Capital Update: May 25, 2017

Charles Rothberg, MD
May 25, 2017
Volume 17
Number 20

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

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

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

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

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

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

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

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

Legislation About Educating Athletes About Sudden Cardiac Arrest Advances In NYS Legislature
Assembly Bill 6538/Senate Bill 3149, sponsored by Assemblymember Michael Cusick and Senator Andrew Lanza has passed the New York State Assembly and is on the Senate calendar for a vote.   This measure requires that the New York State Department of Health develop educational materials for students, their parents and guardians, regarding sudden cardiac arrest. The materials would be developed in conjunction with the Commissioner of Education, the Medical Society of the State of New York, the New York Chapter of the American Academy of Pediatrics, and the American Heart  Association.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MSSNY designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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

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

The topics discussed include

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

Share this link with your patients:

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

 For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:


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

Facilities / Business Details

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

Asking Price: 


Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
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Physician Opportunities

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

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

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

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

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

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

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

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

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