medicaid Services (CMS) recently released a final rule that postponed until January 1, 2018 the effective date of various bundled payment programs for Medicare.  The delay is applicable to the proposed expansion of the Comprehensive Care for Joint replacement (CJR) model as well as implementation of the Advancing Care Coordination through Episode Payment Models (EPMs) and the Cardiac Rehabilitation Incentive Payment Model.   Under these “virtual bundling” programs, hospitals and physicians would continue to be paid by Medicare Part A and Part B on a fee for service basis for the care delivered.  However, there will be a retrospective assessment of the total costs of care provided under Medicare Part A and Part B to patients during their hospitalization and for 90 days after discharge. Initially, hospitals will receive bonuses if their costs fall below historical benchmarks and meet quality standards.  Beginning in 2019, hospitals will have to reimburse CMS if their costs exceed the benchmark, and could require physicians to share in the upside and downside risk. (AUSTER)


Need to Meet Your Pain Management CME Requirement?  MSSNY Pain Management, Palliative Care and Addiction Online Program Available
The Medical Society of the State of New York Pain Management, Palliative Care and Addiction modules are now available on-line here. 

These modules are being offered free of charge to all MSSNY members.  Physicians who are new users to the MSSNY CME site will be required to register as a new user.  As a new user, physicians and non-physicians will be required to enter fields that include: position; name (the name should be what you want to appear on the CME certificate); email address; and then create a password.  MSSNY members who encounter a payment page or have difficulty registering, please email cme@mssny.org for technical support.  Directions for creating a new account/or logging in can be found here.   Non-MSSNY physicians will be charged $50 per module. 

The MSSNY CME is a new site and while many MSSNY members have an account with mssny.org a MSSNY member may not necessary have an account with cme.mssny.org   If in doubt, try to create an account and if it tells you that the email address is unavailable or in use,  an account exists.   Passwords can be reset if you don’t know it.  Physicians who have previously had an account at the MSSNY CME site will need to log into the site using their email and password. The MSSNY CME site provides the ability for physicians and other prescribers to view the archived webinar at their leisure, take the required test, and download their certificate. The online program covers all eight topics required in the New York State statute. MSSNY developed the program with the NYS Office of Alcoholism and Substance Abuse Services (OASAS).  MSSNY is listed as an accrediting organization by the NYS DOH Bureau of Narcotic Enforcement.   Information on the three CME modules is available here.  Additional information or technical support may be obtained by contacting cme@mssny.org . (CLANCY)


DOH Attestation Process for Pain Management CME Must Be Completed by July 1, 2017
The New York State Department of Health has announced the attestation process for prescribers required to complete Pain Management CME.  Prescribers must attest to the completion of the pain management, palliative care and addiction course work or training by July 1, 2017, and again every three years thereafter. The prescriber should only attest after completion of at least three hours of course work or training covering all eight topics. A prescriber with a Health Commerce System (HCS) account will attest online using the Narcotic Education Attestation Tracker (NEAT) application.

Complete the steps to access the NEAT (Narcotic Education Attestation Tracker) application in the NYS Health Commerce System (HCS):

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

Complete the steps to ATTEST to the completion of the education requirement.   A full set of instructions can be found here.

Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll-free at 1-866-811-7957. They may then complete the form and return it by mail to the address provided in the form. The Bureau of Narcotic Enforcement has also released a Frequently Asked Questions (FAQs) on the prescriber mandate.   A copy of the FAQs can be found here. In certain limited circumstances, the New York State Department of Health may grant an exemption to the required course work or training to an individual prescriber who clearly demonstrates to the department that there is no need to complete such training.  Exemptions will be granted only in very limited circumstances, and not solely on the basis of economic hardship, technological limitations, prescribing volume, practice area, specialty, or board certification.  Prescribers may apply for an exemption through the Health Commerce System. Further information may be obtained by contacting BNE at 1-866-811-7957 or narcotic@health.ny.gov.   (CLANCY)


NYS DOH Confirms a Case of Measles; Warns About Potential Exposure to Others
On May 23, 2017, the New York State Department of Health in a press statement confirmed that a tourist from India traveling in western New York has measles.  This tourist has visited a NYS Thruway Travel Plaza in Herkimer County, a Monroe County hotel, Niagara Falls State Park, and a Niagara Falls restaurant between May 11 and May 12, 2017, potentially exposing others to measles. Anyone who visited the following locations may have been exposed:

  • The Iroquois Travel Plaza (rest stop) between Exit 29 (Canajoharie) and Exit 29A (Little Falls) on the NYS Thruway between 8:30 p.m. – 12:30 a.m. on May 11– 12, 2017.
  • The Hampton Inn, 4873 Lake Road, Brockport, N.Y. between 12:00 a.m. – 12:00 p.m. on May 12, 2017.
  • Niagara Falls State Park, Niagara Falls, N.Y. between 11:00 a.m. – 5:00 p.m. on May 12, 2017, which includes the Maid of the Mist.
  • Swagat Fine Indian Cuisine, 24 Buffalo Avenue, Niagara Falls, N.Y. between 2:00 – 6:00 p.m. on May 12, 2017.

According to the DOH, “the times reflect the period that the infected individual was in these areas and a two-hour period after the individual left the area, as the virus remains alive in air and on surfaces for up to two hours. This explains the overlap in times. In a statement by DOH, individuals are not at risk of contracting measles if they are immune. A person is unlikely to get measles if they were born before January 1, 1957, have received two doses of the MMR (Measles, Mumps and Rubella) vaccine or have a lab test confirming immunity. Those individuals lacking immunity or not sure if they have been vaccinated, should contact their health care provider if they develop measles symptoms. Symptoms include a fever, rash, cough, conjunctivitis or runny nose. Symptoms usually appear in 10-12 days after exposure, although they may occur as late as June 2, 2017. To prevent the spread of illness, the NYSDOH is advising individuals who may have been exposed and who have symptoms consistent with measles to contact their health care provider or a local emergency department before going for care. This will help to prevent others at these facilities from being exposed to the illness. Measles is a highly contagious respiratory disease caused by a virus that is spread by direct contact with nasal or throat secretions of infected people.  Symptoms generally appear in two stages. “    (CLANCY)


Register Now for Upcoming Medical Matters 2017 CME Webinar Series
Registration is now open for “Mosquito Borne Diseases” on Wednesday, June 14, 2017 at 7:30 a.m.  Faculty for this webinar are William Valenti, MD chair of MSSNY’s Infectious Disease Committee and member of the MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee and Elizabeth Dufort, MD medical director, Division of Epidemiology from the New York State Department of Health.  .  Registration is now available at this link.

 The educational objectives are: 1) Identify the most prominent mosquito borne diseases, including chikungunya, dengue, West Nile virus, yellow fever and zika.  2)  Describe the epidemiology of mosquito borne diseases.  3)  Review modes of transmission and methods of prevention of infection.  Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.  Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

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. 

MSSNY 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.

Can’t wait until June 14th?  Listen to MSSNY’s Zika podcast here.   (Clancy, Hoffman)


Available for Physicians & Patients – Immunization Podcasts
The importance of immunizations remains paramount!  The Medical Society of the State of New York (MSSNY) has released ten brief informational podcasts for physicians and patients to learn about vaccines.  MSSNY’s immunization podcast series addresses the importance of adult immunizations, as well as herd immunity.  This series was created by MSSNY’s Preventive Medicine and Family Health and Infectious Disease Committees.  Each of these brief podcasts offers insightful commentary about immunizations from committee members (all experts in their fields).  MSSNY’s immunization podcast series can be accessed here .

The topics discussed include

  • Hepatitis B
  • Human Papillomavirus (HPV)
  • Influenza
  • Measles, Mumps and Rubella (MMR)
  • Meningococcal Disease
  • Pneumococcal
  • Tetanus, Diphtheria and Pertussis (TD & Tdap)
  • Young Adults
  • Zoster.

Share this link with your patients: http://www.buzzsprout.com/51522

Additionally, you can contact Melissa Hoffman at mhoffman@mssny.org to request some take-away cards for your patients with links to MSSNY’s immunization podcast series.(Hoffman, Clancy)

 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 jbelmont@mssny.org

CLASSIFIEDS

Medical Practice for Sale in Upscale Westchester Community
Successful well established (1984) and actively growing Internal Medicine/ Primary Care Practice conveniently located only 45 minutes from midtown Manhattan. Great Opportunity for established physician to expand his patient base or for entrepreneurial new graduate.  Lease assignable with option to renew.

Facilities / Business Details
Well known Professional Building with convenient free parking; ground/first floor location, handicap accessible. Contemporary office recently built and painted. Two large exam rooms; one consultation room/doctor’s office, lab, spacious receptionist area and large waiting room. As an independent practice, it provides an extremely appealing option for the patient that does not want to go to a huge impersonal multi-specialty group. Approximately 80% commercial payers; 20% Medicare. Doctor retiring but willing to stay on to introduce new physician to patients and assist in transition.

Asking Price: $175,000

Contact: rpcdb51@yahoo.com

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

Physician Opportunities

Paging Primary Care MDs Who Love Technology
98point6 is a Seattle startup who wants your input. We’re seeking practicing physicians to join our council and help shape the next generation of primary care. If the fusion of health care and technology inspires you, please apply here.

Ophthalmologist Part Time
Ophthalmologist needed to work at multiple nursing homes in all 5 boros except Staten Island. Part time or full-time position available.  Generous salary and incentives.Ttech provided. Opportunity to perform surgery, but not required. Please email cv to privacyssw@gmail.com

Multiple Physician Positions with DOHMH Office of School Health
Office of School Health is the largest program of the New York City Department of Health and Mental Hygiene (DOHMH). This bureau is responsible for managing the health issues and promoting the well-being of the over 1.3 million children and adolescents enrolled in New York City’s 1700 school buildings.

Positions with the Office of School Health (OSH) combine clinical skills and public health training. OSH focuses on child health, asthma prevention, obesity and nutrition, vision screening, dental care, mental health, reproductive health, and childhood disability. We collaborate with various city and community based agencies to provide social and academic services to address the needs of all New York City school children, especially those facing the most significant social, economic, and health challenges.

The Office of School Health is currently undergoing expansion. There is an immediate need for physicians with an expertise in pediatric, adolescent, or family medicine, with the capacity to utilize primary care skills set through a public health lens. OSH is also  interested in public health and preventive medicine graduates with programmatic, analytic, and social medicine skills.

The NYC DOHMH is reaching out to identify candidates for this recruitment. We are enlisting your help to nominate medical professionals who are committed to contributing their talents to improve health and academic outcomes in our schools. Please consider applying for these positions or passing these opportunities on to talented physicians among your own personal networks.

Attached are the American Academy of Pediatrics position statements on the role of the School Physician as well as the job description and recruitment flyers:

  • Adolescent School Health Physician, Family and Child Health/SH Reproductive/City Medical Specialist, Level: 01/Part-time/Flexible Work Schedule (20-35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to:https://a127-jobs.nyc.gov/ In the Job ID search bar enter: Job ID: 277208
  • Field Doctor, Bureau of School Health/SH Medical (pre-K-8 Programs or High School) City Medical Specialist, Level: 01/Part-time/Flexible Work Schedule (20-35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to:https://a127-jobs.nyc.gov/ In the Job ID search bar enter: Job ID: 265869
  • Supervising Medical Doctor,Bureau of School Health/SH Reproductive Health, City Medical Specialist, Level: 02/Part-time (35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to: https://a127-jobs.nyc.gov/ Job ID:  277026

Please list in your cover letter how you heard about this position (including name of the professional association, website, or individual who referred you). If you have questions, please contact Caroline Volel, MD, MPH at OSH@health.nyc.gov.

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

Debate Begins on Single Payer

 drmaldonado PRESIDENT’S MESSAGE

Dr. Joseph R.Maldonado, President

Dear Colleagues:

In the coming weeks, you will be reading more about MSSNY’s progress in moving or stalling numerous legislative bills pertaining to healthcare delivery in New York State.  We anticipate Assemblyman Richard Gottfried’s bill on the New York Health Plan (a single payer plan initiative) will move to the floor of the Assembly for debate next week.

Our country and state are both divided on how best to remedy the complex problems associated with our present multi-payer healthcare system.  These problems are so wicked that many have looked to other countries for alternative models of healthcare delivery.  The vision of a single payer that can obviate the problems inherent in a multi-payer system is enticing.  The ease of access and the administrative attraction of dealing with one payer is appealing.  However, in studying many of these single payer systems, it is clear that physicians are unhappy and frustrated in these systems—albeit for different reasons.

A single payer system may not be the panacea some think it to be.

Several weeks ago, MSSNY’s House of Delegates expressed its views when it declined to support the concept of a single payer system.  As New Yorkers, we find ourselves in tremendous turmoil as our state leadership advances healthcare reform initiatives that will fundamentally change how we practice medicine in New York State.  MSSNY has been engaged in these efforts at the level of DSRIP, SHIP, PHIP and the SHIN-NY.  We are proud of our work in collaborating with the state to implement changes in a manner that will advance healthcare delivery improvements for decades to come.  The disruption of these efforts with the addition of another payment methodology threatens to undermine the physician workforce environment and the state’s efforts in healthcare delivery improvement.  Accordingly, the Society is opposing the New York Health Plan bill currently in the Assembly.

I will continue to support the dialogue within our profession and this state that explores improvements to our healthcare delivery system.  However, at this time, support for a single payer system threatens the viability of thousands of small practices throughout the state that are focused on preparing for ICD-10, e-prescribing, SHIP, SHIN-NY and DSRIP.  Let’s give the profession the opportunity to meet the immediate challenges facing our profession in the coming year before embarking on another megaproject such as transforming NY into a single payer state.

We will continue to work with Governor Cuomo, Assemblyman Richard Gottfried and Senator Kemp Hannon to better define the legislative and regulatory environment in which physicians operate in NY, thus improving the health of our state’s residents.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC 

MSSNY President

Please send your comments to comments@mssny.org

CapitalUpdate

ASSEMBLY WILL VOTE ON SINGLE PAYER BILL
Despite significant opposition from Republican and Democratic Assemblymembers, the Assembly Codes and Ways & Means Committees reported Assemblyman Gottfried’s single payer bill (A.5062/S.3525) to the floor of the Assembly. It can be voted on as early as Wednesday of next week.

Many physicians support this bill as a means to create health system efficiencies while reducing insurer control and influence over the practice of medicine. A significant number of physicians, however, feel that they will lose clinical autonomy under a single payer system. Moreover, based upon their experience with the Medicare and Medicaid systems, they are also concerned that a single payer system will result in a significant and unwarranted reduction in payment for the services they render.

At MSSNY’s most recent House of Delegates held earlier this month, a resolution which called upon MSSNY to support legislation to implement a single payer system was passionately debated by the physician delegates. While there was significant support among the physician delegates there was also overwhelming opposition. The Resolution was not adopted.

All physicians are encouraged to let your perspective be known to your Assembly representative by calling 1-518-455-4100, and asking to speak to your Assemblymember.  (DEARS, AUSTER)

PLEASE CONTACT YOUR LEGISLATORS IN SUPPORT OF HEALTH INSURANCE REFORM LEGISLATION
With just a few weeks left to go in the New York State legislative session, MSSNY continues to strenuously advocate for a number of critically needed health insurer reforms to better assure patients can receive coverage for the care they need from the physician of their
choice, and to reduce the extraordinary administrative burden imposed on physicians and their staff to assure patients can receive the care and medications they need.   Next week, Thursday, May 28, MSSNY President Dr. Joseph Maldonado will participate in a press conference with a number of patient advocacy groups, Assembly Health Committee Chair Richard Gottfried and Assemblymember Matthew Titone to urge the passage of legislation (A.2834-A, Titone/S.3419-A, Young) that would provide physicians with an expeditious method to override a health insurer step therapy/Fail-first protocol when prescribing needed medications for their patients.   To send a letter, click here.

In addition, physicians are urged to send letters to their legislators in support of these bills:

  • A.336 (Gottfried)/S.1157 (Hannon) – permits independently practicing physicians to collectively negotiate patient care contract terms with health insurers under close state supervision.  In the Senate Finance and Assembly Ways & Means Committees.  To send a letter in support, click here.
  • A.3734 (Rosenthal)/S.1846 (Hannon) – requires health insurers to offer Out of network coverage in New York’s Health Insurance Exchange.  In Assembly and Senate Insurance Committees.  To send a letter in support, click here.  (AUSTER, DEARS)

CME MANDATE BILL ON PAIN MANAGEMENT ON THE FLOOR OF BOTH HOUSES; CAN BE VOTED ON AT ANY TIME
Legislation that would require physicians to take three hours of continuing education on pain management, palliative care, and addiction is now on the floor of both houses in the New York State Legislature and can be voted on at any time.

Senate Bill 4348 passed out of the Senate Health Committee and has gone to the Senate floor.  Its companion measure, Assembly Bill 355 is also pending on the Assembly floor.   Immediate physician action is needed to stop this measure from passing.   Physicians are urged to send a letter urging defeat of this measure.

Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal, and Senate Bill 4348, sponsored by Senator Kemp Hannon would require three hours of course work every two years for physicians and other healthcare workers.   Under the bill’s provisions, the course work would include each of the following topics:  I-STOP and drug enforcement administration requirements for prescribing controlled substances; pain management; appropriate prescribing; managing acute pain; palliative medicine; prevention, screening, and signs of addiction; responses to abuse and addiction; and end-of-life care.  Given the success of New York’s I-Stop law and the wide variety of educational tools that prescribers are already using to educate themselves regarding the risks and benefits of various controlled medications, MSSNY remains opposed to the measure.        (CLANCY, DEARS)

SCOPE OF PRACTICE BILLS STATUS AT END OF SESSION
The following are among many scope of practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  • 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill is in the Higher Education Committee in both the Senate and Assembly.
  • 5805 (McDonald)/ S.4857 (LaValle) – a bill that would expand the definition of “collaborative drug therapy management” to include patients being treated by PAs and NPs, not just physicians, and extend collaboration to unspecified disease states. It allows a pharmacist to prescribe in order to adjust or manage a drug regimen, and adds a non-patient specific protocol.  The bill includes nursing homes in the definition of facility.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 123 (Paulin)/ S.4739 (Hannnon) – a bill that would authorize pharmacists to, in addition to those immunizations currently allowed to be administered by pharmacists, administer immunizations to prevent tetanus, diphtheria, pertussis, acute herpes zoster, and meningococcal pursuant to a patient specific or non-patient specific order, and would remove the sunset provisions currently in the law. Pharmacists are currently allowed to administer influenza, pneumococcal, acute herpes zoster and meningococcal pursuant to a patient specific order from a physician.   This bill is in the Higher Education Committee in both the Senate and Assembly.
  • 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand on a bill enacted in 2012, and would allow podiatrists to care for up to the knee. This would include diagnosing, treating, operating or prescribing for cutaneousconditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves.

This bill is in the Higher Education Committee in the Senate and Assembly.

  • 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers, call themselves naturopathic doctors, claims that they cannot do invasive procedures, yet allows them to immunize and perform cryotherapy.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill is on 3rd reading in the Senate, and is in the Higher Education Committee in the Assembly. (ELLMAN)

HEARING AID ACCESS BILL GAINS MOMENTUM IN ASSEMBLY
A.127 (Buchwald)/ S.4080 (Murphy) is gaining momentum in the Assembly, with twenty-five co-sponsors and signing on to the bill, and many memos in support being sent to Legislators from physicians and groups.  The bill is in the Consumer Affairs and Protection Committee in the Assembly and in the Consumer Protection Committee in the Senate.  Physicians are urged to contact their Assembly Member and Senator to support the bill, which would allow an audiologist or hearing aid dispenser, employed in an ENTs office, to sell hearing aids at fair market prices, and calls for a report after two years to show the impact of the bill.  This can be done by clicking on the following link.

New York is currently one of only two states in which physicians are not allowed to sell hearing aids for profit.  (ELLMAN)

MSSNY URGES PHYSICIANS AND PATIENTS TO ADVOCATE IN SUPPORT OF SCHOOL BASED MENINGOCOCCAL IMMUNIZATION
The Medical Society of the State of New York is urging physicians and their patients to advocate in legislation requiring school-based immunizations against the meningococcal disease.  Assembly Bill 791/Senate Bill 4324, sponsored by Assemblywoman Aileen

Gunther and Senator Kemp Hannon, would require that every person entering 6th grade and 11th grade shall have been immunized against meningococcal disease.   This recommendation is consistent with the Advisory Committee on Immunization Practices.  Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis.  The bacteria are spread through the exchange of nose and throat droplets, coughing, sneezing or kissing.  Young people, between the ages of 10-25 years of age, are most at risk for this disease.   If not treated quickly, it can lead to death within hours or lead to permanent damage to the brain and other parts of the body.  Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill:

MSSNY has also developed a patient support letter that patients can use to urge support of this legislation:

The bills are in the respective health committees in each house of the legislature.  (CLANCY)

CADILLAC TAX REPEAL LEGISLATION INTRODUCED IN CONGRESS
Legislation (HR 2050) to repeal the so-called “Cadillac Tax” on comprehensive health insurance coverage contained in the Affordable Care Act was recently introduced by Rep. Joe Courtney (D-CT).  Eight members of New York’s Congressional delegation representing many regions of New York State have joined as co-sponsors, including Representatives
Chris Gibson, Brian Higgins, Hakeem Jeffries, Nita Lowey, Sean Patrick Maloney, Jerrold Nadler, Jose Serrano, and Paul Tonko.  The “Cadillac tax” refers to an excise tax on high-premium health insurance plans that will be implemented in 2018.  It will be a 40% tax on health premiums above a threshold of $10,200 a year for individuals and $27,500 for families.

At its 2013 House of Delegates, MSSNY adopted a policy calling for to repeal of this tax, which will particularly hurt high cost states like New York and dis-incentivize employers from offering their employees comprehensive health insurance benefits.  The negative impact of this tax on patient care access in New York State was recently the subject of a forum where Assembly Health Committee Chair Richard Gottfried and Senate Health Committee Chair Kemp Hannon each expressed their concerns with this tax. For more information about this forum, please see the linked article from Capital New York (AUSTER)                                                                                                    

BILL TO DELAY ICD-10 IMPLEMENTATION INTRODUCED
The AMA recently sent a letter to Rep. Ted Poe (R-TX) in support of his legislation, HR 2126, introduced in the US Congress to postpone the ICD-10 code sets required to be used by physicians in claim submissions as of October 1, 2015.  MSSNY has urged support for a
further delay of the ICD-10 mandate, though prospects for the bill’s passage remain unclear given the commitment of the leaders of the House Energy & Commerce Committee to permitting ICD-10 to be implemented as planned given the support of many healthcare stakeholders including health plans and hospitals.  The letter notes that “the differences between ICD-9 and ICD-10 are substantial, and physicians are overwhelmed with the prospect of the tremendous administrative and financial burdens of transitioning to ICD-10. ICD-10 includes 68,000 codes—a five-fold increase from the approximately 13,000 diagnosis codes currently in ICD-9. Implementation will not only affect physician claims submission; it will impact most business processes within a physician’s practice, including verifying patient eligibility, obtaining pre-authorization for services, documentation of the patient’s visit, research activities, public health reporting, and quality reporting. This will require education, software, coder training, and testing with payers.”

Physicians can send a letter in support of this legislation here. (AUSTER)                                                                                                                         

MSSNY OFFERS FREE PATIENT BROCHURE ON DIABETES FOR USE WITHIN PHYSICIANS OFFICE
The Medical Society of the State of New York Committee’s on Preventive Medicine and Family Health and the Committee to Eliminate Health Care Disparities, has developed a patient brochure that physicians can offer within their office.  The patient brochure discusses risks associated with pre-diabetes and diabetes and is available in English and Spanish.  If you would like copies of this brochure, please contact the Medical Society of the State of New York at (518) 465-8085 or email Terri Holmes at tholmes@mssny.org and request copies of the Diabetes brochure.  The development of the brochure was made possible from a grant from AstraZeneca.  (CLANCY, ELLMAN)

FINAL MEDICAL MATTERS CME WEBINAR TO BE HELD JUNE 9TH; PHYSICIANS URGED TO REGISTER
The Medical Society’s final webinar for the spring will be conducted on June 9, 2015 at 7:30 a.m. William Valenti, MD, chair of MSSNY Infectious Disease Committee will present “Emerging Infections 2015-A look at EV-D68 and Chikunguya”. Physicians are encouraged to register by clicking on https://mssny.webex.com . Click on “Training Center” and then on the “Upcoming” tab to register.

The educational objectives are:

  • Recognize and describe Enterovirus D68 (EV D68)
  • Recall the importance of continued immunizations
  • Recognize symptoms of Chikungunya and describe measures for reporting

Physicians may also contact Melissa Hoffman at mhoffman@mssny.org or at 518-465-8085 to register.

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

It is anticipated that Medical Matters programming for fall/spring 2015-2016 will be announced shortly.  (CLANCY)

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 ldears@mssny.org     mauster@mssny.or
pclancy@mssny.org bellman@mssny.org  

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Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception. The application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered. 

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.

In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:

  • Medicaid only
  • No claims to Medicare
  • Hospital-based

CDC Report Shows Most Distinct Causes Of Death In Each State
The CDC published a report this week in the journal Preventing Chronic Disease: Public Health Research, Practice and Policy that showed the most distinct causes of death in each state from 2001 to 2010. The report labels each state with a cause of death higher on
average than the rest of the country. Pelvic inflammatory disease (PID) is the number 1 unusual cause of death in New York State. The lead author, Francis Boscoe, a research scientist at the New York State Health Department, told ABC News that “they looked for outliers in each state to determine the most distinctive cause of death.”

YouTube Video: What Medicare Professionals Need to Know in 2015
A video recording of the “PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015” presentation has been posted to the CMS MLN Connects® page on YouTube.  This presentation is the same as the webinars that were delivered on March 31, 2015 and April 7, 2015.  A link to the video can be found here.

Last Call for GME Task Force Members|
The GME task force will be charged with making recommendations to MSSNY as to how best address the growing shortage of residency training positions. It will make recommendations to the Council regarding how to advance solutions that address the problem while minimizing the onerous consequences of one-sided solutions.

MSSNY welcomes inquiries from those interested in serving on the taskforce; please contact Eunice Skelly at eskelly@mssny.org 516-488-6100 ext.389.

Take a CME Cruise to Everywhere!
New York physicians are again being offered the chance to sail the Mediterranean while updating their practice skills through a series of onboard CME programs offered through Continuing Education, Inc. Based in Tampa, Florida the organization had just announced
15 cruises with CME programs focused on such topics as cardiology, family medicine, pulmonology, palliative medicine, pediatrics, gastroenterology and a host of other clinical topics. In addition, the company has a variety of other CME cruises available to Alaska, Northern Europe, Hawaii and the Caribbean. Working in concert with major cruise lines, each onboard program is scheduled while the individual ship is at sea to enable physicians and families to enjoy the ports on the ship’s itinerary. For further information, click here.