Debate Begins on Single Payer


Dr. Joseph R.Maldonado, President

Dear Colleagues:

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

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

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

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

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

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

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

MSSNY President

Please send your comments to


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

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

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

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

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

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

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

Legislation that would require physicians to take three hours of continuing education on pain management, palliative care, and addiction is now on the floor of both houses in the New York State Legislature and can be voted on at any time.

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

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

The following are among many scope of practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

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

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

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

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

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

The Medical Society of the State of New York is urging physicians and their patients to advocate in legislation requiring school-based immunizations against the meningococcal disease.  Assembly Bill 791/Senate Bill 4324, sponsored by Assemblywoman Aileen

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

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

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

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

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

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

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

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

The Medical Society’s final webinar for the spring will be conducted on June 9, 2015 at 7:30 a.m. William Valenti, MD, chair of MSSNY Infectious Disease Committee will present “Emerging Infections 2015-A look at EV-D68 and Chikunguya”. Physicians are encouraged to register by clicking on . Click on “Training Center” and then on the “Upcoming” tab to register.

The educational objectives are:

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

Physicians may also contact Melissa Hoffman at or at 518-465-8085 to register.

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

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

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

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

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

To file a hardship exception, you must:

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

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

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

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

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

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

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

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

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

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

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

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

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