MSSNY eNews: December 16, 2020 – Surprise Billing is Flat Out Give Away to Insurance Companies


From MSSNY Govt. Affairs: Please Contact Your Legislator!
Congress is at a critical tipping point on a number of issues as they try to finalize a year end spending package in the next 24 hours or so.  Among the proposals in the mix is a terrible federal “surprise bill” fix which would prohibit consideration of physician charge data in its IDR process to resolve insurer-out of network physician disputes, which would tilt the process enormously in favor of insurers and have a significant negative downstream effect on all participating physicians as well.  It appears to not pre-empt New York’s well-regarded law but it would definitely apply to all ERISA claims and create a precedent for New York to change its more balanced law.

We have also developed a customizable grassroots template that focuses on this and other end of the year issues (more stimulus $ for NY, preventing steep Medicare cuts) that your physicians can use:  Urge Congress to Prevent Medicare Cuts, Expand Lifeline Programs and Oppose One-Sided Surprise Bill Proposals (

Join with @MSSNY Join with @MSSNYtweet to urge Congress to prevent Medicare Cuts, expand financial lifeline programs, and oppose one-sided surprise medical bill solutions.

MSSNY Press Release Dec. 14 re Surprise Billing:
Surprise Billing is Flat Out Give Away to Insurance Companies

“Let’s be clear.

The new House-Senate committees’ surprise billing legislative agreement is a flat out give away to already enormously profitable insurance companies at the expense of community physicians on the front lines during the pandemic.  If this proposal were to be enacted, it will reduce patient choice in New York by compelling even more private practice physicians into forced employment arrangements.

We are disappointed that Congress did not look to New York’s well-regarded surprise medical bill law as a model of balance. Instead, they chose a methodology for resolving surprise bills that is designed to tip the scales grossly in favor of insurance companies and empower them to further squeeze patient care physicians at a time when many physicians are also about to absorb huge Medicare cuts.

Indeed, the CBO estimates that most of the so-called savings from this surprise bill proposal would come from cuts insurance companies would impose of network participating physicians, not out of network physicians.  The end result will inevitably be greatly reduced access to care for our patients.

So, as the year-end nears, instead of a thank you to the hundreds of thousands of physicians across the country who have put their own lives and the lives of their families at risk, Congress is giving these physicians a giant lump of coal.  We continue to urge that Congress take action to protect patients from surprise medical bills, but this proposal is way off the mark.

We urge Congress to go back to the drawing board and develop a more balanced proposal. Our health care safety net depends upon it.”

Crain’s: Legislation will Help Insurance Companies at the Expense of Doctors
The House-Senate committees’ legislative agreement on surprise billing will help insurance companies at the expense of community physicians, the Medical Society of the State of New York says. The agreement calls for insurers to make a payment to a provider that is determined either through negotiation between the parties or an independent dispute resolution process. It specifies that there is no minimum payment threshold to enter dispute resolution, and that claims may be batched together to ease administrative burden.

“If this proposal were to be enacted, it will reduce patient choice in New York by compelling even more private practice physicians into forced employment arrangements,” Dr. Bonnie Litvack, president of the medical society, said in a statement released Monday. “We are disappointed that Congress did not look to New York’s well-regarded surprise medical bill law as a model of balance. “Instead,” Litvack continued, Congress “chose a methodology for resolving surprise bills that is designed to tip the scales grossly in favor of insurance companies and empower them to further squeeze patient care physicians at a time when many physicians are also about to absorb huge Medicare cuts.”

Congressional leaders said Friday in announcing the bipartisan agreement that the proposed legislation would protect patients from surprise medical bills and establish a fair framework to resolve payment disputes between providers and insurance companies.

Litvack said the medical society is urging Congress to continue to take action to protect patients, but to “develop a more balanced proposal.” (Crain’s’ Pulse, Dec. 15)”

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NYSDOH COVID-19 Update Tomorrow 2 PM
Please join the NYS Department of Health Thursday, December 17th at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers:

Audio number and code: 844-512-2950 Access code 6641017#

Gov. Cuomo’s Briefing Highlights, Tuesday, Dec. 15 

  1. Total COVID hospitalizations rose to 5,982. Of the 194,188 tests reported yesterday, 10,353, or 5.33 percent, were positive. There were 1,065 patients in ICU yesterday, up 25 from the previous day. Of them, 580 are intubated. Sadly, we lost 128 New Yorkers to the virus.
  1. New York hospitals continue to receive and administer doses of the COVID vaccine. Among them was Upstate University Hospital in Syracuse, NY, which administered doses that arrived today to the first members of its staff. The doses were administered to Upstate employees Kenzo Mukendi, Caprice Hibbler and Suzanne Buck, by Chief Nursing Officer Nancy Page.
  2. The Finger Lakes region, with 725 hospitalizations, has the highest rate of COVID hospitalization by population. Hospitalizations in the Finger Lakes represent 0.06 percent of the region’s population. Western New York has 520 hospitalizations (0.04 percent of its population); Central New York has 350 hospitalizations (0.05 percent); Mohawk Valley has 192 hospitalizations (0.04 percent); Long Island has 972 hospitalizations (0.03 percent); the Mid-Hudson has 735 hospitalizations (0.03 percent); the Capital Region has 288 hospitalizations (0.03 percent); Southern Tier has 166 hospitalizations (0.03 percent); and New York City has 1,968 hospitalizations (0.02 percent). The North Country, with 56 hospitalizations (0.01 percent), has the lowest rate of hospitalizations due to COVID.

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New York State COVID-19 Vaccination Program Enrollment
The New York State Department of Health (NYSDOH) is now enrolling healthcare provider practices (outside of New York City’s five boroughs) in the NYSDOH COVID-19 Vaccination Program. Practices (outside NYC) interested in administering COVID-19 vaccine when the vaccine becomes available to their group must enroll in the NYSDOH program to be ready to order and receive publicly supplied COVID-19 vaccine and ancillary supplies.

Please review the following attached documentation and complete the online COVID-19 vaccine enrollment application located in the Health Commerce System by Friday, December 18, 2020.

Send questions regarding the NYSDOH enrollment process to:

FDA Verifies Safety, Efficacy Data for Moderna COVID-19 Vaccine Candidate
Ahead of a Dec. 17 meeting of its Vaccines and Related Biological Products Advisory Committee, the Food and Drug Administration released a briefing document confirming Moderna’s data on the safety and efficacy of the mRNA-1273 COVID-19 vaccine candidate. FDA said mRNA-1273 is 94.1% effective in preventing severe COVID-19, with “no specific safety concerns identified that would preclude issuance of an (emergency use authorization).” Like the Pfizer vaccine approved last week, the Moderna candidate requires two doses, albeit 28 days apart, compared with Pfizer’s 21. Once approved for emergency use, Moderna is expected to supply 200 million vaccine doses to the U.S. through the end of 2021. (Dec.15, American Hospital Association)

Updates: COVID-19 Deaths Surpass 300K

  • The nation’s COVID-19 death toll surpassed 300,000 Dec. 14, the same day the first Americans received Pfizer’s vaccine. The U.S. is reporting an average of 2,427 deaths daily, up 300 deaths per day from this spring’s peak, according to data from The COVID Tracking Project.
  • COVID-19 hospitalizations also hit a record 110,549 on Dec. 14, according to COVID Tracking Project data.
  • The average American could receive a COVID-19 vaccine by early April, Anthony Fauci, MD, said in a Dec. 14 interview with MSNBC. The nation’s top infectious disease expert said most Americans could be vaccinated by late spring or early summer. By fall, “the level of infection will be so low in society we can start essentially approaching some form of normality,” Dr. Fauci said.
  • A bipartisan group of lawmakers released a two-part relief plan Dec. 14. The first package contains $748 billion in aid for small businesses, jobless benefits, and healthcare providers. The second $160 billion proposal includes more controversial measures such as state and local aid, as well as liability protections related to COVID-19.
  • The FDA said the Moderna vaccine is highly effective against severe COVID-19, and it is expected to approve the vaccine for use Dec. 18, officials close to the matter told The New York Times. The agency confirmed Moderna’s assessment that its vaccine is 94.1 percent effective, and said potential side effects — including fever, headache, and fatigue — are not dangerous. Moderna’s vaccine would be the second coronavirus vaccine approved for emergency use in the U.S., after Pfizer and BioNTech’s vaccine. (Becker’s Hospital Review, Dec. 16)

COVID-19 Vaccine Codes: Updated Effective Date for Pfizer-BioNTech
On December 11, 2020, the U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID‑19 Vaccine for the prevention of COVID-19 for individuals 16 years of age and older. Review Pfizer’s Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers) regarding the limitations of authorized use.

During the COVID-19 Public Health Emergency (PHE), Medicare will cover and pay for the administration of the vaccine (when furnished consistent with the EUA). Review our updated payment and HCPCS Level I CPT code structure for specific COVID-19 vaccine information. Only bill for the vaccine administration codes when you submit claims to Medicare; don’t include the vaccine product codes when vaccines are free.

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55% Of Pediatric Residents Experience Burnout
New survey data reveal that more than half of pediatric residents experience burnout. Researchers surveyed residents training at more than 120 programs in the U.S. between 2016 and 2018, and found that almost 55% of them each year experienced burnout.

There were no clear demographic trends, but the scientists found correlations between burnout and other factors, such as poor mental health, greater stress, and more sleepiness. At the same time, those experiencing burnout were less likely to show mindfulness, self-compassion, and high levels of empathy and resilience. Those who reported better quality of life in 2017 — including more mindfulness — were associated with a lower risk of burnout the following year, according to the data. These links between quality of life and burnout offer opportunities for future interventions, the authors write.

MSSNY has established a confidential helpline phone number (1-844-P2P-PEER) and an email address ( so that physicians may be connected with a peer 24 hours a day/7 days a week. In addition to offering a trained, empathetic ear, peer supporters may provide information on specific resources that can offer further support, provide positive coping skills, or connect physicians to professionals for more focused assistance.

Now More Than Ever, Patients Need Relief from the High Cost of Prescriptions
While COVID-19 has dominated the headlines for months, many New York residents are also dealing with health issues unrelated to the virus that may require medications. In addition, many have lost their jobs and health insurance. The New York Rx Card may be able to help ease the burden of costly prescription medications for your patients. This savings program is designed to help those who may be uninsured, underinsured or who have health insurance coverage with no prescription benefits – but anyone can use it.

Patients (and physicians) can save up to 80% on prescription drugs by using this free card. All they need to do is present the card at a pharmacy when paying for a prescription. In instances in which patients are unable to go to the pharmacy in person, they should call the pharmacy to provide the information and the discount can be applied.

If you are interested in ordering cards for your practice, clinic, hospital or for yourself, please contact Program Director Chez Ciccone or call 800-931-2297.

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Partnership opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join our practice or merge practices. Contact 516-972-2986 / for more info.

Dermatology Practice for Sale – Staten Island, NY
Building includes 3 exam rooms, waiting area. Please respond by calling 718-987-3300 or email




MSSNYeNews: October 25, 2019 – Surprises

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

October 25, 2019

Vol. 22  Number 40



It’s not the surprise that matters, it’s how you react to it.
Innocent Mwatsikesimbe, Author

This week’s epistle concerns two unrelated surprises. The first is a new law about the performance of pelvic examinations under anesthesia (see story below). For years, one way medical students learned to perform this necessary skill was in the operating room immediately prior to surgery. Concerns were raised (and rightly so) by women who later learned of this unwanted “surprise,” no matter how clinical it might have been. In 2011 (reaffirmed in 2017), ACOG released a Committee Opinion that explicitly states: 

Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery.

Still, sporadic reports indicated that this practice was ongoing which then prompted legislative action. Hospital legal teams are now huddling to draft appropriate consent language. In the meantime, the best way to deal with this (as always) is simply to discuss the matter with your patient ahead of time, eliminating any surprise.

Surprise Bills

As for the second surprise, Surprise Bills are still the subject of furious debate in Congress. Because of your efforts and those of medical societies across the country, the prospect of handing over to insurers, the power to set the benchmark for all fees is no longer a done deal. In fact, the House Bill HR 3630, which would do just that, has but 3 cosponsors while HR 3502, which resembles New York’s law, has 100. Of course, this fight is far from over as the insurers are waging their fight on many fronts. One thing you can do is go here to send a letter to your members of Congress. I urge everyone to do so as this issue is critical to all physicians.

So are these two surprises really unrelated? Perhaps in a way, they are not. There are indeed wheels within wheels. Individually, we may not be able to exert sufficient pressure but together, with everyone’s hand on the needle, we may move it sufficiently to achieve the desired end.

Once again, I leave you with Benjamin Franklin:

We must indeed all hang together or, most assuredly, we shall all hang separately.

Comments?; @sonodoc99

Arthur Fougner, MD
MSSNY President

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Bills Signings Ramping Up – Physician Action Needed!
As of today, there were still nearly 500 bills that passed both houses in 2019 that were awaiting delivery to the Governor.  But with just a few months left in the year, the flurry of bill signings/vetoes has begun.

Physicians can quickly and easily send a letter to the Governor here on the following:

  • Support ending mid-year formulary changes– would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year.  Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please urge the Governor to sign this bill into law here.
  • Support partial prescription fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
  • Oppose liability expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please urge the Governor to veto these bills here.

New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
As recently reported, Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted. The law was designed to respond to reports of medical students being asked to perform such exams, without express patient consent, as part of their medical training in teaching hospitals.

Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance of a pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

  • the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;
  • the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has  already given oral or written consent; or
  • the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

It would also make violation of such provision an element of physician misconduct. Several other states have passed similar laws expressly banning this practice without clinical justification.  MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care.  The American College of Obstetricians & Gynecologists have issued an ethical opinionthat “Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery”. The law takes effect on April 4, 2020.

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Physicians Welcome to Provide Public Comments on DSRIP at 10/30  in Syracuse Public Forum
Next Wednesday, October 30, the New York State Department of Health (NYSDOH) will be holding a Public Comment forum for New York’s 1115 waiver  at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.   A similar forum was held today in New York City.

The open comment period for both forums will be from 11am to 2pm.  In addition to public testimony, written statements may be submitted to through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

Specifically, the NYS Health Department is seeking from the federal government a continuation of DSRIP for the 1-year balance of the 1115 waiver ending on March 31, 2021 and to extend an additional 3 years from April 2021 to March 31, 2024.   Click Here to view the Amendment Proposal.

Background on the DSRIP Program

The roughly $6 billion Delivery System Reform Incentive Payment (DSRIP) program provides incentives for Medicaid providers to create and sustain an integrated, high-performing health care delivery system that can effectively and efficiently meet the needs of Medicaid beneficiaries and low-income uninsured individuals in their local communities by improving  the quality of care, improving the health of populations and reducing costs.

The DSRIP program promotes community-level collaboration and aims to reduce avoidable hospital use by 25% over the 5-year demonstration period. A total of 25 Performing Provider System (PPS) were established in different regions of the State to implement innovative projects across three domains: system transformation, clinical improvement and population health improvement (New York’s Prevention Agenda).

While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as community physician practices, some have raised concerns that not enough funding has been made available to physicians who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.

NYDOH to Offer Free Coaching, Nicotine Replacement Therapy to Vapers
The New York State DOH has announced new services for e-cigarette users seeking help to stop vaping, including free quit-coaching and nicotine replacement therapy through the New York State Smokers’ Quitline. The quitline is available for New Yorkers of all ages, including adolescents.

The DOH added the service to the quitline to address the growing need to help users of e-cigarettes break their dependence on vaping. The New York “Department of Health announced Monday that it has expanded services available through the New York State Smokers’ Quitline in response to a nationwide outbreak of vaping illnesses that has killed 33 people and hospitalized nearly 1,500 more. Those interested can contact the quitline by calling 1-866-NY-QUITS (1-866-697-8487) any day of the week beginning at 9 a.m. A specially trained quit coach will assess users of e-cigarettes for type of product, frequency of inhalation, and dependence.

Based on the assessment, a user may be eligible to receive complimentary patches, gum, lozenges or a combination of these products. Quit coaches also will help users develop a personalized quit-plan and guide them to consult their health care professionals and health insurance plans for additional stop-smoking medication and support.

Similar to the eligibility guidelines for cigarette users, users of e-cigarettes who qualify for the quitline’s free NRT will receive a starter kit with a minimum two-week supply and can receive up to two kits per year – the second after 90 days from the first shipment. More information about eligibility is available online at


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It’s Tomorrow: New York Will Accept Vaping Devices on Drug Take Back Day
New Yorkers will be able dispose of their vaping devices and cartridges at more than 200 locations across the state as part of National Prescription Drug Take Back Day for the first time on Saturday, Gov. Andrew Cuomo announced this morning.

With nearly 150 vaping-related lung illnesses reported in the state, New York will partner with the Drug Enforcement Administration to collect e-cigarette devices and cartridges in addition to prescription drugs and other medications.

New Yorkers can dispose of medications and vaping devices at 223 locations across the state. More than 400 health care facilities will also dispose of their unused and expired medications as part of the national Take Back Day.

Study: How Physicians’ Belief in Treatment Effectiveness Can Impact Patients
The NPR (10/21, Vaughn) “Shots” reports that a study shows “that patients can pick up on subtle facial cues from doctors that reveal the doctor’s belief in how effective a treatment will be,” which “can have a real impact on the patient’s treatment outcome.” The article adds, “Researchers randomly assigned undergraduate students to play the role of a patient or a doctor.”

The study “found that during the administering of the pain stimulus, the doctor group showed measurably less pain expression in their faces when they believed that the patient actors had been given a cream that provided actual pain relief.” Within “trials where the doctor group believed the cream was effective, patients reported that they found the doctors more empathetic.” The results were published in Nature Human Behavior.

CMS Sanctions UnitedHealthcare Plan: 3 Things to Know
One of UnitedHealthcare’s Medicare Advantage plans will face enrollment restrictions for 2020 due to compliance issues.

Three things to know:
1. CMS sanctioned the UnitedHealthcare plan because for the third year in a row, the plan did not adhere to a rule requiring it to have a medical loss ratio of at least 85 percent. A medical loss ratio measures how much of an insurer’s revenue goes toward medical claims versus overhead costs.
2. UnitedHealthcare said despite added benefits, the plan fell out of compliance because of a federal legislation reducing the health insurer’s tax liability for 2018.
3. Enrollment for the affected plan will be suspended for the 2020 contract year. The health plan is sold in nine states to less than 1 percent of UnitedHealthcare’s Medicare Advantage members. Becker’s Hospital News Payer Issues (October 15)

Could Your Practice Use Some Professional Help?
MSSNY’s IMG Subcommittee, through its Clearinghouse Opportunities Program, is looking for physicians who can offer IMG candidates meaningful experiences that will help them become familiar with the US healthcare system and prepare for residency training. Many IMG candidates have previous experience in their own countries as faculty members, practicing physicians or researchers, and they need a way to stay involved in health care as they wait for residency training opportunities. Others have recently graduated from medical school abroad.

IMGs who are ECFMG certified may be asked to assist with computer work, data collection, shadowing you while you treat your patients, help with research and special projects, and assist in any non-clinical activities in physician’s offices. Physicians in any specialty who have a position to offer are encouraged to contact MSSNY. Please send a brief description of the work with which you could use help, your requirements and any compensation that may be available, to Ruzanna Arsenian ( 

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Pro Publica: Doctor Payments from the Drug Industry
Sunshine laws may seem stringent, but doctors continue to benefit from the biopharma industry. A ProPublica investigation has found more than 700 doctors who have earned at least $1 million from drug makers or medical device companies over the past five years alone. Another 2,500 made at least $500,000.

The ProPublica analysis found that Xarelto, a blood thinner made by Janssen, generated the most payments to doctors — with $29.2 million dropped in 2016 alone.

Of the top 20 drugs with the most annual spending on doctors from 2014 to 2018, six made the list in each of the years: Invokana to treat type 2 diabetes, the blood thinners Xarelto and Eliquis, the antipsychotic Latuda, the immunosuppressive drug Humira and the multiple sclerosis drug Aubagio. Another three drugs were on the list for four years: Victoza to treat type 2 diabetes, psoriasis treatment Otezla and the cholesterol-lowering drug Repatha. (Research funding and royalties are not included.)

Xarelto topped the list in spending for four years, totaling more than $123 million in payments from 2014 to 2018. In March, its makers, Johnson & Johnson and Bayer AG, agreed to pay $775 million to settle about 25,000 lawsuits claiming that the companies had failed to warn patients that Xarelto could cause fatal bleeding.

CDC Report: Teen Suicide Rate Spikes
A new CDC report shows suicide rates among youths and young adults ages 10 to 24 spiked over a decade, outpacing the suicide rate of other age groups and ending years of relative stability. Yet, researchers say they are not sure what is driving the jump in suicide rates among youth and young adults.

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TO: New York State Residents and Fellows
MSSNY Announces the 15th Resident/Fellow/Medical Student Poster Symposium 

When:    Friday, April 24, 2020
Where:   Westchester Marriott
Tarrytown, New York
Time:      1:30 pm – 4:00 pm

Click here for detailed guidelines. Deadline for abstract submission is 4:00 pm, Monday, February 3, 2020. We welcome your participation. Participants must be MSSNY members, and membership is free for first-time resident/fellow members. Join online.

Still Time for NY Ambulatory Clinics to participate in the AHRQ Safety Program!
Beginning in December 2019, this program combines evidence-based guidance with strategies to address the attitudes, beliefs, and culture that often pose challenges to improving antibiotic prescribing.

Participation in this AHRQ program will help clinics meet the Centers for Medicare and Medicaid Services Merit-based Incentive Payment System (MIPS) requirements and can demonstrate compliance with the new Joint Commission Ambulatory Antimicrobial Stewardship Standard as many of the concepts are similar.

Continuing education credits including Maintenance of Certification (MOC) for ABIM, ABP, and ABFM will be offered at no charge for participants. 

Benefits of participating include:

  • Reduce unnecessary antibiotic use and increase appropriate antibiotic use

       Enhance teamwork and communication around diagnosis and treatment of infections and antibiotic prescribing in your practice
       Improve patient safety and safety culture

  • Improve workflow, especially during the busy cold and flu season
  • Maintain and improve patient and family satisfaction

Eligible Clinics
Clinics that care for children and/or adults and are:

       Primary care clinics
       Urgent care clinics
       Student health clinics
       Community-based health clinics (e.g., Federally Qualified Health Centers or FQHCs)
       Outpatient specialty clinics that provide primary care (e.g., OB/GYN)

How Can I Learn More?
Attend an Informational Webinar (all times listed are Eastern Time):

October 30 1 p.m.
November 5 at 2 p.m.
November 14 at 2 p.m.
November 26 at noon
December 2 at 2 p.m.

Visit or email

This program is funded and guided by the Agency for Healthcare Research and Quality and led by Johns Hopkins Medicine and NORC at the University of Chicago.


“When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Be sure to sign up for Medical Matters: When is the Flu not the Flu? on November 20 at 7:30am. This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

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

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

Register Now for Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm

The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2 from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432.  Please click here to register.  To view the program flyer, please click here.

Program schedule:

7:30—8:20 am:           Registration and Breakfast

8:20—8:30am:            Welcome and Opening Remarks

8:30—9:30am:            Health Matters for Women: Endometriosis *
 Faculty: Lisa Eng, DO

9:30—10:30am:         Ovarian Cancer and Genetic Risk **
Faculty: David Fishman, MD

10:30—11:30am:       Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis *
Faculty: Florence Shum, MD

11:30—12:30pm:       Genetic Profiling of Breast Cancer and Its implication for Staging, Prognosis and Treatment **
Faculty: Louis Auguste, MD

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

The Medical Society of the State of New York designates EACH of these live activities 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.

**The Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.

The Academy of Medicine of Queens County designates EACH of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä.  Physicians should only claim credit commensurate with the extent of their participation in the activity.



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Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
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Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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:


Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to :

Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.
Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Chemung                Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Dutchess                 Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                 Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*             Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                      Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington            Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

NYS Corrections Personnel Ad

Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: Contact: or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at:

Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail:  Fax: (1-516) 833-4760 Equal Oppty Employer M/F

















MSSNYeNews: August 9, 2019 – House of Medicine Divided Cannot Stand

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

August 9, 2019

Vol. 22  Number 30



“We must indeed all hang together, or most assuredly, we shall all hang separately.”
Benjamin Franklin

This week, famed physician-author Dr. Eric Topol generated quite a buzz with a piece in The New Yorker entitled “Why Doctors Should Organize.” Beginning with the recent #ThisIsOurLane pushback against a snarky NRA piece, Dr. Topol outlines past history of successes achieved when doctors organized. He rightly notes the rise of physician burnout engendered in no small part by electronic medical records which reduce caring professionals to data-entry clerks. The severing of the patient-physician relationship is also noted, thanks to the efforts of Regulators and Managed Care. Physicians, if organized, could be a powerful force but “the profession is balkanized.”

Where Dr. Topol and I part company is his assertion that Medical Societies should not be concerned with “protecting the interests of doctors.” While he is correct in recommending that a medical organization should promote the interests of the public, he’s somehow missed the history of, for example, the AMA post-Sunbeam. Eric, Medical Societies can and should do both. I’ll simply say that if physicians don’t stand up for ourselves and represent, who will?

So Dr. Topol, I am happy to continue this dialogue because you have clearly diagnosed the illness and the cure IS organizing. We must tear down the silos. We agree more than we disagree and I feel we can all work together for the good of our noble profession. We must. Our patients are counting on it.

Or, as Billy Joel put it, we will all go down together.

Arthur Fougner, MD
MSSNY President 

Comments?; @mssnytweet; @sonodoc99

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Physicians Must Make Their Voices Heard on Surprise Billing Proposals
Discussions are still ongoing regarding a national solution to surprise bills and the current incarnation winding its way through Congress would use a disastrous benchmarking system that would leave all of the power in insurers’ hands. Legislation such as S1895 and HR3630 would allow insurers to create an artificial ceiling for payment, giving market dominant insurers new incentives to drop physicians from their networks (as they have in California) and potentially limiting patient access to needed specialty care in in hospital emergency departments.

Given these threats, please take the time to send a letter to your members of Congress by going here. The letter is pre-populated and allows you to get the message to the right individuals in just a few short minutes.  Please also work with your local county medical society to arrange to meet with your Representative of Congress, as legislators are now home in their districts until the end of September.  To find your representative, go here, where you can find their contact information including phone number and Twitter handle. Please speak with their staffs and if possible, request a meeting to discuss the issue in more detail.

For more information about why this legislation is worrisome, check out the following articles. Congress is About to Give Health Insurance Companies the Nuclear Weapon discusses how it would control surprise billing mediation for any patient in an ERISA-regulated health plan and why that would likely lead to a massive cut in physician compensation. Congress, Don’t Harm Patients With The Wrong Surprise Medical Bills Solution also provides a strong overview of the topic.

MSSNY supports an approach such as HR 3502 (Ruiz-Roe-Morelle) that is modeled after New York’s acclaimed law which has shown to be remarkably effective and fair.   It mandates use of an independent dispute resolution system similar to New York’s instead of utilizing an insurer-determined benchmark.

Please do not let Congress give insurers even more ability to implement abusive tactics that interfere with needed patient care.

Five Measles Cases Reported in Mennonite Community in Wyoming County
Health officials say they’ve confirmed five cases of measles in a Mennonite community in western New York. The DOH says Thursday the cases were recorded in Wyoming County. The department has issued an advisory to notify regional health care providers of the potential for exposure.

Amid the nation’s worst measles outbreak in decades, Gov. Cuomo in June signed a law ending all non-medical exemptions for vaccines required for children to attend school in the state. The CDC Control has counted nearly 1,200 cases of measles in 30 states so far this year. About three-quarters of the cases are linked to outbreaks in New York.

FDA Investigating 127 Cases of Seizures After Vaping
The Food and Drug Administration is investigating 127 cases of people suffering from seizures after vaping, the agency announced Wednesday.

The agency received about 92 new reports of people, especially kids and young adults, experiencing seizures after using e-cigarettes since it first announced its investigation into the issue in April. The FDA said it’s unclear whether e-cigarettes caused the seizures and cautioned these cases occurred over a 10-year period.

When the FDA announced its investigation in the spring, it asked for people to let the agency know if they had ever experienced this. The FDA on Wednesday again encouraged people to report if they had seizures after vaping.

“We appreciate the public response to our initial call for reports, and we strongly encourage the public to submit new or follow-up reports with as much detail as possible,” acting FDA Commissioner Ned Sharpless said in a statement.

“Additional reports or more detailed information about these incidents are vital to help inform our analysis and may help us identify common risk factors and determine whether any specific e-cigarette product attributes, such as nicotine content or formulation, may be more likely to contribute to seizures,” he added.

Veterans’ Care Claims Inappropriately Denied
Veteran Affairs (VA) claims processors inappropriately processed claims for emergency care received at non-VA hospitals, resulting in denied or rejected claims for tens of thousands of veterans, according to a VA Office of Inspector General (OIG) report released this week. VA’s OIG noted that denied or rejected claims can leave veterans on the hook for the total costs of their care.

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Play Ball! Baseball Players May Live Longer than Other Pros and American Men
Professional baseball players may live longer than other professional athletes or American men overall, study indicates the New York Times (8/7) reports on a study published in JAMA Internal Medicine, in which researchers found that professional baseball players may have greater life expectancy than other professional athletes “and American men in general.”

The researchers also found that professional baseball players with long careers are less likely to die from cardiovascular disease and certain other diseases, but more likely to die from cancer, especially lung and skin cancer.

New Apps Give Updates to Waiting Family Members During Surgery
The Wall Street Journal (8/6) reports that startups and large healthcare companies are developing tools designed to give family members updates on the status of their relatives during surgery or hospital stays.

Garfunkel Ad

USPSTF Recommends Against Pancreatic Cancer Screening
Reaffirming its 2004 statement, the U.S. Preventive Services Task Force (USPSTF) has issued a ‘D’ recommendation against screening for pancreatic cancer in low-risk adults with no signs or symptoms of this lethal disease.” The USPSTF authors wrote in their recommendation statement  published online in JAMA that “the USPSTF found no new substantial evidence that would change its recommendation and therefore reaffirms its recommendation against screening for pancreatic cancer in asymptomatic adults.”

The task force “concluded that screening has the potential for significant harm owing to the low prevalence of pancreatic cancer (12.9 cases per 100,00 person-years), the poor outcomes of treatment (5-year survival rate of only 9.3%), the limited accuracy of screening tests, and the invasive nature of diagnostic tests.”

Review Suggests Chronic Hepatitis Can Be Eliminated Globally
MedPage Today reports that “chronic hepatitis is a major public health challenge that can be eliminated globally, according to an infectious disease expert” who conducted a review study. The review study found that “although progress has been made in the prevention and treatment of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infections, challenges remain.”

The author suggests one step to achieving elimination of hepatitis is that, “all patients with risk factors should be tested for HCV and HBV and all persons born between 1945 and 1965 should be routinely tested for HCV to prevent liver disease and hepatitis transmission.” Moreover, the researcher “advised that ‘all who are positive for HBsAg or HCV should be evaluated for treatment and those susceptible to HBV or HAV should be vaccinated.’” The findings were published in the New England Journal of Medicine.

CMS Releases Proposed 2020 Medicare Rule; Significant Up & Down Specialty Impacts
CMS recently released a 1700-page proposed rule for the 2020 Medicare physician fee schedule (PFS). CMS notes that “with the budget neutrality adjustment to account for changes in RVUs, as required by law, the proposed CY 2020 PFS conversion factor is $36.09, a slight increase above the CY 2019 PFS conversion factor of $36.04.

On a positive note, the 3-year review of Medicare GPCIs would produce a slight upward adjustment to the Geographic Adjustment Factors for the 5 New York Medicare payment localities.

However, it should be noted that the proposed changes to Medicare payment proposed in this rule could produce some significant upward and downward adjustments to Medicare physician payment, based upon specialty, if CMS finalizes the proposal without modification. Please see Table 111 on pp.1187-1188 of the proposed rule for a possible specialty by specialty impact.

For example, it predicts an overall +16% increase for Endocrinology, +15% for Rheumatology, +12% for Family Practice and Hematology/Oncology, +8% for Urology and Neurology, and +7% for Ob-GYN and Allergy/Immunology.  On the other hand, it predicts an overall -10% decrease for ophthalmology, -8% for Radiology and Cardiac Surgery, and -7% for Anesthesiology, Emergency Medicine and Thoracic Surgery.  The AMA notes that this impact table “should be viewed with caution” as they believe it may contain some errors.

For more information from CMS on the proposed rule, click here.  For a comprehensive AMA summary of the proposed rule, click here.

The AMA provided state medical societies with an overview of 2 of the key components of this rule:

Changes to E&M Coding and the MIPS Program

  • Office Visits – Evaluation and Management – While retaining the important modifications to reduce documentation burden, CMS will implement coding and payment modifications in 2021 that are based on the resources required to perform various levels of office visits. This will ensure that physicians treating the sickest patients are not unfairly penalized, while providing simpler solutions to coding and documentation.

Following CMS’ proposal last year to collapse payment for office visits, the AMA coordinated a response from 170 national medical specialty societies and state medical associations urging a different solution. The CPT Editorial Panel and AMA/Specialty Society RVS Update Committee (RUC) convened a Workgroup, that adopted changes in February 2019, to document office visits on either medical decision making or time spent on the date of the encounter.  According to AMA, CMS accepted most of the CPT framework and RUC recommendations.  Among the key aspects of the Office Visit Proposed Rule:

  • Effective January 1, 2021, CMS will adopt the CPT guidelines to report office visits based on either medical decision making or physician time.
  • CMS adopted the RUC work recommendations for the office visit codes. The work value increases represent $3 billion in redistributed spending, resulting in a 3% reduction in the conversion factor.
  • CMS adopted the RUC physician time recommendations. Coupled with the work value increases and some modifications in direct practice costs, these changes lead to an additional $2 billion in redistributed spending, resulting in an additional 2% across-the-board reduction.
  • Two departures from the CPT and RUC recommendations that we will need to be addressed:
    • CMS would implement an add-on payment for office visits for primary care and patients with serious or complex conditions. This proposal redistributes an additional $2 billion, resulting in an additional 2% reduction to the Medicare conversion factor.
    • Although the surgical specialties participated in the RUC survey and their data and vignettes were incorporated into the RUC recommendations, CMS proposes not to apply the office visit increases to the global surgery packages.
  • Merit-based Incentive Payment System (MIPS) – The AMA noted that it is encouraged by results showing 95% of eligible clinicians successfully participated in MIPS in 2017, increasing to 98% in 2018 based on initial results. However, many physicians report that the current program is too costly and requires reporting for reporting’s sake, diverting time from patient care.

The AMA noted that, in the 2020 proposed rule, CMS embraced the AMA’s proposed concept for streamlining MIPS. The agency outlined a high-level framework and seeks feedback on an episode-based approach to MIPS, which it is calling the MIPS Value Pathways (MVP). The attached MVP diagram is included in the rule.

In the AMA’s view, an MVP-type approach could be a turning point for the program because an option that ties MIPS to episodes of care has the potential to be more clinically relevant, less burdensome, and a stepping stone to alternative payment models.  The AMA does have concerns with several specific aspects of MVP that CMS has proposed, such as a return to the use of controversial population health administrative claims measures that the AMA successfully fought to eliminate from the initial MIPS program.  CMS does not plan initial implementation of an MVP approach until 2021.




Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information:
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room

Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643

Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing

Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room.  Shared secretarial and waiting rooms. Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time.

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:


Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail:  Fax: (1-516) 833-4760 Equal Oppty Employer M/F