President's Message - Michael Brisman, M.D.
If physicians want to succeed, we will have to set priorities. We have to be able to see what is critical and what is less important. When someone is holding a gun to your head, you shouldn’t be looking for your dental floss. Let me tell you what I would fight for.
First, we must fight to preserve our ability to charge and be paid our usual and customary fees. Insurance companies that sell out of network plans should have to pay at least 70% of the usual and customary physician fees. Otherwise, they are selling sham products. It seems, at least in New York, this may occur through a regulatory route rather than through legislation.
We should vigorously fight any attack on “fee for service” or “private practice of medicine” for what they are, an attack on the very profession of medicine. We should also fight any concepts of “bundled” payments, as well as the ACO’s and other nonsensical concoctions whose only purpose is to establish these bundled payments (i.e. NO payments to physicians). There is no evidence this improves care or reduces cost.
We should continue to fight for tort reform, but in a way that is a win-win for us and the trial lawyers. With the hundreds of billions of dollars a year the country would save we could easily double the salaries of all medical malpractice trial lawyers. We pay farmers not to plant certain crops-- we can certainly pay lawyers to stop suing everybody.
We should demand equal pay for an equal medical task. There is no reason for hospitals to be paid such dramatically higher payments for exactly the same service that a private physician performs outside the hospital. This just drives up the cost of care and drives private physicians out of business.
We should immediately declare that Medicare and Medicaid have absolutely nothing to do with usual physician costs or usual physician charges. We should insist not just that the SGR be abolished, but that there be an immediate and dramatic increase in Medicare payments along with standard cost of inflation increases. Why should Medicare and Medicaid pay hospitals so well and physicians so poorly?
We should strongly support private insurance companies while at the same time insisting they adhere to transparency and free market principles. Most people should be encouraged to purchase commercial insurance products. Medicare and Medicaid should be reserved for the very poor and the very elderly. Insurance companies should lose their federal antitrust exemption and compete for business in a free market like everyone else. Insurance companies should only have to pay for medically necessary items.
We need to all be ready to write checks towards the political goals of our profession. We need to seek parity in the healthcare process with the other players: the government, hospitals, insurance companies, pharmaceutical companies, and trial lawyers. When it comes to healthcare discussions, we MUST have a seat at the table, and it should be at the head of the table.
C L A S S I F I E D A D S
Although NCMS believes the following classified advertisements in this section to be from reputable sources. The NCMS does not investigate the offers made and assumes no responsibility concerning them:
SPACE FOR RENT/LEASE
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LYNBROOK– newly renovated medical office to sublet. Suitable for small practice. Call 516-678-4040.
MASSAPEQUA—Medical office available for rent one day per week. Neat clean space. Incl. reception area, 2 exam rooms & bath. Handicapped access. Contact Dr. Gregory Buzzell 516-799-5956. Mon. Wed. Fri.
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Bits and Pieces
Reimbursement for smoking cessation: Every smoker, every visit
Most clinicians do not bill Medicare, Medicaid, or Commercial carriers for the advice they offer to patients on quitting smoking. The resources below provide clinicians with an explanation of physician reimbursement for smoking cessation interventions, and a set of tools that optimize use of physician and support staff time to deliver evidence-based smoking cessation interventions regardless of the patients’ readiness to quit.
The documentation templates support reimbursement for smoking cessation at every visit. Although the reimbursement of $12-20 per visit with an annual limit of eight sessions for Medicare, and six sessions for Medicaid, is modest, a small effort to re-engineer your practice flow to support smoking cessation will substantially impact the health of your patients. Following are links that explain full coverage details and codes for reimbursement.
Outline for Practice Transformation
Tools to assist clinicians in organizing effective delivery of smoking cessation services in the office setting: Outline for Practice Transformation summarizes the essential details of patient flow, documentation, and coding for reimbursement.
Guide to Build a Better Office System
This guide, produced by the American Academy of Family Physicians, addresses the U.S. Public Health Service’s (USPHS) Clinical Practice Guideline; Treating Tobacco Use and Dependence 2008 Update, recommendation for clinicians to change the clinical culture and practice patterns in their offices to ensure that every patient who uses tobacco is identified, advised to quit, and offered evidence-based treatments.
“Reproduced with permission from Treating Tobacco Dependence Practice Manual, 2010, issue of Scientific Activities Copyright © 2010 American Academy of Family Physicians. All Rights Reserved.”
NYS Smokers’ Quitline
A complete source of patient resources for smoking cessation including tools for clinicians to facilitate patient referrals
2009 Update on 529 Plans by Chuck Toth
Since they were created by Congress 10 years ago, 529 plans have been an attractive way to boost college savings for a child or grandchild. This year, changes in the tax code make them look even better.
529 plans, so called because they were authorized by Section 529 of the Internal Revenue Code, allow investment earnings to grow free from federal and, in most cases, state income taxes for the life of the account. The IRS does not tax 529 distributions, nor do many state governments, as long as they are used for qualified higher education expenses, such as tuition, room and board, mandatory fees, books, and even computers.
As of 2009, the amount of money donors may contribute has been raised to $13,000 per person—or $26,000 per couple filing a joint return—per child each year. All 50 states and the District of Columbia sponsor 529 plans; some states, in fact, offer more than one, offering a range of investment options that include stock mutual funds, bond mutual funds, money market funds and age-based portfolios that automatically shift to a more conservative balance of investments as the beneficiary gets closer to college age.
Those assets may be used to pay for education expenses at any accredited college or university in the United States, no matter which state’s plan you choose to participate in. However, residents of certain states have an incentive to invest with their home-state plan, since they may be able to deduct annual contributions from that state’s income tax. For example, New York State residents may deduct up to $5,000 per person—$10,000 per couple—per year for a contribution to their state’s plan; contributions by residents to New Mexico’s plan is fully deductible.*
529 plans have an additional benefit for parents who have already been saving for a child’s education through a custodial account under the Uniform Gift/Transfer to Minors Act. Historically, these custodial accounts were attractive because when the child took control of the money to pay for education expenses (at either age 18 or 21, depending on state law), the distributions were taxed at the child’s tax rate. Beginning in 2009, however, those distributions will be taxed at the parents’ higher tax rate for full-time students through the age of 23 for any investment income greater than $1,800.
You can maintain the tax efficiency of UGMA/UTMA accounts by transferring their assets to a “custodial” 529 plan before the end of 2009. The transferred funds still belong to the minor child, who is allowed to take control of the money when he or she reaches the age mandated by state law. Even better, student-owned 529 accounts do not have to be reported on the federal student aid application and thus have no impact on a child’s eligibility for federal financial aid.
Taxes on capital gains will likely increase after 2010, when current tax rates sunset, so transferring UTMA/UGMA assets now will have the smallest tax consequence. Besides improving your child’s chances of receiving federal financial aid, putting a 529 wrapper around those assets helps ensure that he or she will use those savings for college.
Because only cash may be contributed to a 529 plan, UTMA/UGMA assets must be liquidated to make the transfer, potentially triggering capital gains. Depending on the child’s age, the benefits of tax-free growth over a short time period may not outweigh the tax consequences of liquidating the UGMA/UTMA account. Talk to your Financial Advisor and your tax advisors to determine if this strategy is suitable for you.
In addition to tax-deductible contributions and tax-free withdrawals, noncustodial 529 plans provide a valuable tool for estate planning. You have the option of “front-loading” five years worth of contributions in a single year without incurring gift taxes. An individual may contribute up to $65,000 per beneficiary in one year, or $130,000 from a couple filing a joint return. If you donate the full amount, you use up your gift tax exemption for the next five years. Any other gift given to that same individual during those years will be taxed as a gift.
For all the advantages of 529s, there are a few key caveats to consider before committing the funds. The investment options are limited, and account holders are permitted to change their options only once a year, restricting your ability to respond to market changes. Of course, there is always the risk that investments in a 529 plan can go down in value. Front-loading now when asset values are low may yield superior returns for a child who won’t be entering college for 10 or 15 years, but you may prefer to explore more conservative options for older children. Talk with a Financial Advisor to find the best college-savings options for your situation.
Chuck Toth is Director of Education Savings at Merrill Lynch
Before you invest in a 529 plan, request an official statement and read it carefully. The official statement contains more complete information, including investment objectives, charges, expenses and risks of investing in the 529 plan, which you should consider carefully before investing. You should also consider whether your home state or your beneficiary's home state offers any state tax or other benefits that are only available for investments in such state's 529 plan.
"For more information, contact Merrill Lynch Financial Advisor Jill B. Kremer of the Garden City, NY office at 516-877-8544 or visit www.fa.ml.com/jill_kremer".
Eye On Albany
MSSNY Condemns "D" Rating to Life-Saving Prostate Cancer Screening
The Medical Society of the State of New York (MSSNY) joins the American Urological Association (AUA), the Large Urology Group Practice Association (LUGPA) and the American Association of Clinical Urologists (AACU) in condemning the US Preventive Services Task Force (USPSTF) decision to assign a "D" rating to PSA based screening for prostate cancer as ill-advised and irresponsible. The result will be to discourage men from undergoing screening for this potentially fatal and morbid illness. "One in six men in the United States risks getting prostate cancer during his lifetime. Prostate cancer has always been widespread; however, before 1987, physicians did not screen for it," said Michael M. Ziegelbaum, MD, Vice President of Nassau County Medical Society and a board-certified urologist with Advanced Urology Centers of New York. He added, "At that time 25 percent of men diagnosed with prostate cancer had disease that had spread to other parts of the body, which was inevitably fatal. Today, with early detection, that number has been drastically reduced to less than 5 percent. Overall, the death rate from prostate cancer has decreased by 44 percent in the PSA screening era."
"We are appalled at the USPSTF's recommendation that healthy men should no longer receive prostate-specific antigen (PSA) blood tests as part of routine cancer screening," said Deepak A. Kapoor, MD, President of LUGPA and Chairman and CEO of Integrated Medical Professionals, PLLC. Dr. Kapoor added, "This is a potential public health catastrophe as in five to seven years as those patients we fail to detect early will present with advanced diseases; as a result of this inappropriate recommendation, thousands of men will needlessly die."
The Task Force did not include any urologists or oncologists on its panel and the main study cited – the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial – was seriously flawed. Meanwhile findings of the largest prostate cancer screening trial, European Randomised Study of Screening for Prostate Cancer (ERSPC), which found as much as a 31 percent decrease in cancer-specific mortality in screened vs. non-screened men was discounted by the panel.
The one size fits all downgrade of prostate cancer screening to a "D" recommendation at this time would also deny screening to those at the greatest risk for prostate cancer – African-Americans and those with a family history of prostate cancer. These patients urgently need to be educated about their risks of developing cancer, and the role that screening could play in early diagnosis and treatment.
MSSNY calls on our state legislators to reject this recommendation and to support PSA screening for well-informed men who wish to pursue early diagnosis for a disease that is the second leading cause of cancer death in men. The USPSTF's recommendations risk undoing 20 years of progress in patient education and puts the lives of tens of thousands of men at risk. All concerned citizens are encouraged to contact their State and Federal legislators to demand that access to this life-saving testing is not restricted as a result of these misguided recommendations.
PHYSICIANS URGED TO RETURN EXCESS APPLICATION AND ADDENDUM TO THEIR SECTION 18 CARRIERS
By now, physicians should have received provisional renewal notices from their Excess liability (Section 18) carriers asking them to complete the application and addendum and return it by June 1, 2012 in order to bind coverage for the next policy period beginning on July 1st.
Completion of the addendum is necessary to assist the Superintendent of Financial Services and Commissioner of Health in the completion of a report required by the recently enacted budget which will review the nature and extent of affiliations between physicians, dentists, general hospitals, private practices, and universities and conduct an actuarial analysis concerning the adequacy of premiums paid for the Excess coverage. It must be noted that the question on the questionnaire inquiring as to whether a physician has rendered emergency medical services at the primary affiliated general hospital within the past twelve months does not accurately reflect what state law has required as a condition precedent for eligibility.
To be eligible for the Excess program, a hospital must certify to the Commissioner of Health those “physicians who request such certification and who have professional privileges in such hospital and who, from time to time, provide emergency medical or dental care in such hospital to persons who require such care.” Please consult with your Section 18 carrier if you have not received a provisional renewal notice or have questions concerning the addendum questionnaire.
Don't Be Silent About Smoking
How to Avoid Common Version 5010 Claims Rejections
The deadline for the Version 5010 upgrade was January 1, 2012, and the enforcement discretion period for all HIPAA-covered entities to complete their upgrade to the Version 5010 electronic standards ends on June 30, 2012. The Version 5010 transaction standards have different requirements than those of Version 4010 and 4010A. There are a few things to keep in mind for processing your Version 5010 claims, which should help avoid unnecessary rejections:
You need to include a complete 9-digit ZIP code for the billing provider and service facility location. You should work with your vendor to make sure that your system captures the full 9-digit ZIP.
Billing Provider Address:
You need to use a physical address for your Billing Provider Address. Version 5010 does not allow for use of a PO Box address for either professional or institutional claim formats. You can still use a PO Box, however, as your address for payments and correspondence from payers as long as you report this location as a pay-to address.
National Provider Identifier (NPI):
You were previously allowed to report an Employer’s Identification Number (Tax ID) or Social Security Number (SSN) as a primary identifier for the billing provider. For Version 5010 claims, however, you are only allowed to report an NPI as a primary identifier.
For additional help with your Version 5010 upgrade and Medicare claims, you can contact your Medicare Administrative Contractor (MAC). If you experience difficulty reaching a MAC, you should send a message describing your issue to ProviderFeedback@cms.hhs.gov with “5010 Extension” in the subject line. The Medicare Fee-For-Service group has created a fact sheet that provides guidance to help providers troubleshoot some of the difficulties they may experience with Version 5010 claims processing and links to each of the MAC websites, including lists of the top 10 edits for Version 5010 claims.
10% Monthly Rental Discount
Cindy Mueller, BSN, RN is the Director of Performance Improvement/Staff Development for the Visiting Nurse Association of Long Island (VNA of LI), headquartered in Garden City. VNA of LI is a not-for-profit Certified Home Health Agency with a Long Term Home Health Care Program accredited by CHAP. The agency is committed to improving the quality of life for home health patients and advocates coordinated care and in home technology. For further information on the Cardiac Disease Management Service initiative or other VNA of LI programs and services, please contact Cindy at CindyM@vnali.org or dial (516) 739–1270, Ext. 216. Web site: www.vnali.org.
Department of Anesthesiology
1ST Alumni Reunion
Saturday, July 14, 2012
Join us for Social and Education Events
8AM—12PM Educational Sessions (CME)
Afternoon: Department/Alumni Annual Picnic—Reconnect with Colleagues
Hosted by Dr. Peter Glass and Mrs. Sabrina Glass
For more information: Contact Luisa Escandon
Increase in Shigella infections in the Southwest
The Nassau County Department of Health has identified an increase in Shigella infections in the Southwest region of Nassau County. Since April 1, 2012, 34 cases have been identified. 28 cases reside in the Southwest region in the county. The age range of cases for this time period is 6 months to 78 years. The largest distribution is in children under the age of 17. Since most persons, especially young children, with Shigella infection have very mild symptoms; many cases do not come to medical attention. Of those that do, only cases with culture confirmed Shigella infection are reported to the Health Department. Therefore, we believe, there are many more unreported cases occurring in the community. Because of the low infectious dose, the infection spreads rapidly, especially among communities with young children and in daycare centers. Your assistance is needed to stop the current spread of infection, and prevent an outbreak as large as that seen in previous years.
We ask that you:
- Maintain a heightened level of suspicion regarding complaints of diarrheal illness among your patients and stress the importance of maintaining a high standard of personal hygiene. The key ingredient to controlling the outbreak is education.
- It is not recommended to treat mildly ill patients with antibiotics. If illness is severe enough to require treatment, the choice of empiric therapy should take into account the sensitivity pattern of the Shigella isolates.
- Advise parents that cases of young children with shigella are to be kept home from daycare or preschool. NCDOH will clear children to return to school following two consecutive negative stool cultures 24 hours apart and at least 48 hours after the completion of antibiotic therapy.
- Assist us in our surveillance activities by continuing to report patients with diarrheal illness caused by Shigella.
Cases should be reported to:
During business hours:
Bureau of Communicable Disease at
Phone: (516) 227-9639. Fax (516)227-9669
After hours phone number:
Phone: (516) 742-6154
We appreciate your cooperation in helping to control this outbreak.
Nassau County Department of Health
Bureau of Communicable Disease Bureau of Communicable Disease.
VACCINES ARE FOR GROWN-UPS TOO
Steven Cogan, M.D. Pediatrician
Many primary care physicians unfortunately don’t realize that they can help prevent childhood illnesses and that children are preventing illnesses in them.
The Tdap (Tetanus Diphtheria, and acellular pertussis) vaccine has been recently recommended for all adults. The strategy recognizes that pertussis (whooping cough) is a significant cause of lower respiratory infections in adults and in children. The recent epidemics of pertussis around the country have highlighted the need for booster doses of pertussis vaccine. An anticipated additional benefit of the vaccine is that it will protect infants from the disease until the can finish their own immunization series. The strategy of giving this vaccine to all who spend significant time with infants is called “cocooning”. The vaccine preplaces the Td booster and is safe to give to all adults except those with known contraindications. It is approved from 7 to 65 years as a single booster. It may be given safely one year after a Td booster. Further information is available at the CDC webiste (www.cdc.gov/vaccines). Of note, pediatricians refer the parents and grandparents of their neonatal patients to adult primary care for immunization. Certainly, annual flu vaccine that is recommended for everyone beginning at 6 months of age is a significant preventive measure.
Another vaccine that is now standard in pediatrics is the Hepatitis A vaccine. This is administered to children in the second year of life and can be given as a catch-up vaccine in older children (It is covered by insurance in this age group).
On the other end of the spectrum, that being children protecting adults, infants have been receiving pneumococcal vaccine for the last several years and we have seen a decrease in the incidence of this disease in adults which has been attributed to this approach.