Thursday, February 5th, 2015
Friday, June 13th, 2014
The recent accident on the New Jersey Turnpike that resulted in a death and injury to several people including comedian Tracy Morgan is a reminder of the dangers of driving while tired. According to news reports the driver of the Walmart truck that caused the accident had been awake for over 24 hours prior to the accident. As physicians, whether in training or in practice, we all have experienced being awake for 24 hours or more. Limitations on the hours of house staff offer little protection (a 24 hour shift is still acceptable) and there are no standards for attending physicians when we are on call. This level of fatigue represents a significant risk to the physician as well as members of the community. Friends don’t let friends drink and drive and colleagues shouldn’t let colleagues drive under unsafe conditions. As physicians we need to heal ourselves and prevent unnecessary injuries and deaths.
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Wednesday, June 11th, 2014
PHYSICIANS, PLEASE TAKE NOTE
MSSNY HAS LEARNED THAT OPMC WILL BEGIN TO TAKE ACTION AGAINST A HANDFUL OF PHYSICIANS WHO HAVE NOT UPDATED THEIR PHYSICIAN PROFILES AS REQUIRED BY LAW.
WE ARE ADVISED THAT DOH MADE NUMEROUS ATTEMPTS TO SPEAK WITH THESE PHYSICIANS THROUGH REGULAR NOTICES AND PERSONAL CALLS. AND SINCE THEIR LAST CALL TO THESE PHYSICIANS, MORE THAN SIXTY DAYS HAVE PASSED WITHOUT THESE PHYSICIANS TAKING THE REQUIRED ACTION.
IF YOU HAVEN’T YET UPDATED YOUR PHYSICIAN PROFILE PLEASE DO SO IMMEDIATELY!
For more information and to update your profile, click here.
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Wednesday, December 18th, 2013
The Medical Society of the State of New York (MSSNY) has filed an amicus brief with the Second Circuit Court of Appeals in connection with United Healthcare’s terminations of physicians in their Medicare Advantage network. An additional amici brief was filed with the Second Circuit Court of Appeals regarding UHC’s appeal of the District Court ruling on Tuesday, December 10.
Along with Fairfield and Hartford Counties, several additional Connecticut counties and specialty societies have now joined as part of the amici brief. Other state and national organizations have also joined as part of the amici brief:
United Healthcare has filed a motion for emergency expedited briefing and argument in its appeal to the United States Court of Appeals, Second Circuit, seeking to overturn the preliminary injunction granted by a lower federal court in favor of plaintiffs Fairfield County Medical Association and Hartford County Medical Association, which enjoins United from removing certain physicians from its Medicare Advantage network effective, February 1, 2014.
In New York State, physicians are being terminated on December 31, 2013. Again, in New York, if patients don’t like their Managed Care plan starting in January, they have until February 14, 2014, to revert back to original fee-for-service Medicare, not another Medicare Advantage plan. United argues that its participation agreement with physicians clearly allows United to amend the agreement to add or remove product lines which a physician may participate, including the Medicare Advantage product. According to United, the preliminary injunction deprives United of its contractual right to determine the size and composition of its Medicare Advantage network. United also argues the lower court incorrectly held that the county medical societies have legal standing to bring the legal action on behalf of its members. The participation agreement between United and its physicians includes a provision that requires all disputes to be subject to binding arbitration, and, United argues, the lower court’s ruling is that that the medical societies have standing to bring a lawsuit since United’s actions run “roughshod” over the contract terms its participating physicians.
MSSNY needs to hear from regarding physicians in New York who have been similarly terminated from United’s Medicare Advantage Network “without cause.”
Please contact Regina McNally, VP Socio-Medical Economics at firstname.lastname@example.org MSSNY needs terminated physicians to provide us with the written notice of termination from the Medicare Advantage Network; the United participation agreement; and we need you to tell us how the anticipated hardship caused by the termination will harm your medical practice and your Medicare Advantage patients.
Help us to help you.
Attorney General Schneiderman, at MSSNY’s urging, has written CMS, asking that the open enrollment period be extended for patients to switch between Medicare Advantage Plans. CMS has not yet responded.
As always, keep MSSNY informed of your Medicare Advantage terminations and of any problems you and your patients are having.
Sam L. Unterricht, MD
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Tuesday, October 1st, 2013
As of late afternoon on Monday, September 30, it appears increasingly likely that Congress will miss the deadline for passing a Continuing Resolution (CR) in time to fund federal agencies and programs in the new fiscal year, which begins on October 1. Deliberations continue, and it is anticipated that at least a short-term CR will be enacted in the next few days. In the meantime, however, many government programs will be forced to stop operating after midnight tonight if Congress fails to reach agreement.
Attached is a memorandum released last week by the Department of Health and Human Services that outlines the department’s contingency staffing and operating plans in the event that the government is forced to shut down.
Activities authorized by law, including those that do not rely on annual appropriations, and those that involve the safety of human life and protection of property will largely be unaffected. Following are some of the specific HHS activities that will continue in the event of a federal government shut-down:
Among the activities that will not continue:
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Monday, August 26th, 2013
In response to MSSNY’s urging, below please find a link to a notice from DOH regarding what physicians should do based upon delays in obtaining an HCS account. The notice reflects comments offered by the Director of the Bureau of Narcotics Enforcement earlier this week during the MSSNY I-STOP webinar, and referenced in Dr. Unterricht’s e-news editorial today. We will follow up with a broad alert to physicians across New York State referencing this DOH statement.
The statement from DOH reads as follows:
“The updated Prescription Monitoring Program Registry is operational and has been available on-line since June 12, 2013. All users must access the PMP Registry through the Department of Health’s secure Health Commerce System (”HCS”). With the upcoming effective date of the I-STOP law requiring the use of the PMP Registry, a large late surge of practitioners are now submitting requests for HCS accounts. Although the Department of Health is working diligently to process all requests, this significant influx has resulted in a delay in processing accounts.
During this transition period, practitioners who are making a good faith effort to apply but are unable to establish HCS accounts, should continue to provide treatment to their patients in the same manner as they currently do, including the prescribing of controlled substances without accessing PMP Registry. We expect this transition period to last through October.”
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Wednesday, June 26th, 2013
The Legislature concluded its 2013 Session at 6:50 Saturday morning. While pundits have called this the ‘do nothing’ Session, we must reflect upon the many successes achieved by MSSNY- its physician leaders, rank and file physicians- and MSSNY’s Division of Governmental Affairs.
We faced an onslaught of proposals which would have adversely impacted the practice of medicine- and met them head on.
MSSNY succeeded in defeating a serious proposal which would have prevented 60% or more of the 24,200 physicians who currently have Excess liability protection from remaining eligible for this additional layer of coverage, including successfully opposing a proposal to require Medicaid participation as a condition.
MSSNY also succeeded in defeating every broad scope of practice expansion bill, including the nurse practitioner independent practice bill; the naturopath, podiatrist and dental scope of practice bills; and the retail clinic proposal.
MSSNY defeated two proposals which would have required physicians to complete continuing medical education on pain management.
During the waning days of Session, MSSNY physician leaders’ and lobbyists’ advocacy prevented Assembly passage of the Date of Discovery statute of limitations bill, a measure which would have resulted in an immediate 15% increase in physician medical liability premiums.
Despite strong opposition from the commercial and managed care health insurance industry, MSSNY was able to once again obtain passage of the Out of Network bill by the NYS Senate. We are very disappointed, however, that the bill did not pass the NYS Assembly. We have laid a strong foundation for future action by the Assembly and will continue to enhance these efforts through the summer and fall. Critical to our success will be our ability to secure support from patient organizations from the community level on up. We must assure that policymakers understand that this is a patient protection issue and not just a pocketbook issue. Additionally, we must look to other venues for redress. We must work with the Executive team establishing the Health Benefits Exchange. We must work with our State Attorney General. And we must continue our work with our Governor.
While we have much to do, we must take stock of our victories – they were real and they were substantial. But we must continue to work hard to achieve a financially stable and improved work environment for our physicians who are in private practice as well as for our physicians who are employed by hospitals or by other healthcare providers. We must do so if we are to retain and attract the best and the brightest physicians to New York State. We stand ready to continue this work into 2014.
Your DGA Team,
Liz Dears, Moe Auster, Pat Clancy, Barbara Ellman
1.) Out of Network
The New York State Senate overwhelmingly passed legislation (S.2551, Hannon) strongly supported by MSSNY that would enact a number of different reforms to provide greater coverage and transparency when patients receive coverage from an out of network physician. However, it did not appear this legislation or similar legislation (A.7813) sponsored by Assembly Health Committee Chair Richard Gottfried would be taken up by the State Assembly prior to the end of the regularly scheduled Session.
While Assembly leaders have expressed significant interest in attempting to address this problem, concerns had been expressed by some, including by Assembly Insurance Committee Chair Kevin Cahill, regarding the reliability of the FAIR Health database which S.2551 and A.7813 would set forth as the universal reference point for out of network coverage. Physician leaders and MSSNY staff have had several meetings with Assemblyman Cahill to highlight that the FAIR Health database is neither controlled by the health plans nor health care providers, and reiterated that it was created by settlements by then Attorney General, now Governor Cuomo, to provide greater transparency and independence in determining out of network coverage. These discussions will continue into the summer and fall.
MSSNY continues to urge physicians to contact their Assemblymembers to urge that this legislation be taken up when the Assembly returns to Albany at some point later in the year.
MSSNY’s website includes briefing materials on this issue along with a brief video from Nassau County Medical Society Past-President Dr. Michael Brisman as to why this legislation is so important for all physicians and patients, not just out of network physicians, please click here:
2.) Date of Discovery Statute of Limitations
During the final week of session, the Assembly reported the Date of Discovery statute of limitations bill to the floor of the Assembly. Your DGA team immediately conferred with many members of the Assembly to urge the Assembly to not take up this proposal because of the immediate negative impact it would have on physician liability premium rates (by increasing premiums by as much as 15%) and the resulting patient access delays which would occur. As a result of this action and of the grassroots action by MSSNY leadership and members throughout the year, neither the Assembly not the Senate passed the bill.
Through numerous meetings, communications and press releases, legislators and key staff have been repeatedly advised by MSSNY this year that New York physicians already pay medical liability premiums that are among the very highest in the nation, and that any further increases in these premiums cannot be sustained. New York’s health care delivery system is already at a tenuous state, and cannot sustain the enormous increases these bills would cause, particularly at a time when hundreds of thousands of New Yorkers will be receiving health insurance coverage for the first time as a result of the implementation of PPACA and New York’s health insurance exchange.
Among other liability and premium cost expansion bills considered by the Legislature which were advanced but rejected include:
3.) Non-Physician Scope of Practice Legislation
We faced many threats this year from many non-physician organizations and for-profit retail and pharmacy industry and other interested stakeholders on legislation which would expand the scope of practice of many title VIII health care professionals. Working with many specialty and county medical societies, MSSNY was very successful is defeating an unusually large volume of scope bills this year. While a few bills passed the NYS Senate, the NYS Assembly refused to take action on them. A list of the many bills discussed this year follows.
In addition to scope of practice expansion bills, legislation was advanced which would have negatively impacted the protections afforded by the corporate practice of medicine doctrine by allowing specific non-physician practitioners to partner with physicians. These measures are described below:
4.) Healthcare Professional Transparency Act
Legislation (S. 5493, Griffo/A. 7889, Stirpe) which would amend the Education Law to assure appropriate identification of all licensed health care professionals in their one-on one interaction with patients and in their advertisements to the public was introduced in both Houses of the Legislature in May. It was reported to the Senate floor and was included on the Senate Active list for June 17th but was laid aside and not taken up during the end of session. The bill was not considered by the Assembly.
Importantly, this bill will require that advertisements for services to be provided by health care practitioners identify the type of professional license and board certification (if applicable) held by the health care professional. In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information. Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty.
Additionally, this measure would require that, during patient encounters, health care practitioners wear an identification name tag that includes the type of license held by the practitioner. A resolution supporting the wearing of identification badges in all settings was approved in April 2013 by MSSNY’s House of Delegates. The bill would also require the health care practitioner to display a document in his or her office that clearly identifies the type of license that the practitioner holds.
In a clinical setting, particularly during an emergency or life-threatening hospitalization, it is often impossible for patients to know whether the person providing their care is a physician, nurse practitioner, physician assistant, pharmacist, dentist, or dental hygienist, for example. Greater transparency concerning the credentials of health care professionals in their advertisements will assist the public in making informed decisions concerning the providers from whom they seek treatment.
The bill is supported by the AMA and several national and state specialty societies. MSSNY and the specialty societies will develop a strategy to assure early consideration of the proposal in 2014.
5.) OBS Facility Fee Bill
The Legislature adjourned without taking action on legislation (S.2944-A, Hannon)/A.6702, Quart) which would have assured that physicians with accredited or certified office based surgical practices could apply for and receive additional payment for procedures performed at such practice settings. MSSNY along with many other Specialty Societies supports this legislation.
6.) Mandate on Primary Care Physicians to Offer Hep C Test Passes Both Houses
Over strong MSSNY objection, both Houses have passed legislation (S. 2750A, Hannon/ A. 1286A, Zebrowski) which mandates office-based primary care practices, diagnostic and treatment centers, and hospitals to offer a Hepatitis C test to patients born between 1945-1965. The bill will now be sent to Governor Andrew Cuomo for his consideration. Under the provisions of the bill, “primary care” is defined as family medicine, general pediatrics, primary care, internal medicine, primary care obstetrics, or primary care gynecology, without regard to board certification. The bill requires that, for any patient that is positive or reactive, the physician offer follow-up health care, including a Hepatitis C diagnostic test, or refers that individual to a provider who can. The amendments would also require a report by the commissioner of health. If enacted, the effective date of the bill would be January 1, 2014. The bill provides a sunset provision of January 1, 2020.
The Medical Society strongly opposes this mandate and will urge Governor Cuomo to veto the bill. The United State Preventive Services Task Force (USPTF) currently is at odds with the Centers for Disease Control and Prevention (CDC) on this issue. The U.S. Preventive Services Task Force recommends against screening for Hepatitis C virus infection in asymptomatic adults who are not at increased risk (general population) and has found insufficient evidence to recommend for or against routine screening for HCV infection in adults at high risk for infection. In August 2012, the CDC issued “Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945-1965.” Among its recommendations is the recommendation that adults born during 1945-1965 should receive one-time testing for Hepatitis C. On January 15, 2013, an article entitled “Screening for Hepatitis C Virus Infection in Adults: A Systematic Review for the US Preventive Services Task Force” appeared in the Annals of Internal Medicine. It reported the results of a study which was conducted in response to the CDC’s new recommendations. The study concluded that additional studies were needed prior to the USPTF changing its recommendations for testing for HCV.
Most importantly, the New York State Department of Health is expected to reconvene, in June, a panel of experts to revise and update the Department of Health’s “Clinical Guidelines for the Medical Management of Hepatitis C.” Consequently, MSSNY had urged the Legislature to await the recommendations of these clinicians before taking action with which they may not agree.
7.) CME Mandate on Pain Management
Legislation to mandate the completion of coursework on pain management received much attention in both Houses this year. One bill, (S.2947, Hannon/A.1124, Rosenthal) which would require all health care practitioners to complete course work or training on pain management and palliative care passed the Assembly but died on the Senate floor due in large part to strong MSSNY opposition. The bill would require that all health care practitioners complete course work or training every four years. A second proposal, Senate Bill 2861A, sponsored by Senator George Maziarz, would require prescribers of prescription pain medication to complete a one- time eight hour course related to pain management of opiate-dependent patients. It did not advance from the Senate Health Committee. There is no same as bill in the Assembly. MSSNY actively opposed each of these bills.
8.) OPMC legislation passes Senate
Legislation (S.4527A, Hannon/A.7102B, Gottfried which would make certain changes to OPMC procedures was passed by the NYS Senate but stalled in the NYS Assembly. To strengthen enforcement of clinical competency remediation the bill would allow a Committee on Professional Conduct (Committee), after notice to the licensee and an opportunity to be heard has been afforded, to order compliance with the remediation recommendations of a clinical competency exam. These changes would also allow a Committee to refer the case to the Director of OPMC for presentation to an investigative committee if it determines that there are no reasonable conditions or limitations that could be imposed upon the licensee that would sufficiently mitigate the licensee’s incompetence. Where the Committee determines that there is no practical remediation for the alleged incompetence, then such incompetence would be grounds for a finding of professional misconduct.
The bill would also permit notice of disciplinary proceedings conducted by the Office of Professional Conduct
(OPMC) of the Department of Health (DOH) to be served by mail.
Additionally, the bill would lift the ban on physician use of testimonials. Physicians – like non-physicians- would be able to use testimonials in their advertising providing that such testimonials comply with the specifications of the Rules of the Board of Regents, 8 NYCRR 29 1(b)(12). This proposal is consistent with Resolution 105 adopted by MSSNY’s 2011 House of Delegates.
Importantly, provisions in earlier drafts of this bill that would have imposed significant penalties for failure to follow a Commissioner’s order were removed at MSSNY’s request.
What to expect now that Session has concluded?
1.) Department of Health’s Public Health and Planning Council review of CON Redesign proposals
The Department of Health’s Public Health and Health Planning Council (PHHPC) will continue to review Certificate of Need redesign proposals including a proposal to impose greater regulation on certain physician practices, particularly large group practices and physician practice equipment purchases.
PHHPC’s subcommittee on health planning is holding a series of public meetings to gain input on these proposals. In addition to a meeting held on May 21st, meetings will be held on June 26th, July 17th (Rochester), September 13th and October 4th. With the exception of the July meeting, all meetings will be held in NYC. The meetings are webcast and may be viewed by clicking on the following link: http://www.health.ny.gov/events/webcasts/
The agenda for the June 26th meeting has been posted and can be found below. The focus of the meeting will be on the perspective of the entities that ‘finance payment’ for the services provided in ambulatory settings.
I. Welcome and Introductions
John Rugge, M.D., Chair
II. Ambulatory Care Services: The Perspective of the Financiers
A. Commercial Payers: A Panel Discussion
Donna Frescatore, Executive Director of the New York Health Benefit Exchange
B. New York Health Benefit Exchange
Donna Frescatore, Executive Director of the New York Health Benefit Exchange
C. Department of Financial Services
Troy Oechsner, Deputy Superintendent for Health, NYS Insurance Department
D. Office of Health Insurance Programs, Department of Health
Phil Mossman, Health Care Finance Program Manager, NYSDepartment of Health
III. Principles For Proceeding
· Process Principles
· Outcome Principles
IV. Public Comments
There is some question as to the impact of legislation passed by both Houses this week which appears to establish the Legislature’s intention to be involved in the PHHPC review process on CON redesign. Specifically, A.6838A, Gottfried/A.4493A, Hoylman, if approved by the Governor, would require the Commissioner of Health to conduct a study of “current innovations in the delivery of health care services not presently required to undergo state certificate of need processes nor required to obtain authorization to conduct office based surgery. Entities to be studied shall include, but not be limited to, clinics operating within pharmacies (mini-clinics), medical offices open for extended hours without an appointment (urgent care centers), and major physician practices (whether in one location or multiple locations) whose physicians are linked directly or indirectly in an economic relationship”. The bill requires that the study examine the impact or impacts of the respective entities on the delivery, quality and cost of health care in the respective communities and regions in which they are found. If signed into law, a report is required to be presented to the Governor and the Legislature within one year from the date of its enactment.
2.) Department of Health’s Work Group on Pain Management Education for Prescribers and Patients
The Department’s Work Group continues to deliberate concerning certain I-STOP implementation details and with regard to whether to require prescribers to complete coursework on pain management.
The duty to consult the NYS Department of Health’s Prescription Monitoring Program (PMP) becomes effective Aug 27, 2013. Physicians (or their designated office staff) will be required to check the PMP for every patient that is prescribed a Schedule II, III or IV controlled substance. The “duty to consult” does not apply for inpatients at hospitals or inpatient clinics, but does apply upon discharge. The new Prescription Monitoring System is now up and running and physicians are encouraged to use that system. Please note that a physician designee is prohibited from checking patients on the PMP until August 27, 2013.
To access the PMP, physicians will need to obtain a Health Commerce System (HCS) account. To establish an HCS account, go to the DOH website:
https://hcsteamwork1.health.state.ny.us/pub/top.html and follow the instructions.
New accounts are usually established within two weeks, and once the application is processed, physicians will receive an email back from DOH with documents. The documents must be printed, notarized, and received by the Department of Health for your user ID to be issued.
“Designated office staff” should also sign up for a HCS account. This will enable them to check the PMP database on behalf of the physician on August 27, 2013. Information for establishing this account can be found on the MSSNY website at www.mssny.org under the I-STOP heading. For assistance in setting up the designee, please contact the DOH Commerce Accounts Management Unit (CAMU) at 1-866-529-1890. More information may be obtained by going to: www.health.ny.gov/professionals/narcotic/practitioners
According to the New York State Department of Health, the new PMP site will make it easier for physicians to view and to upload multiple patients by August 27, 2013. The NYS Prescription Registration Form, a copy of the Department of Health brochure, and further information on I-STOP information are all available on the MSSNY website at www.mssny.org. There is also a video presentation of the MSSNY webinar on I-Stop Implementation also located on the site under I-Stop Information. MSSNY is also planning additional webinars in July and August with Terry O’Leary, director of the Bureau of Narcotics Enforcement. MSSNY will notify you once these dates have been secured.
3.) The Department of Financial Services and Department of Health will implement the Health Insurance Exchange- Individuals and Small Businesses Will Be Able to Purchase coverage in October.
MSSNY will continue its ongoing discussions with New York State Health Insurance Exchange staff regarding the products that will be sold through the Exchange. New York state residents will be able to begin enrolling in health insurance products sold through the Exchange starting this October 1, with coverage to begin January 1, 2014. At this time, the Exchange administration is still reviewing the offering of the plans to be sold through the Exchange after plans submitted their proposed offerings in April. New York State will be going forward with a large marketing campaign over the summer and fall to promote New Yorkers’ awareness of the Exchange, including seeking the assistance of community groups and advocacy organizations, including health care provider associations, to promote awareness of the Exchange. MSSNY staff along with Dr. Michael Brisman will be meeting with NYHIE Executive Director Donna Frescatore on Tuesday, July 2 to discuss how the Exchange products will “line up” with MSSNY’s articulated goals, which include: a) assuring a Wide Array of Products to Purchase Coverage b) sufficient Network Adequacy within each plan sold through the Exchange and c) fair coverage for OON services.
4.) MSSNY’s Committee on Legislative and Physician Advocacy Will Develop The Legislative Program for 2014
Working with County and Specialty medical societies, MSSNY’s Committee on Legislative and Physician Advocacy will launch development of MSSNY’s Legislative Program for 2014. You will be apprised of meeting dates and will receive background materials and updates in advance of these meetings.
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