MSSNY eNews: September 8, 2021 – MSSNY Urges No Surprises Act Methodology that is Not Biased Towards Insurance Companies


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MSSNY Submits Comments Urging Methodology for No Surprises Act that is Not Biased Towards Insurance Companies
MSSNY President Dr. Joseph Sellers this week submitted comments on behalf of New York’s physicians to the US Department of Health & Human Services regarding regulations to implement portions of the federal No Surprises Act enacted by Congress last December, and in effect January 1, 2022.  This effort has been joined by many other medical associations, including the American Medical Association and state and specialty societies across the country, urging similar rules for implementation.

The letter notes that MSSNY strongly supports the goal of the regulation to protect consumers, including specific provisions to help reduce cost-sharing obligations for patients, and provisions to ensure enforcement of the “prudent layperson” standard and other protections impacting upon the delivery of emergency care. However, MSSNY also raised concerns about the proposal to calculate the Qualifying Payment Amount (QPA) to be considered in any Independent Dispute Resolution (IDR). If implemented as proposed, it will be unfairly held artificially low (and be biased towards insurers) since it treats payments to individual physicians equally with payment to large physician practices.  MSSNY also urged that there be a far more robust information disclosure requirement imposed on insurers regarding how the QPA was calculated, as well as a detailed process for auditing health insurers to ensure they are being honest in developing this information.

Furthermore, MSSNY raised concerns that the faulty methodology for QPA calculation poses a risk of negative impact on access to care.  Many hospitals and other providers rely on out-of-network specialists to cover care, including emergency and urgent care and complicated procedures.  This is particularly true for rural and urban areas with unmet needs.  The letter notes that if the QPA is fundamentally unfair to physicians we may see coverage and access to care issues, particularly in hospital emergency departments as it may not be feasible for some out-of-network physicians to continue to take calls for patients. This was a critical public health aim that New York’s similar law sought to address when it was passed by the State Legislature in 2014.

Given these profound concerns, MSSNY argued that the QPA should not be the priority factor in determining  payment under an IDR, and that all factors should be weighted equally.


Check with Your Legal Counsel Whether You Are Required to Follow Federal or State Infection Disease Employee Protection Standards
Physician offices should consult with their legal counsel to determine if they are required to comply with the recent federal OSHA Emergency Temporary Standard (ETS) rules for protecting employees from airborne COVID-19 transmission or instead required to comply with newly enacted state requirements for all employers who are not subject to federal rules.

In July, MSSNY’s General Counsel law firm, Garfunkel Wild, prepared an alert OSHA Issues Emergency Rules For Healthcare Employers And Updated Guidance For All Employers | Garfunkel Wild, that provided a summary of the requirements for the OSHA ETS.  The alert notes that exempted from compliance with the OSHA ETS are “employers performing healthcare services on an outpatient basis in a non-hospital setting, if non-employees are screened prior to entry and people with suspected or confirmed COVID-19 are not permitted to enter.”

However, employers that are exempt from the OSHA ETS must establish an airborne infectious disease plan required by New York State for all employers under the “HERO” Act. This week Governor Hochul announced that the Commissioner of Health had designated COVID-19 as a highly infectious communicable disease that presents a serious risk of harm to the public health, which requires all employers to implement workplace safety plans in the event of an airborne infectious disease, helping to prevent workplace infections The New York State Department of Labor (NY DOL) has developed model forms for all New York employers to adopt NY HERO Act.

The question is whether physician offices are required to follow the federal OSHA ETS or the NY HERO Act standards.  MSSNY has received clarification from the NY DOL that “the standard published by the Department provides that it does not apply to ‘Any employee within the coverage of a temporary or permanent standard adopted by the Occupational Safety and Health Administration setting forth applicable standards regarding COVID-19 and/or airborne infectious agents and diseases.’  As such, employers within the coverage of the current OSHA ETS (which is currently limited to healthcare) are not currently required to take action or adopt a plan pursuant to the NY HERO Act.”

Therefore, whether a physician’s office is required to follow the federal OSHA ETS or the NY DOL standard may vary from office to office.  For example, a primary care practice that treats patients with suspected COVID-19 would likely be required to comply with the federal OSHA standard, but an orthopedic practice that instructs all patients with suspected COVID-19 to not enter the office may not be required to follow the federal standard but instead would be required to comply with New York’s HERO Act standards.

To repeat, physicians should consult with their legal counsel for how best to ensure their offices comply with these state or federal requirements, since they will need to comply with one or the other.


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Key Public Health Committee Approves Health Care Worker Vaccination Mandate
As reported last week, the New York Public Health and Health Planning Council (PHHPC) has approved an emergency regulation requiring health care workers in all Article 28 regulated settings – hospitals, nursing homes, clinics, Ambulatory Surgery Centers, dialysis facilities, etc. – to be vaccinated against COVID-19.  This includes physicians and other care providers who may not be employed directly but who provide care at these health care settings (such as a physician with privileges at a hospital or who sees patients at a nursing home).  There is an exemption for health care workers for documented medical contraindications, but after objection from various groups including MSSNY, the proposed “religious exemption” to this vaccination requirement was dropped from the regulation.

Based upon the recommendation of MSSNY’s Emergency Preparedness and Infectious Disease Committees, MSSNY President Dr. Joseph Sellers recently issued a statement supporting mandatory vaccination of health care workers as one important step to increase our vaccination rate and reduce the spread of COVID-19: MSSNY Applauds NYS COVID-19 Vaccination Mandate for Healthcare Workers

The regulation will require health care workers at hospitals and nursing homes to have a first dose by September 27, and for other Article 28 regulated settings, by October 7.  The regulation will be effective for 90 days.

According to the regulation, an acceptable medical exemption to the required vaccine is where a
“licensed physician or certified nurse practitioner certifies that immunization with COVID-19 vaccine is detrimental to the health of member of a covered entity’s personnel, based upon a pre-existing health condition”.  It further provides “the requirements of this section relating to COVID-19 immunization shall be inapplicable only until such immunization is found no longer to be detrimental to such personnel member’s health.”  Furthermore, it instructs these covered health care entities that “the nature and duration of the medical exemption must be stated in the personnel employment medical record, or other appropriate record, and must be in accordance with generally accepted medical standards, (see, for example, the recommendations of the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services), and any reasonable accommodation may be granted and must likewise be documented in such record”.

The ACIP has developed information regarding clinical considerations for practitioners here: Interim Clinical Considerations for Use of COVID-19 Vaccines.  The only listed contraindications are:

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to component of the COVID-19 vaccine; and
  • Immediate (within 4 hours of exposure) allergic reaction of any severity to a previous dose or known (diagnosed) allergy to a component of the vaccine

Moreover, as with other mandatory vaccinations, physicians or other care providers risk disciplinary sanction for certifying a medical exemption without an adequate medical justification for doing so.


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Please Urge Governor to Sign into Law 2 Bills to Assist Patients to Receive Needed Medications
Physicians are urged to contact Governor Hochul to request that she sign into law legislation passed at the end of the Legislative Session critical to helping patients to be able to receive the medications they need as well as to ensure greater oversight over pharmacy benefit formulary development practices.   A letter or tweet can be sent from here: Urge Gov. Hochul to SIGN two RX bills – Regulating PBMs and Restricting Mid-Year Formulary Changes.

The first bill (A.1396, Gottfried/S.3762, Breslin), will provide greater accountability and transparency of the practices of pharmacy Benefit Managers (PBMs). The bill was significantly revised from the version that passed the Legislature in 2019, but vetoed, to address concerns raised in your veto message.  The bill would require that PBMs be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS. The bill would also provide for the disclosure of all possible revenue streams and terms and conditions that they place on their networks of pharmacies.MSSNY has supported greater oversight and regulation of PBMs as one manner to address restrictive formularies and excessive prior authorization requirements that interfere with patients obtaining needed medications.

The second bill (A.4668, People-Stokes/S.4111, Breslin) , would significantly limit the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year. A substantially similar passed the Assembly and Senate in 2019 but was vetoed. To address concerns raised in the 2019 veto message, the new legislation would prohibit the applicability of a mid-year formulary change for those patients who were on the medication at the beginning of the policy year or suffer from a condition for which the medication is part of a treatment regimen, for that condition. However, other mid-year formulary changes could still occur.

Both of these bills would help to minimize hassles for patients in obtaining needed medications and reduce hassles for physicians in prescribing medications.  Please contact Governor Hochul today.


Urge Your Members of Congress to Push Back Against Steep Medicare Cuts for 2022
Physicians are again urged to contact their local Representatives of Congress to urge them to join a letter demanding action to prevent a nearly 10% cumulative cut to Medicare physician payment in January 2022.  Ask your representative to sign-on NOW! Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) recently circulated a “Dear Colleague” letter to send US House leadership highlighting the financial uncertainty within the Medicare payment system and the dangers facing the physician community if Congress fails to enact legislation to address these problems.

In what amounts to a “perfect storm” of payment cuts going into effect on January 1, 2022, physician practices face the following stack of Medicare financial hits:

  • Expiration of the current reprieve from the repeatedly extended 2% sequester stemming from the Budget Control Act of 2011. Congress took action earlier this year to prevent the 2% cut but that authorization expires 1/1/22.
  • Imposition of a 4% Statutory “PAYGO “sequester resulting from passage of the American Rescue Plan Act. Should lawmakers fail to act, it will mark the first time that Congress has failed to waive Statutory PAYGO.
  • Expiration of the Congressionally enacted 3.75% temporary increase in the Medicare physician fee schedule (PFS) conversion factor to avoid payment cuts associated with budget neutrality adjustments tied to PFS policy changes.
  • A statutory freeze in annual Medicare PFS updates under the Medicare Access and CHIP Reauthorization Act (MACRA) that is scheduled to last until 2026, when updates resume at a rate of 0.25% a year indefinitely, a figure well below the rate of medical or consumer price index inflation.

This would result in a combined 9.75 % payment cut on January 1! And all of this comes at a time when physicians are still confronting the pandemic, and practices recover from the enormous emotional and financial impact of the public health emergency. It’s time to give New York’s and our country’s physicians the peace of mind they deserve as they continue to fight on the front lines of the COVID-19 pandemic without having to worry if their practices will survive these potentially catastrophic cuts.

MSSNY has been working together with the AMA and other state and specialty medical associations to prevent these cuts from going forward. A strong collection of bipartisan cosigners to the Bera-Buchson letter will help demonstrate to House and Senate leadership that this confluence of payment cuts needs to be prevented via legislation ASAP.  Please contact your Representative today and urge them to show their support by signing on to Reps. Bera and Bucshon’s “Dear Colleague” letter.


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MSSNY Member Obituaries

ATWELL, Marshall Erding; Rochester NY.  Died January 12, 2021, age 84.  Monroe County Medical Society

BLUM, Craig E.; Orchard Park NY.  Died August 04, 2021, age 71.  Erie County Medical Society

BRANDT, Max; New York NY.  Died March 16, 2021, age 90.  New York County Medical Society Inc.

DEHAVEN, Kenneth E.; Rochester NY.  Died June 20, 2021, age 82.  Monroe County Medical Society

EMMENS, Robert Walter; Rochester NY.  Died August 02, 2019, age 78.  Monroe County Medical Society

GANDELL, David Lee; Rochester NY.  Died March 04, 2021, age 68.  Monroe County Medical Society

GINSBURG, Selig M.; New York NY.  Died August 01, 2021, age 96.  New York County Medical Society Inc.

GOLDSTEIN, Robert S.; New Rochelle NY.  Died August 16, 2021, age 84.  New York County Medical Society Inc.

GUERINOT, Gerard Thomas; Rochester NY.  Died January 02, 2021, age 89.  Monroe County Medical Society

HARRIS, Jerome R.; Laguna Woods CA.  Died July 08, 2021, age 100.  Medical Society County of Queens Inc.

KIM, Doo Joe; Cornwall NY.  Died April 17, 2021, age 86.  Medical Society County of Orange

LONG, C. Parker; Green Valley AZ.  Died October 06, 2020, age 96.  Medical Society County of Ontario Inc.

MCVEIGH, Robert C.; Pittsford NY.  Died June 02, 2021, age 90.  Monroe County Medical Society

MELTZER, Jay Ivan; New York NY.  Died July 03, 2021, age 92.  New York County Medical Society Inc.

MILCH, Robert Alan; Buffalo NY.  Died June 04, 2021, age 78.  Erie County Medical Society

NAPLES, R. Joseph; Pittsford NY.  Died April 15, 2021, age 97.  Monroe County Medical Society

NOONAN, James M.; Ballston Spa NY.  Died November 19, 2019, age 68.  Saratoga County Medical Society Inc.

OLIVER, Herman; Great Neck NY.  Died April 14, 2021, age 91.  Nassau County Medical Society Inc.

PERRONE, Francis S.; New York NY.  Died August 14, 2021, age 94.  New York County Medical Society Inc.

PULVINO, A. Thomas; Newark NY.  Died April 15, 2021, age 85.  Wayne County Medical Society

QUINTERO-CHICA, Jairo J.; Hyde Park NY.  Died August 03, 2021, age 90.  Dutchess County Medical Society

RUDOLPH, Lionel A.; Fayetteville NY.  Died August 06, 2021, age 98.  Onondaga County Medical Society Inc.

SCHAEFER, Norman Edward; Chatham NJ.  Died November 20, 2020, age 96.  Richmond County Medical Society Inc.

SCHECHTER, David Charles; New York NY.  Died June 20, 2021, age 90.  New York County Medical Society Inc.

SHRAGOWITZ, Jacob; Monsey NY.  Died April 13, 2020, age 97.  Medical Society County of Westchester

SZE, Kenneth Chiache; New York NY.  Died July 22, 2021, age 103.  New York County Medical Society Inc.

TREVISANI, Gino Angelo; Waterville NY.  Died July 28, 2021, age 89.  Medical Society County of Oneida Inc.

WOOLF, George; Middletown NY.  Died March 29, 2020, age 95.  Medical Society County of Orange


 

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September 8, 2017 – Insurers Act BADLY!


PRESIDENT’S MESSAGE
Charles Rothberg, MD
September 8, 2017
Volume 17
Number 34

Dear Colleagues:

I need to inform you of recent adverse activities on the part of a few insurers.

Emblem Health appears to have begun notifying a number of participating physicians that they will no longer be in network effective Jan 1, 2018. This is reminiscent of a campaign two years ago, when approximately 700 physicians were not renewed in an apparent attempt to narrow Emblem’s networks.   In its recent letter, Emblem explained to physicians that this non-renewal was not related to quality or performance issues and need not be reported to credentialing bodies.

A few physicians have filed appeals with the company for re-consideration of their non-renewal status. Presently, one physician had his status overturned and will remain “in network” after
January 1.

Some physicians, already renewed by Emblem’s Medicare Advantage plan, still face uncertainty regarding their Emblem Health commercial line participation.

On an unrelated insurance issue, I was made aware that Anthem health, parent of Empire Blue Cross plans in New York, have been improperly collecting personal identifying information belonging to practice employees – including Social Security numbers, birth dates, and home addresses – in conjunction with the Empire Provider Application.

In this matter, Anthem staff appear to have misapplied 42CFR 455.104. that pertains to disclosure requirements for entities that bill various plans for federal funds— such as Medicare and Medicaid.  Individual solo-practices and some physician group practices are specifically excluded from the necessity to disclose a staff member’s personal information.

As a result of a conference call between MSSNY and Anthem, the insurer agreed to revise its application forms and data collection process.   I anticipate that in short time, they will produce an amended Empire Provider Enrollment Application and that they will properly discard any improperly collected information.  In the meantime, physicians in solo and small practices should be aware that the submission of this information is not required.

MSSNY also continues to seek legislation (A.2704/S.3943 – passed the Assembly this year, but not the Senate) that would require health plans to provide physicians with appropriate due process protections before they non-renew a physician’s contract.  You can send a prepared letter to your Senator by visiting MSSNY’s Grassroots Action Center today.

Late Breaking Response to MSSNY from Emblem Health:
“We continuously review our network as it relates to our membership and to reflect our partnerships in value-base arrangements. We emphasize that this change in our network impacted less than .05% of the physicians within our network. Emblem also recommends physicians who received a non-renewal notice have the option to appeal the decision relating to their Medicare agreement.”

For further information, please call VP of Socio-Medical Economics Regina McNally at 561-488-6100 ext. 334.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


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Top New York Court Rejects Right to Physician-Assisted Suicide
On September 7, the New York Court of Appeals ruled that physician-assisted suicide is not a fundamental right, and that it would not block the New York Legislature from passing legislation banning physician-assisted death. Physician-assisted suicide is illegal in most states, but in recent years, Colorado, California, Oregon, Vermont, Washington, and the District of Columbia have approved legislation allowing people to request life-ending medication from physicians. No state court, however, has recognized assisted suicide as a fundamental right. (Wall Street Journa l9/7)

The case was brought by three people with terminal illnesses. Two have since died. The plaintiffs had argued that the state’s existing ban on assisting a suicide should not apply to those seeking merciful ends to incurable illnesses.The court disagreed, noting that while state law allows terminally ill patients to decline life-sustaining medical assistance, it does not allow anyone to assist in ending patients’ lives. “The assisted suicide statutes apply to anyone who assists an attempted or completed suicide,” the court wrote in its unanimous decision. “There are no exceptions.”

In their lawsuit, the plaintiffs argued that New York’s prohibition on assisted suicide violated guarantees of equal protection under the law. They alleged the law unlawfully discriminates between terminally ill patients who have the option of dying by declining life-sustaining medical assistance and other terminally ill patients who are unable to hasten their deaths simply by rejecting medical assistance.

MSSNY’s Bioethics Committee is working on an Aid to Dying survey to gather New York physicians’ positions on this topic.

Gov. Reduces Health Insurance Barriers to Substance Abuse Treatment Coverage
New York Governor Andrew Cuomo announced new regulatory guidance this week to better assure New Yorkers can more readily overcome insurance coverage barriers to receiving medications necessary to treat a substance abuse disorder. It was part of a series of initiatives announced this week by the Governor to facilitate new addiction treatment, recovery and support services to residents suffering from substance use disorders in underserved communities throughout New York City and Long Island.

Specifically, a new regulation was issued by the New York Department of Financial Services (DFS) that will require insurers who offer large group coverage to allow consumers to appeal coverage denials for medically necessary addiction medications when they are not on the list of covered drugs.

The regulation calls for an insurer to notify the patient and the prescribing physician within 72 hours of the request and provide coverage of the non-formulary medication for the detoxification or maintenance treatment of a substance use disorder for the duration of the prescription, including refills.  Furthermore, the regulation requires an expedited appeal process for “exigent circumstances” where notification of the determination must be provided to the patient and the prescribing physician no later than 24 hours following receipt of the request.

Moreover, DFS issued a “circular letter”  to New York insurers designed to eliminate impediments to addiction services coverage, “to prevent insurers from excessively reviewing the medical necessity of opioid treatment, and to bar the inappropriate delay of coverage.”

MSSNY Attends DOH: Future of Integrated Care in New York State Workgroup
In 2016, the NYS Department of Health announced that the Fully-Integrated Duals Advantage (FIDA) program received federal approval to be extended until the end of 2019.  The FIDA program is designed to provide managed care coverage to individuals covered by both Medicare and Medicaid.  In response, the DOH workgroup on the Future of Integrated Care in New York State has committed to mapping out a strategy that would help New York State reach its objectives of increasing integration of services, providers, payments, and delivery systems.

The planning committee kicked-off in July where the NYSDOH and CMS presented on the value of integrating Medicare and Medicaid services while sharing insights into models that other states have found success in using. This week’s workgroup focused on target populations, covered services, care coordination/management elements, and assessment and service planning requirements. The Future of Integrated Care in New York State workgroup series will continue on with three additional meetings over the fall in which MSSNY will continue to participate and provide critical input.

Topics to be discussed in these future meetings include network adequacy, payment and rate considerations, and geographic scope.  For more information on the FIDA program, click here.



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Addiction Medicine Track Offered at ASAP Conference on September 17, 2017
The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) and the Alcoholism and Substance Abuse Providers of New York State (ASAP) is now offering the Addiction Medicine Track at a September 17, 2018 conference.

The conference begins on Sunday September 17, 2017 and finishes on Monday September 18, 2017 and is being held at the Buffalo Niagara Convention Center in Buffalo, New York, near Niagara Falls
.  The ASAP conference runs concurrently and will actually finish on Wednesday September 20, 2017 for those who may wish to register for and stay for that.  To register for this program please click here.
This conference track is appropriate for physicians, nurse practitioners, physician assistants and any other staff who may find the material interesting or relevant.  This live activity, Addiction Medicine Track at ASAP’s 18th Annual Conference: Building Bridges, with a beginning date of 09/17/2017, has been reviewed and is acceptable for up to 15.00 prescribed credit(s).


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!


Texas Medical Society: Physicians Helping Physicians
The Texas Medical Foundation is soliciting funds to use for grants to help reestablish the delivery of patient care in physician practices in federally designated disaster areas damaged by Hurricane Harvey.

The program will help cover expenses (not covered by insurance or other sources of funding) for relocating or rehabilitating a physician’s medical office. This may include replacing equipment, aiding needed staff, rebuilding patient records, and other similar needs all towards the goal of helping affected physicians once again begin treating their patients. https://www.texmed.org/Harvey

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MSSNY President to Be Honored at Harvest Moon Ball in Glen Cove
MSSNY President Charles N. Rothberg is being honored at the Brookhaven Hospital Harvest Moon Ball at the Nassau Country Club in Glen Cove (Long Island) on Saturday, October 14, 2017 from 6PM to 10PM. Dr. Rothberg will be receiving the Dr. Jacob Dranitzke Award.  For tickets, to donate or be a sponsor, please go here.

Sept. 15: 2017 MSSNY Continuing Medical Education Provider Conference
To meet the challenges facing planners, providers and participants of CME, MSSNY recognizes the need for ongoing education and training of its Accredited Providers as well as physicians and other healthcare professionals in NYS.
The conference will take place on Friday, September 15, 2017, at the Westbury Marriott
.  The program is scheduled from 7:30 AM to 3:45 PM.

This conference will inspire participants to explore and interactively address challenges such as self-directed learning for physicians and compliance with the changing accreditation criteria that clearly address practice gaps and practice-based needs while creating opportunities for measurable change in physicians and reinforcing the undeniable link between a successful CME activity and quality improvement for physicians and patients alike.

Registration links and more information are available here.  Featured speakers include Steve Singer, PhD; Vice President of Education and Outreach, Accreditation Council for Continuing Medical Education (ACCME) and Mary Kelly, Project Administrator, AMA PRA Standards and Policy.  MSSNY President Charles Rothberg, MD will deliver the welcome and opening remarks. For more information, please contact Miriam Hardin at mhardin@mssny.org. More information.

Oct. 10-14: Free Vets Health Care Training Program Conference in Niagara Falls
The Medical Society of the State of New York, the New York State Psychiatric Association, and the National Association of Social Workers – New York State Chapter are hosting a two- day conference on
Friday, 10/13 Saturday,10/14 at the Niagara Falls Conference Center, 101 Old Falls St, Niagara Falls, NY.
The conference will consist of interactive seminars and panel discussions focusing on the current and evolving healthcare needs of veterans.

MSSNY and NYSPA will be conducting three CME accredited trainings for primary care physicians and specialists. The CME programs are “Invisible Wounds of War: PTSD, TBI & Combat-Related Mental Health Issues,” “Recognition, Management and Prevention of Veteran Suicide,” and “Substance Use Disorders among Returning Veterans.”


There is no cost, but separate registration will be required for both the trainings and conference. More information will be coming shortly.


Dr. Jerome Adams Sworn in As US Surgeon General
The new Surgeon General of the US, Jerome Adams, an anesthesiologist with a master’s degree in public health, was sworn in on Tuesday, September 5.  Dr. Adams previously served as Indiana’s health commissioner.

At the ceremony Tuesday afternoon, Dr. Adams said his motto as surgeon general will be to create “better health through better partnerships” in an effort to address wide-ranging health issues, such as the opioid epidemic, mental health and childhood obesity. He said that law and healthcare must work together to tackle the opioid fight.

Vice President Pence praised Dr. Adams for his work on cutting Indiana’s infant mortality rate, addressing Ebola and helping curb an HIV outbreak stemming from injection drug use. Dr. Adams said that he is eager to start helping victims of Hurricane Harvey as the “nation’s doctor” and reaffirmed his commitment to “letting the science lead him to facilitating locally-led solutions to difficult health problems.”

Plant-Based Diet As Effective As PPIs in Treating Laryngopharyngeal Reflux
Findings published online in JAMA Otolaryngology-Head & Neck Surgery reports that “a plant-based diet is just as effective as proton pump inhibitors in treating laryngopharyngeal reflux,” researchers found in a six-week study involving “85 patients with an average age of 60 treated with the P.P.I.s Nexium [esomeprazole magnesium] and Dexilant [dexlansoprazole], and 99 treated with alkaline water and the Mediterranean diet, a regimen low in meat and dairy, and rich in olive oil, nuts, fish, beans, fruits and vegetables.”

Garfunkel Wild Hosting 4th Annual Ambulatory Surgery Center Symposium
Garfunkel Wild will be hosting its 4th Annual Ambulatory Surgery Center Symposium on October 20, 2017 at the Crowne Plaza Times Square.  Speakers include representatives from major managed care organizations, CMS, state and national ASC association leaders, hospitals and management company executives, leading consultants and many more. To register or for more information, visit www.nymetroasc.com or call 516-393-2294.

According to CDC Stats, One in Three Americans Are Obese
The Trust for America’s Health and the Robert Wood Johnson Foundation released a report based on statistics from the Centers for Disease Control and Prevention that showed
one in three American adults and one in six children to be obese.
The highest obesity rates are found in West Virginia, Mississippi, Alabama, and Arkansas, although the rates of increase in some states may be stabilizing. Trust for America’s Health President and CEO John Auerbach commented, “The adult rates are showing signs of leveling off and the childhood rates are stabilizing. In our review of the policies and strategies, we found that many (states) show a lot of promise for reversing the trends and improving health if we make them a higher priority.”

The data compiled from the Behavioral Risk Factor Surveillance System, relies on self-reported weight data, “so it likely underestimates true rates.” Despite state obesity statistics leveling off, the data indicates that the nation is “at risk of poor health” if programs to address obesity lose funding, according to the Trust for America’s Health CEO.

District Court: Govt. “All But Ignored” Calls for Insurer Payment Transparency
The US District Court for the District of Columbia has ruled on a motion filed by the American College of Emergency Physicians (ACEP) in regard to its lawsuit against the federal government (ACEP v. Thomas E. Price, MD) that argued a regulation under the Affordable Care Act (ACA) violated Congressional intent.
“This is a clear step in the right direction,” said Rebecca Parker, MD, president of ACEP. “It does not invalidate the federal regulation, but
it supports ACEP’s contention that the federal agencies ignored significant concerns raised by public commenters regarding a lack of transparency by health insurance companies in determining payments.
Congress in the ACA required that reasonable amounts be paid for emergency care, based on an objective standard, when patients receive it outside of a qualified health plan’s network.”

The court remanded the case back to HHS for further explanation, saying that comments during the regulation’s development had been submitted to CMS expressing concerns “for example, that the methods it used to set payments were not transparent and could be manipulated by insurers…The Departments all but ignored these comments and proposals.”

ACEP originally filed suit in May 2016 against then-Secretary Burwell after the federal government did not address the concerns raised to CMS about out-of-network emergency physician payments, which the agency set at the “greatest of three” options: (1) Medicare (which often does not even cover providers’ costs) (2) In-network rates (set without the provider’s input) (3) “Usual and customary” (as determined by the health plans).  As written, this regulation opened the door for insurers to use non-transparent (“black box”) methods to determine these “usual and customary” payment amounts without providing any means to externally verify the data.

CMS Poster for Coding Information for Preventive Services
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html


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Beautiful, fully-equipped medical sweet for rent or share – Glen Oaks, NY
For Rent or Share – Glen Oaks, NY
(border of Queens & Long Island)
Available for full or half-days.
Beautiful, recently renovated office
available for part-time share
OR available for rent.
Centrally located /Close to expressways.
The practice is 5 minutes from LIJ/Northwell Hospital.
8 exam rooms/procedure rooms. Waiting room, break room and
personal office with private bathroom.
(~2500 sqft) Free WIFI.
6 parking spots for patients and 2 for doctor.
The previous tenant, a full-time primary care
physician with a part-time cardiologist coming
in turned it over to an associate a year ago
but has been here for about 10 years. He needed more space
and bought a building about 20 minutes away. Our building gets a lot of drive-by traffic and pedestrian traffic from the mall across the street. Weekly we have patients walk in inquiring about the practice.
The dental practice next door sees over 2500 patients per year and refers actively to the medical suite.

Follow the link for a video of the space (all furnishings, exam tables, chairs, oxygen, orthoscope included in lease – about $500k in value): https://youtu.be/f9gr62fKaVs

Contact Haresh at hareshshah54@hotmail.com or 516-220-3297


Upper East Side Medical Office for Rent
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house.  Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800

For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
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CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355