January 22, 2016 – Yes to Corporate Partnerships?

January 22, 2016 admin

PRESIDENT’S MESSAGE
Dr. Joseph R. Maldonado

January 22, 2016
Volume 16, Number 3

Dear Colleagues:

Yesterday’s Council meeting included a lengthy discussion concerning changes related to the corporate practice of medicine statutes being considered by the New York State Departments of Health and Financial Services. The architects of healthcare reform in the state of New York are seeking to improve how healthcare services are delivered to the residents of the state. There is a prevailing view that in order to improve health outcomes, adjustments need to be made that change how relevant services are delivered.

The current view is that services that are critical to improving outcomes for many costly chronic conditions is delivered in an incomplete and/or fragmented fashion. In order to improve outcomes, we must improve the coordination of services as well as the modalities and organizations that provide the relevant services. This is where things get wickedly complex and where we, as the highest order licensed healthcare professionals, have the duty to weigh in to insure safe delivery of high quality, evidence-based medical care.

Separation of Physicians and Non-Physicians

We enter into the arena of “wicked problems,” because the healthcare initiatives being considered challenge many of our longstanding beliefs concerning the practice of medicine and the separation of licensed professionals so that non-physicians cannot create professional medical organizations to deliver professional services. These new models do not always seek to create entities that deliver professional physician services. Rather, they seek to allow for the creation of new— perhaps hybrid— entities wherein physicians can deliver professional services that only they can deliver while others—perhaps non-professionals— deliver other services that are critical to the improvement of the physicians’ medical services.

Do we allow room for exploring new delivery models that challenge our views of how we protect the scope of practice of our profession? Do we push the envelope a bit to allow room to explore new models, making sure that physicians have the professional medical and financial control of these new delivery models? Do we simply draw a line in the ground and raise the standard in the name of protecting our patients while archaic and cumbersome models continue to fail us? Do we take the risk that our hard stance on the corporate practice of medicine gets railroaded by the political and regulatory machinery to the detriment of our patients because we were unwilling to initiate changes in a manner whereby we could safeguard the health and wellbeing of our patients and our profession?

The challenges facing us are great. Many of us do not like the changes being proposed. Nonetheless, our Oath, when we entered the profession, requires us to rise above long-held beliefs, and rethink these beliefs in light of changes.

We Must Lead the Way

We must consider these changes and create the mechanisms that improve the delivery of care while we stand firm in the defense that it is the MEDICAL PROFESSION that must lead and control these novel delivery systems in order to insure evidence-based quality and safety outcomes that provide the desired value for our money.

Short of these, the most advanced healthcare system in the world is doomed to collapse or fall into mediocrity.

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

Please send your comments to comments@mssny.org

MSSNY Lobby Day Scheduled for March 8^th – Physicians Urged to Attend and Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on March 8^th in the Lewis Swyer Theatre in the Egg located at the

Empire State Plaza in Albany, New York. Please register here if you plan to attend.

A full slate of legislators have been invited to dialogue with Advocacy Day participants including:

Donna Frescatore, Executive Director, NYS Health Benefit Exchange;
Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited. A brief luncheon to which members of each House are invited to dine and speak with their constituents will follow the morning program. County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Given the wide range of threats physicians face including legislation that would expand the statute of limitations with a broad date of discovery exception potentially increasing physician premiums by 14.5%; legislation to repeal the Trial Lawyers contingency fee limits, potentially increasing premiums by over 10%; significant reductions in eligibility of the Excess Program; legislation that will mandate physicians to take a 4-hour Pain Management CME course every two years; and a move to effectuate statutory and regulatory changes to implement a value-based payment structure under Medicaid and potentially to Medicare and commercial products as well.

PHYSICIANS ARE ENCOURAGED TO IMMEDIATELY REGISTER TO ATTEND THE MARCH 8^TH LOBBY DAY IN ALBANY.
(GOVERNMENTAL AFFAIRS STAFF)

Physicians Urged to Oppose Huge Cuts to Excess Medical Liability Insurance Program
Physicians are urged to contact their legislators to object to the huge cuts contained in the Executive Budget to the Excess Medical Malpractice Insurance program. If permitted to go forwarded, it would unfairly result in more than half of the physicians currently enrolled being dropped. MSSNY’s strong opposition to these cuts will be a major component of MSSNY’s testimony to the joint meeting of the Assembly Ways & Means and Senate Finance Committees this Monday examining the proposed Health Budget.

Specifically, the proposal would prioritize funding for those physicians who practice in higher risk specialties and in more litigious regions of the State. However, by cutting the funding by $25 million, it would mean that 55% of physicians who currently receive this essential coverage would be dropped from the program. In upstate communities north and west of Greene and Columbia counties, coverage would continue only for neurosurgeons, bariatric surgeons and OB-GYNs. That means that in the Capital District, in Northern New York, in Central New York, in western New York and in the Southern Tier every family physician, internist, pediatrician, ophthalmologist, emergency room physician, vascular surgeon, cardiologist, radiologist, pathologist, otolaryngologist, dermatologist and allergist would be automatically dropped. Even in some downstate communities including in the Bronx, Kings, Queens, Westchester, Sullivan and Orange counties, many primary care physicians, ophthalmologists, otolaryngologists, pathologists, dermatologists and allergists would be dropped.

The Excess Medical Liability Insurance Program provides an additional layer of $1M of coverage to physicians with hospital privileges who maintain primary coverage at the $1.3 million/$3.9 million level. The program was created over 30 years ago as a result of the liability insurance crisis of the mid-1980’s to address concerns among physicians that their liability exposure far exceeded available coverage limitations. They legitimately feared that everything they had worked for all of their professional lives could be lost as a result of one wildly aberrant jury verdict. This fear continues today since New York State has failed to enact meaningful tort reform to ameliorate this risk. The size of verdicts in New York State has continued to grow significantly and physician liability premiums remain far out of proportion compared to the rest of the country. Absent meaningful liability reform, full funding for the Excess program is absolutely essential in today’s very challenging practice environment.

At a time when the state is seeking to attract and retain physicians, this proposal deters physicians from wanting to practice in New York State for fear of putting themselves and their families in financial jeopardy for judgements and settlements exceeding the limits of their primary coverage.

Please urge your legislators to reject these cuts and restore full funding for the program!
(AUSTER, DEARS)

Contact Your Legislators to Support a Health Republic Guarantee Fund
With the failure of the Executive Budget to include a Guarantee or other fund to cover the likely hundreds of millions in payments due to Health Republic contracted providers, all physicians are urged to continue to contact their legislators and demand that the State Legislature take action to create such Guarantee or other fund. Urging the Legislature to enact a Guarantee fund as part of the State Budget process will be a major component of the testimony that MSSNY will give this Monday at a joint meeting of the Assembly Ways & Means and Senate Finance Committees.

MSSNY has worked with hospital associations to press key State Legislative leaders that it is absolutely imperative for the stability of our health care system that this be addressed soon. We have shared with public officials the results of MSSNY’s survey that concluded that physicians are owed at least tens of millions of dollars in outstanding claims, of which:

11% are owed $100,000 or more;
20% are owed $25,000 or more; and
49% are owed $5,000 or more.

Moreover, we have shared data from 5 large medical practices in the Lower Hudson Valley that together are owed over $12 million.

Please be on the lookout early next week for a new survey that seeks updated information from you whether this amount has grown since our initial survey was sent in November. Please take the time to complete this survey, as the data is critical to our advocacy efforts.

And please take the time to send a letter to your legislators at this link.

Remind them that, with physicians facing so many other challenges in seeking to keep their doors open to deliver patient care, including high liability costs, expensive electronic medical record equipment, employee costs, insurance companies dropping physicians from their networks and declining payments from insurers, failure to assure payment for these claims would have serious negative consequences for patient care and employment in your community.
(AUSTER, DEARS)

Disastrous Liability Expansion Bill Back on Assembly Calendar; Physicians Must Contact Their Legislators to Oppose Now!
All physicians must continue to contact their Senators and Assembly members to urge that they oppose legislation (A.285, Weinstein) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule. The letter can be sent here.

With the bill having passed the Assembly in 2015, but not the Senate, it resumed a place on the Assembly Calendar, where it could be voted on by the full Assembly at any time. The bill was brought up for initial consideration on Monday 1/11, but was “laid aside” by the Assembly Republican Conference.

While the bill currently does not have a Senate sponsor, it is possible that similar legislation could be introduced shortly. At the conclusion of the 2015 Legislative Session, Senate Majority Leader Flanagan noted in response to a question from a Daily News reporter that issues like malpractice reform “have never been done in isolation” and that they would be working with representatives on both sides of this issue. Since that time, MSSNY working together with MLMIC and hospital associations have met with top Senate staff to discuss comprehensive medical liability proposals to work towards legislation that would reduce the outrageous cost of physician medical liability premiums.

As these discussions ensue, you need to let your legislators know that no liability increases can be tolerated! MLMIC’s estimate is that A.285 could increase physician liability premiums by an untenable 15%! New York physicians continue to pay liability premiums that are among the very highest in the country. They also face rapidly increasing overhead costs to remain in practice such as the huge costs associated with implementing expensive and cumbersome electronic medical record systems. At the same time, they face reduced payments from Medicare and commercial insurers, and many practices face losses of tens of thousands, hundreds of thousands and in some cases millions of dollars in losses due to the collapse of Health Republic.

And to make matters even worse, trial lawyers are aggressively pushing the Legislature to consider additional liability expansion bills such as legislation that would eliminate the statutory limitation on contingency fees in medical liability actions, legislation that MLMIC has estimated could have the effect of raising your premiums by over 10%. Physicians need liability reform to bring down these costs, not legislation that increases them!
(AUSTER, DEARS)

CME Mandate Bill Taken Off NYS Assembly Health Committee Agenda; Senate Bill Moving in Health Committee
Assembly Bill 355 (Rosenthal) and Senate Bill 4348A (Hannon) which would create a continuing medical education mandate for practitioners with prescribing privileges was taken off the agenda of the Assembly Health Committee on Thursday but a slightly different Senate version of the legislation is on the Senate Health Committee agenda for next week. Physician action is vitally important. They are urged to contact their elected representatives to urge that they vote against this mandate! Send an email through MSSNY’s Grassroots Action Center.

4348A, sponsored by Senator Kemp Hannon, authorizes the Commissioner of Health to establish standards and to review requirements for CME on pain management, palliative care and addiction, is on the Senate Health Committee agenda for Tuesday, January 26^th. It would require health care professionals authorized to prescribe controlled substances to complete three hours of continuing medical education, prior to renewal of registration to practice, that involves pain management. The curricula must include but is not limited to, I-STOP and drug enforcement administration requirements for prescribing control substances; pain management; appropriate prescribing; managing acute pain; pain; palliative medicine; preventative, screening and signs of addiction; responses to abuse and addiction; and end of life care. The Commissioner may allow for exemptions if the health care professionals meet requirements to the Commissioner’s satisfaction. The Commissioner must report on the impact of this legislation and any recommendations no later than three years after its enactment.

MSSNY has strongly opposed this measure in previous legislative sessions. Continuing Medical Education is valuable to physicians in keeping up-to-date on new clinical information, and physicians throughout the state voluntarily take continuing medical education for continued professional development in those areas that pertain to their individualized practice. However, this bill fails to recognize that the Medical Society of the State of New York, the specialty societies, the American Board of Medical Specialties, and the American Osteopathic Association have all been aggressively promoting voluntary CME on pain management and that there is other course work that addresses many of the above issues. (CLANCY, DEARS)

Concerns with One-Sided Workers Compensation Reform Proposals to be an Important Component of MSSNY’s Budget Testimony
MSSNY’s testimony to the Senate Finance and Assembly Ways & Means Committees to be presented this Monday will raise significant concerns with the sweeping Workers’ Compensation reform proposal contained in the Executive Budget. Among the proposals of greatest concern to physicians and their injured worker patients:

Removes the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation, which is currently an important peer review function provided by county medical societies to assure physician applications are complete and physician applicants are appropriately qualified to deliver this needed care to injured workers;
Enables treatment of injured workers and direct payment for care by nurse practitioners and physician assistants, without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery with physicians; whether new funds will be allocated or whether existing fees will need to be cut to cover this expanded list of care providers; and whether a non-physician can perform an IME of an injured worker to review the care provided by a physician to an injured worker;
Removes the requirement for a referral by a physician as a pre-condition for an injured worker to receive psychological care;
Expand the circumstances when a physician or other health care provider can have their authorization removed and empowers the Board to impose a $5,000 fine on a physician or any other Board-authorized health care provider for violating a Workers Compensation rule; and
Prohibits an injured worker not subject to a collective bargaining agreement from seeking medical treatment from outside a Workers Compensation PPO before 120 days after his or her first visit to a preferred provider organization provider.

Exacerbating these concerns is that the proposal also does not meaningfully address the many excessive administrative hassles identified by physicians that have caused many physicians to choose to not participate in the Workers Compensation program. While there have been some modestly positive actions taken by the WCB in recent years to encourage physician participation in the WC program through removal of arbitration fees and development of an electronic portal for facilitating authorizations from carrier, the Budget proposals if enacted could further chase physicians away from the program.

MSSNY has reached out to labor organizations to coordinate its advocacy in opposition to these adverse proposals. MSSNY has also been working closely with county medical society leadership from across the State to encourage their outreach to their local Senators and Assemblymembers to request that these proposals be jettisoned from the Budget.
(AUSTER, DEARS)

Physicians Encouraged to Register for Opioid Prescribing Webinar on January 26
Physicians and other prescribers are encouraged to register for the first free webinar on opioid prescribing which will take place on Tuesday, January 26^th at 12:30 p.m. at the following link.

Click on the upcoming tab and select the programs. Physicians will need to register for each webinar.

The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are jointly providing this free, four part webinar series on opioid prescribing. Entitled, “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

The first webinar will be conducted by Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN and the educational objectives are:

Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

The remaining webinar series will be held on:

Wednesday, February 10, 2016, 7:30 a.m. Faculty: Charles E. Argoff, MD. The educational objective: Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m. Faculty: Jeffrey Selzer, MD and the educational objective: Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.

Thursday, March 10, 2016, 7:30 a.m. Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM and the educational objectives: Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed; discuss strategies to reduce risk of treating pain in patients with substance use disorders.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent. This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing.

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.

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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.
(CLANCY, DEARS)

Bill to Limit Opioid Prescriptions to Three-Ten Day Supply on Senate Health Agenda
Senate Bill 6091A, which would limit the initial prescription of Schedule II or III Controlled Substance to a three to ten day supply, is on the Senate Health Committee agenda for Tuesday, January 26^th. Sponsored by Senator Kemp Hannon, the bill is intended to encourage patients whose acute pain lasts longer than initially expected to follow up with a physician and it lessens the number of the pills left in medicine cabinets and available for diversion. The bill does limit the number of co-pays for patients should they need additional prescriptions.

The Medical Society of the State of New York is opposed to this measure and believes that having the New York State Legislature place an arbitrary limit on any type of prescriptions interferes with the practice of medicine. Its companion measure, A. 8601, sponsored by Assemblymember John T. MacDonald III, is in the Assembly Health Committee.

Physicians are urged to contact Senators on the Health Committee and urge defeat of this measure. Senate Health Committee members are: Senators Kemp Hannon, Hugh Farley, Simcha Felder, Martin Golden, Ruth Hassell-Thompson, Brad Hoylman, William Larkin, Betty Little, Jack Martins, Velmanette Montgomery, Terrence Murphy, Roxane Persaud, Gustavo Rivera, James Seward, Toby Stavisky, David Valesky, and Catharine Young.
(CLANCY, DEARS)

Governor Nominates Vullo for DFS Superintendent
Governor Andrew Cuomo this week nominated Maria T. Vullo to serve as the Superintendent of the New York State Department of Financial Services. She is currently of counsel at Paul, Weiss, Rifkind, Wharton & Garrison LLP, where she was a partner for 20 years, and previously oversaw the Economic Justice Division in the Office of the New York State Attorney General. DFS has had multiple Interim Superintendents since the previous Superintendent, Benjamin Lawsky, left the position last spring. To read more about Ms. Vullo’s background, click here.
(AUSTER)

Centerlight Healthcare Settles for $47 Million in Medicaid Fraud Case
On Thursday, January 21^st, Attorney General Eric Schneiderman announced a $47 million settlement with CenterLight Health Care and Centerlight Health System stemming from allegations of fraudulent Medicaid billing for unrendered services to 1,200 Medicaid recipients. As part of the settlement agreement CenterLight admitted that it enrolled ineligible Medicaid beneficiaries in its Managed Long Term Care Plan (“MLTCP”), which was contracted by NYS DOH to provide long-term community based health care; and that it used adult day care centers to provide community-based MLTCP personal care services that did not qualify as personal care services. In addition to its $47 million settlement, CenterLight agreed to additional monitoring for two-years by an independent compliance monitor and the A.G.’s Medicaid Fraud Control unit, and if necessary to revise its compliance policies.
(MCPARTLON)

Inside Correctional Facilities—Increase in Staff Training on Inmate Mental Health
On January 21^st, the New York State Senate passed a one-house bill sponsored by Senator Carlucci (D- Rockland/Westchester) which clarifies the eight-hour annual requirement for training of residential mental health treatment unit staff, as well as security, program services, mental health and medical staff with direct contact of inmates with mental illnesses. The bill was passed unanimously by the Senate, as it contains the language of a previously negotiated chapter amendment to a bill signed into law by Governor Cuomo last month. Current NYS Correction Law similarly requires that new corrections staff receive initial training in mental health treatment upon recruitment. The training topics include: types and symptoms of mental illnesses, the goals of mental health treatment, the prevention of suicide and training in how to effectively and safely manage inmates with mental illness. While a same-as bill has yet to be introduced in the Assembly, it will likely do so shortly. (MCPARTLON)

CMS Posts Information Regarding How Physicians Can Apply for Meaningful Use Hardship
The Center for Medicare and Medicaid Services (CMS) today posted information regarding changes to Medicare EHR Incentive Program hardship exception process. Medicare is implementing these modifications as a result of the recently passed Patient Access and Medicare Protection Act, which established that the Secretary may consider hardship exceptions for “categories” of EPs, eligible hospitals, and CAHs that were identified on CMS’ website as of December 15, 2015. Prior to this law, CMS was required to review all applications on a “case-by-case” basis. The AMA had advised that it will review CMS’ materials and begin to educate physicians about how they can best apply for the exception. Here is a link to the information CMS posted.

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.org
pclancy@mssny.org	bellman@mssny.org

Council Meeting Notes: January 21, 2016

MLMIC’s Vice President, Don Fager, announced a 20% dividend for policyholders who are insured by May 1, 2016, and maintain continuous coverage through July 1, 2016.
Council approved the Board of Trustees report, which included approval of $100/day for delegates at the 2016 House of Delegates and approval for a MSSNY financial audit for 2015.
Council discussed MSSNY’s approach regarding the corporate practice of medicine as being proposed within the DSRIP program and agreed to enable leadership to carry on discussions with appropriate parties.
Dr. Maldonado stressed the importance of Legislative Day this year, which will be held on March 8 in Albany. He called on physicians to help ensure a large turnout to demonstrate the importance of our issues to legislators.
MSSNY will partner with the American Cancer Society and the American Cancer Society Action Network in a new anti-smoking campaign, 2016 New York is Kicking Butts Quit Smoking Campaign. The campaign is currently centered on NYC, but ACS hopes to expand it throughout the state. In New York City, smoking continues to be the number one cause of preventable death.
Council approved the following Resolutions:

2015-268: MSSNY will encourage further research into genomic sequencing, including its ethical implications, its clinical implications and its financial implications and will also encourage efforts to increase the number of qualified genetic counselors in anticipation of the increasing clinical need.
2015-253: MSSNY will seek federal legislation to ensure that as the government moves forward to value based payment and reform that the legislature and federal agencies seek direct physician input to ensure that bundled payments result in quality care and best patient outcomes, rather than just concentrating on the cost of care.
2015-263: MSSNY will seek legislation or regulation to ensure that Medicare, Medicaid and insurance plans allow physicians to make dosing adjustments for approved medications to allow the patient to achieve therapeutic levels regardless of BMI and differing metabolic considerations. The dose administered should be within the purview of the treating practitioners based on clinical parameters, documented in the medical record.
First District Branch E-Prescribing Motion: MSSNY will press for legislation or regulation that would allow patients’ requests for paper prescription and pharmacy choice to be honored and that this legislation or regulation permit any patient to request opting out of electronic prescribing by requesting the same in writing to a physician who will then be permitted to issue a paper prescription in person or by fax.

MLMIC Policyholders Will Receive 20% Dividend
Our mission is to provide insurance at cost, without a profit motive. To offset premiums, we offer dividends to our policyholders whenever we can. This year, MLMIC policyholders will receive a 20% dividend. To take advantage of this dividend, you simply need to be insured by May 1, 2016, and maintain continuous coverage through July 1, 2016.

MLMIC is a mutual insurer, owned by our policyholders. Over the years, our financial strength has allowed us to pay more than $300 million in dividends to our policyholders, something no other insurer can match.

Learn More or call (888) 793-0393.

Medical Schools Seek Dollars for Diversity
The Associated Medical Schools of New York is lobbying the state legislature to boost its funding for fiscal 2017. The organization, which represents 16 public and private medical schools throughout the state, is requesting $2.4 million for scholarships and diversity initiatives, up from $1.6 million last year. The bulk of the money, $2 million, would fund four post-baccalaureate programs that help students from underrepresented backgrounds get into medical school. An additional $400,000 is for launching a new scholarship. African-Americans, Latinos and indigenous peoples make up 35% of New York’s population but only 9% of the physician workforce, according to a 2014 report from the SUNY Albany Center for Health Workforce Studies. Funding for AMSNY’s diversity initiatives was slashed by about 20% after the 2008 financial crisis. The requested funding would help restore the programming that was dropped, said Jo Wiederhorn, the group’s president and chief executive.

Mt. Sinai HCV Intensive Training Preceptorship Program
The Mount Sinai Institute for Advanced Medicine – CEI HIV/HCV Center for Excellence is proud to debut our HCV Intensive Training Preceptorship program! This 2-day clinical education program (March 24-25, 2016) provides an intensive experience for practicing clinicians (e.g. physicians, physician assistants, nurses and nurse practitioners) in New York State. Through a combination of didactic sessions and experiential training, clinicians are able to enhance their HCV prevention, treatment, and care knowledge and competence to better serve their patients.

All clinical experience shadowing will take place at a Mount Sinai affiliated clinic located in Manhattan, NY. Accepted applicants from upstate New York will be provided with an honorarium to assist with transportation and lodging expenses.

The deadline to apply is Friday, January 25 at 5pm. For more information, please visit: https://www.surveymonkey.com/r/HepCPreceptorship or contact sjobe@chpnet.org.

EHR Incentive Hardship Exception Instructions Available NOW
Today, CMS has posted new, streamlined hardship applications, reducing the amount of information that eligible professionals (EPs), eligible hospitals, and CAHs must submit to apply for an exception. The new applications and instructions for a hardship exception from the Medicare Electronic Health Records Incentive Program 2017 payment adjustment are available here.

This new, streamlined application process is the result of PAMPA, which established that the Secretary may consider hardship exceptions for “categories” of EPs, eligible hospitals, and CAHs that were identified on CMS’ website as of December 15, 2015. Prior to this law, CMS was required to review all applications on a “case-by-case” basis.

Importantly, EPs, eligible hospitals, and CAHs that wish to use the streamlined application must submit their application according to the timeline established in PAMPA:

Eligible Professionals: March 15, 2016
Eligible Hospitals & CAHs: April 1, 2016

Please note: CAHs should use the form specific for the CAH hardship exceptions related to an EHR reporting period in 2015. CAHs that have already submitted a form for 2015 are not required to resubmit.

In addition, we have heard from stakeholders that they would like a more efficient approach for submitting applications from groups of providers. We have reviewed our administrative authorities and determined that groups of providers may apply for a hardship exception on a single application. Under the group application, multiple providers and provider types may apply together using a single submission. The hardship exception categories are the same as those applicable for the individual provider application.

Providers will have the option to submit an electronic file (in excel or csv formats) with all National Provider Identifiers (NPIs) or CMS Certification Numbers (CCNs) for providers within the group or use a multiple NPI or CCN form to submit their application. In addition, facilities which include both inpatient and outpatient settings may include both the individual NPIs for any eligible professionals and the CCN for the eligible hospitals and CAHs on the same single submission for their organization.

Physicians in Western New York Wary about Medical Marijuana Treatment
The Buffalo (NY) News (1/19, Davis) reports that “of the 226 doctors certified to recommend marijuana in New York State as of last week, 12 of them work” at the Dent Neurologic Institute in Amherst. Dr. Laszlo Mechtler, Dent’s medical director, is a “strong advocate for marijuana’s use where the scientific evidence shows it can help,” but “like many other physicians – remains wary about the drug.”

For physicians, the four-hour NYSDOH approved course is now available online. The online course is provided by TheAnswerPage, an established online medical education site, and includes the following topics: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence. The course will cost $249 to take. Successful completion of the course will provide 4.5 hours of CME credits. The course may be accessed here.

Peconic Bay Joins Northwell Health Group
Newsday (1/19, Ochs) reports that Peconic Bay Medical Center and Northwell Health Group signed a formal agreement on Tuesday, making Peconic Bay the “21st hospital in the health system and anchoring Northwell’s presence on the East End.” Peconic Bay chief executive Andrew Mitchell “said the agreement signals the beginning of a ‘new era for health care in central and eastern Suffolk’ that will make Peconic Bay, which serves about 200,000 patients and employs 1,300, a regional health care provider.” The agreement also signals the end of “Peconic Bay’s 10-year relationship with Stony Brook University Hospital and the demise of the East End Health Alliance formed in 2008.”

CDC: Physicians Should Be Aware of Zika Virus in Pregnant Women
The CDC issued a travel warning to pregnant women and women of child-bearing age to avoid traveling to 14 countries in Central America and the Caribbean due to the risk of contracting the Zika virus, which is linked to severe birth defects. CDC is warning physicians to look out for symptoms of the Zika virus in pregnant women returning from trips to South and Central America http://wwwnc.cdc.gov/Travel. Published in

MMWR, the recommendations include:

All pregnant women should be asked if they have recently traveled to areas with active Zika virus transmission.
Those with recent travel to such areas and with symptoms of fever, rash, muscle aches, or conjunctivitis during or within 2 weeks of travel should be tested for Zika.
For pregnant women who test positive for Zika, clinicians should consider conducting ultrasounds every 3 to 4 weeks to monitor the fetus’s growth.

Zika is a mosquito-borne virus suspected of causing thousands of cases of microcephaly in infants born in Brazil over the past year. Last week, the CDC warned pregnant women to consider postponing travel to countries with ongoing Zika transmission. Click here to read the full MMWR article.

Physicians Should Avoid Overuse of Antibiotics For Respiratory Problems
The CDC and the American College of Physicians have issued guidelines available at http://annals.org/article.aspx?articleid=2481815 intended to help physicians avoid overuse of antibiotics for respiratory problems. The guidelines were published in Annals of Internal Medicine. The guidelines “lay out how doctors begin deciding if antibiotics are warranted for” certain “respiratory complaints, explain that decision to patients and offer guidance on symptom relief.”

Longtime MSSNY Member Rufus Nichols, MD Passes Away
Rufus Nichols, MD passed away on January 20, 2016 after a battling a long illness. Today would have marked Dr. Nichols’ 46 years as a member of the Society. Many of you may remember seeing him at the House of Delegates. He served on many important MSSNY Committees: Committee to Eliminate Health Care Disparities; International Medical Graduates Committee; Long Term Care Committee; Organized Medical Staff Section (Officer); and Preventive Medicine and Family Health Committee.

Notes of condolence may be sent to Mrs. Jackie Nichols, 394 Joanne Court, Bartonsville, PA 18321.The funeral will be held at Bethlehem Church, 89-45 Lefferts Blvd., Richmond Hill, NY 11418. Here is the website – Bethlehem Church NYC.

Services are as follows:

Saturday, January 30 – Wake (at the church) 9:30 – 11:00 am
Saturday, January 30 – Funeral (at the church) 11:00 – 1:00 pm
Saturday, January 30 – Repast 2:30 – (at location TBD)
Monday, February 1- Internment at Calverton Cemetery – 11:30

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

Office Near UN for Rent
Modern, 3000 sq. ft. medical office to rent near the United Nations. Located at 340 East 49^th Street, this ground level office is handicapped accessible. Private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at uneyes@verizon.net or call 914-772-5581

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

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