MSSNY eNews: NYU’s Bold Step


Thomas J. Madejski, MD MSSNY President

Thomas J. Madejski, MD
MSSNY President

August 24, 2018
Volume 20  Number 31


Dear Colleagues:

When NYU School of Medicine announced last week that it will offer full tuition scholarships to all new, current and future students, it signaled a potential game-changer for the future of medical education in this country.

NYU Medical School students will graduate and move into residency with the ability to choose a path based on their passion—which might include research, family medicine or pediatrics—rather than choosing a more lucrative specialty in order to pay back loans. NYU will also benefit from an increasingly competitive applicant pool.  Hopefully, this will translate into new research initiatives and improved access and health outcomes for patients in the years ahead.

Presently, some residents may choose a specialty based on future income potential because of their massive loan debt. I don’t think that is a consideration for most students when they enter school, but has to be part of the equation for choosing a specialty as the bills pile up. According to the Association of American Medical Colleges, three out of four medical school graduates in 2017 graduated in debt—with the median amount at $192,000.

MSSNY and the American Medical Association both have concerns about the indebtedness of medical school graduates affecting their choice of specialty, as well as practice location.  While it is reasonable to postulate that reduced or no tuition will free medical students to follow their passion, the impact of loan forgiveness programs to date is less than compelling.

I practice in a rural, underserved area in upstate New York.  While New York State and the Federal government have a number of programs to entice physicians to practice in underserved areas, it is unusual to have a participant in those programs stay long term.

Studies that look at the long term effects of loan forgiveness are challenged to demonstrate any long term positive effect.  Having some of these gifted clinicians practicing in underserved areas is good for the community but, as demonstrated  by the decline in practitioners and small hospitals in rural areas in upstate New York, has not had a long lasting impact.  Nonetheless, every one of these physicians who stays long term is critical to maintain access and improve the health of their community.

The NYU initiative is a bold step in the right direction towards solving the long-standing issue of onerous and out-of-control medical school debt. Personally, I am skeptical that it will have a major effect on specialty choice as debt is just one of many factors in choice of specialty.  Will it help to improve access to care and health of our communities?  Is the $600 million cost of the program money well spent?  How will other medical schools respond to the NYU initiative?

Please share your thoughts and comments with me at

Thomas J. Madejski, MD 
MSSNY President


MSSNY Testifies in Support of Transaction to Bolster Financial Stability of MLMIC
MSSNY Executive Vice-President Phil Schuh testified in support of MLMIC’s acquisition by Berkshire Hathaway, during a New York Department of Financial Services hearing this week examining the proposed transaction.  Mr. Schuh noted that “MLMIC’s alliance with Berkshire Hathaway will fortify its finances and enable MLMIC to continue its mission to assure physicians, dentists and hospitals have access to quality medical malpractice insurance coverage and risk management services long into the future”.

If the proposed transaction were to be approved, MLMIC policyholders between July 15, 2013 and July 14, 2016 would be eligible to receive approximately 1.9 times the amount paid in premiums over that time period.

Mr. Schuh’s testimony also urged that DFS assure that there is a strict deadline for release of the funds following the closure of the transaction after approval. Specifically, he urged that there be a prompt resolution to situations where a Policy Administrator (such as a health system or physician group) believes it has a legal right to payments otherwise due to the physician policyholder because it had paid premiums on behalf of that physician policyholder.  He noted that “some physicians have expressed concerns that entities with enormous resources at their disposal could coerce a physician to give up their statutory right to these proceeds because of the fear of excessive litigation costs.   He suggested that DFS impose a condition on the conversion approval “to assure a strict deadline for release of the funds from escrow following the closure of the transaction, whereby the funds will be awarded to the policyholder at the conclusion of such period if the process for resolving the dispute has not yet been completed.”

Governor Urged to Sign Legislation to Require Greater Transparency of Insurer Compliance with Mental Health & SUD Parity Laws
Physicians are urged to send a letter to the Governor requesting that he sign into law legislation (S.1156-C, Ortt/A.3694-C, Gunther) which directs the NY Department of Financial Services (DFS) to collect certain key data points and elements from health insurers in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws. A letter can be sent from here.

MSSNY, working together with the New York State Psychiatric Association and other specialty societies, had strongly supported this legislation as it passed the Legislature nearly unanimously.  While many physicians weighed in with their legislators in support earlier this year, advocacy should now be directed to the Governor’s office in support of this important measure.

If signed into law by the Governor, the information collected would be analyzed and used for the preparation of a parity compliance report that would be contained within in the annual “Consumer Guide to Health Insurers” issued by the DFS. Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, recent Attorney General settlements note that there continue to be patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services.  The goal of the legislation is to better ensure compliance with these laws.

Photos from the MSSNY Booth at the Great New York State Fair
The Great New York State Fair is now underway in Syracuse (August 22-September 3). Come Visit the MSSNY booth in the Hall of Health outside gate #2!


Karen Jonas from Central New York Care Collaborative (left)
and Dr. Joseph Maldonado (right) 

Dr. David Page checks blood pressure at the MSSNY Booth

Attention: Guide to Timely Filing is Now Available
The “Guide to Timely Billing” presentation being used by the Department of Health for its August webinar series has been posted to Click here to view the PDF. For more information, contact 1-800-343-9000 or

Emblem Notified Its Network of A New Policy on July 19 re Modifier 25
The “Guide to Timely Billing” presentation being used by the Department of Health for its August webinar series has been posted to Click here to view the PDF. For more information, contact 1-800-343-9000 or

Modifier 25 with Evaluation and Management Services Reported with Procedures

Date Issued: 7/19/2018

Modifier 25 is used to describe a significant, separately identifiable evaluation and management (E/M) service that was performed at the same time as a procedure.

Beginning October 30, 2018, our current coding policy will apply to GHI plans regarding E/M services billed with modifier 25 within 28 days of a previous face-to-face service. The E/M service will be denied when both of the following apply:

  • The E/M service (92002-92004, 92012-92014, 99201-99380, 99441-99499) is billed with modifier 25 on the same day as a procedure with a 0-day, 10-day, or 90-day postoperative period.
  • The patient has had a face-to-face service with the same provider for the same condition as the E/M service, and the 0-day, 10-day or 90-day procedure within the previous 28 days.

Face-to-face service codes included in this medical policy: 10021-36410, 36420-44680, 44800-69990, 90935-90993, 92002-92371, 92502-92504, 92511, 95831-95852, 96365-96379, 96405-96406, 96440, 96450, 96542-96999, 97597-97755, 97802-98943, 99100-99170, 99201-99285, 99291-99337, 99341-99357

After members questioned MSSNY about the veracity of this policy change, MSSNY questioned the plan.  Their Medical Director responded, as follows:

“As per the definition of Modifier 25, if there is a significant separate and distinct problem, not associated with a procedure performed or during the global period for a prior procedure, then the physician should appeal the determination by providing the appropriate documentation that substantiates the additional billing.”

                                                                    Regina McNally, MSSNY VP Socio-Med

New York Ranks Second Among States in Healthcare Spending

The Poughkeepsie (NY) Journal (8/22, Robinson) reports New York spent $57.6 billion, or about $3,000 per person, on healthcare in 2015, the second-highest total in the nation, behind New Mexico, according to a new study. The biggest driver of healthcare costs is Medicaid, accounting for about 80 percent of annual state health costs. More than six million New Yorkers are enrolled in the program, approximately one third of the state’s population. The state’s healthcare spending, however, “doesn’t appear to be translating into better quality,” as it “recently was ranked the 17th best health care system in the country based on cost, accessibility and medical outcomes.”



Join MSSNY’s Member Perks Program and Enjoy $4,500 in Savings!
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Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. . Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day (about $180) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

Upper East Side Plastic Surgery Office Available for Rent Part Time
Located in posh Carriage House off Park Avenue with fully certified operative suite (AAAASF). OR can be rented separately.  OR Packages available for multiple case use. Please contact 212-628-7600between 11am and 6pm for further information.

Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
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Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up:


Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated.  The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services.  The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee.  The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review.  The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff.  The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.

Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, 

or by email to with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.

Physicians Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology startup committed to delivering more affordable, accessible, high-quality primary care. To support our mission, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are compensated for their participation, which requires only a few hours annually.

Interested? Learn more and apply today at 

Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


















September 15, 2017 – QPP for NEWBIES!

Charles Rothberg, MD
September 15, 2017
Volume 17
Number 35

Dear Colleagues:

Finally, there is a user-friendly video that shows physicians, in a straight and forward manner, how to avoid 4% Medicare Payment Penalties in 2019. IT’S SURPRISINGLY QUICK.  IT’S SURPRISINGLY EASY.  AND it is available at:

The Quality Payment Program (QPP) is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and is administered by CMS. Because the QPP is new this year, MSSNY and the AMA want to make sure physicians know what they have to do to participate and the QPP’s “Pick your Pace” options for reporting. This is especially important for those physicians who have not participated in past Medicare reporting and programs and may be less FAMILIAR WITH the steps they can take to avoid being penalized under the QPP.

This SHORT  video developed by the AMA, titled “One Patient, One Measure, No Penalty: How to Avoid a Medicare Payment Penalty with Basic Reporting ,” offers step-by-step instructions on how to report so physicians can avoid a negative 4% payment adjustment in 2019.  Under the “Pick-Your-Pace” mode,  this is the TEST component.  DESPITE CMS CHARACTERIZATION OF ” one-patient, one-measure” on one claim, our VP of MSSNY’s Socio-Medical Economics Division  Regina McNally ADVISES PHYSICIANS THAT, “Just to be safe, file three or four measures on three or four patients just to makes sure the government gets it.”

The AMA and the Federation stressed to CMS the importance of establishing a transition period to QPP and, as a result, physicians need only to report on at least one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019 under the Merit-based Incentive Payment System (MIPS). On this website , there are also links to CMS’ quality measure tools and an example of what a completed 1500 billing form looks like.

Regina McNally, strongly urges our members who are “lost” and want no part of MIPS to view this video. “This is the first video I have seen that simplifies the process, explains the process clearly and succinctly, and could help physicians from paying penalties,” she said.

Please visit:

Charles Rothberg, MD
MSSNY President

Please send your comments to

enews large

September 14 Council Notes

  • MSSNY’s VP of Legislative and Regulatory Affairs John Belmont presented information on Physician Advocacy Network (PAL), an initiative aimed at getting MSSNY’s message out to legislators in an innovative new way. MSSNY recognizes that many physicians have relationships with various legislators and others activists.  The goal would be to have at least two or three members assigned as a liaison to each state legislator and for these PALs to meet personally with their assigned legislator at least twice a year to develop or further solidify relationships with elected officials. MSSNY is currently in the process of updating and retooling our key contact list to assist in our legislative advocacy and is looking for assistance from members in reaching out and identifying physicians who have close relationships with legislators. For more information, contact John Belmont at or 518-465-8085.
  • Speaker Kira Geraci-Ciardullo, MD announced key information and deadlines for the House of Delegates meeting, which will begin on Friday, March 23, 2018 and will adjourn on Sunday, March 25, 2018. All activities will take place at the Adam’s Mark Hotel in Buffalo. The window for submitting Resolutions is January 22, 2018-February 9, 2018 at 5 pm.
  • A letter was sent by 41 state medical societies (including MSSNY), and 33 National Medical Specialty Societies, to Dr. Nora of the American Board of Medical Specialties regarding the ongoing contentious issue of MOC. The letter informed ABMS about both a high-level summit that recently took place regarding MOC, and an upcoming meeting in December with the ABMS, the Council of American Specialty Societies and state medical societies to share physician views and seek agreement on how to reshape the MOC process. Dr. Madejski will represent MSSNY at the December meeting.
  • Council reconsidered Resolution 2017-157: Development and Promotion of Evidence-based Ultrasound –First Radiation Mitigating Protocols, and voted to Not Adopt Resolution 157.
  • MESF will present Physicians Leadership Seminar on October 20-21, 2017 at the Albany Hilton. Topics include Where the NYS Legislature is Leading Us in Health Care; Strategic Leadership of the Health Care Enterprise: Creating Value in Turbulent Times; and Blue Ocean Thinking: Focusing on Where the Fish are Swimming. Featured speakers include Jon Chilingerian, Ph.D, Carole Carlson, MBA.

New Law to Prohibit Medical Record Charges When Needed to Support a Patient’s Government Benefit Application
Governor Cuomo has signed into law legislation (S.6078, Valesky/A.7842, Gottfried) that prohibits health care providers and facilities from charging patients for copies of medical records when such records are needed “for the purpose of supporting an application, claim or appeal for any government benefit or program”.  While existing law already prohibits charging for medical records when a patient is unable to pay, the purpose of the new law is to respond to numerous complaints lodged by patients where they were charged for medical records necessary to assist applications and appeals for government programs assisting lower income patients such as Social Security Disability Insurance (SSDI) and the Supplemental Nutritional Assistance Program (SNAP), or other government benefit program such as those for 9/11 first responders.  While noting that it did not condone the actions of health care providers who were charging low-income patients for medical records, MSSNY did express concerns that the terminology “any government benefit or program” in the legislation was too broad, and suggested that the bill be amended to specifically enumerate in the law those low-income government benefit programs to which this fee charge prohibition should apply. However, that change was not made. S6078 letter to the Governor

Centene to Buy New York’s Fidelis Care For $3.75 Billion
The Wall Street Journal (9/12) reported that Centene Corp. announced Tuesday that it will buy nonprofit health insurer Fidelis Care in a $3.75 billion deal. The deal adds 1.6 million members in New York to Centene. Centene is a leader in Medicaid managed care business and Medicare, and is also active in Affordable Care Act exchange plans. The deal is expected to close in the first quarter, according to the Journal.

Unlike its competitors Aetna, Anthem, UnitedHealth Group, and Humana, Centene is expanding into new markets and “has been able to successfully manage the costs of sick uninsured Americans buying individual policies on the ACA’s public exchanges. Centene had nearly 1.1 million customers enrolled in ACA marketplaces as of June 30 this year, compared to 617,700 at this time last year. Fidelis, the article says, is “an established player in New York’s Obamacare, Medicaid and Medicare Advantage markets.” Forbes (9/12)

Promo Code: MSSNY

The Law: Pharmacy Providers Cannot Demand Copays from Those Who Cannot Pay
The NYS Medicaid Pharmacy Program has been notified that some pharmacies are refusing to dispense medications to patients for their inability to pay the copayment. Social Security Act §1916 specifies that no Medicaid enrolled provider may deny care or services to an individual eligible for such care or services on account of such individual’s inability to pay a deduction, cost sharing, or similar charge. The September 2011 Special Edition Medicaid Update cover-page and the March 2012 Medicaid Update page 15, confirm this Federal law applies to all Medicaid providers, both fee-for-service and managed care. Providers may attempt to collect outstanding copayments through methods such as requesting the co-payment each time the member is provided services or goods, sending bills or any other legal means

Dr. Rosenblatt: Desperately Seeking Physician Support for Proposed Office-Based Surgery Guidance Changes
The NYS Department of Health has an Office Based Surgery (OBS) Advisory Committee, of which I have been a member since 2006.  In July of 2017, the NYS DOH decided it would conduct a voluntary pilot with OBS practices requiring them to report the number of cases they perform and the AMA-CPT codes of these cases via the Health Commerce System (HCS).

The first foray by the DOH to mine data was meant to be voluntary.  However, starting January 2018, the DOH wants to make the provision of this information mandatory by all NYS OBS practices. They feel that they have the authority to require this because of the following wording in the OBS law:

Reference: PHL § 230-d, 4. (b): “The department may also require licensees to report additional data such as procedural information as needed for the interpretation of adverse events.”

As a plastic surgeon, and MSSNY’s representative on the OBS Advisory Committee, I am only one of   a few practicing office-based physicians on the DOH Committee.  We practicing OBS physicians are outnumbered by the significant number of state employees and full-time hospitalists on the Committee. I have been speaking against this requirement for the following reasons:

  • Much of the data that the DOH is seeking and asking to be reported is publicly available. For example,  AAAASF already provides the number of cases done per 6-month period to the DOH.The law already requires an OBS physician or center to report certain types of adverse events (AE).
  • This kind of regular health record reporting requirement would be burdensome and not needed to develop policies to protect patients in office-based surgical facilities.
  • This proposed requirement represents an unfunded time consuming mandate for practicing physicians
  • I don’t agree that the law allows the DOH to require all OBS facilities to regularly report this information

For many plastic surgeons who provide OBS, the vast majority of our procedures are not reimbursed by insurance.  Therefore, AMA-CPT codes are not used for recording those procedures.

In NYS there are over 990 OBS facilities.  To locate a specific OBS site, click on Number of accredited practices by county and select the county of your choice.

Effective July 14, 2009, physician offices that perform surgical or invasive procedures using more than mild sedation or liposuction over 500cc under straight local must be accredited by one of these agencies:

There are about 650 OBSs that are certified by AAAASF, which provides the NYS DOH with the number of cases done. Neither AAASF nor the Joint Commission ask their facilities for those numbers; and therefore, doesn’t supply that information to the NYS DOH.  If the DOH wants the number of cases, they should ask the two other certifying agencies to provide them the data and not hassle the doctors.

So far during the voluntary reporting, only 179 of the over 900 OBS facilities in NYS have reported.   When the DOH leaders were asked what will occur if facilities do not report in 2018, their answer was that the OBS sites would be reported to the OPMC.  Can you imagine what the OPMC would do with the report of hundreds of non-reporting facilities?  They are overburdened by their current workload.

MSSNY and I are looking for support from all the NYS OBS facilities.  We need to mobilize the NYS Plastic Surgical Society, NY Regional Society of Plastic Surgery, Gastroenterology, invasive radiology and all other specialists who work in their own accredited office-based surgical facilities to urge the NYS DOH to obtain the data they seek from the OBS certifying agencies.

If you feel that the DOH is overstepping their charge, as I do, please call the DOH or Rosemarie Casale  (518) 408-1219) ( and express your displeasure at having to fill out more forms.

If you have any more ideas, I will be glad to speak to any of you.

William Rosenblatt MD
Past President of MSSNY
Vice-President AAAASF

Managed Care Network Physicians: Medicaid Provider Enrollment Requirement
Section 5005(b)(2) of the 21st Century Cures Act amended Section 1932(d) of the Social Security Act (SSA) and requires that effective January 1, 2018, all Medicaid Managed Care and Children’s Health Insurance Program providers must enroll with state Medicaid programs. The SSA requires that the enrollment include providing identifying information including name, specialty, date of birth, social security number, National Provider Identifier (NPI), federal taxpayer identification number, and the state license or certification number.

For example, if a physician currently participates in a network with a Medicaid managed care plan that provides services to, or orders, prescribes, or certifies eligibility for services for, individuals who are eligible for medical assistance, the physician must enroll with New York State Medicaid.

Common Enrollment Questions:

  • To check on your enrollment status, please call CSRA at 1-800-343-9000. Practitioners may also check the Enrolled    Practitioners Search function at:
  • If you are already enrolled as a Medicaid fee-for-service (FFS) provider and are listed as active, you will not have to enroll again.
  • If at one time you were a FFS provider, and your enrollment has lapsed (no longer actively enrolled), you may be able to keep your original Provider Identification Number (PID), also known as MMIS ID, by reinstating.
  • Practitioners who do not wish to enroll as a Medicaid FFS billing provider may enroll as a non-billing, Ordering/Prescribing/Referring/Attending (OPRA) provider. The enrollment form for this function is attached.
  • Enrollment in Medicaid FFS does not require providers to accept Medicaid FFS patients.

If you are not actively enrolled, please go to:  and navigate to your provider type. Print the Instructions and the Enrollment form. At this website, you will also find a Provider Enrollment Guide, a How Do I Do It? Resource Guide, FAQs, and all forms related to enrollment in New York State Medicaid.

As a point of information, under 42 CFR 455.104 defines the following providers as excluded from the definition of “disclosing entity”:

  • Solo practitioners such as an individual physician, psychologist, or chiropractor.
  • Group of individual practitioners, such as a group of cardiologists, or a group of radiologists.”

Therefore, physicians do not need to complete Section 5.

If you have questions, please call Regina McNally

Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!

Donate to AMA’s Physician Disaster Fund
MSSNY Councilor Josh Cohen, MD, MPH is also President, AMA Foundation Board sent a letter providing information as to how New York physicians can aid fellow physicians affected by the recent storms.

The physician community rallied together to help our peers in Texas who were adversely affected by Hurricane Harvey. Now, as a result of the havoc caused by Hurricane Irma, more of our colleagues are experiencing the same devastation in Florida and need our support. It is vital for doctors to quickly rebuild their medical practices to continue serving their communities. The AMA Foundation created the Physician Disaster Recovery Fund to offer relief to doctors in this time of great need.

Your gift today to the AMAF’s Physician Disaster Recovery Fund will directly support Texas and Florida to help to reestablish delivery of patient care by physician practices impacted by Hurricane Harvey and Hurricane Irma.

Join us and please make a gift to the AMAF’s Physician Disaster Recovery Fund. Let’s work together to enable our fellow physicians to get back to the vital work of caring for their patients.

If you have already made a gift – thank you for your generosity!

Coding Tip of the Week
By Jacqueline Thelian, CPC, CPC-I, CHCA Medco Consultants, Inc.

Q: I have been denied by many insurance carriers for invalid radiology orders. What am I doing wrong?

A:  Diagnostic tests are currently under scrutiny from many insurers. To be sure your orders are in good order make sure they include the following:

  • The patient’s name
  • The test requested
  • Clinical indications for the test (diagnosis)
  • The legible name, signature and date of the ordering provider
  • Signature stamps are not acceptable
  • The Medicare Claims Processing Manual (Chapter 23, Section 10.1.2) states that the ordering physician must provide the diagnostic information at the time the study is ordered.

Also keep in mind insurance carriers are also verifying the orders with the ordering provider to make sure the medical necessity for ordering the test is documented. In some cases, the insurance carrier is leaving that responsibility up to the servicing provider.

The source document frequently referenced by the carriers is the DOH Medicaid Update May 2006 Vol.21, No 5, Documentation Requirements for Ordered Services. Check it out

If you have a coding or compliance question you would like to have answered please send your question to MSSNY at, and complete the subject line with “Tip of the Week.”

Feds: NY Paid $1.4B to Providers with Medicaid Compliance Problem
The AP (9/12) reports that New York State paid $1.4 billion in Medicaid funds in 2014 to long-term care providers who did not comply with state rules for the program, according to federal Office of the Inspector General report published Tuesday. The report “revealed a large number of providers who failed to document patient assessments, provide community-based services or provide written care plans to patients, all requirements spelled out in their contracts with the state.” New York Medicaid Director Jason Helgerson disagreed with the report’s conclusions, stating that many are “simple paperwork problems” and “wouldn’t be sufficient reason to demand full refunds from the providers.”

Many of the deficiencies outlined in the report amount to simple paperwork problems, he said, and wouldn’t be sufficient reason to demand full refunds from the providers, a move he likened to the “death penalty.” He said the report’s conclusion that $1.4 billion could have been saved is “a complete mischaracterization.”

“They’re suggesting that if any (provider) plan has any clerical error – if they have any deficiencies – we should recoup entire years of reimbursement,” he said. “If we were to basically ding them for a full year’s reimbursement, no one would ever sign that contract.”

He said the agency is looking at using fines as a way to ensure providers are complying with the rules.

“We want full compliance,” he said, “but at the same time we have to have a measured response.”

MSSNY President to Be Honored at Harvest Moon Ball in Glen Cove
MSSNY President Charles N. Rothberg is being honored at the Brookhaven Hospital Harvest Moon Ball at the Nassau Country Club in Glen Cove (Long Island) on Saturday, October 14, 2017 from 6PM to 10PM. Dr. Rothberg will be receiving the Dr. Jacob Dranitzke Award.  For tickets, to donate or be a sponsor, please go here.

Monroe County Joins ABMS Multi-Specialty Portfolio Program
The Monroe County Medical Society (MCMS) has joined the American Board of Medical Specialties’ (ABMS) Multi-specialty Portfolio Program. The program, functioning in the quality collaborative segment of the Society, will assist the organization in providing basic guidelines for clinical care across the region.

Based in Rochester, the Monroe County Medical Society covers Livingston, Monroe, Ontario, Steuben, Seneca, Wayne and Yates counties, advocating for betterment of health care in the region.

“As an ABMS Portfolio Program Sponsor, MCMS will ensure that we provide meaningful QI [quality improvement] project opportunities to the physicians in our region, bringing expertise of the Quality Collaborative and physician leadership oversight to the program,” said Christopher Bell, executive director of MCMS, in a statement. “We will encourage physicians to be innovative in their project designs or participate in projects developed within the Quality Collaborative and will welcome their feedback during the process to ensure they have input throughout it.”

In the early hours of the program, the MCMS expects 250 primary care physicians to participate. The result, as Bell stated, is intended to be a push for better quality control for health care in the region.

“MCMS’ participation in the Portfolio Program provides additional recognition of the valuable efforts these physicians and their teams are undertaking to improve the care of not only their current patient population, but through their various collaborations, even more patients and families throughout the state,” said David Price, executive director of the Portfolio Program.

Utilized nationwide, the Portfolio Program, to date, has initiated over 2,000 improvement efforts to health care systems.


Great Neck – Medical Zoned Condo
2690 Sqft – $699,000 – quick easy access to North Shore University Hospital, Long Island Expressway and Long Island Rail Road. 10 Exam rooms plus waiting room & large secretary area . Call Chris Pappas, LAB 516-659-6508

Beautiful, Fully-Equipped Medical Suite for Rent or Share – Glen Oaks, NY
For Rent or Share – Glen Oaks, NY
(border of Queens & Long Island)
Available for full or half-days.
Beautiful, recently renovated office
available for part-time share
OR available for rent.
Centrally located /Close to expressways.
The practice is 5 minutes from LIJ/Northwell Hospital.
8 exam rooms/procedure rooms. Waiting room, break room and
personal office with private bathroom.
(~2500 sqft) Free WIFI.
6 parking spots for patients and 2 for doctor.
The previous tenant, a full-time primary care
physician with a part-time cardiologist coming
in turned it over to an associate a year ago
but has been here for about 10 years. He needed more space
and bought a building about 20 minutes away. Our building gets a lot of drive-by traffic and pedestrian traffic from the mall across the street. Weekly we have patients walk in inquiring about the practice.
The dental practice next door sees over 2500 patients per year and refers actively to the medical suite.

Follow the link for a video of the space (all furnishings, exam tables, chairs, oxygen, orthoscope included in lease – about $500k in value):

Contact Haresh at or 516-220-3297

Upper East Side Medical Office for Rent
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house.  Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800

For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at
or 631-318-4008

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at


Child and Adolescent Psychiatrist – Lockport, New York, Eastern Niagara Hospital
Eastern Niagara Hospital is seeking a Full Time Medical Director for its 12 bed Child and Adolescent Psychiatric Unit.  Responsibilities include inpatient care, shared on-call responsibilities and Medical Director duties.  Competitive compensation package.  For more information, please contact David DiBacco at 716-514-5501 or email to


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?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at

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


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.