MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF …...MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS...

MEDICAL SOCIETY OF THE STATE OF NEW YORK

NEWS OF NEW YORKProv id ing In format ion to Ass i s t Phys i c ians in the State o f New York

INSIDE NEWSCLICK ICONS TO FOLLOW MSSNY ON

FACEBOOK OR TWITTER.

Volume 74 • Number 7 www.mssny.org September 2018

Survey Findings on Continuing Certification �� page 2

MSSNY Speakers on Physician Burnout ��page 10

NYS Sexual Harassment Training Mandate ��page 11

New Deadline for MIPS Targeted Review Request ��page 13

up to 40% on movies, theme park tickets, concerts, hotels, and thousands of family entertainment destinations inside your perks program.

Over 302,000 offers across 10,000 cities

Easy mobile access

No hidden fees

4 Join now at https://mssny.abenity.com

All discount offers are subject to change at any time without notice. Log in regularly to view the latest

discounts available. Abenity, Inc. Copyright 2018.

Enjoy member-only discounts and corporate rates on everything from pizza

and the zoo, to movie tickets, car rentals, and hotels. With over 302,000

offers across 10,000 cities and easy mobile access, you’ll always have a

reason to Celebrate Your Savings!

NEARBY

OFFERSWELLNESS

MONTHLY

GIVEAWAYS

MOVIE

SHOWTIMES

INSURANCE

BENEFITS

VACATION

PLANNER

MOBILE

APPS

Member Perks ProgramLog in at prks.co/mssny

All discount offers are subject to change at any time without notice. Log in regularly to view the latest discounts available. Abenity, Inc. Copyright 2018.

SaveMSSNY Members Only

Effective Immediately: Marijuana Can Be Prescribed for Chronic PainOn July 12, the New York State Department of Health

announced the filing of emergency regulations adding any condition for which an opioid could be prescribed as a qualifying condition for medical marijuana. Effective immediately, registered practitioners may certify patients to use medical marijuana as a replacement for opioids, provided that the precise underlying condition for which an opioid would otherwise be prescribed is stated on the patient’s certification. This allows patients

(Continued on page 11)

Are Insurance Companies Following the New STEP Therapy Law?

MSSNY supported the enactment of this law, which is applicable to all NY-regulated health plans as of January 1, 2018. It requires ALL NY-regulated health insurers to grant an override of its step therapy protocol upon receipt of information from the physician “that includes supporting rationale and documentation” that the drug(s) being required by the health insurer:

• Is contraindicated or will likely cause an adverse reaction by physical or mental harm to the patient;


More charts on page 10.

Slightly over two-fifths (41%) of residents indicated that future earnings are extremely or very influential in their specialty choice, compared with 98% in 2017. More men (36% vs 33% of women) said that future earnings are extremely or very influential. Still, not everyone is influenced by income. “Potential earnings do not play a part in my specialty choice,” says Gregory Pelc, a third-year res-ident at Indiana University School of Medicine’s internal medicine residency program. He has chosen to subspecialize in hospice and palliative medicine

Medscape Residents Salary & Debt Report 2018

• MSSNY’s News of New York • September 2018 September 2018 • MSSNY’s News of New York • Page 3

To inform decisions about the future of the American Board of Medical Specialties (ABMS) Member Boards’ Maintenance of Certification (MOC) programs, the Continuing Board Certification: Vision for the Future (Vision Initiative) Commission conducted an online survey to elicit feedback from three key stake-holder groups: physicians, non-physician providers and other stakeholders involved in the delivery of health care, and the general public. The survey provided an open forum for input.SURVEY DESIGN - CONVENIENCE SAMPLE

The survey questions were devel-oped by the Vision Initiative Planning Committee, which included represen-tatives from ABMS, the Accreditation Council for Continuing Medical Education, Accreditation Council for Graduate Medical Education, Coalition for Physician Accountability, Council of Medical Specialty Societies, and Council on Medical Education of the American Medical Association, as well as public members. The survey included a combination of closed- and open-ended questions.

The survey was implemented using Survey Monkey, a popular online plat-form. Participants were invited to take the survey through a variety of means, which resulted in a convenience sam-ple. The survey invitation was widely distributed to individuals and organiza-tions who shared it with their staff and members. The organizations that helped promote the survey included the Council on Medical Specialty Societies, Specialty Society Chief Executive Officer Coalition and the American Association of Medical Society Executives, individual associa-tions and state medical societies. The Vision Initiative Commission appreciates the support of all the organizations who distributed the survey invitation.

In total, 36,392 people participated in the survey, including 34,616 physicians, 1,373 non-physician providers and stake-

holders involved in the delivery of health care, and 403 members of the general public. The physician survey included responses from all 24 ABMS Member Boards and all 50 states.

Important Note: While the survey includes more than 36,000 responses from across the three audiences, it used a convenience sample and is likely to reflect selection bias. However, the results are impor-tant for the Commission to consider and are consistent with previous feedback received by ABMS and its Member Boards.SURVEY FINDINGSPhysician Findings

When asked if they value MOC, one in 10 physicians (12%) said they value the program, nearly half (46%) said they have mixed feelings about it, while 41 percent said they do not value the program.

The survey asked physicians about their concerns regarding the MOC program. Participants were allowed to choose up to four options from a set list. The most frequently cited response was “costs” (58%). “Burdensome” was next highest (52%), followed by “does not accurately measure my ability as a clinician” (48%). “Does not help me improve my practice in a meaningful way” (43%) was the fourth most popular response.

Physicians were also asked to select which activities from a set list should be considered by the Vision Initiative Commission for continuing certification. The most popular responses were “con-tinuing medical education” (84%) and “self-assessment questions delivered at regular intervals” (52%). Less popular choices were “open-book exam” (34%) and “assessment of the quality and safety of care provided” (24%), among the other choices.

Of the physician respondents, 96% are Board Certified. Additionally, 69% of respondents noted they are currently enrolled in a primary specialty MOC pro-

gram, and 33% are currently enrolled in a subspecialty MOC program. Sixteen percent are lifetime certification holders. These categories are not mutually exclu-sive. Finally, six percent are not enrolled in an MOC program or are a lifetime cer-tificate holder.

In summary, approximately half of physician respondents see MOC as too costly, burdensome, and not a true reflec-tion of their abilities as clinicians. Some physicians want continuing certification to focus on practice-relevant continuing medical education (CME) opportunities, self-assessment, open-book exams and quality of care assessments.OTHER HEALTHCARE STAKEHOLDERS FINDINGS

When asked how familiar they are with the requirements that physicians must fulfill to maintain their Board Certification, 39% of stakeholders said they were “very familiar,” 46% said they were “somewhat familiar,” nine percent said “somewhat unfamiliar,” and five percent said they were “not at all familiar” with the requirements.

When asked if they consider Board Certification when selecting a physician, more than half of the stakeholder respon-dents (57%) said they always consider it, more than a quarter (27%) said they sometimes consider it, and 15% said they never consider it. Next, when asked if Board Certified physicians provide higher-quality care than non-Board Certified physicians, nearly six in 10 respondents (59%) believe they do; one in five (22%) didn’t know. One in five (19%) said Board Certified physicians don’t provide higher-quality care.CONSUMER FINDINGS

When asked if they consider Board Certification when selecting a physi-cian, more than half of the general public respondents (56%) said they always consider it, more than a quarter (28%) said they sometimes consider it, and 16 percent said they never consider it. Next,

Stakeholder Beliefs About the Future of Continuing Certification: Survey Findings

MSSNY is pleased to announce our newest member benefit! Our new Abenity App provides members with exclusive perks and over $4,500 in sav-ings on everything from restaurants, City Pass, AMC movie tickets, theme parks, hotels, car rentals, mortgage savings, auto care and much more!POPULAR FEATURES INCLUDE:• Nearby Offers: Use our show and

save mobile coupons to quickly access

savings on the go.• eTickets On Demand: Save up to

40% with no hidden fees.• Showtimes: Find movies, watch

trailers and save up to 40% at a the-ater near you.

• Monthly Giveaways: Win cash, movie tickets, electronics and more with our monthly contests.And, with over 302,000 available dis-

counts across 10,000 cities in the United

States and Canada, you’ll never be far from savings!REGISTER & LOG IN:• Click on the following link: http://

mssny.abenity.com • Create a unique user name and

password• Visit the App Store and download the

Abenity App• Begin Saving!

Join MSSNY’s Member Perks Program and Enjoy $4,500 in Savings!


• MSSNY’s News of New York • September 2018 September 2018 • MSSNY’s News of New York •

Endorsed by MSSNY

Choose NY’s #1 medical liability insurance provider.For 40+ years, MLMIC has been providing New York medical professionals from Buffalo to the Bronx with localized risk management insights, claims protection, and 24/7 legal advice. Our policyholders enjoy benefits and expertise not found anywhere else – supported by concierge-level service every step of the way.

For medical malpractice insurance in New York, nothing compares to MLMIC.

Learn more at MLMIC.com/betterOr, call (888) 996-1183

No one knows

better than MLMIC.


Colleagues:I recently attended a meet-

ing at the Medical Society of the County of Erie in order to better understand the DEA’s role in audits and investi-gations of buprenorphine providers.

Representing the medical community at this meet-ing were: Gale Burstein, MD, Chair, Public Health Committee (MSCE) and Commissioner-Erie County Department of Health; Nancy Nielsen, MD, PhD, Senior Associate Dean for Health Policy, Medicine, SUNY at Buffalo; and Christine Nadolny, Executive Director-MSCE. Representing the DEA were: Edward Orgon, Resident Agent in Charge-US DEA, Joseph Cowell, Group Supervisor – US DEA Diversion Squad and Michael Cereo, Group Supervisor, US DEA Tactical Diversion Squad.

There are two types of visits that a prescriber might receive from the DEA:

• Compliance Inspections and Audits: Compliance Inspection is a minimally-invasive visit to an office wherein the DEA represen-tative interviews the provider and may check buprenorphine stock on hand. This is done unannounced, but we received assurances that

the DEA does not “shut down the office” while this is taking place, is done in a very respectful manner and in a way that does not alert patients that the DEA is on the premises.

• Audits, which are nor-mally only done after a compliance inspection and only if the DEA feels that a more thorough audit of the practice may be necessary.

According to Mr. Cowell (US DEA Diversion Squad), the only reason the audits are conducted is to ensure that buprenorphine is not being diverted onto the streets and prescribing physi-cians are employing all the prescribing protocols put forth by SAMHSA and state and federal regulations, which include:

• Verifying the prescriber’s credentials

• Checking on the number of patients under the prescriber’s care

• Ensuring that patients are moni-tored regularly during their treatment

• Verifying the ages of patients being treated

• Verifying the number of prescrip-tions being written v. number of patients

MEDICAL SOCIETY OF THE STATE OF NEW YORK

NEWS OF NEW YORK

MEDICAL SOCIETYOF THE STATE OF NEW YORK

Thomas J. Madejski, MD, PresidentRobert Hughes, MD, Board of Trustees Chair

Philip A. Schuh, CPA, Executive Vice President

COMMUNICATIONS AND PUBLICATIONS Maria Basile, MD, MBA, Commissioner

NEWS OF NEW YORKPublished by Medical Society

of the State of New York

Vice President, Communications and EditorChristina Cronin Southard

[email protected]

News of New York StaffManager, Communications Division

Julie Vecchione [email protected]

Roseann Raia, Communications [email protected]

Steven Sachs, Web [email protected]

Susan Herbst, Page Designer

NEWS OF NEW YORKADVERTISING REPRESENTATIVES

For general advertising information contactChristina Cronin Southard

Phone 516-488-6100 ext [email protected]

The News of New York is published monthly as the official publication of the Medical Society of the State of New York. Information on the publi-cation is available from the Communications Di-vision, Medical Society of the State of New York, 865 Merrick Avenue, P.O. Box 9007, Westbury, NY 11590.

The acceptance of a product, service or com-pany as an advertiser or as a membership benefit of the Medical Society of the State of New York does not imply endorsement and/or approval of this product, service or company by the Medical Society of the State of New York. The Member Ben-efits Committee urges all our physician members to exercise good judgment when purchasing any product or service.

Although MSSNY makes efforts to avoid clerical or printing mistakes, errors may occur. In no event shall any liability of MSSNY for clerical or printing mistakes exceed the charges paid by the advertis-er for the advertisement, or for that portion of the advertisement in error if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the error. Liability of MSSNY to the ad-vertiser for the failure to publish or omission of all or any portion of any advertisement shall in no event exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement omitted if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the omission. MSSNY shall not be li-able for any special, indirect or inconsequential damages, including lost profits, whether or not foreseeable, that may occur because of an error in any advertisement, or any omission of a part or the whole of any advertisement.

PRESIDENT’S COLUMN

Thomas J. Madejski, MD


As those lazy, hazy crazy days of summer transition to falling leaves that drift past windows (calling out all you Nat King Cole fans), the fall elections will be upon us before we know it.

Legislators have long since scattered out of Albany to focus their attention on attempting to win re-election. As you may have seen, there is an intense battle underway for political control of the State Senate, which is currently narrowly divided with the GOP in control. The Governor is also running for re-election, and several candidates are vying to take the place of Eric Schneiderman as the next New York Attorney General.

Not to mention the likely several close races for seats in the US Congress across New York State.CANDIDATES SEEKING FINANCIAL SUPPORT

As these candidates get ready to blanket the public with TV, radio, social media and print ads, many groups, including MSSNYPAC, have been

MSSNY-PACTransitioning to the Fall Elections



Real estate agents affiliated with The Corcoran Group are independent contractors and are not employees of The Corcoran Group. Equal Housing Opportunity. The Corcoran Group is a licensed real estate broker located at 660 Madison Ave, NY, NY 10065. All information furnished regarding property for sale or rent or regarding financing is from sources deemed reliable, but Corcoran makes no warranty or representation as to the accuracy

thereof. All property information is presented subject to errors, omissions, price changes, changed property conditions, and withdrawal of the property from the market, without notice.

For information on these properties and for the largest selection of Healthcare Properties in New York City, call:Paul L. Wexler | Lic. Associate Real Estate Broker | o: 212.836.1075 | [email protected] | www.healthcare-properties.com

Premier Available Medical/Dental PropertiesThe Undisputed Leader in New York City Healthcare Properties

THE BEST OF PARK740 Park Avenue

Between East 71st & East 72nd Street Size: 2,100 SF +/- for sale

BUILD TO SUIT418 East 71st Street

Between First & York AvenueSize: 985 – 4,735 SF +/- for lease

MURRAY HILL MEDICAL CONDO308 East 38th Street

Between First & Second AvenueSize: 516 SF +/- for sale

THE DOWNTOWN MEDICAL BUILDING156 William Street

Between Ann & Beekman StreetSize: 4,157 – 16,385 SF +/- for lease

UPPER EAST SIDE MEDICAL OFFICE106 East 85th Street

Between Park & Lexington AvenueSize: 600 SF +/- for sale

WASHINGTON HEIGHTS COMMUNITY CENTER531 West 159th Street

Between Broadway & Amsterdam AvenueSize: 4,482 SF +/- for lease

PRIME CHELSEA RETAIL/MEDICAL181 7th Avenue

Between West 21st & West 22nd StreetSize: 5,700 SF +/- for lease

FABULOUS PARK AVENUE LOCATION580 Park Avenue

Between East 63rd & East 64th StreetSize: 770 – 1,700 SF +/- for Sale

EAST END SURGERY SUITE200 East End Avenue

Between 89th & 90th StreetSize: 4,170 SF +/- for sale

FABULOUS FIFTH AVENUE800A Fifth AvenueAt East 61st Street

Size: 950 – 1,770 SF +/- for lease

PARK-SIXTY MEDICAL 110 East 60th Street

Between Park & Lexington AvenueSize: 4,500 – 155,000 SF +/- for lease

NEW WEST SIDE DEVELOPMENT600 West 58th Street

At Eleventh AvenueSize: 18,620 SF +/- for lease

RITZ TOWER MEDICAL111 East 57th Street

At Park Avenue Size: 1,228 – 37,579 SF +/- for lease

THE SUNNYSIDE38-01 Queens Boulevard

Between 38th & 39th StreetSize: 1,500 – 120,000 SF +/- for lease

SPECTACULAR PARK VIEWS4 West 58th Street

Between Fifth & Sixth AvenueSize: 3,974 – 23,470 SF +/- for lease

MOVE-IN READY MEDICAL114 East 72nd Street

Between Lexington & Park AveSize: 750 SF +/- for sale

SMALL GEM ON FIFTH 1056 Fifth Avenue

Between East 86th & East 87th StreetSize: 678 SF +/- for sale

UPPER EAST SIDE MEDICAL CONDO212 East 70th Street

Between Second and Third AvenueSize: 1,700 SF +/- for sale

WEST 57TH STREET MEDICAL57 West 57th Street

At Sixth AvenueSize: 1,648 SF +/- for lease

RARE CENTRAL PARK WEST7 West 96th Street

Between CPW & Columbus AvenueSize: 1,276 SF +/- for sale

PRESTIGIOUS CENTRAL PARK WEST262 Central Park West

Between West 86th & West 87th StreetSize: 1,000 SF +/- for sale

LOWER EAST SIDE COMMERCIAL CONDO62 Rivington Street

Between Allen & Eldridge StreetSize: 1,382 SF +/- for sale

MOVE-IN READY MEDICAL785 Park Avenue

Between East 73rd & East 74th StreetsSize: 1,200 SF +/- for sale

HUDSON YARDS CONDOS509 West 38th Street

Between Tenth & Eleventh AvenueSize: 11,374 – 36,503 SF +/- for sale or lease

RENTAL ON FIFTH AVENUE 1050 Fifth Avenue

Between East 86th & East 87th StreetSize: 1,890 SF +/- for lease

25-FOOT WIDE TOWNHOUSE168 East 80th Street

Between Lexington & Third AvenueSize: 7,600 SF +/- for sale/lease

BOROUGH PARK MEDICAL4802 New Utrecht AvenueBetween 48th & 49th Street

Size: 3,000 – 34,000 SF +/- for lease

TURTLE BAY MEDICAL338 East 49th Street

Between First & Second AvenueSize: 4,730 SF +/- for lease

PRIME MEDICAL ON UPPER EAST SIDE1041 Third Avenue

Between East 61st & East 62nd StreetSize: 1,120 – 3,901 SF +/- for lease

MIDTOWN MEDICAL OFFICE108 1/2 East 37th Street

Between Park & Lexington AvenueSize: 550 SF +/- for sale

CENTRAL PARK WEST MEDICAL40 West 72nd Street

Between CPW & Columbus AvenueSize: 1,425 SF +/- for lease

SUTTON PLACE RETAIL/MEDICAL2 Sutton Place North

York Avenue at 61st StreetSize: 2,000 SF +/- for lease

PRESTIGIOUS PARK AVENUE950 Park Avenue

Between East 81st & East 82nd StreetSize: 1,100 SF +/- for sale

FABULOUS MEDICAL/RETAIL OFF CPW27 West 72nd Street

Between CPW & Columbus AvenueSize: 10,000 SF +/- for sale or lease

UPPER EAST SIDE MEDICAL/RETAIL260 East 67th Street

At Second AvenueSize: 1,915 to 10,858 SF +/- for lease

40686_Wexler_NYSMedicaSociety_8.5x11.indd 1 8/17/18 11:31 AM


• Is expected to be ineffective based on the known clinical his-tory and conditions of the patient and his/her drug regimen;

• Has been tried by the patient or another prescription drug(s) in the same pharmacologic class or with the same mecha-nism for action and such drug(s) was discontinued due to a lack of efficacy or effectiveness, diminished effect or an adverse event;

• Should not be required because the patient is stable on a drug other than the drug being required by the insurer; or

• Is not in the best interest of the patient because it will likely cause a significant barrier to a patient’s adherence with his/her plan of care, will likely worsen a comorbid condition of the patient, or will likely decrease the patient’s ability to achieve or maintain reasonable functional ability in perform-ing daily activities.

Health insurers must respond to a step therapy override request within 72-hours of the request. A health insurer is required to respond within 24-hours if the request is for a patient with a medical condition that places the health of the patient in serious jeopardy without the prescription drug or drugs prescribed by the patient’s physician. If the health insurer fails to act within these 72 or 24-hour time periods, the request will be granted in favor of the patient.

The new law also requires that health insurers’ step therapy protocols be based on evidence-based and peer-reviewed clinical criteria that also take into account the needs of atypical patients. These criteria must be made available to physicians upon request.RESOURCE LINKS:• Webinar: How to override a health insurer’step therapy

protocol• Template for physicians/staff to use in requesting a step ther-

apy protocol override• File a complaint with the Office of the NY Attorney General

New STEP Therapy Law(Continued from page 1)

Insurance Services Since 1920 Athol Springs, NY 800-333-5220 | www.sellersinsurance.com

INTEGRATED MEDICAL REFERRALS, INC.

OPPORTUNITY TO AUGMENT YOUR PRIVATE PRACTICE BY PERFORMING INDEPENDENT MEDICAL EXAMS

We provide: Referrals Credentialing

Marketing Scheduling Billing & Collections Transcription Quality review of reports Office space, receptionist & medical assistant

Contact us today to join our panel of board certified

physicians and allied health professionals! www.integratedexams.com

(p) 516-358-2675 • (f) 516-747-0180

EMAIL CV TO: [email protected]

For Advertising Opportunities with MSSNY Contact: Christina Southard

[email protected] or 516-488-6100 x 355

WC Board Announces Technical Specifications for CMS-1500 InitiativeAs announced on April 17, 2018, in Subject Number

046-1058 Proposals to Improve Medical Care for Injured Workers, the New York State Workers’ Compensation Board (Board) will replace the current Board treatment forms: Doctor’s Initial Report (Form C-4), Doctor’s Progress Report (Form C-4.2), Occupational/Physical Therapist’s Report (Form OT/PT-4), Psychologist’s Report (Form PS-4), and Ancillary Medical Report (Form C-AMR) with the CMS-1500 to help reduce paperwork and lower provider administra-tive burdens. This initiative will leverage providers’ current medical billing software and medical records while promot-ing a more efficient workers’ compensation system. It is expected that the initiative will roll out in three phases, as follows:PHASE 1: COMMENCING JANUARY 1, 2019:

• Providers may voluntarily transmit CMS-1500 medi-cal bills (and required medical narratives, and/or attachments as applicable) through an approved XML Submission Partner (“clearinghouse”) to workers’ compensation insurers/payers. Guidance on required medical narratives and attachments is available on the Board’s website. As previously conveyed in Subject



HILTON GARDEN INN TROY: 235 HOOSICK STREET, TROY, NY 12180

JOIN US for an exciting full-day clinical conference focusing on HIV prevention and care for women of all experiences. This conference will feature interactive presentations and panel discussions highlighting the vital role of medical providers in women’s health.

Register Today! http://rebrand.ly/CEIOct12Registration is free of charge and required as seating is limited. This program is for New York State medical providers including physicians, physician assistants, nurse practitioners, nurses, certified nurse midwives, dentists, and pharmacists. Check back for CE updates!

Questions? Contact Jessica Steinke at 212-731-3789 or [email protected]

Friday, October 12, 2018 9am-5pm

HIV in 2018 KEEPING THE

VISION ON WOMEN


Kathleen L. HarthRegional Claims Manager MLMIC

A 58-year-old female presented to a MLMIC-insured hospital emergency department (ED) complaining of a cough for the past two days and aches and pains around her ribcage. She had decreased breath sounds on the right side of her lungs, but no rhonchi or rales. The ED physician interpreted her chest x-ray as right upper lobe infiltrates and diagnosed acute pneu-monia. The patient was prescribed Zithromax, cough syrup, and Motrin and advised to be re-checked by her own physician in one week.

The following day, a MLMIC-insured radiologist officially read the chest x-ray. His impression was an abnormal density in the patient’s right upper lobe. If the patient was symptomatic for pneumonia, treat-ment was advised; otherwise this density could represent a mass of another variety, perhaps neoplas-tic. He recommended follow up to demonstrate resolution if the patient presented with infiltrating symptomatology. However, the radi-ologist did not notify either the patient or the ED of his findings. Three days after the patient was seen in the ED, the reading was transcribed and elec-tronically signed the following day.SIX MONTHS LATER

Six months later, the patient returned to the hospital’s ED complaining of a worsening cough with clear white spu-tum and tightening of the chest.

The patient was admitted to the hospital by the co-defendant primary care physician. A CT scan was ordered and read by the same MLMIC-insured radiologist. There was a large mass in the right upper lobe to the right of the hilum with at least one hilar node and possible mediastinal node. The mass had no benign criteria. The radi-ologist noted that the possibility of an underlying neoplasm was greater than demonstrated on the prior film. This information was relayed to the attending. A MLMIC-insured pulmon-ologist was called in for consultation. He ordered blood work and a bron-choscopy to rule out lung cancer. A bronchoscopy, multiple biopsies and brushings were performed. They were negative for malignancy, although there were reactive bronchial cells

present. The patient was worked up for a possible myocardial infarction, but her enzymes were negative. An EKG showed a borderline increase in the thickness of the left ventricular wall.

A PET scan was recommended, but was not available at the insured hos-pital. The patient was discharged from the hospital and advised to follow up with both the pulmonologist and her primary care physician. The final diag-nosis at discharge was a right lung mass of unknown etiology, a tricuspid valve disorder, unspecified chest pain and a non-specific abnormal EKG. She was status post bronchoscopy and stress test.

PATIENT DID NOT RETURNFive days after her discharge, the

pulmonologist saw the patient. She now was having hemoptysis. Her pul-monary function tests showed mild COPD. He planned to perform a PET scan and obtain a thoracic surgery evaluation. However, the patient did not return to see him. Two months later, her primary care physician con-tacted the patient to determine why she failed to both undergo the PET scan and to keep two appointments with the pulmonologist. The pulmo-nologist also sent the patient a letter advising her of the medical necessity of undergoing the PET scan.DIED FOUR YEARS LATER

Subsequently, the patient advised the pulmonologist that she was being treated by a thoracic surgeon. One week later, the PET scan was per-formed at another hospital. The findings of the scan were extensive hypermetabolic activity which occu-pied most of the right upper lobe of her lung. Although she was evaluated to see if a surgical resection of her lung would be beneficial, it was determined that the cancer was not resectable. The patient then underwent chemo-therapy and radiation. However, the

cancer metastasized and she expired four years later.

A lawsuit was initially commenced by the patient. After her death, her daughter, the administratrix of her estate, was substituted as plaintiff. A cause of action for wrongful death was added to the lawsuit in addition to medical malpractice.

The patient’s medical records were reviewed by MLMIC experts. The in-house emergency medicine expert opined that a discrepancy report should have been completed by the radiologist, since his reading differed from the x-ray reading by the ED phy-sician. Hospital policy and procedure required this. Further, the ED staff

never alerted the emergency physi-cian who initially read the film of the abnormal reading.

The expert found that at the ini-tial visit, there was no suspicion that the right upper lobe consolida-tion was cancer. The ED physician appropriately identified this area as a possible pneumonia, requir-ing antibiotics. However, the expert

was very concerned that the radiolo-gist failed to communicate with this ED physician to notify him that he had identified a potentially neoplastic lesion in the right upper lobe, which differed from the original reading by that emergency physician.ED PHYSICIAN’S NAME NOT ON REPORT

Unfortunately, the name of the ED physician was not placed on the radi-ologist’s report. Rather, the report was addressed only to the “Emergency Room doctor.” As a result, no spe-cific person received the report and it was filed in the patient’s record with-out being reviewed. Because the ED physician did not make the diagnosis of carcinoma based on this x-ray, the failure of the radiology department to communicate with this physician about this significant and potentially abnor-mal finding was extremely detrimental to the patient.

The MLMIC radiology expert who reviewed the original ED films found they showed a mass-like density with lobulated, rather sharply defined bor-ders posteriorly in the right upper lobe of the lung. He agreed that, although this could represent pneumonia, this was more suggestive of a mass or com-

Lack of Communication Between Treating Physicians is a Serious Detriment to Patient Care


The plaintiff initially demanded $1.5 million to resolve the lawsuit.

However, the lawsuit was eventually settled for $675,000. Of that sum,

the radiologist paid $540,000 and the pulmonologist paid $135,000.


All discount offers are subject to change at any time without notice. Log in regularly to view the latest

discounts available. Abenity, Inc. Copyright 2018.

Enjoy member-only discounts and corporate rates on everything from pizza

and the zoo, to movie tickets, car rentals, and hotels. With over 302,000

offers across 10,000 cities and easy mobile access, you’ll always have a

reason to Celebrate Your Savings!

NEARBY

OFFERSWELLNESS

MONTHLY

GIVEAWAYS

MOVIE

SHOWTIMES

INSURANCE

BENEFITS

VACATION

PLANNER

MOBILE

APPS

Member Perks ProgramLog in at prks.co/mssny


Almost half of primary care residents said they plan to sub-specialize, 40% said they will work in primary care, and 14% indicated that they will specialize but are undecided about the specialty. These results are similar to last year’s.

Residents’ schedules are quite rigorous. Over one third of residents (37%) are loggin more than 60 hours per week see-ing patients, while almost one fifth (18%) are spending 51-60 hours per week. Only 12% are seeing patients 30 hours or less per week. In Medscape’s Physician Compensation Report 2018, over half of physicians (56%) reported that they spent 30-45 hours a week seeing patients.

Almost half (46%) of residents are performing 1-10 hours of scut work (defined as unskilled tasks) on a weekly basis. Over one quar-ter (28%) have 11 to 20 hours, while 12% are spending 21 to 30 hours a week on scut work.

Almost a quarter of male and female residents have no med-ical school debt. Almost one quarter of both male and female residents have over $300,000 in medical school debt.

Medscape Residents Salary & Debt Report 2018

The MSSNY Committee on Physician Wellness and Resilience offers resources to help address the increasingly serious chal-lenge posed by stress and burnout in the medical profession. The Committee’s Speakers Bureau is pleased to offer pre-sentations on the causes, effects and treatment of physician burnout. These were developed for three different audiences to provide insight and effective approaches that can be taken to address the problem.

If interested in scheduling a presentation for your medi-cal staff, group practice, county medical society, residency program or other meeting, please contact [email protected] to make arrangements.

Please specify which kind of presentation you are seeking:• One geared for individual physicians, on ways to reduce

stress

• One for health system administrators, on actions that can be taken to reduce institutional stressors

• One for other stakeholders, such as health insurers, mal-practice carriers, etc.

The committee plans to enlist other MSSNY members to add to the ranks of possible presenters on this topic. We are grateful to have already heard from a number of volunteers. Plans are now being prepared to familiarize volunteers with our presentations, and committee representatives will be fol-lowing up with all volunteers soon.

If you are interested in having one or more of our pre-pared presentations to your group or institution, and haven’t volunteered already, please email [email protected] and we’ll include you as part of our Speaker’s Bureau on Physician Wellness and Resilience.

MSSNY Speakers Available to Address Groups Regarding Physician Burnout

(Continued from page 1)


with severe pain that doesn’t meet the definition of chronic pain to use medical marijuana as a replacement for opioids.

In addition, the regulation adds opioid use disorder as an associated condition. This allows patients with opioid use disorder who are enrolled in a certified treat-ment program to use medical marijuana as an opioid replacement.

Plans to add opioid replacement as a qualifying condi-tion for medical marijuana were first announced in June. As of June 18, 2018, there are 59,327 certified patients and 1,697 registered practitioners participating in the program.

Opioid replacement joins the following 12 qualifying conditions under the state’s Medical Marijuana Program: cancer; HIV infection or AIDS; amyotrophic lateral sclero-sis (ALS); Parkinson’s disease; multiple sclerosis; spinal cord injury with spasticity; epilepsy; inflammatory bowel disease; neuropathy; Huntington’s disease; post-trau-matic stress disorder; and chronic pain.

The permanent regulations were published in the New York State Register on August 1, 2018, and will be sub-ject to a 60-day public comment period. In addition, certified patients and designated caregivers will be able to print temporary registry ID cards. This will allow them to purchase medical marijuana products more quickly after registering for the program. Patients may use the temporary registry ID card in conjunction with a gov-ernment issued photo identification to purchase medical marijuana products from a registered organization’s dis-pensing facility. Prior to this enhancement to the Medical Marijuana Data Management System, it could take 7 to 10 days for patients and their caregivers to receive their registry identification cards after their registration was approved.

Other recent enhancements to New York’s Medical Marijuana Program include adopting new regulations to improve the program for patients, practitioners and regis-tered organizations; authorizing five additional registered organizations to manufacture and dispense medical marijuana; adding chronic pain and PTSD as qualifying conditions; permitting home delivery; and empowering nurse practitioners and physician assistants to certify patients.

As of July 10, 2018, there are 62,256 certified patients and 1,735 registered practitioners participating in the program.

For more information on New York’s Medical Marijuana Program, go here.

The following is the public list for physicians reg-istered with the medical marijuana program: https://www.health.ny.gov/regulations/medical_mari-juana/practitioner/public_list.htm

The report was issued by the DOH under the direction of Governor Andrew Cuomo, who directed NYS agencies to evaluate the health, public safety and economic impact of legalizing marijuana. The report, to MSSNY’s knowledge, did not involve any outside medical groups or organiza-tions in making this assessment. A copy of the report can be found here.

Marijuana Can Be Prescribed(Continued from page 2)

MSSNY MEMBERS:

Your Patients Can Save

Up to 75%For information or to order FREE

cards to distribute to your patients,contact: [email protected]

All Employers Must Act By October 9, 2018 to Comply With the New York State

Mandate Requiring Sexual Harassment Training

On April 12, 2018, New York State Governor Andrew Cuomo signed into law new measures aimed at preventing sexual harassment, which require prompt action by all New York State employers, regardless of the number of employees they have. Notable highlights include:

Required Sexual Harassment Training: By October 9, 2018, all employers must comply with a requirement of con-ducting annual sexual harassment training. Training must be in-person and interactive, and computer training will no lon-ger be deemed sufficient to meet the requirement.

Mandatory Sexual Harassment Policies: By October 9, 2018, employers must adopt a written sexual-harassment prevention policy and distribute it to employees. New York City will be mandating similar requirements that will be effec-tive in April 2019.

We want to be sure you are aware of this requirement and that it applies to medical societies, hospitals, group prac-tices and to every independent physician who has even one employee.

We have asked attorneys from Garfunkel Wild, P.C., MSSNY’s General Counsel, to be available to help members in meeting the requirement. Garfunkel Wild has a history of providing clients with sexual harassment training, handling internal investigations, litigating sexual harassment cases and draft-ing and reviewing sexual harassment policies.

Call Garfunkel Wild at 516-393-2200 to help your practice meet the requirements.


Number 046-785, if a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A listing of approved clearing-houses for the CMS-1500 will be posted on the XML Forms Submission section of the Board’s website after each entity successfully completes testing and exe-cutes an XML Submission Partner agreement with the Board.

• Workers’ compensation insurers/payers will accept CMS-1500 medical billing files from clearinghouses and electronically return acknowledgments of receipt of CMS-1500 files. Such acknowledgements (including receipt date) will be forwarded from the clearing-houses back to providers and the Board.

• The Board will receive CMS-1500 files, narrative attachments and acknowledgements of receipt from clearinghouses in a designated XML format. The CMS-1500 forms and narrative attachments will be combined and displayed in the applicable claimants WCB case folders

PHASE 2: ON OR ABOUT JULY 1, 2019:• Workers’ compensation insurers/payers will electroni-

cally transmit Explanations of Benefits (EOB) to their clearinghouses upon adjudication of the associated electronic CMS-1500 medical bills. Such EOB data will be forwarded from the clearinghouses back to provid-ers and the Board.

• The Board will receive EOB data from clearinghouses in a designated XML format.

• The Board plans to eliminate the requirement for the insurer/payer to file Form C-8.1B or C-8.4 form (to object to full or partial payment of a medical bill) when an EOB for the medical bill was transmitted through the clearinghouse and the Provider may file Health Provider’s Request for Decision on Unpaid Medical Billing (Form HP-1) (based on receipt of EOB).

PHASE 3: ON OR ABOUT JANUARY 1, 2020:• Providers will be required to submit electronic CMS-

1500 medical bills (and required medical narratives, as applicable) through their clearinghouses to work-ers’ compensation insurers/payers and to receive EOBs back through their clearinghouse.

• Providers will be required to electronically transmit any disputes for unpaid medical bills to their clear-inghouse using the Board-prescribed form. The clearinghouses will electronically transmit medical disputes to the Board in a designated XML format. The Board will eliminate Forms C-4, EC-4, C-4.2, EC-4.2, C-4.1, PS-4, C-4AMR, EC-4AMR, OT/PT-4, EOT/PT4 and EC-4NARR forms. Web submission and XML sub-mission of these forms will no longer be available.

• The Board will establish a hardship exception process for providers who are unable to meet the mandatory electronic reporting requirements.

Visit the CMS-1500 Initiative section of the website to access technical specifications for the CMS-1500 medical billing and associated acknowledgement data and to find periodic updates.

Please direct questions to [email protected].

CMS-1500 Initiative(Continued from page x)GARFUNKEL WILD

ASC SYMPOSIUM NOVEMBER 2, 2018

MSSNY Members Receive$65 Discount

November 2, 2018 is Garfunkel Wild’s 5th Annual NY Metro ASC Symposium at the Marriott Marquis (Manhattan).

Please find the agenda for the day and additional information

by clicking here.

MEDICAL SOCIETY OF THE STATE OF NEW YORK2017 ALBION O. BERNSTEIN, MD AWARD

The Medical Society of the State of New York is accepting nominations for the 2017 Albion O. Bernstein, MD Award.

This prestigious award is given to:“…the physician, surgeon or scientist who shall have made the most widely beneficial discovery or developed the most useful method in medicine, surgery or in the prevention of disease in the twelve months prior to December, 2017.”

This award was endowed by the late Morris J. Bernstein in memory of his son, a physician who died in an accident while answering a hospital call in November, 1940.

The $2,000 award will be presented to the recipient during a MSSNY Council Meeting.

Nominations must be submitted on an official application form and must include the nominator’s narrative description of the significance of the candidate’s achievements as well as the candidate’s curriculum vitae, including a list of publications or other contributions.

To request an application, please contact:Committee on Continuing Medical Education

Miriam Hardin, PhD, Manager, Continuing Medical EducationMedical Society of the State of New York

99 Washington Avenue, Suite 408Albany, NY 12210

[email protected]

DEADLINE FOR NOMINATIONS: September 30, 2018


If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and per-formance feedback is now available for review on the Quality Payment Program website. The payment adjustment you will receive in 2019 is based on this final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party inter-mediary), including those who are subject to the APM scoring standard may request for CMS to review their performance feedback and final score through a process called targeted review.WHEN TO REQUEST A TARGETED REVIEW

If you believe an error has been made in your 2019 MIPS payment adjust-ment calculation, you can request a targeted review until October 1, 2018 at 8:00pm (EDT). The following are

examples of circumstances in which you may wish to request a targeted review:

• Errors or data quality issues on the measures and activities you submitted

• Eligibility issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)

• Being erroneously excluded from the APM participation list and not being scored under APM scoring standard

• Not being automatically reweighted even though you qualify for auto-matic reweighting due to the 2017 extreme and uncontrollable circum-stances policy

Note: This is not a comprehensive list of circumstances. CMS encourages you to submit a request form if you believe a targeted review of your MIPS pay-ment adjustment (or additional MIPS payment adjustment) is warranted.HOW TO REQUEST A TARGETED REVIEW

You can access your MIPS final score and performance feedback and request a targeted review by:

• Going to the Quality Payment Program website

• Logging in using your Enterprise Identity Management (EIDM) cre-dentials; these are the same EIDM credentials that allowed you to sub-mit your MIPS data. Please refer to the EIDM User Guide for additional details.

When evaluating a targeted review request, we will generally require addi-tional documentation to support the request. If your targeted review request is approved, CMS will update your final score and associated payment adjustment (if applicable), as soon as technically feasible. CMS will determine the amount of the upward payment adjustments after the conclusion of the targeted review submission period. Please note that targeted review decisions are final and not eligible for further review.

For more information about how to request a targeted review, please refer to the Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet and the Targeted Review of 2019 MIPS Payment Adjustment User Guide.

Workers’ Compensation ChangesIn July, we informed you about significant changes being pro-

posed by CMS for the physician fee schedule. The NYS Workers’ Compensation Board has listened to us and is intent on reducing physician burden and enticing more participation in its program.

The New York State Workers’ Compensation Board (Board) will replace the current Board treatment forms: Doctor’s Initial Report (Form C-4), Doctor’s Progress Report (Form C-4.2), Occupational/Physical Therapist’s Report (Form OT/PT-4), Psychologist’s Report (Form PS-4), and Ancillary Medical Report (Form C-AMR) with the CMS-1500 to help reduce paperwork and lower provider administrative burdens. This initiative will leverage providers’ current medical billing software and medical records while promoting a more efficient workers’ compensa-tion system.

Beginning January 1, 2019, physicians may voluntarily transmit CMS-1500 medical bills (and required medical narra-tives, and/or attachments as applicable) through an approved XML Submission Partner (“clearinghouse”) to workers’ com-pensation insurers/payers. Guidance on required medical narratives and attachments is available on the Board’s web-site. If a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A listing of approved clearinghouses for the CMS-1500 will be posted on the XML Forms Submission section of the Board’s website after each entity successfully completes testing and executes an XML Submission Partner agreement with the Board.

Workers’ compensation insurers/payers will accept CMS-1500 medical billing files from clearinghouses and electronically return acknowledgments of receipt of CMS-1500 files. Such

acknowledgements (including receipt date) will be forwarded from the clearinghouses back to providers and the Board.

The Board will receive CMS-1500 files, narrative attachments and acknowledgements of receipt from clearinghouses in a designated XML format. The CMS-1500 forms and narrative attachments will be combined and displayed in the applicable claimants WCB case folders.

MSSNY’s Committee on Worker’s Compensation and No-Fault Insurance has been asking the Board to make these accom-modations for several years. Using the CMS 1500 is anticipated to be less cumbersome than the former C4 Forms and filing electronically should help to alleviate many of the filing difficul-ties resulting from the limitations and hassles of paper claims.

For more information on this matter, please click here.

The Deadline for Submitting MIPS Targeted Review Request is Now October 1

NYS County Contacts in Your County for Workers Compensation Applications

In June 2017, the NYS WCB asked MSSNY for clarity about where physicians should be referred when seeking to be authorized for treating WC injured workers and/or being authorized to provide Independent Medical Examinations (IMEs) for WC. The information for the NYS County Medical Society contacts for these WC applications is available here.

If you have any additional questions, please call Regina McNally at 516-488-6100, ext. 332 or email [email protected] or contact your county executive from the above link.


New York State Drug Take-Back Bill Becomes LawGovernor Andrew Cuomo signed the Drug Take-Back Act, which requires phar-

maceutical manufacturers to finance and manage the safe collection and disposal of unused medications. The law requires pharmacies with ten or more locations to participate as drug collection sites to help ensure convenient access for residents. Program implementation will begin in mid-2019.

Unused medications accumulate in the home, where they are accessible to potential abusers and a danger to seniors, children and pets. When improp-erly disposed down the drain or in the trash, unused drugs contaminate New York waterways and harm aquatic organisms. New York is the fourth state to require manufacturers to fund and safely manage drug take-back, preceded by Massachusetts, Vermont and Washington, along with 22 local governments throughout the U.S.

The new law designates the New York State Department of Health (DOH) to oversee the program. Notably, the legislation gives pharmacies and other collec-tors the option to use kiosks, mail-back, or “other” approved systems.

The Importance of Making Connections:

AMAA Annual Meeting Highlights

The 2018 AMA Alliance 95th Annual Meeting was held in Chicago, June 9-12. The theme was “Making Connections.” In outgoing AMA Alliance President Kim Moser’s address, she stressed the impor-tance of all members to “celebrate our accomplishments, plan for our future and enjoy the camaraderie that binds us.” The AMAA meeting was centered on ways in which we could connect with our members by examining the way we function as leaders and as a board.

Keynote speaker Matt De La Cruz, Founder and CEO of The Winning Minds Group and a leader in the per-sonal development industry, focused his talk on “Unleashing the Leader Within.” His goals were to inspire us, by first equipping us with the proper tools. He stressed that “respect” was the pinnacle that all leaders need to strive for. Matt said that, “Leadership is not a title, position, power or stat-ure. It is influence, nothing more, nothing less.” He closed his presen-tation with, “A leader sees more, sees farther, and sees before others.”

Another speaker, David Schreier, founded a professional services firm that assists nonprofit organizations with “capacity building.” He focuses on “resource development” and the ways to “catalyze and keep your board engaged.” He noted that there are three key areas: “people, culture and dynamics and board responsibil-ities.” David said that for all volunteer organizations the difficulty is that as a president you must be able to get “everyone to buy into your ideas and goals.” He said we must be “inten-tional in our vision goals” and that in order to build membership “you need to be the leader.”SAVE THE DATE

The Alliance is planning our Fall Conference, which will be held September 30-October 1 at the Homewood Suites Schenectady. AMA Alliance member and Physician Family magazine editor Donna Rovito will be our guest speaker on Monday morning, October 1. She will join us via a web-based presentation.

MSSNY ALLIANCE

besieged by requests by candidates to support these efforts with finan-cial support.

Public data shows that many interest groups, including those that reg-ularly oppose our agenda, are supporting these candidates’ efforts in record numbers. The physician community risks having its voice being crowded out by these competing voices.

We very much need your help to help assure that MSSNYPAC can pro-vide assistance to those candidates and party committees who have a demonstrated history of supporting initiatives that help protect patient access to needed physician care.THE FEW SUPPORT THE MANY

We appreciate that many of you have answered the call. But not enough do. We cannot let the few continue to support the many. Our numerous policy victories benefit all physicians, but are supported by only a rela-tive few. This cannot keep up if too few physicians support these efforts.

To quote the great Stevie Wonder – “Sleepers, just stop sleeping.” We are trying to reach the “Higher Ground.”

In addition to providing MSSNYPAC ongoing support (please contribute here), it is imperative for physicians to be actively involved in engaging with local candidates for office. Assuring that their constituents have access to timely quality care is almost always a priority for candidates, but they need to hear from you about the challenges we face in assuring the availability of this care.

MSSNYPAC has developed a number of tools to assist physicians as they consider which candidates for office they should support for the 2018 elections:

• A “scorecard” for PAC members to provide information regarding the incumbent candidate’s voting records and co-sponsorship regarding key legislative items MSSNY supports and MSSNY opposes.

• A candidate questionnaire that has been distributed to county medi-cal society leaders so they can use as a tool to engage their local candidates for State Senate and State Assembly.

The MSSNY State Candidate Evaluation Committee and Federal Candidate Evaluation Committees met during August to recommend to the MSSNY Council which candidates for office MSSNYPAC should endorse.

Please avail yourselves of these tools. Engage your candidates. Go to Town Hall meetings. Check out their campaign websites. Find out where they are on the key health care challenges facing us.

And support your profession’s efforts to be sure legislators hear our voices on these issues.

Again, join MSSNYPAC today, or increase your contribution here. The future you save may be your own.

MSSNY-PAC(Continued from page 4)


Operated by Amsterdam House Continuing Care Retirement Community Inc., a not-for-profit organization.

300 E. Overlook, Port Washington, NY 11050 | www.TheAmsterdamAtHarborside.com

When your senior patients need to explore their next steps in health care, trust The Tuttle Center at The Amsterdam at Harborside. We offer licensed on-site health care, including enriched housing, memory support, rehabilitation, skilled nursing care and hospice care. Our Tuttle Center skilled nursing was awarded a Five-Star Quality Rating from the Centers for Medicare and Medicaid Services, which is the highest rating possible. Nationwide, only 20% of facilities have achieved this grade. Our individualized services are provided in affiliation with the Northwell Health System, one of the largest health care providers in the nation.

HELP YOUR SENIOR PATIENTS TAKE THEIR BEST NEXT STEP IN HEALTH CARE.For more information about The Tuttle Center at The Amsterdam at Harborside, call 516-858-4866 or visit us online at www.TheAmsterdamAtHarborside.com.

AWARD-WINNING CARE FOR YOUR SENIOR PATIENTS

MEMBER BENEFITSome Benefits of the Merrill Lynch

Bank of America Doctor Loan Program• Put as little as 5% down on mortgages up to $1 million• 10% down on mortgages up to $1.5 million – customized

solutions available for amounts over $1.5 million• Exclude your student loan debt from the total debt calcu-

lation – gives you a lower debt/income ratio which helps justify a lower mortgage rate (benefit varies for each indi-vidual calculation

• Close on your new home up to 90 days prior to starting your new position – get a mortgage before you start a new job (need a valid state medical license in state where job is located and real estate is located) Contact Dennis Singh, CRPC®, CFP® at Merrill Lynch 516.498.3356; [email protected]

NYC Health Department Re-Opening Electronic

Death Registry October 1The NYC Health Department will again attempt to

roll out an electronic death registration program that was plagued with glitches in October – and critics say the timing is problematic.

The $5.8 million “eVital” system launched in October of 2017 using facial recognition software so funeral directors and doctors could log in using cellphone self-ies. But some morticians and doctors could not access the system, forcing the agency to pull it within days of launching.

Because burials and cremations require a signed death certificate, funeral home directors had to scram-ble to pick up certificates in person at hospitals and doctors’ offices. Then they had to deliver them to the Health Department’s Burial Desk to obtain the burial permit.

Some families waited days to bury loved ones – a disaster for the Jewish and Muslim communities whose customs require burials “as soon as possible,” accord-ing to Noor Rabah, president of the Muslim Funeral Services.

When eVital is re-launched on Oct. 1, there will be a 48-hour window between the time the existing “Electronic Vital Events Registration System” is taken down and the eVital system goes up – meaning mor-ticians and doctors will be forced to use the same manual process that delayed burials in the fall.

Support MSSNYPAC Call 518-465-8085 and ask

for Jen Wilks

ARE YOU UP TO DATE ON YOUR DUES?WWW.MSSNY.ORG


when asked if Board Certified physicians provide higher-quality care than non-Board Certified physicians, more than eight in 10 respondents (84%) believe they do; the remaining 16 percent said Board Certified physicians don’t provide higher-quality care.

General public respondents were also asked about the activities physicians should be required to do to stay up to date and maintain clinical skills and expertise. The participants were given a set list and asked to select all the options that may apply. More than half of general public respondents selected the follow-ing options: “participate in a minimum number of CME hours each year” (85%), “periodic exercises to measure, and if nec-essary, improve quality of care” (74%), “periodically assess performance to com-pare with other doctors in the specialty” (64%), “have communication and clinical skills rated via patient surveys” (59%), “have performance rated via colleague surveys” (56%), and “take exam at regu-lar intervals assessing clinical knowledge” (56%). The only activity not selected by more than half of the respondents was “self-assessment activities to determine

how well he or she is doing” (48%). Two percent said, “none of the above.”CONCLUSIONS

While these data must be interpreted with caution, the results provide impor-tant insights for the Vision Initiative Commission. The Commission will con-sider these results as part of their overall continuing certification testimony.Physicians

While a small percentage of physi-cians value MOC, a larger portion has either mixed views or do not value MOC. They currently see MOC as too costly and burdensome, not an accurate depic-tion of their abilities or relevant to their practice, and duplicative. However, phy-sicians see some value in MOC for its CME opportunities and tracking, focus on lifelong learning, keeping physicians up to date and self-assessment programs. Respondents want continuing certifica-tion to include a focus on relevant CME opportunities, self-assessment delivered at regular intervals, openbook testing and an assessment of the quality and safety of the care provided.Other Health Care Providers and Consumers

Board Certification is a recognized cre-

dential and plays an important role in selecting a physician. In fact, both groups strongly indicated that Board Certification is important when selecting a physician and they believe Board Certified physi-cians provide a higher quality of care.ABOUT THE VISION INITIATIVE COMMISSION

As a collaborative process, the Commission brings together multiple partners to vision a system of continu-ing Board Certification that is meaningful, relevant and of value, while remaining responsive to the patients, hospitals and others who expect that physicians are maintaining their knowledge and skills to provide quality specialty care.

The Commission framework began with a comprehensive assessment of the cur-rent continuing Board Certification system. The Commission holds hearings, provides information publicly and tests and seeks feedback on concepts and ideas during the process. The Commission’s final rec-ommendations will be submitted to ABMS and its Member Boards for consideration and implementation in February 2019.

American Association of Medical Society Executives. All rights reserved.

(Continued from page 2)Stakeholder Beliefs

The American Medical Association (AMA) has urged the U.S. Department of Justice (DOJ) to block the proposed acquisition of Aetna, Inc. by CVS Health Corporation, and shared with federal regulators an exhaustive AMA analysis indicating the proposed merger would likely substantially diminish competition in many health care markets to the detriment of patients.

“The CVS-Aetna deal is popularly described as a vertical merger involving two companies that don’t operate in the same markets,” said AMA President Barbara L McAneny, M.D. “But in fact, CVS and Aetna do operate as rivals in some of the same markets, rais-ing substantial concerns that are specific to horizontal mergers. A merger of these two rivals would risk a substantial reduc-tion of competition in the stand-alone Medicare Part D prescription drug plan market and the pharmacy benefit management (PBM) services market.”

The 29-page analysis compiled by the AMA noted that the merger is expected to increase premiums due to an increase in market concentration in 30 of 34 Medicare Part D regional mar-kets. In 10 of 34 Medicare Part D regional markets, the deal would exceed a threshold set by federal antitrust guidelines for a merger that should be presumed likely to enhance market power. According to the DOJ, “a merger enhances market power if it is likely to encourage one or more firms to raise price, reduce out-put, diminish innovation or otherwise harm customers as a result of diminished competitive constraints or incentives.”

The AMA analysis also notes that Aetna and CVS each have their own share of the highly concentrated market for PBM ser-

vices. According to the AMA, the combined impact of the proposed merger on the PBM services market raises significant competitive concerns under federal antitrust guidelines. With the acquisition of Aetna the PBM market would lose a national health insurance company with an established brand, a significant customer base, expertise, capital, and years of experience as a major player in the PBM market.

In addition to the extensive anticom-petitive concerns generated by horizontal aspects of the merger, the AMA urged the DOJ to challenge the deal because the ver-tical ramifications of the merger violate federal law. Since CVS and Aetna already operate in concentrated or highly con-centrated markets, the AMA expects the proposed merger would increase barriers

to market entry and foreclose competitors. The AMA also urged the DOJ to beware of vague and specula-

tive efficiency claims that would not outweigh the anticompetitive effects of the proposed merger. As an example, the AMA analysis notes the alleged consumer benefits from combining CVS’ phar-macy data with Aetna’s medical data. However, Aetna already performs its own core PBM functions and already integrates phar-macy and medical data to lower health care costs. According to the AMA analysis, “the alleged principal efficiency justification for the merger is nonexistent.”

To ensure patients are better served by dynamic and competi-tive health care markets, the AMA will urge state regulators to review the analysis presented to the DOJ and continue to per-suade state and federal officials to oppose the CVS-Aetna merger.

AMA Urges DOJ to Challenge CVS-Aetna Merger

A merger of these two rivals would risk a substantial reduction of competition in the stand-alone Medicare Part D prescription drug plan market and

the pharmacy benefit management (PBM) services market.


BUSINESS SHOWCASE

Over 35 years of experience representing physicians, nurses and other licensed health care providers in: • OPMC Investigations, Interviews and Hearings; • OPD Investigations, Interviews and Hearings; • Substance Abuse issues; • Medical Record Keeping; • Sexual Misconduct Investigations; • Claims by HMOs and Medicare/Medicaid for Reim-

bursement; • Resolving Criminal Convictions with OPMC and

OPD.

Experienced, Reliable, Efficient and Discreet.

315 West 106th Street, Suite 1ANew York, New York 10025212-244-9090/ [email protected]

PAUL E. WALKER, ESQ.ATTORNEY AT LAW

• Effectiveness and outcomes of treatment with buprenorphine

• Verifying that patients being referred to coun-seling are required to undergo urine testing for substances being administered (and results of testing).

• Verifying whether the prescriber is dispensing or administering buprenorphine on site or prescrib-ing buprenorphine.

• A physician practicing medicine in a lawful way has nothing to fear from either type of visit from the DEA.

Mr. Cowell provided some stats that prove that these types of aforementioned actions by the DEA are rare:

Of the 16,000 prescribers in the jurisdiction of the Division of the DEA that Mr. Orgon oversees, there have been only 20 cases of physicians being prose-cuted criminally in the last 5 years. There is always a thorough investigation and evidence in hand before the DEA will “shut the office down” and bring an indict-ment against a provider.

The number of visits to provider’s offices (within the 17 counties overseen by this particular DEA office’s jurisdiction) have steadily decreased from 40 visits in 2013 to 9 visits in 2017, indicating that providers are prescribing within the confines of the law. The DEA has not conducted one inspection or audit of a buprenor-phine provider in the 17 counties to date in 2018.

It was clear during our discussion that all par-ties involved have the same goal in mind—the safe prescribing of buprenorphine to stop diversion of buprenorphine on the streets and to keep the health and safety of the public as the main priority.

PRESIDENT’S COLUMN(Continued from page 4)

MSSNY’s Infection Control Course Includes Newly Required Section on Sepsis

New York State law requires that all licensed health care pro-viders—including physicians, physician assistants, nurses, nurse practitioners and dentists—receive training on infection control and barrier precautions every four years. The Medical Society of the State of New York is approved by the New York State Department of Health and the state Education Department to provide Infection Control and Barrier Precautions to all healthcare professionals.

MSSNY recently updated its course to include the newly required content on Sepsis. If your medical license is up for renewal any time after July 1, 2018, you are required to take this updated course. Every New York state physician must be in compliance by July 1, 2022.

Click here to take the up-to-date Infection Control course. New participants to the MSSNY CME site must first create an account.

Why Airlines Hope Physicians Aren’t on Board During Medical Emergencies

Physicians and other clinicians are called upon to help passengers during in-flight medical emergencies, but airlines often prefer the guidance of on-the-ground consultants in order to avoid diversions, according to Bloomberg.

A medical emergency occurs once every 604 flights, with 7.3 percent leading to diversions that ground the plane, according to a study in The New England Journal of Medicine. While it is standard protocol to first find out if a medical professional is on board before calling a consultant, a diversion can cost as much as $200,000, and airlines look to avoid these diversions whenever possible.

Passenger clinicians are more likely to recommend diversions, so airlines rely on contracted consultants on the ground, who are less likely to recommend such action, to guide pilots. Though the final decision rests with pilots and dispatchers, they rely heavily on the advice of consultants.

Becker Hospital Review, May 2018


Donnaline Richman, Esq.Fager Amsler Keller & Schoppmann, LLP, Counsel to MLMIC

This case confirms the importance of physician-to-physician communi-cation. It also illustrates the need to carefully follow hospital or office policy and procedure when communicating either abnormal results of a test or a discrepancy between a formal reading by a radiologist and a reading by an emergency department (ED) physician.

One of the major legal deficits in this case was that the radi-ologist failed to follow hospital policy and complete a discrep-ancy report when his reading of an image differed from that of a non-radiologist. Further, the report did not specifically name the ordering physi-cian, which required some effort by the ED to identify that individual. Thus, the original ED physician was never alerted that he had missed a possibly abnormal result. The fact that neither the patient nor the primary medical physician were notified about the abnormality precluded the patient from receiving necessary follow-up testing and care, to the patient’s detriment.

The failure of physicians to commu-nicate frequently leads to disastrous results such as serious delays in diag-nosis and treatment or even a patient’s death. This case is particularly concern-ing because of the recent enactment of Lavern’s Law, which extends the stat-ute of limitations for the misdiagnosis or failure to diagnose cancer or tumors

to a cap of seven years in most cases. Those cancers or tumors that might have been discovered earlier but were not identified within the prior two and a half years and for which there was no continuous treatment can now be pursued beyond the previous two-and-a-half-year statute of limitations, until the patient has actually or reasonably should have discovered the presence of

that undiagnosed cancer or tumors for up to seven years.

The American College of Radiology (ACR) has developed an educational practice parameter for the communi-cation of diagnostic imaging findings.1 This parameter provides that “effective communication is a critical component of diagnostic imaging” and indicates that “quality patient care can only be achieved when study results are con-veyed in a timely fashion to those responsible for treatment decisions.” It also provides that a final report is to be transmitted to the ordering phy-sician. This parameter states that “a significant variation in findings and/or conclusions between the prelimi-nary and final interpretations should be reported in a manner that reliably ensures receipt (of the new information) by the ordering or treating physician/

healthcare provider,particularly when such changes may impact patient care.” The ACR further recommends that all non-routine communication be docu-mented by the radiologist in a log in the radiology department and that the final report incorporate documentation of the communication of discrepancies. It additionally provides that, “when the ordering physician cannot be contacted expeditiously, it may be appropriate to convey the results to the patient, depending upon the nature of the imaging findings.” Unfortunately, in this case, none of the ACR parameters were met.

However, the radiologist was not alone in failing this patient. The ED was also subject to serious criticism by the physician reviewers. All reports com-ing back to the ED, and particularly discrepancies, should be reviewed by a licensed individual. Although the ED physician was not specifically identi-fied in the report, the ED had sufficient information to identify that physician by the patient’s name and the time of the order. The patient should be informed of the results, before the report is filed in the patient’s medical record. Further, if the ED physician who initially read the image was not on duty when the

final report was transmitted, the on-duty ED physician should have been advised of the discrepancy in the reading and recommended contacting both the patient and primary care physician. Thus, there was poor compliance with the poli-cies and procedures of the facility and department.

In summary, when there is a serious lack of communication between physi-cians about a critical discrepancy in a test result in addition to noncompliance with practice parameters and a facility’s policies and procedures, patients can suffer serious, even deadly, injuries. The failure to timely diagnose a tumor or cancer due to the lack of commu-nication between radiologists and other physicians will likely be impacted in the future by the extended statute of limitations of Lavern’s Law, to the detri-ment of all physicians

1. American College of Radiology. The ACR practice parameter for communi-cation of diagnostic imaging findings. (Revised 2014, Resolution 11). Reston, VA: American College of Radiology; 2014:1-9.

bination of masses with surrounding infiltration. Therefore, in his opinion, it was the obligation of the radiolo-gist to communicate this high level of suspicion of a possible malignancy promptly to the patient’s physician by telephone to make certain that the patient was closely followed.

The radiologist’s suspicion of a neo-plasm was sufficiently high that the expert felt the radiologist failed to follow the recommendations of the American College of Radiology for direct communication between the radiologist and referring physician. He concluded that this was clearly neg-

ligent. He concurred with the MLMIC emergency medicine expert that the radiologist should have completed a discrepancy report because of the difference between his interpretation and that of the ED physician. Receipt of such a report should have triggered prompt notification of the patient of both the abnormal result and recom-mendations for follow-up.

The plaintiff initially demanded $1.5 million to resolve the lawsuit. However, the lawsuit was eventually settled for $675,000. Of that sum, the radiologist paid $540,000 and the pulmonologist paid $135,000.

Lack of Communication Between Treating Physicians is a Serious Detriment to Patient Care

(Continued from page 8)

A Legal & Risk Management Perspective

In summary, when there is a serious lack of communication between physicians about a

critical discrepancy in a test result in addition to noncompliance with practice parameters and a facility’s policies and procedures, patients can

suffer serious, even deadly, injuries.


MEDICAL DIRECTOR IN THE NYS OFFICE OF HEALTH INSURANCE PROGRAMSDIVISION 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 reim-bursement 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 Com-mittee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Deci-sions 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 [email protected] 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 afford-able, 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 www.98point6.com/pcc/

CHIEF OF MEDICAL SERVICESMinimum 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 Medi-care 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 deliv-ery 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 fa-cility operated by the NYS Department of Health located in Chenango County.

It is an Affirmative Action/Equal Opportunity Employer. –––––––––––––––––––––––

CLASSIFIED ADVERTISINGClassified ads can be accessed at www.mssny.org. Click classifieds.

OCTOBER 2018 ISSUE CLOSES SEPTEMBER 15 • $200 PER AD; $250 WITH PHOTOPHYSICIANS’ SEARCH SERVICES • ALLIED MEDICAL PLACEMENTS • LOCUM TENENS PRACTICE VALUATION • PRACTICE BROKERAGE • PRACTICE CONSULTING • REAL ESTATE

FOR HELP, INFORMATION OR TO PLACE YOUR AD, CALL CHRISTINA SOUTHARD 516-488-6100 X355 • FAX 516-488-2188

HELP WANTED

DE COSTA, Carol V. R.; Brooklyn NY. Died April 15, 2018, age 61. Medical Society County of Kings DEAN, David Campbell; Amherst NY. Died May 21, 2018, age 87. Erie County Medical SocietyDURGIN, Francis John; Camillus NY. Died July 24, 2018, age 88. Onondaga County Medical Society FAEGENBURG, David Herbert; Roslyn Heights NY. Died May 10, 2018, age 87. Nassau County Medical Society FOLSOM, Alan Laurence; Plattsburgh NY. Died March 27, 2018, age 86. Clinton County Medical SocietyFREEMAN, Edwin Ned; South Hadley MA. Died June 29, 2018, age 88. Monroe County Medical Society

HERMAN, Barry Joseph; Clarence NY. Died June 24, 2018, age 85. Erie County Medical SocietyHUMPHREY, Eleanor Nicholson; Spencerport NY. Died June 13, 2018, age 102. Monroe County Medical SocietyJAKUBIAK, Jerome V.; Buffalo NY. Died May 13, 2018, age 82. Erie County Medical SocietyKIRK, Kurken V.; Kingston NY. Died March 31, 2018, age 96. Medical Society County of UlsterLAWRENCE, William D.; Buffalo NY. Died May 18, 2018, age 69. Erie County Medical SocietyLEKA, Agim; New York NY. Died March 08, 2018, age 94. Nassau County Medical Society LEVENTHAL, Harvey R.; Staten Island NY. Died

March 14, 2018, age 90. Richmond County Medical Society O’SULLIVAN, John Alfred; Rochester NY. Died May 20, 2018, age 80. Monroe County Medical SocietyPAINTON, J. Frederick; Williamsville NY. Died May 18, 2018, age 79. Erie County Medical SocietyREMPEL, Jacob; Lewiston NY. Died June 13, 2018, age 78. Medical Society of the County of NiagaraSCHEN, Charles R.; Hamburg NY. Died April 16, 2018, age 91. Erie County Medical SocietyYUDIN, Howard Stephen; Purchase NY. Died June 23, 2018, age 72. Medical Society County of Westchester

OBITUARIES

RARE FIND -- GREAT OFFICE SHARE

Wonderful office share in ter-rific location at great price.

Choice of smaller windowed consultation room

with adjoining exam room or big windowed consulta-tion 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 avail-able, along with many other amenities, including internet,

ultrasound, EMG Kitchen, optional C Arm.

Willing to make changes for new tenant.

Call 646-642-0700.

ORTHOPEDIST TO RENT SPACESports Medicine

Multidisciplinary PracticeMIDTOWN MANHATTAN

Exclusive Referrals Available.

Turn key operation with full services. Unique opportu-

nity with little to no risk.Excellent for satellite or

primary office. Flexible op-tions available.Inquire with [email protected]

manhattanmd.com

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 212-628-7600 between 11am and 6pm for

further information.

OFFICE SPACE FOR LEASE/RENT/SHARE

MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF …...MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS...

Documents

Transcript of MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF …...MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS...