Tonight, I write this column with a heavy heart after losing my beloved father to a decade long battle with Parkinson’s disease. To know my father was to be blessed by a ray of sunshine. He was a gifted educator who helped shape a generation of teachers in the New York metropolitan area. He had a special passion for science and math and succeeded in eliciting excitement for STEM education in young children long before the term was coined. My father approached life with joy, humor, and conviction. It is with an eye toward his memory, that I view this week’s very positive milestones.
Our State budget was finalized this week and thanks to the collective advocacy efforts of MSSNY and our county and specialty societies, the budget package includes several “victories” for organized medicine. Click MSSNY eNews – Stop Health Cuts! for full details.
- The Excess Malpractice Insurance Program was Extended with full funding without physician cost sharing.
- Physician Due Process was Protected in the OPMC process by the deletion of adverse provisions that would have permitted the Commissioner to publicly disclose information regarding a complaint filed against a physician and would have created a nebulous standard for imposing a summary suspension prior to the conclusion of disciplinary proceedings.
- The Pharmacy Scope Changes that would have expanded the physician-pharmacy Collaborative Drug Therapy program, permitted pharmacist self-ordering of lab tests, and significantly expanded the number of the immunizations that can be performed by pharmacists were rejected.
- Essential Plan Enhancements were included.
- E-Prescribing Waivers were protected.
- Cuts to MSSNY’s Committee for Physicians Health were restored.
This week, I was named to the Governor’s newly formed Essential Workers Advisory Committee to help build a monument to Essential Workers. I am humbled to be chosen to help honor the service and sacrifices of our New York State Physician heroes and I will endeavor to ensure a fitting and a lasting legacy.
A very important step forward was taken this week on the health equity front with the CDC labeling “racism as a serious public health threat.” With this statement comes funding to address disparities and a much needed and long overdue commitment to dismantling systemic racism and advancing health equity.
As the week comes to a close and my heart begins to mend, I feel that there is somehow a calming symmetry–my father now at peace and my profession healing.
Bonnie Litvack, MD
MSSNY Weekly Podcast
State Budget Finalized with Numerous Victories for Physicians
This week the New York State Legislature completed passage of a $212 billion Budget package that produced several “victories” for organized medicine following months of extensive advocacy by MSSNY working together with county and specialty medical societies. These issues include:
Excess Malpractice Insurance Program Extended
The final State Budget provides full funding for an additional year for the Excess Medical Malpractice Insurance program, which provides 17,000 physicians with a bonus $1 million/$3 million layer of liability insurance above the primary layer purchased by a physician. The State Budget restores the proposed $51 million cut in program funding and deleted an Executive Budget proposal strongly opposed by MSSNY to impose a 50% physician cost share requirement, which would have resulted in the imposition of thousands to tens of thousands of dollars of new costs on these 17,000 enrolled physicians.
Physician Due Process Protected
The final State Budget deleted several provisions proposed in the Executive Budget and opposed by MSSNY to substantially curtail physician due process rights when a complaint has been filed against them with the OPMC. The adverse provisions that were deleted included permitting the Commissioner to publicly disclose information regarding a complaint filed against a physician and creating a nebulous standard for imposing a summary suspension prior to the conclusion of disciplinary proceedings.
Pharmacy Scope Changes Rejected
The final State Budget deleted several provisions opposed by MSSNY that would have expanded the scope of pharmacists, including proposals to greatly expand the physician-pharmacy Collaborative Drug Therapy program, permitted pharmacist self-ordering of lab tests, and significantly expanded the number of the immunizations that can be performed by pharmacists.
Essential Plan Enhancements
The final Budget contains provisions supported by MSSNY to eliminate the premium requirements for the over 800,000 New Yorkers enrolled in the State’s Essential Plan, as well as providing bonus pool funding for physicians and other care providers participating with these plans.
Medicaid Cuts Defeated
The final Budget deleted a proposed 1% across the board cut to Medicaid health care provider payments that had been opposed by MSSNY.
Protect Ability to Apply for E-Prescribing Waivers
The final State Budget deletes the Executive Budget proposal opposed by MSSNY to eliminate the ability for physicians and other prescribers to apply for a year-to-year waiver of e-prescribing requirements (availed by over 2,000 prescribers across the State of New York).
Protect Medicaid “Prescriber Prevails”
The final Budget deletes the Executive Budget proposal opposed by MSSNY to remove the statutory protection for the prescriber’s determination (not State Medicaid’s) to prevail for a medication prescribed to a patient covered by Medicaid fee for service.
No-Fault De-credentialing Rejected
The final Budget deletes the Executive Budget proposal MSSNY had raised concerns with to expand the power of the Superintendent of Financial Services to prohibit certain physicians from submitting claims for No-Fault services.
Addressing Cuts to MSSNY’s Committee for Physicians Health
The final Budget restored the proposed $198,000 cut to MSSNY’s Committee for Physicians Health.
The final State Budget includes an expansion of site locations where telehealth services can both provided and received. Importantly, it deletes a provision opposed by MSSNY advocacy that would have established an “interstate compact” of out of state health professionals to provide health care services to New York patients. Unfortunately, the final Budget also did not include “parity” for the payment of telehealth services, but MSSNY will continue to advocate in the remaining weeks of session to pass this legislation.
“Pass-Through” Entity Tax Option
The final State Budget includes a provision that will permit partnerships the option to pay taxes through the entity rather than on an individual basis, which would permit the individual to fully deduct State and Local Taxes (SALT) instead of being subject to the otherwise applicable federal $10,000 SALT deduction cap. Other high tax northeastern states, including Connecticut, Maryland and New Jersey recently passed similar laws.
Ensure Collaborative Practice by Nurse Practitioners with Physicians
The final Budget includes a provision to extend for an additional year – until June 30, 2022 – the existing law permitting certain nurse practitioners to practice without a written collaborative agreement with a physician provided they have proof of “collaborative arrangements” with physicians in the same specialty practiced by the NP. MSSNY has advocated for much stronger collaboration requirements for nurse practitioners in order to protect patients, however, with the sunset of the existing law coming up in two months, legislation (A.1535/S.3056) has also been introduced and strongly opposed by MSSNY that would repeal the requirements to even maintain proof of these collaborative arrangements. (DIVISION OF GOVERNMENTAL AFFAIRS)
NYS Continues to Expand Vaccine Eligibility to 16 Years of Age and Older
On April 6, 2021, New York State expanded eligibility to the COVID-19 vaccine to adults 16 years and older. The guidance is here: Click Here.
As of April 8, 2021, 22.3% of New Yorkers have completed the vaccine series and 19.9% of Americans have been fully immunized. 35.1% of New Yorkers have received at least one dose.
All providers can vaccinate any New Yorker, including those with comorbidities or underlying conditions, and individuals 16+. Enrolled providers other than pharmacies may vaccinate any eligible individual. Pharmacies must prioritize K-12 school faculty and staff and childcare workers but are also authorized to vaccinate individuals aged 30 and older and individuals with comorbidities.
MSSNY has been working closely with the state to get vaccine supply to community physician offices and several physician practices around the state may receive an allocation of vaccine supply shortly. MSSNY has been informed that over 190 practices have received vaccine. Physicians who would like to become a COVID-19 immunizer, will need to enroll into either the NYSIIS or CIR systems. Physicians can find information about enrolling here: Click Here.
Providers in receipt of COVID-19 vaccine, irrespective as to whether such doses are via a direct State or federal allocation or a redistribution, will now be required to report to the vaccine tracker on Mondays and Thursdays by 10 am. All providers with COVID -19 vaccine doses on hand or that depleted their allocation since their last report are now required to fill out the vaccine tracker both days. This reporting will continue to be used for allocation determinations and is still required.
Physicians and patients can determine eligibility by going here. (CLANCY)
New York State Legalizes Recreational Marijuana
As reported last week, Governor Andrew Cuomo signed a bill into law legalizing recreational marijuana sales and use. The bill passed by the Senate and Assembly will create a regulatory system to oversee the cannabis industry, allow limited home growth as well as expunging an untold number of criminal records. Here is the link to the statement by Governor Cuomo regarding the signing of this into law that contains a comprehensive summary.
The bill would among other key components:
- Direct that 20% of the funding generated from the tax revenue be set aside for drug treatment and education. 40% of the total state tax revenue from cannabis would be set aside to assist communities historically disproportionately impacted by marijuana laws. Another 40% would go toward state education funding.
- Create an Office of Cannabis Management at the state level and a Cannabis Control Board to promulgate regulations. Gov Cuomo would have three appointments to the board, including the chairperson, while the Legislature would have two
- Set a 13% tax rate on retail sales of cannabis products. Of that, 9% of the 13% would go to the state, while 4% would be directed to localities, with counties to receive a quarter of that revenue, while the municipality would receive the remainder.
- Permit possession of three ounces of the drug, and 24 grams of concentrate, outside the home. Five pounds is allowed to be kept at home but must be stored away from children.
- Expanding the medical cannabis program to increase the number of health conditions that a prescriber could certify a patient to receive medical cannabis.
Legal sales of adult use marijuana will be permitted sometime in 2022, though prior to 2022 cities, towns and villages can pass a resolution to prohibit dispensaries and social consumption locations within their municipality.
Many groups including MSSNY, the NYSPTA, NYS Association of County Public Health officials and various law enforcement associations raised serious concerns throughout the debate over the last few years regarding legalization including the need for additional research into the impacts of marijuana use on physical and mental health and the traffic safety impact. MSSNY will continue to work closely with these organizations as well as various state agencies as this law is implemented, to ensure a proper emphasis is being placed on protecting public health. Here is a link to an additional summary of the passed legislation. (ALI)
Legislation Signed to Eliminate Covid Legal Protections – Effective April 6
Governor Cuomo signed legislation (S.5177/A.3397) into law recently passed by the State Legislature to eliminate the Covid liability protections provided to physicians and other care providers enacted during the height of the pandemic last spring. The elimination of these protections is effective April 6 – the date the bill was signed into law.
Many groups including MSSNY wrote to legislators to oppose A.3397/S.5177, noting that regardless of nursing home concerns that led many to question the continuing need for these legal protections, it is important to maintain these absolutely essential protections for the duration of the public health emergency for the front-line physicians and other health care workers still managing the thousands of new Covid cases in New York every day with an increasing penetration of more easily spread variants.
Given that statutory construction rules presume legislation is to be applied prospectively in the absence of clearly defined statutory intent to the contrary, we are pleased there were comments made by several Assemblymembers during the floor debate on the legislation when it was passed by the NYS Assembly that re-iterated that the “effective date” language means that the repeal provisions would only apply after the date the bill was signed into law. The point was also made by Senator Shelly Mayer during the floor debate in the Senate. (AUSTER)
US House Expected to Pass Legislation to Prevent 2% Medicare Cut Until 2022
Next week, the House of Representatives on its return to DC is expected to vote favorably on legislation to extend the 2% Medicare sequester moratorium that expired on April 1. On March 25th the US Senate voted 90-2 to pass an agreement reached by Leaders Schumer and McConnell that provides a 9-month extension of the moratorium, through December 31. If the legislation is not passed by the House, a 2% Medicare payment cut will go into effect.
The Centers for Medicare & Medicaid Services has held off on processing April Medicare claims to avoid making payments with reduced amounts. (AUSTER)
Updates for Accelerated and Advanced Payments Program
During this session, we will review the revised repayment and recoupment process and provide the latest updates on the Accelerated and Advanced Payments program. If your facility received an accelerated or advanced payment from Medicare due to the COVID-19 public health emergency, then attending this webinar will provide the most current information from CMS.
Medicare Part B
Apr 15, 2021 10:00 a.m ET – 11:00 a.m ET
COVID-19 Medicare Part B Advanced Payment, Repayment and Recoupment Process
If you requested accelerated or advanced payments from Medicare due to the COVID-19 public health emergency, this learning session is for you. CMS expanded the accelerated and advance payment program for financial hardship relief during the COVID-19 public health emergency. Accelerated or advanced payments need to be repaid to the Medicare Trust Fund. During this webinar, we will review the repayment and recoupment process and address your questions.
MSSNY Medical Matters Program on Mental Health of Children and Teens During COVID
Registration now open
Medical Matters: COVID-19 & Mental Health of Children and Teens
Date: April 21, 2021 @ 7:30am
The COVID-19 pandemic has affected the mental health of the entire population. Learn more about how children and teens have been affected by registering for Medical Matters: COVID-19 & Mental Health of Children and Teens. This webinar will take place on Wednesday, April 21st at 7:30 am. Linda Chokroverty, MD will serve as faculty for this program. Click here to register for this webinar.
- Identify normal stressors impacting children and teens and those that have resulted from the COVID-19 pandemic
- Examine what is known so far about the mental health impact of COVID-19 on children and teens
- Describe resources to assist children and teens during the COVID-19 pandemic
- Appraise the scope of COVID-19’s long term mental health impact on children and teens
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (HOFFMAN)
Veterans Matters: Military Culture: Everything Physicians Need to Know about Veterans as Patients Webinar
Registration Now Open
Thursday, April 22nd @ 7:30 am
The Medical Society of the State of New York is hosting a Continuing Medical Education (CME) program entitled Veterans Matters: Military Culture: Everything Physicians Need to Know about Veterans as Patients live webinar on Thursday, April 22, 2021 at 7:30 am.
Click HERE to register for the program! View the program flyer HERE.
When: April 22, 2021 at 7:30 am
Faculty: Lt. Colonel Lance Allen Wang (Ret.) & Sharran Chambers-Murphy, Desert Storm-era Veteran
- Describe the unique aspects of military culture and how they impact patients who are veterans;
- Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality; and
- Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back to civilian life.
For more information, contact Jangmu Sherpa at firstname.lastname@example.org or call (518) 465-8085.
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. (SHERPA)
Webinar for Physicians Applying to PCF Model on April 31
Physicians considering applying for the PCF model to start in 2022 are invited to register now for a webinar to be offered Tuesday, April 13, from 6:00-7:00 pm ET by the American Medical Association, American College of Physicians, American Academy of Family Physicians, and the CMS Innovation Center. PCF is open to medical practices that provide primary care services in 26 regions across the country, with an application deadline of April 31, 2021.
The live webinar will allow participants to hear from CMS and medical society experts about the model and how participation could affect their practice revenues. Additional details, including the request for applications, a map of the 26 regions, and lists of the practices and other payors that are participating as part of the 2021 cohort are available on the CMS Primary Care First website.
Physicians Experienced Little Relief from PA as COVID-19 Soared
As new cases of COVID-19 in the United States were peaking in late 2020, most physicians reported that health plans continued to impose bureaucratic prior authorization policies that delay access to necessary care and sometimes result in serious harm to patients, according to new survey results issued by the AMA.
According to the AMA survey, almost 70% of 1,000 practicing physicians surveyed in Dec. 2020 reported that health insurers had either reverted to past prior authorization policies or never relaxed these policies in the first place. More than nine in 10 physicians (94%) reported care delays while waiting for health insurers to authorize necessary care, and nearly four in five physicians (79%) said patients abandon treatment due to authorization struggles with health insurers.
“Delayed and disrupted treatment due to an archaic prior authorization process can have life-or-death consequences for patients, especially during a public health emergency,” said Dr. Bailey. “This hard-learned lesson from the current crisis must guide a reexamination of administrative burdens imposed by health insurers, often without any justification.”
Nearly one-third (30%) of physicians reported that prior authorization requirements have led to a serious adverse event for a patient in their care, according to the AMA survey. More specifically, prior authorization requirements led to the following repercussions for patients:
- Patient hospitalization – reported by 21% of physicians
- Life-threatening event or intervention to prevent permanent impairment or damage – reported by 18% of physicians
- Disability or permanent bodily damage, congenital anomaly, birth defect, or death – reported by 9% of physicians
While the health insurance industry says prior authorization criteria reflect evidence-based medicine, the physician experience casts doubt on the credibility of this claim. Only 15% of physicians reported that prior authorization criteria were often or always based on evidence-based medicine.
- Other critical physician concerns highlighted in the AMA survey include:
Nine in 10 physicians (90%) reported that prior authorization programs have a negative impact on patient clinical outcomes.
- A significant majority of physicians (85%) said the burdens associated with prior authorization were high or extremely high.
- Medical practices complete an average of 40 prior authorizations per physician, per week, which consume the equivalent of two business days (16 hours) of physician and staff time
- To keep up with the administrative burden, two out of five physicians (40 %) employ staff members who work exclusively on tasks associated with prior authorization.
The findings of the AMA survey illustrate a critical need to streamline or eliminate low-value prior-authorization requirements to minimize delays or disruptions in care delivery. The AMA has taken a leading role in advocating for prior authorization reforms and convening key industry stakeholders to develop a roadmap for improving the prior authorization process.
In January 2018, the AMA and other national organizations representing pharmacists, medical groups, hospitals and health plans signed a consensus statement outlining a shared commitment to improving five key areas associated with the prior authorization process. However, health plans have made little progress in the last three years toward implementing improvements in each of the five areas outlined in the consensus statement.
The AMA continues to work on every front to streamline prior authorization. Patients can share their own personal experiences with prior authorization at FixPriorAuth.org.
Fauci Thanks Workers for Sacrifices; Admits PPE Shortages Drove Up Death Toll
Dr. Anthony Fauci thanked America’s health care workers, who “every single day put themselves at risk” during the pandemic, even as he acknowledged that PPE shortages had contributed to the deaths of more than 3,600 of them. “We rightfully refer to these people without hyperbole — that they are true heroes and heroines,” he said in an exclusive interview with The Guardian. The deaths of so many health workers from covid-19 are “a reflection of what health care workers have done historically, but putting themselves in harm’s way by living up to the oath they take when they become physicians and nurses,” said Fauci. (KHN, 4/9).
33% of COVID-19 Survivors Later Diagnosed with Psychiatric Issues, Study Finds
Among 236,379 patients who had a confirmed COVID-19 infection, nearly 34 percent were diagnosed with a neurological or psychological condition within six months, according to research published April 6 in The Lancet Psychiatry.
To conduct the research, scientists analyzed EHR data from patients across 62 healthcare organizations, primarily in the U.S., and found 33.62 percent of those with COVID-19 were diagnosed with a neurological or psychiatric condition within six months. In 13 percent of those cases, it was the patient’s first neurological or psychiatric diagnosis.
The most common diagnosis was anxiety, occurring in 17.39 percent of patients. Neurological disorders, such as stroke and dementia, occurred in 2.10 percent and 0.67 percent of the study population, respectively.
Overall, patients with severe COVID-19 were more likely to experience neurological and psychiatric outcomes compared to those with milder illness. For example, among patients who required intensive care, stroke later occurred in 6.92 percent, and dementia in nearly 2 percent.
Researchers also found that most of the neurological and mental health disorders included in the analysis were more common in patients with COVID-19 compared to those who had influenza or other respiratory tract infections.
“Our results indicated that brain diseases and psychiatric disorders are more common after COVID-19 than after flu or other respiratory infections, even when patients are matched for other risk factors,” said Max Taquet, PhD, study co-author and psychiatry professor at the University of Oxford in the U.K. “The study cannot reveal the mechanisms involved, but does point to the need for later research to identify these, with a view to preventing and treating them.” To view the full findings, click here.
Blood Clots Rare Side Effect of AstraZeneca’s Vaccine, European Agency Says
The European Medicines Agency said April 7 a safety committee has concluded that unusual blood clots combined with low blood platelets should be listed as a very rare side effect of AstraZeneca’s COVID-19 vaccine, but that it believes the overall benefits of the vaccine in preventing COVID-19 still outweigh the risks.
As of April 4, 169 cases of cerebral venous sinus thrombosis, a type of brain blood clot, as well as 53 cases of splanchnic vein thrombosis, a blood clot in the abdomen, in people receiving AstraZeneca’s vaccine have been reported to the agency, out of a total of roughly 34 million people receiving the vaccine.
Most cases have been reported in women under age 60 within two weeks of receiving the vaccine, the agency said. Specific risk factors for the blood clots have not yet been identified. The EMA said people who have received AstraZeneca’s vaccine should seek medical assistance immediately if they develop symptoms of the combination of blood clots and low blood platelets, including shortness of breath, chest pain, leg swelling, persistent abdominal pain, neurological symptoms, and tiny blood spots under the skin beyond the injection site.
A possible explanation for the blood clots is that the vaccine triggers an immune response and causes a condition similar to one seen in some patients treated with heparin, a blood thinner, the EMA said. The agency said it is conducting more studies to learn more.
The blood clots remain very rare, and the benefits of the vaccine outweigh the risk of side effects, the agency said.
Britain will offer alternatives to the AstraZeneca vaccine to adults under the age of 30, The New York Times reported April 7.
Read the agency’s full news release here.
Majority of People Delaying COVID-19 Vaccination Want J&J’s Shot
Fifty-six percent of people who haven’t received a COVID-19 vaccine yet because they are waiting to see how inoculation plays out for others said they would probably or definitely get Johnson and Johnson’s single-shot vaccine, according to recent research from Kaiser Family Foundation. KFF surveyed a nationally representative sample of 1,862 adults March 15-22, 2021. The survey found 17 percent of Americans have not received a COVID-19 vaccine yet because they are waiting to observe vaccination outcomes in others, down from 39 percent who cited the same reason in December.
Of those taking the “wait and see” approach, 16 percent said they would definitely get Johnson & Johnson’s vaccine, and 40 percent said they would probably get it. Eight percent said they would definitely get Pfizer’s vaccine and 7 percent said they would definitely Moderna’s; and 39 percent said they would probably get Pfizer’s vaccine and 36 percent said they would probably get Moderna’s.
The survey also found 24 percent of Americans with a COVID-19 vaccine brand preference said a one-dose regimen was the main reason.
FDA Approves First New Pediatric ADHD Drug in More Than a Decade
The FDA has approved the first new drug designed to treat ADHD in children in over a decade. The FDA April 2 approved Supernus Pharmaceuticals’ Qelbree to treat ADHD in children ages 6 to 17.
Qelbree is a daily capsule, and unlike other ADHD drugs, it’s not a stimulant, so it’s less addictive and less likely to be abused, according to The Hill. The drug comes with a warning that it may cause suicidal thoughts and behavior, which was observed in less than 1 percent of clinical trial volunteers. In clinical trials, 477 children ages 6 to 11 took Qelbree for six weeks, and symptoms of inattention and hyperactivity were found to decrease by 50 percent compared to the placebo group, according to The Hill. The drug is currently in late-stage testing for adults.
Rockville, Md.-based Supernus Pharmaceuticals has not disclosed the price of the drug. Read Supernus’ full news release here. (Becker’s Hospital Review, April 6)
Documents provided to MedPage Today offer an inside look at the finances of one of the 24 member boards that make up the American Board of Medical Specialties (ABMS). In some respect, they paint a portrait of a well-run business: one that brings in almost $19 million a year while sitting on nearly $40 million in reserves. But they also show an enterprise with generous pay for executives and staff, and where luxury travel is the norm.
It is all funded by practicing physicians who have little choice but to maintain their certification, else they will not be employed by hospitals or paid by insurers — all despite a paucity of data that continuing certification programs make physicians better.
How Physicians Can Improve Their Telehealth Technique
Learn what it takes to make virtual medical visits as good as the in-person variety. Read more from the AMA.
Anesthesiology Group Squeezed ‘Like a Boa Constrictor’ Sues Insurer
U.S. Anesthesia Partners — a single-specialty practice that operates in nine states — is suing UnitedHealthcare (UHC) in Texas and Colorado, alleging the insurance titan forced doctors out of its network and launched a series of anti-competitive actions against the group.
USAP last month filed separate lawsuits in Texas and Colorado state courts, both making similar claims against UHC. The physician-owned, private equity-backed practice — which in total serves more than 2.3 million patients a year — says UHC’s actions have taken aim at its operations in both states.
Central to the claims is that UHC made moves to force doctors out-of-network — harming USAP’s revenues and squeezing the practice from all sides “like a boa constrictor,” as the group’s Colorado suit put it.USAP alleged in each complaint that the efforts “were not enough to satiate United’s greed, so United then embarked on a scheme to interfere with, undermine, and eliminate [USAP’s] existing business and contractual relationships with healthcare facilities, individual surgeons, and patients.”
USAP stated in each complaint that the alleged scheme has involved bribing in-network surgeons with new contracts that provide incentives — such as about 50% more compensation — in exchange for their commitment to steer patients away from USAP. It also alleged that the insurer-imposed penalties on hospitals and other facilities that have contractual agreements with USAP.
USAP noted in its complaints that UHC’s parent company also owns Optum, which — through its division OptumCare — operates a physician practice organization with tens of thousands of employees and affiliated physicians and plans to add more. The group noted that Optum, in turn, owns a significant interest in Sound Physicians, which includes anesthesiologists and certified registered nurse anesthetists.
“In this way, United and its affiliates have extended their tentacles into virtually every aspect of healthcare, allowing United to squeeze, choke, and crush any market participant that stands in the way of United’s increased profits,” USAP stated in its complaint filed in Texas. “UHG [UnitedHealth Group, the parent company], United, and their affiliates are abusing their collective behemoth strength during a global pandemic to drive revenue away from healthcare providers and toward United.”
“Simply put, the less United pays or reimburses healthcare providers for their services, the more United profits from the ever-rising insurance premiums it collects,” USAP added.
USAP stated in each complaint that patients do not benefit from such trends and healthcare costs do not decrease. Rather, the practice stated, patients — including UHC’s members — risk losing access to high-quality anesthesia providers. Plan sponsors may also pay more as higher surgeon fees may be passed through to them, and the total cost of care may be higher as well. Clinical outcomes, USAP alleged, may be worse.
USAP declined to comment on the suits beyond what it stated in its complaints.
Though the practice alleges in its complaints that UHC’s actions have been taken to boost the insurer’s own profits, UHC blames rate demands made by USAP.
In a statement provided to MedPage Today, the company said “USAP’s lawsuit is just the latest example of the group’s efforts to pressure us into agreeing to its rate demands and to distract from the real reason that it no longer participates in our network…. The reality is that many private equity-backed physician staffing companies like USAP expect to be paid double or even triple the median rate we pay other physicians providing the same services.”
“While these egregiously high rates help meet the profit expectations of their private equity owners, they also drive up the cost of care and make health care less affordable for people across the country,” UHC said.
UHC asserted that a few physician staffing companies — often backed by private equity — are trying to protect their ability to charge high rates, which drive up the cost of care for everyone, including the insurer’s employer customers.
UHC said that reimbursing USAP at the median rate the insurer pays anesthesiologists in Texas and Colorado would save employers in Texas more than $104 million in a single year, and employers in Colorado more than $19 million. Such savings could be passed on to employees through steady or lower premiums, or other benefits. (Medpage Today, April 7)
The Medical Society of the State of New York is accepting nominations for the 2020 Albion O. Bernstein, MD Award. This prestigious award is given to:
“…the physician, surgeon or scientist who shall have made the most widely beneficial discovery or developed the most useful method in medicine, surgery or in the prevention of disease in the twelve months prior to December 2020.”
This award was endowed by the late Morris J. Bernstein in memory of his son, a physician who died in an accident while answering a hospital call in November 1940.
The $2,000 award will be presented to the recipient during a MSSNY Council Meeting.
Nominations must be submitted on an official application form and must include the nominator’s narrative description of the significance of the candidate’s achievements as well as the candidate’s curriculum vitae, including a list of publications or other contributions.
To request an application, please contact:
Committee on Continuing Medical Education
Miriam Hardin, PhD, Manager, Continuing Medical Education
Medical Society of the State of New York
99 Washington Avenue, Suite 408
Albany, NY 12210
Classified Ads Available for:
Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate
For help, information or to place your ad, call Christina Southard 516-488-6100 x355 • fax 516-488-2188
For the MSSNY 2021 Ad Rate Sheet, please click here.
Ophthalmic Office to Sublet – NYC
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Please contact Scott Weissman MD. email@example.com.
Two Offices Available for Rent in Established SoHo Primary Care Practice
Newly constructed loft space. Dedicated private waiting area available. This space is ideal for individual psychiatry, psychology, social work, physical therapy, or acupuncture services. Potential to work with existing Primary Care Practice as a referral source. Centrally located in the heart of SoHo, close to all subways. Available 7 days/week. Contact: SpringPrimaryCare@gmail.com.
Medical Office and Medical Practice (Upper East Side)
79th St near Lexington / Park. 750 sq Ft beautiful, street entrance, medical office for sale with a 25 + yr internal medical practice for sale. Office is in move in condition. Physician retiring. Waiting room. Secretarial area for 3. 1 Consult room. 2 exam Rooms 2 Toilets. Please contact: 917-770-8700 / email firstname.lastname@example.org
For Rent Medical Office 800 2nd Ave, 806
FOR RENT 800 2nd Avenue, 806 – Fully built out Medical office ready for use – reception area; 2 office/ consultation rooms; 4 examination rooms with plumbing; 1 sterilization room or pantry; 1 file/ nurse room, Total 8 rooms. All examination rooms are set up with plumbing and cabinetry. 24/7 doorman/ Elevators. Central location, Grand Central Station, buses Subways. Rent: $65 per Rentable Sq Ft; Sq Ft: 1,482 Rentable; Gross Lease. Showings or video contact Maya – Broker – email@example.com or mobile 646-258-4460 listing information http://www.mallannyhomes.com/properties/detail/800-second-avenue-806/
Allergy Practice For Sale, Forest Hills, NY
Founded in 1988, this well-established Single Practitioner Allergy Practice has over 3500 active patients, with very positive patient reviews. The office is only one of a few in the area, but patients are seen from throughout the NYC Metropolitan Area, as well as Long Island. Potential for growth. Centrally located next to major public transportation. Retirement planned. Lease is assignable. Well-trained, extremely personable staff of three, including a Registered Nurse. Payer mix85% private, 10% Medicare 5% other.
Email any questions to: firstname.lastname@example.org
Two (2) Prime Commercial Spaces
Two (2) affordable office spaces available for immediate occupancy. Located in Sheepshead Bay Brooklyn, surrounded by multiple co-ops and private homes. Space can be viewed at your convenience. Price negotiable. Call: Avi 212-736-3680 ext. 15
Date Posted: 03/23/21 Applications Due: 04/06/21 Vacancy ID: 85272
||Health, Department of
||Health Program Director 2 -TBD
Other Professional Careers
||M/C – Management / Confidential (Unrepresented)
||From $122092 to $154253 Annually
Hours Per Week
|Compressed workweek allowed?
||CCH; Division of Family Health
Corning Tower, ESP
||Twelve years of professional level work experience, three of which must have included managerial, decision-making and/or oversight responsibilities for a major health-related program or in the direction of a major administrative function of a large health-related organization. A bachelor’s degree may be substituted for four years of the general professional experience.
Twelve or more years of progressively responsible administrative experience in programs that improve perinatal health, child and/or adolescent health, early care, and learning, and/or sexual violence prevention, including four years of managerial, decision-making, and/or program direction. Seven years of this experience would also include fiscal management, policy making and oversight responsibilities, and statewide supervision of professional level staff. The preferred candidate would be familiar with representing departmental interests and serving as a spokesperson and liaison to Executive staff, and have experience working with other state and federal governmental programs. Experience with second-level professional supervision as well as strong oral and written communication skills is also desired. A master’s degree in an appropriate field may substitute an additional one year of the general professional experience, not to exceed a maximum of five years total allowable educational substitution. Please refer to full listing
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