Legislature Not Going Home Yet – June 19, 2015

June 19, 2015 admin

PRESIDENT’S MESSAGE
Dr. Joseph R.Maldonado

Dear Colleagues:

It had been my hope that this week’s post would relay good news regarding our efforts in Albany. Alas, the legislative session has gone into overtime and will be going into next week. Thanks to all of you who have reached out to your Assemblyperson and Senator asking for their support of MSSNY’s position against the mandated pain management CME and extending the Statute of Limitations for filing a malpractice claim to run from the date of discovery. Please keep an eye on your emails from MSSNY during the next five days as unexpected surprises may require us to issue an ALERT asking you to contact your state legislators once again.

At the federal level, we continue our joint efforts with other state and specialty societies in seeking assistance for physicians as we transition to ICD-10 on October 1, 2015. While MSSNY and many other physician associations strongly support and have advocated for postponing ICD-10, the efforts to delay its implementation or to completely bypass ICD-10 have been unsuccessful. At this time, many of us in leadership at the state and specialty society level believe our efforts to assist physicians with the challenges of ICD-10 implementation should be directed towards establishing a grace period. Such a grace period would allow for physicians to begin compliance with the requirement to use ICD-10. However, during said period, physicians would not be penalized for errors made in coding using the ICD-10 codes. Data would be collected and physicians would be notified concerning errors in coding so that they can make appropriate changes in future coding. However, payment for services would not be delayed because of errors.

This week, the four states with the largest numbers of physicians signed a joint letter to CMS’ Acting Administrator Mr. Andy Slavitt asking him to implement a two-year grace period. This period is consistent with the recent vote of the House of Delegates of the AMA. I would encourage you to review the attached letter and write to your Congressperson and our U.S. Senators asking for their support of this request.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org

LEGISLATIVE SESSION CONTINUES INTO NEXT WEEK- DEAL ON RENT CONTROL REMAINS ELUSIVE
A deal on rent control has not yet been reached. Late last evening the Senate and Assembly passed a five day extender of the rent control laws until Tuesday, June 23^rd. The Senate then left town. The Assembly remained in Session on Friday. Physicians must remain vigilant on two issues discussed in greater detail in separate articles below: (1) the Date of Discovery state of limitations bill (A.285, Weinstein and similar proposal S.911A, Libous) which has passed the Assembly and (2) the CME mandate on pain management, addiction and end of life care which has passed the Senate and is on the floor of the Assembly. Over the weekend we urge physicians to continue their grassroots efforts by sending letters to their legislators urging defeat of each of these bills.

Link to Date of Discovery Statute of Limitations Letter in Opposition.

Link to CME Mandate Letter in Opposition.

PHYSICIANS MUST CONTINUE TO CONTACT THEIR SENATORS TO OPPOSE HUGE MEDICAL LIABILITY EXPANSION LEGISLATION
With the Legislature continuing its Session beyond its scheduled end date, all physicians must continue to contact their Senators to urge that they oppose legislation (S.911-A, Libous) 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. Last week, the bill was passed by the New York State Assembly by a 120-25 vote (roll call here).

MLMIC’s estimate based upon similar legislation is that could single bill could increase physician liability premiums by an untenable 15%! While many other states do have some exceptions to their statutes of limitation for “discovery” of alleged negligent acts, the vast majority of these states also place strict limitations on non-economic damages. As New York physicians continue to pay liability premiums that are among the very highest in the country and face dwindling payments from Medicare and commercial insurers, any changes to permit more lawsuits must be considered only as part of a comprehensive package that seeks to bring down these exorbitant costs.

MSSNY is working with many other provider associations also impacted by this legislation, including hospitals, nursing homes, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation. This past week, there were print ads in several newspapers across New York State, and radio ads on several Albany stations, urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care. To view the print ad, click here.
(AUSTER, DEARS)

NYS SENATE PASSES CME MANDATE BILL; BILL STILL ON ASSEMBLY DEBATE LIST —URGENT ACTION IS NEEDED TO OPPOSE THIS LEGISLATION
Legislation requiring physicians to take three house of continuing medical education on pain management, palliative care, addiction and ISTOP, has passed the NY Senate and is on the Assembly debate list and could be voted on at any time. Physicians are urged to contact their assembly members and urge them to reject this legislation. Physicians are urged to send a letter urging defeat of this measure. Or they can call their member at the generic Assembly phone number (518)455-4100 and ask to speak with him/her.

Senate Bill 4348(Hannon) and Assembly Bill 355 (Rosenthal), would require physicians to take three hours of continuing education on 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. When speaking to their Assembly members, physician can speak about how the mandate to check the Prescription Monitoring Program (PMP) has change behavior. Notably, New York State now ranks 50^th in overall utilization of opioids and has shown a -12.4% reduction in the filling of hydrocodone prescriptions between 2013 when the ISTOP law was first implemented and 2014. This comparison data is from IMS, Inc. Plymouth Meeting PA, — a company that provides information, services and technology for the healthcare industry. It is the largest vendor of U.S. physician prescribing data in the nation. It was provided to MSSNY from the American Medical Association. Nationwide, there are 13 states that require physicians and other prescribers to complete either a one-time course or a course every two to four years in pain management and opioid prescribing. All of these states ranked higher than New York State (50th) in overall utilization of opioids (annual prescriptions per capita 2014 Opioid Products). New York State was 46^th in the growth in opioid utilization by state (per change in filled prescription 2014 vs 2013)—only two states with CME had a greater reduction in the growth of opioid utilization. New York State also ranked 45^th in growth on hydrocodone utilization by state (NY saw a reduction of -12.4% in filled prescriptions between 2014 vs. 2013)—again only two states that require CME had greater reduction—Rhode Island ( a state that requires CME) had a -12.9% reduction in filled prescriptions. According to IMS Health, Inc., NY is ranked 49 in overall utilization of Controlled Substances II and 41 in growth in Controlled Substance II utilization. Overall utilization of Controlled Substance III, New York State is ranked 27^th, however, growth in Controlled Substance III was reduced by -5.8% and the state is ranked 50^th in growth of utilization with all CME states above New York.

This data shows strong evidence that prescribing practices by physicians have changed within the last two years due to the implementation of ISTOP in August 2013 that required physicians to check the Prescription Monitoring Program (PMP) prior to issuing a prescription for any controlled substances. There has been strong physician compliance with the law and in many respect; it has been successful in achieving its goals to significantly reduce doctor shopping and reduce drug diversion. According to the New York State Department of Health and the policy paper by Brandeis University: Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States— since the implementation of ISTOP drug diversion in New York State has been reduced by 75%. MSSNY believes that the implementation of the I-STOP law and the statutory requirement for all prescribers to check the PMP prior to issuing a Controlled Substances II, III, IV prescription has already changed prescribing practices within New York State in a relatively short period of time. It would appear from the data noted above the PMP has changed behavior more significantly than would continuing medical education coursework and training in the area of pain management and opioid use as noted by the data by the IMS Health, Inc. MSSNY also believes that the implementation of the E-prescribing requirement for controlled substances and non-controlled substances in New York State, will also significantly impact prescriber’s behavior and the exercise of their clinical judgment in the use of controlled substances.
(CLANCY, DEARS)

NYS ASSEMBLY PASSES BILL TO INCLUDE E-CIGARETTES UNDER CLEAN INDOOR AIR ACT; ACTION IS NEED IN NYS SENATE

The NY State Assembly passed legislature to prohibit e-cigarette use in all public places in accordance with the NYS Clean Indoor Air Act. The measure is pending in the NY State Senate. A. 5595B/Senate Bill 2202B sponsored by Assemblywoman Linda Rosenthal, and Senator Kemp Hannon and must see action in the Senate before it can become law. Physicians are urged to contact their senators in support of this measure by sending a letter.

Patients can also send a letter through MSSNY Grassroots Action Center.

In 2003, New York updated its Clean Indoor Air Act by prohibiting the use of tobacco products in all workplaces. The purpose was to protect workers from the dangers of secondhand smoke and to provide clean indoor air for the overwhelming majority of New Yorkers who do not smoke. Due to this law and other important steps that New York has taken, the state have seen major reductions in smoking rates. However in recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit. Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions. Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law. The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure. The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute. MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air.
(CLANCY, ELLMAN)

LEGISLATURE PASSES BILL TO REDUCE MEDICAID MANAGED CARE PRESCRIBING HASSLES
Legislation (A.7208, Gottfried/S.4893, Hannon) to reduce hassles experienced by physicians when prescribing certain medications for their patients insured through Medicaid Managed Care plans passed the Senate and Assembly this week. MSSNY articulated its strong support for this legislation, along with many other patient advocacy organizations, and will urge the Governor to sign this legislation into law.

For many years, New York State has held to the important principle that patients covered under the Medicaid “fee for service” program are entitled to receive the prescription medications that are recommended by their treating physician, and such decisions may not be overruled by Medicaid administrative staff. After the Medicaid pharmacy benefit was included within Medicaid managed care, in 2012, the Legislature and Governor agreed to assure that these important “prescriber prevails” protections continued to be in effect for several classes of medications needed by patients affected with very serious health conditions, including medications in the anti-depressant, anti-retroviral, anti-rejection, seizure, epilepsy, endocrine, hematologic, immunologic and atypical antipsychotic therapeutic classes. Since that time, many physicians have reported situations where health insurers forced them to wait an unreasonably long time to receive approval to assure their patients could receive a needed medication from one of these drug classes, despite the “prescriber prevails” protections. This legislation would help to reduce these hassles, and assure that patients can receive needed medications more quickly.
(AUSTER, DEARS)

SCHOOL BASED MENINGOCOCCAL IMMUNIZATION LEGISLATION PASSES NYS LEGISLATURE; WILL NOW GO TO GOVERNOR
A.791C/S. 4324A, sponsored by Assemblywoman Aileen Gunther and Senator Kemp Hannon, has passed the NYS Legislature. The bill will now go to Governor Andrew Cuomo for his consideration. The bill will require school-based immunizations against the meningococcal disease for every person entering seventh grade and 12^th grade. The Medical Society of the State of New York is part of a coalition of organizations supporting this legislation. This bill is consistent with the Advisory Committee on Immunization Practices. Organizations in support of the measure included the GMHC, the American Academy of Pediatrics NYS Chapter, District II, Latino Commission on AIDS, Kimberly Coffey Foundation, March of Dimes, Meningitis Angels, National Meningitis Association, the Nurse Practitioner Association New York State, New York State Academy of Family Physicians, and the New York Chapter of the American College of Physicians.
(CLANCY)

CVS HEALTH MAKES ADDITIONAL EFFORT AT THE END OF SESSION FOR AUTHORITY TO ESTABLISH RETAIL CLINICS- MASSNY WORKING WITH NURSES ASSOCIATION AGAINST THIS EFFORT
CVS HEALTH which operates CVS Pharmacies, a pharmacy benefit manager, mail order and specialty pharmacies, and retail-based health clinic subsidiary, MinuteClinic, made another effort during the waning days of the legislative session to secure passage of legislation (S. 5458, Hannon and a similar bill A. 1411, Paulin) to secure approval to establish retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law.

The Senate bill passed the Senate earlier this week. MSSNY working closely with the Nurses Association and other medical specialties sought to defeat the Assembly proposal when considered by the Assembly Codes Committee earlier this week. The bill was defeated in Committee. Later in the week, however, additional efforts were advanced to have the bill placed back on the Committee agenda. Again, MSSNY and Nurses Association lobbyists worked together to assure that the bill remained in Committee.

Earlier this year MSSNY successfully advocated to the legislature to reject a similar initiative advanced as part of the proposed state budget. ‘Convenience care clinics’ or ‘retail clinics’ operate in states outside New York in big box stores such as Walgreens or CVS retail pharmacies. They are a growing phenomenon across the nation, particularly among upper class young adults who live within a one mile radius of the clinic. These clinics are usually staffed by nurse practitioners and focus on providing episodic treatment for uncomplicated illnesses such as sore throat, skin infections, bladder infections and flu. Physicians feel strongly that retail based clinics pose a threat to the quality of patient care and to the ability of physician practices to sustain financially and should not be allowed to propagate in New York.

Another significant concern is the potential conflict of interest posed by pharmacy chain ownership of retail clinics which provides implicit incentives for the nurse practitioner or physicians’ assistant in these settings to write more prescriptions or recommend greater use of over-the-counter products than would otherwise occur. The same self-referral prohibitions and anti-kickback protections which apply to physicians are not applicable to retail clinics, raising the concern for significant additional cost to the health care system. Rather than bend the cost continuum, we are concerned that costs will increase and quality of care will be negatively impacted.

MSSNY will remain vigilant against any further efforts to advance this measure before the end of session.
(DEARS, AUSTER)

COLLABORATIVE DRUG THERAPY MANAGEMENT BILL PASSES BOTH HOUSE OF THE LEGISLATURE- ISSUES RAISED BY MSSNY ADDRESSED.
Legislation (A. 5805-A, McDonald/S. 4857-A, LaValle) has passed both houses of the Legislature which would extend the authorization of pharmacists to perform collaborative drug therapy management (CDTM) in certain settings. The final bill addressed many of the numerous issues raised by MSSNY with the initial version of this bill.

MSSNY was concerned that the bill removed protections which had been included when this demonstration program was first enacted which assured that the treating physician remained in control of the care provided to the patient. Specifically, the initial version of the bill would have allowed for the substitution of a drug which differed from that initially prescribed by the patient’s physician without authorization by the treating physician. The bill was modified to prohibit such substitutions or adjustments without authorization by the treating physician. Moreover, the initial version of the bill would have eliminated language which required the patient to consent to the collaborative drug therapy management. This protection was restored at the request of MSSNY. The initial version of the bill had inserted the term “prescribing” when ordering an adjustment or managing a drug regimen. MSSNY noted that “prescribing” remains outside of the pharmacist’ scope of practice and this term was removed from the bill. The original version of the bill would have extended to NPs and PAs the ability to collaborative with a pharmacist in collaborative drug therapy management. The extension of such collaborative authority was removed at MSSNY’s request. Lastly, MSSNY was concerned by the extension of CDTM to a nursing home or residential health care facility setting primarily because these settings are not well staffed by physicians. The final bill allowed for the extension of CDTM to other hospital settings including a nursing home but only if it has an on-site pharmacy staffed by a licensed pharmacist. The bill did not extend CDTM however to dental clinics, dental dispensaries, residential health care facilities and rehabilitation centers.

The bill extended the collaborative drug therapy demonstration with this parameter for three more years.

MSSNY is grateful to the sponsors of the bill and the Chairs of the Higher Education Committees for their consideration of our concerns in constructing this on-going demonstration.
(DEARS, ELLMAN)

NYS LEGISLATURE APPROVES BILL TO ALLOW PHARMACISTS TO PROVIDE ADULT IMMUNIZATIONS; BILL WILL NOW GO TO GOVERNOR FOR CONSIDERATION
Pharmacists will expand the list of immunizations that they can provide to adults under legislation that has passed the New York State Legislature. A. 123B/S. 4739A, sponsored by Assemblywoman Amy Paulin and Senator Kemp Hannon, would add Diphtheria, Tetanus and Pertussis (DPT) to the list of vaccines that can be administered by pharmacists. The bill now goes before Governor Andrew Cuomo for his consideration and action. The bill would allow physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines. The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script. The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis. Importantly, the bill requires the pharmacist to report the administration of the vaccine to the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry. Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner. The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide. The bill also contains a three year sunset. The Medical Society of the State of New York opposed this measure, because of its belief that this policy would further fracture the medical home. (CLANCY, DEARS, ELLMAN)

AS SESSION WINDS DOWN SCOPE OF PRACTICE BILLS STATUS UNCHANGED WITH TWO EXCEPTIONS
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 remains in the Higher Education Committee in both the Senate and Assembly.
719-A (Pretlow)/ S.4600-A (Libous) – a bill that would expand on a bill enacted in 2012, and would allow podiatrists to diagnose, treat, operate or prescribe for cutaneous conditions of the ankle up to the level of the knee. 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 also 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 remains 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 passed the Senate, and remains in the Higher Education Committee in the Assembly.
5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill is in the Senate Higher Education Committee. There is no same-as bill in the Assembly.

The bills that have passed both Houses were vigorously negotiated by MSSNY to make them more acceptable to medicine.
(ELLMAN, DEARS)

BILL REQUIRING EDUCATION OF ATHLETES REGARDING SUDDEN CARDIAC ARREST PASSES NYS ASSEMBLY; PENDING IN SENATE RULES COMMITTEE
Assembly Bill 8107/Senate Bill 5984, sponsored by Assemblymember Michael Cusick and Senator Andrew Lanza, has passed the NYS Assembly. Its companion measure is pending in the Senate Rules Committee. The legislation would require that the New York State Department of Health to develop an educational brochure on preventing sudden cardiac arrest among student athletes. Under the bill’s provisions, the NYS Commissioner of Health shall provide educational materials for students and their parents and guardians regarding sudden cardiac arrest. The Medical Society of the State of New York supports this measure and worked with the sponsors to help develop this legislation. The bill also calls for this material to 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 brochure would include an explanation of sudden cardiac arrest, a description of early warning signs, and an overview of options that are privately available for screening. The State of New Jersey currently has a 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.

Sudden cardiac death is the result of an unexpected failure of proper heart function, usually (about 60% of the time) during or immediately after exercise without trauma. Since the heart stops pumping adequately, the athlete quickly collapses, loses consciousness, and ultimately dies unless normal heart rhythm is restored using an automated external defibrillator (AED). About 100 such deaths are reported in the United States per year. According to the American College of Cardiology, the chance of sudden death occurring to any individual high school athlete is about one in 200,000 per year. Sudden cardiac death is more common: in males than in females; in football and basketball than in other sports; and in African-Americans than in other races and ethnic groups. It remains important that athletes, parents, coaches and the health care community are educated about the issue of sudden cardiac arrest and the importance of recognizing the early warning signs and be provided with information about available screening options. Additionally, it is important that all school officials and coaches are trained in the use of AEDs and having them available on the athletic field.
(CLANCY, AUSTER)

HEALTHCARE PROFESSIONAL TRANSPARENCY ACT HITS SNAGS DURING LAST WEEK OF SESSION- COMMITTEE CHAIRS AND SPONSORS COMMIT TO WORKING TO RESOLVE ISSUES DURING THE OFF SESSION
Throughout the Session MSSNY has worked closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, in pursuing legislation (S.4651-C, Griffo/A.7129-D, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public. Specifically, the bill would require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional. In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information. Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty. Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship. Importantly, this measure would have also required health care practitioners to wear an identification name tag during all patient encounters that includes the type of license held by the practitioner.

While the bill advanced to the floor of the Senate and was placed on an Assembly Committee agenda, changes were proposed to the Assembly bill which could not be embraced. Of concern is the issue of whether practitioners should be subject to professional misconduct in all instances where they fail to wear the identification badges. The Chair of the Assembly Higher Education Committee and the sponsors of the legislation have agreed to work with the physician community to address these concerns.
(DEARS, ELLMAN)

US HOUSE TO CONSIDER IPAB REPEAL LEGISLATION NEXT WEEK
Legislation is expected to be voted on next week by the U.S. House of Representatives to repeal the Independent Payment Advisory Board (HR 1190, Roe) enacted as part of the ACA. Among the 235 co-sponsors of the IPAB repeal legislation are New York Congressional delegation members Chris Collins, Peter King, Sean Patrick Maloney, Chris Gibson, Tom Reed, Elise Stefanik, Richard Hanna and John Katko. Physicians are urged to contact their Respective member of the US House of Representatives in support of this legislation. To find contact information for your respective House member, please go to MSSNY’s Physician Action Center here.

The IPAB is charged with making recommendations to cut Medicare expenditures if spending growth reaches an arbitrary level that can only be overturned by a supermajority of Congress. MSSNY recently signed on to a patient and provider advocacy letter in support of repeal of the IPAB. The letter notes that “The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decision making responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.”
(AUSTER)

MSSNY JOINS OTHER STATE MEDICAL SOCIETIES TO URGE 2-YEAR ICD-10 TRANSITION PERIOD
MSSNY joined the medical associations of California, Florida and Texas in writing to CMS Acting Director Andy Slavitt to urge a two-year ICD-10 “grace period” when physicians and other health care providers are required to use ICD-10 codes starting October 1, 2015. At its recent meeting, physician delegates to the AMA House of Delegates overwhelmingly called upon the AMA to seek such 2-year “grace period”. The letter notes that “the Oct. 1 mandatory implementation of the ICD-10-CM coding system is a looming disaster. The results of the recent end-to-end tests give us little confidence that the nation’s physicians, electronic health records, claims clearinghouses, commercial insurance companies, and government agencies will be ready when we “throw the switch” to ICD-10.”

Specifically, the letter asks that CMS implement the following steps with regard to ICD-10 implementation:

A two-year period during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system;
A two-year period in which physicians will not be subject to RAC audits related to ICD-10 coding mistakes;
A two-year period during which physician payments will not be reduced or withheld based on ICD-10 coding mistakes; and
Advanced payments in the event that claims are delayed.
(AUSTER)

CME WEBINARS ON PTSD AND TBI IN RETURNING VETERANS

MSSNY will be offering two CME webinars on the topic of “PTSD and TBI In Returning Veterans: Identification and Treatment.”

June 24, 2015, 7:00 – 8:00 AM

Faculty: Frank Dowling, MD

Registration:

June 30, 2015, 6:00 – 7:00 PM

Faculty: Joshua Cohen, MD

Registration:

Course Objectives:

Explain the two most common disorders facing returning veterans today, their prevalence, risks, costs, and comorbidities.
Identify common symptoms and causes of PTSD and Traumatic Brain Injury (TBI), especially those that affect returning veterans most.
Outline proven treatment options in psychotherapy and pharmacotherapy, from concept to implementation.
Outline the process of recovery and post-traumatic growth.
Discuss barriers to treatment, including those unique to military culture, and how to overcome them.

The sessions are sponsored by MSSNY through a grant offered by the NYS Office of Mental Hygiene.

Program flyer can be accessed here:

For more information, contact Greg Elperin at gelperin@mssny.org or (518) 465-8085.

(DEARS, ELPERIN, HARDIN)

FINAL “ADVOCACY MATTERS” SESSION ON SHIN-NY PATIENT LOOK-UP
The final “Advocacy Matters” CME webinar on the topic “SHIN-NY Statewide Patient Record Look-Up,” co-sponsored by MSSNY in conjunction with the New York Chapter of the American College of Physicians (NYACP) and the New York eHealth Collaborative (NYeC), will be held on June 24, 2015, from 6-7 PM. The faculty will include David Whitlinger, CEO of NYeC, Inez Sieben, NYeC COO, Lisa Halperin Fleischer, NYeC CMO, and Paul Wilder, NYeC CIO.

Course objectives:

Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
Give Healthcare Providers Information on how they will be able to access and share patient records through the SHIN-NY
Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access.

Registration link is below:

June 24, 2015 (6-7 PM): Register here

Flyer is available here:

Information sheet on the Data Exchange Incentive Program is available here:

For more information, contact Miriam Hardin at mhardin@mssny.org or (518) 465-8085. (DEARS, HARDIN)

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 Notes from June 18 Meeting

Dr. Thomas Madejski was elected to the AMA’s Council on Medical Service at the June AMA Meeting in Chicago.
Dr. John Kennedy has been named Chair of the AMA Delegation with Dr. Charles Rothberg as Vice-Chair.
Dr. Sellers presented the MSSNYPAC report, which included information about the possibility of procuring data to enrich the PAC database. The data would be used as a tool for increased contributions. MSSNYPAC has a mobile donate site at www.mssny.org/mobile and active Facebook and Twitter accounts.
The Medical, Educational, and Scientific Foundation of New York (MESF) reported the following:
- MESF has completed The Essentials of Leadership: What They Didn’t Teach You in Medical School program, which was presented by Rick Popovic to 13 county medical societies and other organizations. The total attendee count was nearly 400.
- As a follow-up to the basic Leadership Training Program, MESF has responded to an RFP from the Physicians Foundation and has submitted an application for funding for additional leadership training programs. The grant application is for $150,000 for a two year program.
- MESF has held discussions with Johns Hopkins in Baltimore for the development of a series of two year online programs on various Internal Medicine topics. The approach will permit efficient use of Johns Hopkins faculty time while taking advantage of readily available medical writers in India.

NY Workers Comp Business Re-Engineering Project (BPR) Roadshow Series
The BPR team has scheduled its next series of roadshows. The roadshow sessions will provide an update on current BPR initiatives and talk about what is planned for Phase 2. Here is the agenda: Programmatic Updates; Medical Authorization Portal; Payor Compliance; and BPR Phase 2: New Initiatives to Come

The full schedule is listed below.

District Office
Brooklyn	111 Livingston Street 19th Floor, Room 1917 Brooklyn, NY 11201	6/23/15	12:00 pm 4:00 pm
Manhattan	215 West 125th Street Room 509-511 New York, NY 10027	6/24/15	12:00 pm 4:00 pm
White Plains	75 South Broadway White Plains, NY 10601	6/30/15	12:00 pm
Queens	168-46 91st Avenue 3rd Floor, Room 325 Jamaica, NY 11432	7/1/15	12:00 pm 4:00 pm
Hauppauge	220 East Rabro Drive Board Room 116-H Hauppauge, NY 11788	7/2/15	12:00 pm 4:00 pm
Buffalo	Ellicott Square Building 295 Main Street Suite 400, Room 438 Buffalo, NY 14203	7/7/15	12:00 pm 4:00 pm
Rochester	130 Main Street West Basement Conference Room Rochester, NY 14614	7/8/15	12:00 pm 4:00 pm

These sessions offer an opportunity for stakeholders to learn about what is happening on the BPR project directly from the BPR team leaders. They also have become an important means of direct communication with their stakeholders. The team looks forward to addressing questions and exchanging ideas. Please email bpr@wcb.ny.gov with any questions.

Many Seniors Treated in ED after Car Crash on Pain Meds Six Months Later
Many seniors injured in motor vehicle crashes remain in pain for months afterwards, negatively affecting their quality of life and ability to live independently, according to a study published in Annals of Emergency Medicine available here.

The study looked at patients aged 65 and older who visited one of eight emergency departments after a motor vehicle crash between June 2011 and 2014 and were discharged home after evaluation. More than half of the patients were still taking some type of pain reliever after six months and about 10% had become daily users of opioid pain relievers, the study found. Of patients with persistent moderate to severe pain, 73% had experienced a decline in their physical function and 23% had experienced a change in living situation to obtain additional help. “The types of injuries that younger people recover from relatively quickly seem to put many seniors into a negative spiral of pain and disability,” said lead author Timothy Platts-Mills, M.D. “Older adults are an important subgroup of individuals injured by motor vehicle crashes and their numbers are expected to double over the next two decades.”

OPRA Prescription Reminders for Unlicensed/Foreign Residents and Interns
In December 2013, New York State (NYS) Medicaid issued a Special Edition (Vol.29, No.13) of the Medicaid Update to provide enrollment requirements and guidance for all Ordering, Prescribing, Referring, and Attending (OPRA) servicing/billing providers.

The purpose of this article is to provide a reminder regarding OPRA prescription requirements for unlicensed residents, interns and foreign physicians in training.

NYS Medicaid recognizes prescriptions written by providers legally authorized to prescribe per NYS Education Law Article 131 Section 6526 and 10NYCRR 80.75(e). This includes unlicensed residents, interns and foreign physicians in training programs, under the supervision of a NY State Medicaid enrolled physician.
In accordance with NYS Education Law, NYS Medicaid does NOT require the name and signature of the supervising physician to be included on the prescription. However, in order to enable billing by the dispensing pharmacy, prescriptions written by unlicensed residents must include the NPI of the supervising/ attending physician who is enrolled in Medicaid (see last bullet point below regarding billing requirements).
NYS Medicaid only enrolls licensed providers. As a result, unlicensed residents, interns or foreign physicians in training programs are not eligible for enrollment as NYS Medicaid providers.
Effective January 2014, NYS Fee-For-Service (FFS) Medicaid implemented claims editing that enforced the OPRA requirement for healthcare professionals, practice managers, facility administrators, and servicing/billing providers. Therefore, pharmacy claims for services ordered by unlicensed residents, interns and foreign physicians in training programs reject when initially submitted for payment. The following two (2) options continue to be available to pharmacies, to enable payment:
1. Resubmit the claim, using the National Provider Identifier (NPI) of the enrolled NYS Medicaid provider (the intern or resident’s supervising physician).
2. In the event the NPI number of the supervising physician cannot be obtained – or – the pharmacy’s billing system is limited to submitting only one prescriber NPI number then use the urgent/emergency override option (outlined below).

Ask the HPV Experts: CDC Experts Answer Your Questions
The questions and answers in this edition of IAC Express, all related to human papillomavirus (HPV) vaccination, first appeared in the May 2015 issue of Needle Tips.
The questions are answered by experts, medical officer Andrew T. Kroger, MD, MPH; and nurse educator Donna L. Weaver, RN, MN. Both are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC).

Narcotic Addicts Can Sue Doctors and Pharmacies for “Enabling” Them
In a 3-2 decision, the Supreme Court of West Virginia ruled that narcotic addicts may sue pharmacies and physicians for facilitating their addictions. A suit was brought on behalf of 29 pain center patients who had been treated with narcotics for various injuries and became addicted. One article quoted the Chief Justice’s explanation: “A plaintiff’s wrongful or immoral conduct does not prohibit them from seeking damages as the result of the actions of others.”

The court recognized that most of the plaintiffs “admitted their abuse of controlled substances occurred before they sought help “at the pain clinic. In a dissenting opinion, one justice wrote that the decision “requires hardworking West Virginians to immerse themselves in the sordid details of the parties’ enterprise in an attempt to determine who is the least culpable—a drug addict or his dealer.”

In response to the ruling, the West Virginia Medical Association issued a statement: “It may cause some physicians to curb or stop treating pain altogether for fear of retribution should treatment lead to patient addiction and/or criminal behavior. It may create additional barriers for patients seeking treatment for legitimate chronic pain due to reduced access to physicians. It would allow criminals to potentially profit for their wrongful conduct by taking doctors and pharmacists to court.”

A post on the American Pharmacists Association website explained that pharmacists were included in the ruling “because they were aware of the ‘pill mill’ activities of the medical providers. The plaintiffs said these pharmacies refilled the controlled substances too early, refilled them for excessive periods of time, filled contraindicated controlled substances, and filled ‘synergistic’ controlled substances.”

Classifieds

Board Eligible Plastic Surgeon Seeks Full Time Position

Brookdale University Hospital Attending Emeritus is resuming practice after retirement. 20 years private practice experience in cosmetic, reconstructive and hand surgery. Plastic Surgery Board Eligible. Seeks full time position with NYS group; flexible salary, will relocate. 6 month on the job preceptorship required to activate NY Medical license. Please email fredricjcohenmd@aol.com.

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

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