NEWS OF NEW YORK - Medical Society of the State of New York

Transcription

Workers’
Comp
Survey
MEDICAL SOCIETY OF THE STATE OF NEW YORK
NEWS OF NEW YORK
Volume 70 • Number 8 • www.mssny.org
page 6
Providing Information to Assist Physicians in the State of New York
Recommended Adult Immunization Schedule – United States – 2014
September 2014
NY State Physicians and Public Health
Officials Launch “IMMUNIZE NY”
For more information visit cdc.gov.
Vaccine Preventable Diseases are on the Rise
in this Country Due to Lack of Immunization
The
World
Health
Organization estimates that
vaccination prevents 2.5 million deaths each year. In an
effort to address the rise of
preventable diseases due to
lack of immunization, New
York State Physicians and
public health officials have
launched a program to encourage New Yorkers to be vigilant
in keeping their immunizations
up-to-date.
The Medical Society of the
State of New York (MSSNY),
along with the New York
Chapter of the American
College of Physicians, the New
York State Chapter of Academy
of Family Physicians and the
New York State Association of
County Health Officials have
launched “IMMUNIZE NY” to
promote immunizations within
the adult population. The campaign strongly encourages
adults to discuss immunizations
with their physicians and to ask
specifically about pertussis,
influenza, pneumococcal, HPV
and shingles vaccinations.
Vaccine Preventable
diseases on the Rise
“The world is shrinking due
to international travel, and vaccine preventable diseases are on
the rise,” noted William Valenti,
MD, Chair of the Infectious
Disease Committee for the
Medical Society of the State of
NY (MSSNY). “Immunization
is the best protection to prevent
the spread of diseases.”
Monica Sweeney, MD, agrees
The 2014 ACIP Adult Immunization Schedule was
approved by the Centers for Disease Control and Prevention’s
(CDC) Advisory Committee on Immunization Practices
(ACIP), American Academy of Family Physicians (AAFP),
the American College of Physicians (ACP), the American
College of Obstetricians and Gynecologists (ACOG), and
the American College of Nurse-Midwives (ACNM). On
February 3, 2014, the adult immunization schedule and a
summary of changes from 2013 were published in Annals of
Internal Medicine, and a summary of changes was published
in the MMWR on February 7, 2014. All clinically significant
postvaccination reactions should be reported to the Vaccine
Adverse Event Reporting System (VAERS). Reporting
forms and instructions on filing a VAERS report are available at www.vaers.hhs.gov or by telephone, 800-822-7967.
Additional details regarding ACIP recommendations for
each of the vaccines listed in the schedule can be found at:
www.cdc.gov/vaccines/hcp/acip-recs/index.html.
that immunization is especially
important in a state like New
York. “Vaccines are important
not only for people in general,
but I think it takes on extra
importance when you’re in a
cosmopolitan state like New
York,” said Dr. Sweeney, vice
chair of the MSSNY Committee
to
Eliminate
Healthcare
Disparities and a member of
the MSSNY Infectious Disease
Committee. “We have exposures all the time to people
from everywhere. And so, to the
extent that there is a vaccine to
prevent it we should use it. We
have to make sure that we have
the population entirely ready
for all of these communicable
diseases.”
“Many adolescents and
adults are under-immunized
and are missing opportunities
to protect themselves against
diseases such as HPV, influenza, shingles, pertussis and
pneumococcal disease,” said
MSSNY’s William Valenti,
MD. “That is why we, as physicians, are encouraging all adults
to speak with their physicians
about immunizing them against
these diseases. Not only do
adults need to be immunized
for these diseases, they need to
ensure that they have received
the necessary ‘booster’ shots to
continue their immunity.”
One of Five NY Health
Priorities
Preventing diseases through
vaccine is one of the five public health priorities for the New
(Continued on page 13)
Reminder:
Mandatory E-Prescribing of
ALL Substances Begins
3/27/15
Inside News
Marijuana – Who
Can get a
Prescription?
.......................page 2
MSSNYPAC
Considers
Endorsements
.......................page 4
MSSNY Lags
Behind in Political
Spending
.......................page 4
Assure Your
Sunshine Act
Info is Correct
.......................page 6
CDC to Create a Nationwide Monitoring Index
of Antibiotic Use
A new government initiative looks to create the first nationwide prescribing index to
monitor the use of antibiotics among various facilities and identify areas where a potential
outbreak of antimicrobial resistant bacteria is likely to occur.
CDC Director Dr. Tom Frieden said that the agency planned to launch its Antibiotic Use
and Resistance reporting module shortly.
The program will be a part of the agency’s already established National Healthcare
Safety Network, a healthcare-associated infection tracking system that allows more than
12,000 participating facilities to receive information on infection problem areas and
measures to prevent their spread. The AUR will be able to provide real-time data on
facility-specific antibiotic use as well as give information on resistance trends going on
throughout a particular region. Network healthcare providers, which include acute-care
hospitals as well as long-term-care and nursing home facilities, will be able to electronically share antibiotic resistance information from testing laboratories and antibiotic
prescribing data from regional health providers.
Health officials have been warning for years that the overuse of antibiotics by many
providers coupled with a dearth of the development of new antibiotics has resulted in a
rise in the prevalence of antibiotic-resistant infections, some of which, as in the case of
gram negative bacteria, have proven to be resistant to most, if not all, currently available
medications.
Governor Cuomo Signs the
Medical Marijuana Bill into Law
Now that Governor Cuomo has signed into law legislation that permits the medical use of marijuana, the legislation adds a new Article V-A to the Public Health
Law that will comprehensively regulate the manufacturing, sale and use of medical
marijuana.
A patient will be required to be certified by a “practitioner” in order to obtain
medical marijuana. The new law defines “practitioner” as (i) a physician who is
licensed by NYS and who practices in the state; (ii) who by training or experience is
qualified to treat a “serious condition” and (iii) has completed a 2 to 4 hour course as
will be determined by the Commissioner of NYS DOH in regulations, and registered
with NYS DOH. The term “serious condition” includes one of the following: cancer, HIV positive status or AIDS, amyotrophic lateral sclerosis, Parkinson’s disease,
multiple sclerosis, damage to the nervous tissue of the spinal cord with objective
neurological indication of intractable spasticity, epilepsy, inflammatory bowel disease, neuropathies, or Huntington’s disease.
The Commissioner of NYS DOH is empowered to add other conditions or symptoms to the list. The Commissioner is also empowered to deem nurse practitioners
as “practitioners” who are authorized to certify the use of medical marijuana. Upon
approval for the certification, NYS DOH will issue registry identification cards (with
photo) for the certified patient and designated caregiver. NYS DOH will be issuing
additional regulations and required forms to implement this new law.
File A Complaint If Your Claims
Are Not Paid Promptly
Do you know that New York State has a law that
requires clean claims submitted electronically by physicians to insurance companies be paid within 30 days
(within 45 days if submitted by paper)?
Do you know that, every year, the New York State
Department of Financial Services (DFS) imposes millions of dollars in fines on insurance companies that fail
to follow this law?
In recent weeks, we have heard that some insurance
companies, including some who participate in New
York’s Health Insurance Exchange, have been delinquent in making payments to physicians for the care
they have provided to their patients. We are anxious to
help physicians who have experienced similar delays so
that we can help you to be paid promptly. If you wish,
we can contact insurance companies on your behalf.
If you file complaints with DFS, the State can take
enforcement actions against these companies who may
be trying to cheat you and your patients. MSSNY routinely talks to DFS’ investigative staff.
If insurance companies are not paying your claims
according to the law, the DFS encourages physicians to
bring complaints to their attention. To file a complaint
directly with DFS, visit www.dfs.ny.gov/consumer/
fileacomplaint.htm.
Alternatively, feel free to contact Regina McNally,
MSSNY’s Vice-President for Socio-Medical Economics,
at 516-488-6100, x332 or [email protected].
From Socio-Med VP Regina
McNally re: Forge-Proof
Scrip Pads
A number of physicians have been asking
what they should do with their forge-proof paper
prescription pads. The e-prescribing mandate is
a component of the NYS I-Stop Program. Based
on my contact with staff at the NYS DOH, it is
recommended that these pads be kept. Although
they will not be permitted for use on or after
3/27/15 except for certain limited exceptions,
these pads will be needed in the event of a power
failure or when prescribing services other than
drugs (i.e. diagnostic tests, labs, etc.).
For additional information, review the information at www.medicexchange.com/directory/
eprescribing-software.html.
In the event that you might not be using an
EMR or EHR, you might want to consider
searching the Internet, or locating an application
(app) for your “smart” phone.
Page 2 • MSSNY’s News of New York • September 2014
September 2014 • MSSNY’s News of New York • Page 3
PRESIDENT’S COLUMN
NEWS OF NEW YORK
We Are Lagging Way Behind on Political Spending
Medical Society
of the State of New York
Andrew Y. Kleinman, MD President
Michael Rosenberg, MD Chairman of the Board
Philip A. Schuh, CPA
Executive Vice President
COMMUNICATIONS AND
PUBLICATIONS
L. Carlos Zapata, MD, Commissioner
News of New York
Published by Medical Society of the State of New York
Vice President, Communications and Editor
Christina Cronin Southard, Editor
[email protected]
News of New York Staff
Julie Vecchione DeSimone, Assistant Editor
[email protected]
Janice Morano, Marketing Relations
[email protected]
Steven Sachs, Web Administrator
[email protected]
Susan Herbst, Page Designer
News of New York
Advertising Representatives
For general advertising information contact
Christina Cronin Southard
Phone 516-488-6100 ext 355
[email protected]
• The trial lawyers PAC contributed nearly 350% more than
MSSNYPAC.
The comparisons are even more startling when you consider
that there are nearly 5 times as many physicians as dentists
practicing in New York State. So, that means that the dentists
have basically spent 15x more per capita on political activity in
New York than physicians. The New York State Trial Lawyers
Association indicates it has 4,500 members. Assuming that
most are members of NYSTLA, that means that the trial
lawyers have basically spent more than 60x more per capita
on political activity in New York than physicians, not even
counting the huge amounts that trial lawyers spend individually on campaigns.
Are you kidding me?
MSSNY IS Dwarfed by Other PACs
How much is your future worth?
The news didn’t get any better when the New York State
Board of Elections made public the PAC filings of various
interests for the first 6 months of 2014, basically concurrent
with the Legislative Session. Once again, it highlighted that
our political efforts are being dwarfed by many other groups
who often actively oppose us on our priority issues.
The filings showed that:
• The hospitals PAC contributed nearly 40% more than
MSSNYPAC.
• The dentists PAC contributed over 300% more than
MSSNYPAC.
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 publication
is available from the Communications Division, 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 company 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 Benefits 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 advertiser 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
advertiser 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 liable 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.
Success Despite Difficulties
I know many physicians are upset by the difficulties they
face in their practices. MSSNY has a comprehensive legislative and regulatory agenda for addressing these problems.
And despite our political limitations, we had a very successful
legislative session this year. However, just think what we could
accomplish if more physicians joined the PAC.
For example, if just 25%, or 20,000, of New York’s 80,000
physicians, joined at the basic MSSNYPAC membership
level of $175 – less than $12 per month - it would result in
$3,500,000 for MSSNYPAC.
If we are to make the changes to the health care system that
are necessary to protect our ability to continue to deliver the
care expected by our patients, it is imperative that we play
a significant role in the political process, this fall and in the
future. If we do not participate meaningfully in the process to
select those who make policy, we forfeit our right to complain
about that process.
I thank the many of you who have supported MSSNYPAC.
For the vast majority who have not, I urge you to join today.
Our livelihood is at stake!
myssny paC
Mssnypac Considers Candidate Endorsements
Over the summer, the
MSSNYPAC Subcommittees
on State and Federal Candidate
Evaluation have met to
develop a list of candidates
to endorse. Their recommendations are first vetted and
approved by the MSSNYPAC
Executive Committee and then
submitted to the MSSNY Council for final approval. As will
be discussed below, two candidates were vetted and approved
by the MSSNY Executive Committee because their contested
primaries will be held before the Council meeting.
This will be only the third time in its history that
MSSNYPAC has endorsed political candidates. The first year
(2010) MSSNYPAC endorsed only two candidates (Senator
Kemp Hannon (R) and Senator Neil Breslin (D) because of
their support for our program, including our collective bargaining bill. The second year (2012), MSSNYPAC endorsed
eight candidates, two for Congress (Chris Gibson (R) and Nan
Hayworth (R) and six for state legislature (Senator Elizabeth
Little (R), Senator Stephen Saland (R), Senator Kemp
Hannon (R), Senator Martin Golden (R )and Assemblymen
Richard Gottfried (D) and Robin Schimminger (D)). All but
two of our endorsed candidates (State Senator Saland (R)
and Congresswoman Hayworth (R)) have won re-election.
The process is usually begun by staff that looks at the legislative sponsorship, voting records and leadership positions and
makes recommendations of legislators they feel should receive
special recognition for their past substantive contributions
toward the advancement of MSSNY advocacy objectives. At
the last meeting of the MSSNY Council, the endorsement of
Senator Kemp Hannon was advanced and approved. Senator
Hannon has been a good friend and advocate of physician and
AT YOUR SERVICE
MSSNY’S WESTBURY OFFICE
Main Phone Number......................................516-488-6100
Toll Free Number...........................................800-523-4405
Main Fax Number..........................................516-488-1267
MSSNY Website......................................... www.mssny.org
Extensions for specific services
Alliance.. ........................................................................396
Communications............................................................ 351
Computer Information Systems..................................... 361
Member Benefits/Marketing.......................................... 424
Membership Information............................................... 336
Medical, Educational & Scientific Foundation.............. 350
Office of the Executive Vice President.......................... 397
Ombudsman Claims Assistance..................................... 318
Physician Records/Credentials....................................... 367
Socio-Medical Economics............................................. 332
albany office
Continuing Medical Education...........518-465-8085 ext.17
Public Health Committees.................518-465-8085 ext. 11
Governmental Affairs.....................................518-465-8085
Fax..................................................................518-465-0976
Other Numbers
Committee for Physicians’ Health.................800-338-1833
Dispute Resolution Agency............................516-437-8134
Kern, Augustine, Conroy & Schoppman.......516-294-5432
Did you know that New York’s dentists spend 15 times more per capita
on political activity than New York’s
physicians?
Did you know that New York’s trial
lawyers spend at least 60 times more
per capita on political activity than
New York’s physicians?
New York physicians, through
Andrew Y.
MSSNY and MSSNYPAC, play an
Kleinman, MD
important role in helping to shape
health care policy in New York State.
However, we do not have as much power to shape policy as
we would like because of the overwhelming political power of
often competing interest groups.
As we head into the very critical fall election season where
control of the State Senate is once again up for grabs, we must
work to change that immediately. The stakes – my professional
future, your professional future, and your patients’ care – are
far too high.
Earlier this year, Crains’ published a list of the top contributors to political campaigns in New York State. According to the
list, SEIU was #4, the Greater New York Hospital Association
#6, the trial lawyers #7, the dentists #9, and HANYS #11.
And where was MSSNYPAC ranked? 40th!
patient issues. A more formal
announcement will be published in next month’s News of
New York.
Two of the candidates for
2014, however, Assemblyman
William Magee (D, Madison,
Oneida, Otsego) and State
Senator Toby Ann Stavisky
(D, Queens) are in the middle of hotly contested primaries.
The primary election will be held on September 9 – two days
before the Council meeting. Since the endorsement of these
two candidates is really only meaningful to them before the
primary is held on September 9 (since, in both seats, the
winner of the primary will almost certainly win the general
election) two days before the Council meeting and, therefore,
time was of the essence, the Executive Committee was asked
to consider the approval of the endorsement of Assemblyman
William Magee and Senator Toby Stavisky with a view toward
review by the full Council in September. The Executive
Committee approved the endorsement of Assemblyman
Magee and Senator Stavisky.
There are a number of ways physicians can help elect
friends of medicine. They can work on campaigns themselves
walking their neighborhoods with the candidates, holding
“get to know” you events at their home, and making calls on
their behalf. Physicians can also make contributions directly
to the campaign committee of their favorite politician.
Most importantly, physicians can and should join
MSSNYPAC. It is through MSSNYPAC that the collective
strength of organized medicine can be found. MSSNYPAC is
strong but it can become infinitely stronger if your friends and
colleagues join. Go to the link below to join or to increase the
level of your MSSNYPAC contribution: http://bit.ly/1oB2wv7.
The NEWS of NEW YORK ISSN 0028-9264, Periodical POSTAGE PAID at Westbury and other additional mailing offices. The NEWS of NEW YORK is published monthly by the
Communications Division, Medical Society of the State of New York, 865 Merrick Avenue, Westbury, NY 11590. Please address all correspondence to the Editor. POSTMASTER:
Please forward all change of address forms to the Editor, NEWS of NEW YORK, Medical Society of the State of New York, 865 Merrick Avenue, Westbury, NY 11590. Subscription,
$36.00 non-members, $18.00 members.
MSSNY Offers CME Program on
Viral Hemorrhagic Fever
The Medical Society of the State of New York has an on-line program on Viral Hemorrhagic
Fever that is available to physicians free of charge at http://cme.mssny.org/.
Objectives include understanding the clinical manifestations of VHF and diagnosis and
treatment. This program has been accredited for one hour of AMA PRA Category 1 CreditsTM
. Physicians and other health care workers who are new to the site must first register by clicking onto “new users” and filling out the required information. Physicians would then access
the modules by clicking on “My Training” at the top of the screen. After completing the
module, physicians will be required to take a post test, and to also evaluate the program. Upon
successful completion of the post-test, a physician’s CME certificate then becomes available for downloading. The “My Training” page provides customized information on which
modules have been viewed, the test status, survey completion, and the certificate. Physicians,
who have already registered for the site, would just need to log onto the site, enter their email
and password and go directly to the training page. Further information may be obtained by
contacting Pat Clancy, VP, Public Health and Education at [email protected].
New York State of Health Releases
Detailed Enrollment Report
New York State Health Insurance Exchange
officials recently released a report that provides detailed demographic data regarding
the policies in which New Yorkers enrolled.
To read the report in its entirety, including county by county enrollment data, visit
http://info.nystateofhealth.ny.gov/news/
press-release-ny-state-health-details-information-nearly-1-million-who-enrolled-through.
Here are some of the highlights:
Total Enrollment - Of the 960,762 people
enrolled in the Exchange, 55% signed up for
Medicaid, 7% enrolled in Child Health Plus
and 38% enrolled in a commercial health plan.
Of the 370,604 people who enrolled in a commercial health plan, 74% of them were eligible
for cost-sharing subsidies, with the average tax
credit of $215 per month.
Commercial vs. State-subsidized coverage - 81% of those who enrolled through the
Exchange reported that they were uninsured
at the time of application. Of that number,
93% of those who enrolled in Medicaid were
previously uninsured, and 63% who enrolled
in commercial coverage were previously
uninsured.
Market Share - Of the 16 plans offering
coverage in the “individual” commercial market, Health Republic had the largest market
share, at 19% of the market, followed by Fidelis
at 17%, MetroPlus at 15%, Empire BC/BS at
14%, Emblem at 9% and MVP at 8%.
Type of Coverage - 13% of the commercial enrollees chose “platinum” coverage, 10%
chose “gold” coverage; 10% were in “silver”
coverage with no subsidy; 45% were in “silver”
coverage plans with some level of subsidization; 19% were in “bronze” coverage; and 2%
enrolled in “catastrophic” plans
Age of Enrollees – Nearly 50% of people
who enrolled in a private health plan were
between 45 and 64 years old, 40% between 26
and 44, and 10% 25 and younger.
Small Business Enrollment
3,106 businesses provided coverage
through the small business SHOP Exchange,
encompassing 10,000 employees and 9,787
dependents.
Of the 10 insurers offering coverage in the
SHOP, Health Republic again had the highest
market share here, with 34% of the market,
followed by Excellus at 22%, Oxford at 12%,
MVP at 11%, and Independent Health at 7%.
35% of small business owners chose “platinum” plans; 27% chose “gold” plans; 27%
chose “silver” plans; and 11% chose “bronze”
plans.
E-Prescribing Mandate of Non-controlled and
Controlled Substances Becomes Effective March 27, 2015
E-prescribing will be required for ALL
New York State prescriptions, including controlled substances on March 27, 2015. While
the E-prescribing mandate goes into effect
on March 27, 2015, physicians who comply with these regulations may now begin to
electronically prescribe controlled substances
(EPCS), as long as their EPCS systems are
DEA certified. Physicians must register their
EPCS software with NYS Bureau of Narcotic
Enforcement (BNE). Transmission of a prescription of a controlled substance using
software that is not DEA certified will fail.
The prescription will not be filled. A waiver
process from the E-prescribing mandate has
been established under regulations. A waiver
is only good for one year, and physicians will
need to apply directly to the Commissioner of
Health. BNE officials have indicated that they
are not currently taking any waiver applications as the law is not yet fully in effect. There
will be guidance on the waiver process beginning early next year.
Additional information can be found at the
department’s website at: www.health.ny.gov/
professionals/narcotic/electronic_prescribing
The E-prescribing of ALL substances was
required under the passage of the I-STOP law
in 2012.
MSSNY Offers a 10-Installment Plan for 2015 Dues
In an effort to make dues payments easier to manage, MSSNY will offer the option to pay
2015 dues by credit card in ten installments, at no additional cost. Members can choose the
items they want to include in addition to county and state medical society dues.
Once signed up, you will automatically be enrolled in the installment payment plan in the
future, for seamless payments. But we will alert you each year prior to the start of the program
to provide the opportunity for you to opt out or change your credit card information and your
choice of voluntary items.
You must respond by October 7 in order to participate in the installment payment plan.
2015 dues will be charged to your credit card in ten equal installments on October 8, 2014;
November 10, 2014; December 8, 2014; January 7, 2015; February 11, 2015; March 11,
2015; April 8, 2015; May 12, 2015; June 10, 2015; and July 8, 2015.
We have a secure site for online payment. Please watch your emails for the link and call the
Membership Division at 800.523.4405, ext. 403, if you have any questions.
What You Need to Assure Your
Public “Sunshine Act”
Data Is Accurate
The Physician Payments Sunshine Act requires manufacturers of drugs, medical devices and biologicals that
participate in U.S. federal health care programs to report
certain payments and items of value given to physicians
and teaching hospitals. The Centers for Medicare &
Medicaid Services (CMS) has been charged with implementing the Sunshine Act and has called it the Open
Payments Program.
As part of this program, manufacturers are now
required to submit reports on payment, transfer and ownership information. Physicians have the right to review
their reports and challenge reports that are false, inaccurate or misleading. However, the timeframe for initiating
disputes and having data corrected or publicly marked
as disputed is extremely limited. The AMA has developed a toolkit (available at http://tinyurl.com/k8q2tto) to
assist physicians with reviewing their reports and making corrections.
For additional information provided by the AMA, visit
http://tinyurl.com/kwjmnh5.
Physicians can still initiate disputes on 2013 data until
December 31, 2014, but it will not be flagged in the public database until 2015. On September 30, CMS will be
publish data including physician specific information.
MSSNY Hosting E-Prescribing
Webinars in Fall for
MSSNY Members
The Medical Society of the State of New York will
host an additional four webinars on “New York State’s
Requirement for E-prescribing of All Substances”
throughout the fall. The webinars are for MSSNY members only. Terence O’Leary, Esq., Bureau Narcotics
Enforcement will be featured. Objectives of the program
are: 1) Describe the e-prescribing mandate, to whom
it applies, when it becomes effective, and how physicians can comply with its requirements. 2) Describe the
practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and
the information required to be provided by physicians
in order to register eRX software with the Bureau of
Narcotics Enforcement. 3) Describe the exceptions to
the e-prescribing mandate and any additional requirements associated with those exceptions. 4) Describe
the application process and criteria for a waiver from
the e-prescribing mandate. 5) Describe what rules pertain to physicians who only prescribe non-controlled
substances.
Webinar dates and times:
• Wednesday, September 24, 2014 7:30-8:30 a.m.
• Wednesday, October 8, 2014 6-7 p.m.
• Wednesday, October 29, 2014 7:30-8:30 a.m.
• Wednesday, November 5, 2014 6-7 p.m.
Physicians must register for the webinars and seating
at each webinar is limited to 94 seats. Physicians may
view the webinar from their home or office. To register for one of these sessions, please visit https://mssny.
webex.com and click on the “Upcoming” tab. Then click
the “Register” link to the right of the date you wish to
select. Please note that the September 9, 2014 webinar
for Advocacy Matters has reached capacity and is no
longer accepting registrations.
“
“If you engage in an unethical
practice...you should be fired.
Period.
”
President Obama, after he signed
VA reform legislation that would give
the VA secretary more power to fire top-level
employees based on their performance
members in the news
Lutheran Medical Center Names
George Fernaine, MD, Chief of Cardiology
MSSNY member George
Fernaine, MD, was recently
named Chief of Cardiology at
Lutheran Medical Center in
Brooklyn. Since joining the hospital in 2007 as an attending
cardiologist, Dr. Fernaine has
served as associate director of
the May Ellen and Gerald Ritter
Cardiology Center, director of
Interventional Cardiology, mediDr. George Fernaine cal director for Cardiac Rehab,
and the cardiology fellowship site
director. In these roles he has successfully developed primary and elective PCI programs at Lutheran.
“It gives me great pleasure to assume this new position,”
Dr. Fernaine said. “Lutheran’s Cardiology department
has seen significant growth and expansion over the last
decade and I am looking forward to building on this solid
foundation while working with Lutheran’s accomplished
cardiologists to ensure continued success and to help bring
Lutheran’s cardiology services to the next level.”
A graduate of Emory University, Dr. Fernaine received
his medical degree from SUNY Health Science Center at
Brooklyn. He completed an interventional cardiovascular
fellowship at Lenox Hill Hospital, as well as a cardiology fellowship and internal medicine residency at Saint
Vincent’s Hospital. He is board certified in internal medicine, interventional cardiology, cardiovascular diseases,
echocardiography and nuclear cardiology.
A member of MSSNY since 2000, Dr. Fernaine is also
a member of the American Medical Association, National
Collegiate EMS Foundation and the American Society of
Echocardiography. He was named an honorary police surgeon by the New York City Police Department in 2010.
Dr. Grace Rabadam Receives Outstanding
Alumnus Award
Grace Rabadam, MD was
named
Most
Outstanding
Alumnus of the Year at the
recent Far Eastern University
Dr. Nicanor Reyes School of
Medicine (FEUDNRSM) Alumni
Foundation convention.
A MSSNY member since 1973,
Dr. Rabadam was awarded the
MSSNY Fifty-Year Citation in
2013 for her many years of dediDr. Grace Rabadam cation and loyalty to medicine.
Following her 1963 medical
school graduation in the Philippines, Dr. Rabadam came
to the U.S. and began a rotating internship at Overlook
Hospital in Summit, NJ. She was chief pediatric resident
at St. Vincent’s Hospital Medical Center in New York City.
After her fellowship, she moved to Long Island and started
a pediatric practice in Patchogue. As an attending physician at Brookhaven Memorial Hospital Medical Center, Dr.
Rabadam served as a member of the medical board, and the
following committees: utilization review, pediatric audit,
home care and infection control.
A diplomate of the American Academy of Pediatrics, fellow of both the American Academy of Pediatrics and the
Suffolk Academy of Medicine, Dr. Rabadam also served
as a member of the boards of both the Suffolk County
Pediatric Society and the Suffolk County Heart Association.
Additionally, she served as th einternational medical graduate liason of the Suffolk County Medical Society.
Should I Stop Attending Drug-Sponsored CME Programs?
Question: I heard recently that the Centers for Medicare
& Medicaid Services (“CMS”) is proposing to eliminate
the CME exception under the Open Payments Program
(the “Sunshine Act”). Does this mean I should stop attending any CME programs sponsored by drug and device
companies?
Answer: There is no immediate need to stop attending such
programs, and there may not be any need to stop attending such programs even if the exclusion is eliminated.
However, the change will require drug and device companies to disclose sponsorship of such events and, very likely,
a list of attendees at any such events, in the same manner in
which they are already required to disclose payments made
directly to physicians for permissible activities. CMS had
previously considered sponsorship of CME programs to be
an exclusion from the reporting requirement with the understanding that there were already enough safeguards in place
within the CME program to protect against the types of
OIG Special Fraud Alert:
Laboratory Payments to
Referring Physicians:
On June 25, 2014, the Office of the Inspector General
of the Department of Health and Human Services
issued a Special Fraud Alert on Laboratory Payments to
Referring Physicians. The Special Fraud Alert addresses
compensation paid by laboratories to referring physicians and physician group practices for blood specimen
collection, processing, and packaging; and for submitting patient data to a registry or database. The OIG has
issued a number of guidance documents and advisory
opinions addressing the subject of remuneration offered
by laboratories to referring physicians that may raise
issues under the Medicare and Medicaid Anti-Kickback
Statute. The new Special Fraud Alert supplements the
prior guidance documents and focuses upon two areas:
(i) blood specimen collection, processing and packaging arrangements and (ii) registry payments. For more
information visit: http://ow.ly/z8ZQ0.
payments the Sunshine Act intended to eliminate. However,
there is new concern that the CME exception has simply
allowed drug and device companies to continue doing the
same things that are prohibited by the Sunshine Act under
the guise of CME sponsorship. CME organizations are
understandably upset about the proposal of such a sudden
change to the Sunshine Act after they have spent well over
a year modifying their programs and procedures to be compliant with the Sunshine Act as it currently stands. There is
also concern that elimination of the exclusion would create a stigma attached to CME programs sponsored, even in
part, by drug and device manufacturers that might discourage physicians from attending such CME programs.
For more information on the Sunshine Act and its current
rules and regulations, visit http://ow.ly/yVfwF.
If you have any questions, please contact our Managing
Partner, Michael J. Schoppmann, Esq at 1-800-445-0954.
CMS Proposes 2015 ASC,
HOPD and Physician Fee Schedules
On July 3, 2014, CMS proposed the 2015 fee schedules for
ambulatory surgical centers, hospital outpatient departments
and physicians. CMS is in the process of establishing new
payment rates for the physician fee schedule that will be more
transparent and allow for greater public input prior to payment
rates being set. CMS is also proposing to include anesthesia
in the definition of colonoscopy screening, so that Medicare
beneficiaries will not be required to pay co-insurance on the
anesthesia portion of the screening.
The proposed rule would also change several of the quality
reporting initiatives associated with the physician fee schedule
and continues to phase in the physician value-based payment
modifier created by the Affordable Care Act, which will affect
payments to physicians and groups based on the quality and
cost of care they furnish to Medicare beneficiaries enrolled in
fee-for-services programs. The adjustment to the ASC schedule
shall be 1.2 percent for 2015. A final rule will be issued on or
around November 1, 2014. For more information visit http://
ow.ly/z90GS and http://ow.ly/z90yl.
Physician DOH Profile: Disciplinary Action if You Fail to Update
The New York Office of Professional Medical Conduct
has announced that it will be taking disciplinary actions
against those physicians who have failed to update their
Physician Profile. Hospital privileges, along with any other mandatory section, must be updated within one month of a change. All
other changes must be made within a year, or within six
months of renewing your registration.
Following are instructions for completing the profile
online, offline and by phone.
Online
If you have a Health Provider Network (HPN) account:
• Go to https://commerce.health.state.ny.us
• After logging in with your User Id and Password, click
on the Physician Profile Survey icon to review and
update the profile information
• You may want to keep a copy of the submitted changes,
at least until the updates are reflected on the internet.
If you are not able to login to the HPN site, please contact
their support line at 1-866-529-1890 for assistance.
If you do not have a Health Provider Network (HPN)
account:
If you would like to request an application on-line, go
to https://hcsteamwork1.health.state.ny.us/pub/top.html to
apply.
Please note this usually takes a couple of days
By Mail
Go to www.nydoctorprofile.com and select “Click here to
search for a physician”:
• Enter your name and last name and click “search”
• After successfully finding your name and selecting it,
click on “Select Items to Print”
• Select “All information about the physician”, then click
“Go to Printer Friendly Page”
Use your computer’s or browser’s dialogue to print out the
document
To update your profile simply write all updates in the margin area.
PLEASE NOTE: When updating your profile, all sections you do not need to change should be noted as “NO
CHANGE” in the margins. To do so, you may write the
words “NO CHANGE” on the margins of the document
Send your updated profile via fax: 917-228-8700 or via
mail to:
New York State Physician Profile
PO Box 5007
New York, NY 10274-5007
Please keep copies of all documents faxed/mailed as well
as the fax confirmation page.
By Phone
Submit your updates verbally by calling 1-888-338-6999.
For more information on updating your Physician Profile,
call Kern Augustine Conroy and Schoppmann, P.C. at
800.445.0954 or visit www.drlaw.com. You may also call the
New York State Physician Profile Help Desk at 1-888-3386998 with any questions regarding your physician profile
and this requirement.
President Obama Signs Bill to
Overhaul VA Healthcare
Over 260 MSSNY Physicians Have
Signed Up to Treat Vets
The Veterans Access, Choice and Accountability
Act of 2014 will allow hospitals to hire more physicians and let veterans use public and private
healthcare providers if they cannot get prompt
appointments at a veterans hospital. The main goals
of the law are: to provide access to care in the private sector for veterans who are not able to secure
an appointment at a VA facility within a prescribed
amount of time or who live more than 40 miles from
a VA facility; to provide for the hiring of additional
physicians, and other practitioners, and acquisition
of additional facilities; and to improve administrative functions throughout the system. The specifics of how the Secretary will negotiate
agreements with private providers will need to be
worked out by the VA in the coming weeks.
Though the conference process proceeded mostly
behind closed doors, the AMA was able to determine that the proposed language left significant
ambiguity as to whether the Secretary would have
the authority to enter into agreements with private
physicians or rather, as the AMA believed, only
hospitals and other facilities. Though leadership
and committee staff assured the AMA that was the
intent, they agreed to insert clarifying language in
the final bill. However, in the rush to finalize the
draft, the necessary language was not included. Because of this oversight, the AMA worked with the
committees of jurisdiction and House and Senate
leadership staff and others, to craft the necessary
language. This language was included in a separate Concurrent Resolution which authorized the
Clerk of the House to make the necessary adjustments to the bill during the enrollment process. The
Concurrent Resolution was passed by unanimous
consent at the same time the underlying legislation
was adopted, therefore ensuring that veterans will
have access to private physicians who wish to participate in this VA program. If a patient presents to a physician’s office with a
Veteran’s Access Choice card, the physician would
need to call the local VA facility to ensure that the
veteran is eligible for non-VA physician care. If
approved, the service would be eligible and the
reimbursement could be negotiated with the VA up
to the maximum of the Medicare participating fee
schedule for covered services. For further information, review the VA Providers’ Guide at http://bit.
ly/1yBkVId.
Sign Up Now
MSSNY will continue to keep you updated, as
specifics are worked out in detail. If you haven’t
already signed up for MSSNY’s Veterans Registry
and would like to do so, please visit http://www.
mssny.org/MSSNY/Veterans/VeteransRegistry.
aspx.
Workers’ Comp Survey Results: Too Much Paperwork, Low Fees, Ti
As part of its efforts to re-engineer the
Workers’ Compensation program and reinvolve more physicians in the WC program,
the Board is looking to convert the WC fee
schedule, in a “revenue-neutral” way, to the RB/
RVS system used by Medicare (with a unique
WC “conversion factor”). The Board is looking to implement this change by April 1, 2015.
This is likely to produce increases for some
physicians and decreases for other physicians.
Since the Board has actively sought MSSNY’s
input into this change, and is required by law to
consult with MSSNY before fee schedules are
changed, we conducted a survey of New York
State Physicians last month in order to assure
these changes are made fairly and will enable
the Board to meet its goal to expand patient
access to timely physician care.
LOWER THE RATES AND I QUIT!
If W/C changes it’s fee schedule as described,
I, like many others, will stop taking W/C
patients.
Orthopaedic Surgery, Great Neck
Unacceptable. There is no basis for fee
decreases. Our overhead and onerous nonfunded mandates (CME, re-certification, etc)
are not decreasing. I will fight strongly to get
my group to drop all workers’ comp if this
goes through I will actively encourage my colleagues not to participate. Enough is enough.
Let’s tie comprehensive medical tort reform to
this issue. MSSNY should be strongly against
this. All MDs should have fee increases.
Orthopedic Surgery, Poughkeepsie
I will definitely drop WC if rates change.
Neurosurgery malpractice starts at 350k in
these counties. No profit margin.
Neurosurgery, Queens
The only reason the difficulties inherent in the
system are tolerated is because of the current
fees being paid. If there is any decrease in
revenue associated with treating WC patients,
then I would stop accepting new WC patients.
Will not be operating or seeing W/C Patients
on the Medicare fee schedule.
Orthopedics, Stony Brook
130% of Medicare not worth the trouble,
honest MDs will avoid it. Only the crooks will
participate, thus increasing costs.
Orthopedic Surgery, Westchester
Changing the fee schedule in this manner
will significantly decrease fees for orthopedic
WC procedures and will result in most of my
colleagues and myself dropping WC patients
altogether.
Orthopedic Surgery, Bronx, Queens
Current payments are barely tolerable.
Tethering to Medicare is unacceptable and our
entire practice would stop seeing medicare
patients. The WC population is very challenging to treat and consume a good deal of office
resources to treat effectively. Tying payment to
Medicare would make it completely not worthwhile to take care of these patients.
Orthopedic Surgery of the Spine, Manhattan
I will drop comp if the rates go to 130% of
medicare rates, is just not worth the hassle.
Orthopedics, Middletown
Hand Surgery, Great Neck
Workers’ Comp patients are much more
demanding than Medicare and other private
payors in terms of the time spent providing
care and documenting. Additionally, there are
multiple forms and reports that have to be filed
with the carrier, the board, the workers comp
attorney and then usually with the defense
attorney; which are invariably followed by
denials and hearings and depositions. It takes
3x as much time and effort to provide care to a
workers’ comp patient. The Board has already
eroded the quality of care provided to injured
workers in NY with endless red tape and
medical treatment guidelines and a significant reduction in the fee schedule. 130% of
Medicare will further deter doctors in NY from
accepting workers comp patients. I definitely
would stop accepting them. Not worth all the
hassle and paperwork. 30% of the time a
doctor doesn’t get paid anyway by W/C so this
would basically be the same as Medicare fees
for triple the work. No thanks.
These are most challenging and difficult
patients to treat. Routinely cancel or don’t
show up for surgery or routine office visits
unless it suits their purpose. Fees presently are
too low. Carriers routinely don’t respect the
fee schedule or the Medical Guidelines.....very
cumbersome system weighted against the
physician. Much worse now than before the
system was “reformed.” Lowering the fees will
lead me to reconsider participating in W/C.
Neurology, Manhattan
The surgical fee schedule is about the only
incentive to continue to accept Workers’
Compensation patients. Should the fee schedule be decreased, I definitely would reconsider
accepting Workers’ Comp patients. Too much
paperwork hassle to make it worth my while.
Orthopaedic Surgery, Rochester
The proposed fee schedule would make
it economically impossible to care for WC
patients.
Orthopedics, New York
Orthopedics, Buffalo
If you reduce the fees to Medicare based fee
schedule I will immediately withdraw from
W/C. I think this will be what happens virtually across the board if this happens. They
need to start paying like in NJ and Illinois.
These are time consuming , labor intensive,
paperwork intensive patients. If the fees are
lowered to 130% of Medicare, I know at least
100 physicians who participate with W/C who
will withdraw immediately. Count me as one of
them.
Orthopedics, Manhattan
I will stop seeing Workers’ Comp if the fee
schedule decreases. It is not worth the administrative burden.
Orthopedic Surgery, Bronx
If the fee schedule is reduced for orthoepedics, I will no longer accept WC patients
and will consider leaving NYS.
Orthopedics, White Plains
If the comp fee schedule becomes like the
Medicare fee schedule, then comp work will
suffer. Why deal with the hassles for those
kinds of fees. Medicare at least pays promptly,
no hassle. Why wait two years for a medicare
fee from comp. I will drop out of comp if the
fees are reduced for orthopedic surgery.
Orthopedics, Great Neck
PAPERWORK AND POOR
COMPENSATION
All of the general internists and family docs in
CNY quit compensation due to the paperwork
and poor compensation. So we now have a
system staffed by surgeons and proceduralists that do not provide comprehensive care.
So the system generates a lot of surgery and
patient frustration. Bringing primary care back
into the mix will reduce cost and improve
outcomes.
Family Medicine, Syracuse
Workers’ Comp doesn’t pay. Takes too much
time to do paperwork.
Internal Medicine, Flushing
The most frustrating aspect of all this: I treat
the patient in good faith, knowing that few dermatologists will see him, and then I get the run
around for months until a claim is processed.
At least 50% of the time the insurer comes up
with some reason to deny the claim.
Dermatology, Hewlett
Even if the fees are increased, we will not take
W/C because of the paperwork, poor payment histories by carriers and need to testify
sometimes in hearings. All of these are too
burdensome and make it prohibitive to take
W/C.
Dermatology, Albany County
Too much paperwork. Fees are usually better
than Medicare.
Plastic Surgery, New York
Paperwork and rules are arcane and only
worthwhile if you have a large volume. As a
PCP, not being able to offer services for WC
(or NF) for my own patients stinks.
Medicine, New Hyde Park
Patients are being denied the care they need
already since the W/C guidelines changed. If
doctor fees are reduced, the already frustrated
physicians will stop seeing W/C patients. The
amount of time it takes to do the paperwork
and spend comforting the frustrated patients
will not be cost effective.
Pain Management/Anesthesiology,
East Patchogue
Such a change would adversely affect neurologists, and because of the admin burden and
payment processing problems, drastically
reduce access.
Neurology, Tarrytown
Workers’ Comp reimbursements are really
deplorable. Look up some of the codes for
reimbursement i.e repair of extensor tendons
of the hand. Are you kidding? These are working people’s hands we are talking about. The
fee schedule is antiquated. Get a clue, W/C
board. Go look at states like MA and see what
their W/C cases reimburse.
Orthopaedic & Hand Surgery, Huntington
Often quite time consuming and difficult to
process claims.
Dermatology, Brooklyn
We tolerate WC paperwork and low office-visit
payments because the surgical fees are so
much higher than commercial rates. If I only
got paid commercial rates, I might give it up
because the paperwork really taxes my office
staff.
Orthopaedic Surgery, Rochester
The biggest obstacle is the constant denials
and paperwork that treating doctors have to
go through and the denials that make scheduling very challenging.
Orthopedics, Patchogue
Paid too little for office visits. Way too much
paper work. Not sure if it’s worth my time.
Guidelines are too subjective to show improving with PT.
Orthopedic Surgery, White Plains
Paper work is onerous.
Ortho, White Plains
Workers’ Comp is low paying, slow to pay and
fraught with ridiculous amounts of paperwork.
I have recently stopped seeing Workers Comp
patients.
Internal Medicine, West Islip
The system is so old and needs to be updated.
The reimbursement is terrible. As an orthopedist you almost have to take work comp. The
patients are difficult. The insurance carriers
are difficult to work with. Too much paperwork
for too little reimbursement. Make it worth our
time to do this work. Motivate the patients
to get back to work. Why does it take a bad
ankle sprain in a non-work comp patient a few
days to get back to work and the same type of
patient who is a workers comp patient takes
3-4 months to go back!!!!
Orthopedic Surgery, New York
I STOPPED TAKING WORKERS
COMPENSATION BECAUSE…
We don’t take it anymore because it is too
much of a hassle.
Rheumatology, New York
The real problem is that workers (patients) cannot get the care they need in a timely manner
as WC does not promptly approve services.
That is why I withdrew form WC.
Family Medicine, Groton
We were par with Workers’ Compensation
until our billing department made us aware
of a rule that said we could be fined if we did
not take new cases. We were already having
difficulty with the documentation requirements. So we resigned. I would add that there
are a lot of docs who are willing to follow their
ime-Consuming, Too Many Hassles and Patients are Labor Intensive
not justify the extra hassel. Also the paperwork sent to every physician involved in care
is excessive as is the constant need to justify
everything you are doing in your efforts to care
for these patients.
PM&R, Cooperstown
INSURERS AND LAWYERS ARE THE
PROBLEM
Need sanctions to insure timely payment of
claims. Some carriers are notorious in defying
the guidelines for timely payment.
Psychiatry, Huntington
The paperwork allows the carriers to deny
and delay payments. If the guidelines are
changed, experts in numerous fields need to
be involved, not just occupational health.
Pain Management, Clifton Park
Carriers are looking for any loophole not to
pay legitimately injured workers. The system is
confusing for patients which results in delays.
Timely filing should be a year, like Medicare.
Of course most claims would be filed sooner
but some cases just need more time to file.
Internal Medicine, Lancaster
own patients but not take new cases. I regret
that my patients are having difficulty finding new comp docs despite what the board
says. Additionally, the independent medical
exam is at best a bad joke. Time after time I
have seen patient benefits summarily reduced
based upon a 10-15 minute exam resulting in
hours of uncompensated paperwork to appeal
these decisions. Why would anyone want to
participate in this kind of system regardless of
what they pay?
Internal Medicine, Buffalo
Dropped W/C due to losing money from participation. Need to significantly raise fees and
get rid of prior authorizations.
Family Practice, Syracuse
When the new guidelines and reporting
requirements take effect 2015, I will be dropping Workers’ Comp.
Family Practice, New York
I stopped taking W/C cases because 50% of
the time I would not get paid and the procedures to navigate the program were too
onerous and not worth my time.
Neurology, New York
As a primary care doctor I stopped doing WC
for three reasons – paperwork, inability to get
tests authorized and releasing someone’s
entire medical record for a Workers’ Comp
claim (including STD testing, drug use, etc).
Family Medicine, Syracuse
Have not been in the system for years and
continue to enjoy the benefits.
Family Medicine, Stony Brook
I do not feel qualified to determine disability
so I am stopping doing this work. For many
patients it is their only means of getting health
insurance, hopefully this will change. It is dificult to ignore their other health problems while
doing WC.
Family Practice
Years ago, when I realized that there was
a moratorium on payments to urologists, I
stopped seeing these patients. The State was
basically making me see these patients for
free.
Urology, Manhattan and Lawrence
WC has failed to pay me as an “outsider”
on numerous occasions. I do not participate
because of that. If I was assured honest payment in a reasonable time, I would take these
patients.
Psychiatry, Great Neck
Have no interest except in the few patients I
now see.
Psychiatry, Buffalo
Board treated me disdainfully when I asked for
help. Resigned. We should be treated as if
we are providing value.
Family Medicine, Manlius
WORKERS’ COMPENSATION PATIENTS
NEED A LOT OF ATTENTION!
Work Comp patients require much more time
and energy to take care of for providers looking to provide appropriate and ethical care.
New York Workers’ Comp should model itself
like Illinois and New Jersey Workers’ Comp
where reimbursement is higher and providers who provide evidence based medicine
and have the best outcomes preferentially are
referred patients.
Orthopaedic Surgery, Manhattan
I reluctantly take Workers’ Comp out of compassion for these patients, but it takes as much
time in a week (or more) to deal with four workers comp patients/week, than it does to attend
to 30+ Medicare visits.
Physical Medicine and Rehabilitation,
Riverdale in Bronx County, and Manhattan
These are very time consuming patients and
physicians should therefore be reimbursed
appropriately.
Neurology, Jericho
The care of Workers’ Compensation patients
carries an enormous administrative burden which is much higher than non worker
compensation patients. In my opinion, if the
fee schedule was 130% of Medicare, fewer
doctors would be able to care for worker compensation patients because they would not
reimburse adequately to cover the increased
time/administrative costs of that care.
Orthopedic Surgery, Lake Placid
Workers’ Comp is an enormous burden, both
administratively and clinically. In a significant
majority of cases, patients are difficult, noncompliant, and primarily motivated to game
the system. Fees need to be increased, and
patients / workers need to be educated that
the physician is bound by legal guidelines
regarding return to work, disability percentages, SLOU, etc.
Orthopedic Surgery, Syracuse
Workers’ Compensation patients are difficult
patients to care for. They require more time
and effort with regard to managing them as
patients as well as the significant amount of
paperwork. In addition, their motivation for
a good outcome is predicated most significantly on their job satisfaction rather than their
result from surgery. If fees are decreased they
will immediately become more undesirable
patients to manage. I and our large group
practice will immediately decrease our W/C
patient numbers.
Orthopedic Surgery, Great Neck
Treating Workers’ Comp patients is onerous
and not cost effective. It must be improved. In
other states, physicians who perform in-office
procedures (and therefore keep patients out
of the OR) are able to charge the facility fee
to make this possible. It saves the Workers’
Comp system the cost of anesthesia and
makes the cases more cost effective for the
physician.
Plastic/Hand Surgery, Harrison
Taking care of a Workers’ Compensation
patient is far more time consuming than a
non-W/C patient so the reimbursement should
be higher.
Plastic Surgery, Rye Brook
WC patients are the most labor intensive
patients in our practice. They require three
full time employees just for the paperwork
and billing. This is not including the Doctors’
time involved in the paperwork. The comp
depositions are becoming more and more
frequent and in the depositions, the Doctors
refer to the chart for all their answers; the same
charts sent to the carrier and the board. Why
can’t they just send specific questions if they
are unable to make a judgment based on the
information already sent to them in the chart?
With reimbursement being cut for many of the
procedures it will not be fiscally possible to
see the amount of patients we see now. This
would be a great loss to the people in our area
because we treat the patients with respect and
in a caring way. As you know getting comp
patients back to work can be a chore in itself,
but we do it on a timely basis and the patients
don’t argue it because we have the information
to back up our decision and they respect that.
Orthopaedic Surgery, Spine Surgery,
Hamilton/Madison
The Workers’ Compensation process is onerous. These are often among the most difficult
patients to treat. Tying the fee schedule to
Medicare is questionable as the Medicare fee
schedule often bearly covers the cost of doing
business, so the increased fee differential does
Adjusters do not follow Judge’s decisions,
repeatedly delay approving treatments
and medication, causing patient to go into
withdrawal; return appropriately filled forms
stipulating there was an error in order to
delay the process in the hope someone will
forget; adjusters never answer the phone
and messages have to be left again delaying
the process and causing aggravation
in the office.
Anesthesia/Pain, Williamsville
As long as they can pass it on to a thirdparty admin so they can continue to pay
God-awful low rates (lower than the fee
schedule), you won’t get more participation.
The long waits (years) must end, too, for
payment (USPS).
Family Medicine, Fulton
The hassles, delaying and reducing payments,
are a major problem. The insurers place
obstacles in the way of treatment and payment, deny medications and prevent changes
in medications, when necessary because of
problems, side effects, etc. Everything must
be approved by idiots, preventing or delaying
treatment.
Psychiatry, North Salem
Most carriers use third party administrators
who are essentially immune from regulation
and can not be ordered to pay claims even by
the courts.
Psychiatry, New York
Insurers insist on language which is not common to EHRs.
Family Medicine, Bronx
There needs to be a level playing field with
no PPO, HMO or secret unknown deductions by carriers. Just like med mal expert
witnesses, the IME doctors have to be held
accountable for their reports and not “work”
for the carrier.
Orthopedic Surgery, Parkchester
The system is functioning as if the law to
protect injured workers is in fact to favor the
reluctance of the insurance carriers not to live
up to their mandate.
Psychiatry, New York
The problem I have is the layer of adversarial
activity with lawyers quibbling over who will
pay, and hammering the doctor’s opinion
and suspecting the patient as a scammer.
There are so many other administrative burdens with ACA HC reform, who would want
to take on WC patients and the complexity
to get paid in this environment. Make the
experience blind to the patient and physician
Workers’ Comp Survey Results
(Continued from page 9)
in the beginning--allow injured patients to use their existing
coverage so they don’t delay the care they need. Then if their
are quibbles, let the insurance carriers fight it out all they want
between themselves.
Psychiatry, Rochester
There is a lot of time spent responding to lawyers and sorting out
whether visits are covered by workers comp, other insurance or
not at all.
Otolaryngology, Huntington
My practice is obliged to take WC partly because the other
groups do, partly because NO ONE else does around here at
all. The additional issues are inconsistency and lack of approvals / delays in approvals for clearly needed services. We’ll be
told to fill out incorrect forms, duplicate forms. Things that are
in the guidelines are not covered immediately as they should
be. The paperwork is CONFUSING and COMPLICATED. I use
the guidelines constantly and still feel like I don’t get it. Terrible
system. WHY DO ALL THE PATIENTS NEED LAWYERS TO
GET ANYTHING APPROVED???? It’s a SHAM to make more
money for LAWYERS on BOTH ends. Why is there 30 days to
respond for things that need to be done right away?? That’s not
fair to the patients. Physicians do not like to have their hands
tied for patient treatment, I apologize to every W/C patient I see
because their situation is unfair.
otherwise. What is particularly frustrating for treating
physcians is that the carrier can appeal any decision they
don’t like and stop coverage for medication and treatment
unilaterally and in many instances capriciously. Their ability
to do this places patient health and safety potentially at
risk, as abrupt withdrawl of certain medications can have
Neurology, Albany serious ramifications, and yet they assume no liabiltiy. The
system needs to be modified such that lawyers and carriThe carriers are increasingly ignoring/subverting the mediers are not given such latitude; that they are effectively left
cal treatment guidelines by getting IME’s to deny care when
unchecked. A more organized review process is needed
it’s approved in the guidelines. The board should educate the
and the current telephone deposition system needs to
carriers that the guidelines cannot be overturned by an IME,
be converted from once again an adversarial system to a
as it only delays patient care and frustrates the purpose of the
guidelines, which is to return the injured worker to employment more education based system. Lawyers and the insurance carrier need to understand the rational for treatment.
in a timely fashion.
Orthopedic Surgery, Poughkeepsie Unfortunately many of the IME physicians and WCB
regulations are hopelessly out of date and as such the
The current system as designed has a fatal flaw. It is an adversar- IME physician’s opinions many times are incorrect at best,
ial system, as it is lawyer and insurance carrier driven. Its default
and potentially dangerous or counter productive espemode is to assume that the treating physician is wrong till proven cially when it comes to such things as opinions regarding
otherwise and that the IME physician is correct until proven
utilization of certain classes of medications, particularly
neuromodulators. I realize that these comments are rather
scathing. They are not meant to be a condemnation of
the system, but rather an opportunity to reach across to
the other side to hopefully facilitate constructive change
and improvement. In the end the system only works if the
patient gets treated and offered the best chance to get
back to work.
PM&R, Albany
If a case is open when we see a patient we have to get
paid for those visits. Insurance carriers should not be
allowed to retroactively not pay us. IME fees = treating
physician fees. We have a system of medical whores (i.e.,
if you pay them enough they will tell you and do anything
you want.)
PMR, Williamsville
These patients get such bad care since the carriers do not
care about their workers.
I’m happy with the New York State Insurance Fund
and with private carriers, but, the New York City Law
Department is horrible. It’s almost as if they are trying to
impede our ability as physicians to care for injured workers. Upon further reflection, however, it seems like that
would take some effort and they appear to adhere to a
policy of avoid & neglect and effort seems beyond what
they are capable of. It is an entirely new level of incompetence mixed with indifference.
Hand Surgery, Astoria
Medicare RBVS is already flawed. Everyone knows it.
Insurance companies use it to lower reimbursement to
physicians. A more reasonable benchmark should be a
percentage of fairhealthconsumer.org fees.
SYSTEM IS ONEROUS, ARCANE
AND ADVERSARIAL
Workers AND doctors deserve much better.
Family Medicine, Rochester
Guidelines, skipping payments of visits, not paying after
authorizing treatments, delaying treatment after positive
test results are known, asking for forms like MG-2 to get
treatment when it is clearly written in my narrative office
and then not allowing it if my office forgets to file the
MG-2, disruptive PT visits – they authorize 12 but must be
done within one month or the ones not used can not be
used, etc. etc..
Orthopedic Surgery, Lynbrook
The system is so tough it precludes much treatment.
PMR,White Plains
Medical Guidelines are nonsense; determination of disability is not based on fact and is an alphabet soup! The
forms, C4 and the like are complete wastes of time as
all of the information is contained in submitted narratives
- why do triple work - willing to assist in any way I can thank you.
Neurology, Yonkers
I find the system onerous, arcane and adversarial as it
currently exists.
Family Medicine, Owego
We have a lot of problems with specialists refusing to
perform procedures without written approval from carriers and carriers refusing to provide such, stating that
these are not necessary and thus won’t be provided. This
AG Settles with Emblem Health Re
Mental Health Parity Law Violations
51 Statistics On How Income Impacts Physicians in 2014
by Sheri Sorrell and Keith Jennings, June 17, 2014
Each year, Jackson Healthcare studies trends impacting
physicians’ careers and medical practices.
We hope this information helps physicians make more
informed, strategic decisions in their career and practice. And
we hope these statistics help healthcare executives, industry
thought leaders and media professionals better understand the
attitudes, challenges and opportunities physicians face.
Physicians whose INCOME DECREASED in the past year
are more likely than those whose income increased to:
There were a number of statistically significant (and interesting) findings in our 2014 study.
In this piece, we highlight 51 statistics that emerged from
our look at physicians reporting compensation increases (12
percent of participants) versus those reporting a decrease in
compensation (45 percent of participants) from 2013 to 2014.
We will not look at trends related to the 43 percent who
reported no change in income.
Billing & Collections
1. Be age 45+ (85 percent of those whose income has decreased
vs. 72 percent of those whose income has increased)
2. Own / retain an ownership stake in a single specialty practice
(23 percent vs. 11 percent)
3. Internal medicine subspecialists (21 percent vs. 12 percent)
4. Anesthesiologists (8 percent vs. 1 percent)
30. Say billing and collections from Medicaid does not apply to
their practice (40 percent vs. 29 percent)
31. Say billing and collections from Medicare does not apply to
32. Say billing and collections from insurance companies does
not apply to their practice (28 percent vs. 12 percent)
33. Say billing and collections from patients does not apply to
Billing & Collections
Patients
Demographics
5. Say billing and collections from insurance companies over
the last year has been more difficult (62 percent vs. 38 percent)
6. Say billing and collections from patients over the last year
has been more difficult (61 percent vs. 34 percent)
7. Say billing and collections from Medicare over the last year
8. Say billing and collections from Medicaid over the last year
Patients
9. Say their patients are delaying services, procedures, electives, etc. (77 percent vs. 49 percent)
10. Say their patients have become more cost-conscious over
the last year (73 percent vs. 59 percent)
11. Say their patients are doing more cost-comparative shopping for medical services (54 percent vs. 39 percent)
Workload & Career Outlook
12. Say they will not remain in private practice because the
overhead costs are too high (76 percent vs. 0 percent)
13. Say they do not have partnerships with insurers, hospitals
and local companies to provide care to their patients and the community (69 percent vs. 59 percent)
14. Say they are unlikely to encourage a young person to enter
the field (61 percent vs. 31 percent)
15. Say they do not use Advanced Practice Professionals (48
percent vs. 37 percent)
16. Say they are dissatisfied with the practice of medicine (43
17. Say they schedule less surgical procedures on a surgery day
this year vs. last (40 percent vs. 10 percent)
18. Say the outlook for a career in medicine in 2014 is generally
negative (40 percent vs. 14 percent)
19. Say the number of patients they see in an office day has
decreased (39 percent)
20. Say they are strongly considering leaving the practice of
medicine or retiring (14 percent vs. 4 percent)
21. Say they have made the decision to practice medicine parttime or on assignment. Slowing down, not completely leaving (11
Payor Mix
22. Say they are not accepting new Medicare patients because
of low / declining reimbursements (73 percent vs. 31 percent)
23. Have a higher percentage of Medicare patients in their practice (31 percent of their practice make-up vs. 25 percent)
Affordable Care Act
24. Say they have lost patients who have lost their insurance or
had their policies canceled as the ACA has been implemented (35
25. Say they are not planning to participate as providers on the
health insurance exchanges (27 percent vs. 19 percent)
26. Say they’ve lost patients as the ACA has been implemented
because they no longer accept their insurance (21 percent vs. 9
percent)
Physicians whose INCOME INCREASED in the past year
are more likely than those whose income decreased to:
Demographics
27. Be younger than 45 (28 percent of those who say their
income has increased vs. 15 percent of those who say it has
decreased)
28. Specialize in behavioral health (13 percent vs. 4 percent)
29. Specialize in hospital based medicine (10 percent vs. 5 percent)
34. Say their patients have not been doing more cost-comparative shopping (62 percent vs. 46 percent)
35. Say their patients have not been delaying services, procedures, electives (51 percent vs. 24 percent)
36. Say their patients have not become more cost-conscious
over the past year (41 percent vs. 27 percent)
Workload & Career Outlook
37. Say they will definitely be practicing medicine in 2014 (91
38. Say the outlook for a career in medicine in 2014 is generally
favorable (45 percent vs. 14 percent)
39. Say they are very satisfied with their careers in medicine (45
40. Say the number of patients they see in an office visit during
the past year has increased (43 percent vs. 20 percent)
41. Say they chose hospital employment over private practice
because they wanted to be doctors, not business people (41 percent vs. 17 percent)
42. Say they use nurse practitioners (41 percent vs. 31 percent)
43. Say they have partnerships in place with insurers, hospitals
and local companies to provide care to their patients (41 percent
vs. 32 percent)
44. Say they use physician assistants (40 percent vs. 28 percent)
45. Say they are very likely to recommend a career in the field
to a young person (35 percent vs. 11 percent)
46. Say they see/care for/round on more patients in a single hospital shift (33 percent vs. 17 percent)
47. Say they work 8 hours a day (26 percent vs. 16 percent)
48. Be a hospital employee (26 percent vs. 12 percent)
49. Say they use foreign medical graduates (16 percent vs. 6
percent)
Affordable Care Act
50. Say they are planning to participate as a provider in the
health insurance exchanges (59 percent vs. 49 percent)
51. Say that as the ACA has been implemented that they
have added patients who have obtained insurance through the
exchanges (26 percent vs. 16 percent) or to say they have had had
no changes to their patient panels (59 percent vs. 45 percent)
Final Thoughts
While this list contains some obvious statistics (naturally physicians with increasing income are more likely to be satisfied with
their careers than those whose income is decreasing) it also contains statistics that align with broader trends seen in other Jackson
Healthcare and industry research.
With the shift from private practice ownership to employment
continuing throughout the U.S., the impacts of decreasing reimbursements, billing & collection hassles and lifestyle choices are
apparent throughout these 51 statistics.
You May Also Enjoy Reading:
51 Statistics on Satisfied and Dissatisfied Physicians
Survey Methodology
A total of 1,527 physicians completed this survey, which was
conducted between April 18 and June 5, 2014. The error range for
this survey was +/- 2.5 percent at a 95 percent confidence level.
Invitations for Jackson Healthcare’s surveys are emailed to
subsets of a database, which include physicians who have been
placed by Jackson Healthcare’s staffing companies and those who
have not.
Respondents to all surveys were self-selected and spanned all
50 states and medical/surgical specialties.
See more at: http://bit.ly/1sJ9fok.
In July, New York Attorney General Eric Schneiderman
announced a settlement with Emblem requiring the health
insurer to reform its behavioral health claims review process, cover residential treatment and charge the lower,
primary care co-payment for outpatient visits to mental health and substance abuse treatment providers. The
settlement also requires Emblem to submit previously
denied mental health and substance abuse treatment
claims for independent review.
The settlement arose out of an investigation by the
AG’s Health Care Bureau that found that since at least
2011, EmblemHealth, through its behavioral health subcontractor, Value Options, issued 64% more denials of
coverage in behavioral health cases than in medical cases.
Moreover, the plan denied 36% of its members’ claims
for inpatient psychiatric treatment and 41% of its members’ claims for inpatient substance abuse treatment. To
read more about the settlement, visit http://www.ag.ny.
gov/press-release/ag-schneiderman-announces-settlement-emblem-health-wrongly-denying-mental-health.
“Our mental health parity laws were enacted to ensure
that New Yorkers have adequate access to mental health
and substance abuse treatment,” Attorney General
Schneiderman said. “Insurers must comply with the
laws – and they must treat people with mental health and
substance abuse conditions as they do those with medical conditions. Under this settlement, improved services
will be available to the millions of New Yorkers who are
members of EmblemHealth plans. My office will make
sure that everyone, including big insurance companies,
play by the rules.”
New York’s mental health parity law, known as
Timothy’s Law, was enacted in New York in 2006, and
requires that insurers provide mental health coverage at
least equal to coverage provided for other health conditions. The federal Mental Health Parity and Addiction
Equity Act, enacted in 2008, prohibits health plans from
imposing greater financial requirements or treatment
limitations on mental health or substance use disorder
benefits than on medical or surgical benefits.
Settlement Requires Independent
Review of Denials
The settlement requires EmblemHealth to provide
members with an independent review of claims or
requests that were denied as not medically necessary
going back to 2011, and to reimburse members for residential treatment costs that the plan did not pay due to its
exclusion of coverage for this service. Members will be
notified by Emblem of their eligibility for this independent review. In total, this could result in more than $31
million in reimbursement to more than 15,000 members.
Emblem will also submit to monitoring by an external
entity, will file an annual parity compliance report and
will pay $1.2 million to the OAG as a civil penalty.
The settlement states that EmblemHealth has agreed to
overhaul its claims review process by:
• Removing visit limits for almost all behavioral health
services;
• Classifying claims correctly so that reviews are done
expeditiously and members are afforded full appeal
right;
• Removing the requirement that members “fail” outpatient substance abuse treatment before receiving
inpatient rehabilitation treatment;
• Basing the number of treatment days or visits
approved on members’ needs rather than arbitrary
limits;
• Integrating medical and behavioral health claims
review staff, which will facilitate the coordination of
members’ care;
• Ensuring that letters denying behavioral health claims
are accurate and specific, so that members and providers understand the reasons for the plan’s denials,
and can exercise their appeal rights;
• Continuing coverage of treatment pending the completion of appeals, so that treatment is not interrupted;
• Only charge members the lower, primary care copayment for members’ outpatient visits to behavioral
health professionals; and
• Appoint full-time behavioral health advocates to help
to provide information regarding claims review and
treatment options.
MSSNY Past-President Dr. Robert B. Goldberg Honored at Workers’ Compensation Centennial Conference
MSSNY
Past-President
Robert B. Goldberg, DO
was awarded the Dr. Stephen
Levin Award for “significant
achievement in the care and
treatment of injured workers”
at the Centennial Conference
of the New York State
Workers’
Compensation
Board on July 15.
“Throughout my experience, nothing has been more
challenging to navigate than
Dr. Robert B. Goldberg
the workers’ compensation
system,” said Dr. Goldberg.
“And as hard as it is for doctors, it can be impossible for
patients. Rather than continue to gripe, I decided to try to fix
it – and I have been working on it with MSSNY and others
for over 20 years. It’s gratifying to see the results of these
efforts.”
Dr. Goldberg has been a tireless advocate on these issues
for both patients and physicians in New York State. “After
40 years of complaints, the board convened a task force to
develop Medical Treatment Guidelines (MTG) to expedite
patient access to care and reduce the burden on physicians,”
said Regina McNally, MSSNY’s Vice President, SocioMedical Economics. “Although a number of MSSNY
members are disheartened by the added burden of MTGs, if
it wasn’t for Dr. Goldberg’s altruism towards all affected specialties, the board’s treatment guidelines would have been far
more onerous.”
“Dr. Goldberg has demonstrated the highest levels of commitment to assuring that his patients and, indeed, all injured workers
throughout New York are able to receive the timely needed
care they deserve,” said Moe Auster, MSSNY’s Vice President,
Legislative and Regulatory Affairs. “His ability to work cooperatively with all interested parties in Workers Compensation
– organized labor, lawyers, employers and insurers – has been
tremendously helpful to MSSNY’s advocacy efforts on behalf of
its physicians and the patients they treat.”
In 2013, Dr. Goldberg was elected Vice Chairman of
MSSNY’s Board of Trustees, and served as MSSNY’s
President from 2007-08. He has been a member of MSSNY’s
AMA delegation since 2009 and currently serves as delegation chair.
Dr. Goldberg is dean of the Touro College of Osteopathic
Medicine in New York City. He previously served as the
first Associate Dean for Community Medical Affairs and
Advocacy for Touro.
A graduate of Rutgers College, Dr. Goldberg earned his DO
degree at the Philadelphia College of Osteopathic Medicine
in Philadelphia, where he also completed his internship.
He completed his residency in Physical Medicine and
Rehabilitation Medicine at St. Vincent’s Hospital and
Medical Center in New York City. He has been a medical
educator for over twenty years, training medical students,
interns and residents. He was recently honored by MSSNY’s
Medical Students Section with the Charles D. Sherman, M.D.
award for extraordinary assistance, availability and support
provided to medical students.
Dr. Goldberg has received numerous honors for his participation in the reform of workers’ compensation in New York
State, including the Clara Lemlich Public Service Award.
He received a citation from Governor George Pataki for his
efforts in forging alliances with consumer groups, legal organizations and other medical associations on behalf of medical
coverage for the underserved. In 2008, he received a citation
from Governor David Paterson acknowledging his dedication to the advancement of medicine and the improvement
of Healthcare.
Recently chosen as a “New York Super Doctor” by the New
York Times, Dr. Goldberg has also been selected numerous
times as one of the “Best Doctors in New York” by New York
Magazine.
For Your Patients
Elderly Pharmaceutical Coverage
Program Is Expanded to
Cover More Seniors
The New York State 2014-15 budget included the
expansion of the Elderly Pharmaceutical Insurance
Coverage Program (EPIC) to cover the prescription
needs of more seniors. Eligible income brackets were
expanded from $35,000 to $75,000 for singles and
from $50,000 to $100,000 for married couples.
EPIC has two plans based on income. The Fee Plan
is for members with income up to $20,000 if single or
$26,000 if married. The Deductible Plan is for members with incomes ranging from $20,001 to $75,000 if
single or $26,001 to $100,000 if married.
The new income brackets will be added to existing
ones and current EPIC members will not be impacted.
EPIC income is based on the previous income year and
does continue to include the reporting of net Social
Security Income. Seniors must also be a NYS resident,
65 or older and be enrolled or eligible to enroll in a
Medicare Part D drug plan and not be receiving full
Medicaid benefits.
EPIC provides secondary prescription coverage for
Medicare Part D and EPIC covered drugs after any
Medicare Part D deductible is met. By using EPIC
together with Medicare Part D, members save more
money on the cost of their prescription drugs.
Less Expensive for Many Seniors
For many seniors, it is less expensive to enroll in
EPIC and Medicare Part D than just Medicare Part D
alone. EPIC pays the Part D drug plan premiums up to
$37.23 per month in 2014 for members with income up
to $23,000 single or $29,000 married. Higher income
members are responsible for paying their Medicare
Part D premiums but will receive Part D assistance in
the form of reduced EPIC deductibles.
Seniors may apply for EPIC at any time during
the year even if they do not have a Medicare Part D
Plan. Enrolling in EPIC will provide eligible seniors
a Special Enrollment Period from Medicare allowing
them to join a Medicare Part D drug plan or switch to
another Medicare Part D plan outside of their Open
Enrollment Period.
For an application or more information, call the
toll-free EPIC Helpline at 1-800-332-3742 Monday
through Friday from 8:30 AM to 5:00 PM or visit the
EPIC website at www.health.ny.gov and click on EPIC
for Seniors on the left side of the page.
“IMMUNIZE NY”
York State Department of Health. The Affordable
Care Act’s prevention provisions now cover vaccines
that are recommended by the Advisory Committee on
Immunization Practices (ACIP) with no co-payments
or other cost-sharing requirements when those services are delivered by an in-network provider. “The
prevention effort being put forth by the Affordable
Health Care Act will make it easier for patients to be
vaccinated,” said Dr. Sweeney. “The absence of cost is
really an important factor for people to be vaccinated.
I think there will be an increased demand if we all do
a good enough job.”
The Affordable Care Act has brought both awareness
and access to vaccines. “It focuses on adult vaccination
in a way that we haven’t really talked about before. Most
of the time we talk about childhood vaccination schedules and adults are sometimes not addressed in the same
way,” said Dr. Valenti. “I think this puts the focus on
adult vaccination,” said Dr. Valenti.
Although easily prevented through vaccine,
seasonal flu continues to cause serious health complications each year. “Every year in the U.S., on average,
5% to 20% of the population gets the flu, more than
200,000 people are hospitalized from complications and, about 23,500 people die from seasonal flu.
In some years, there are as many as 48,000 deaths,”
said Lawrence Eisenstein, MD, FACP, director of the
Disease Control Committee of the New York State
Association of County Health Officials (NYSACHO)
and Commissioner of Health in Nassau County. OIG’s List of Excluded Individuals/Entities
Question: I recently received a notice that a third party
payor is going to begin requiring me to periodically
perform a check of the Office of the Inspector General’s
(“OIG”) List of Excluded Individuals and Entities
(“LEIE”). Is this really necessary?
Answer: Yes – regardless of any third party requirement,
it is important that all physicians and medical practices
perform regular periodic reviews of the OIG’s LEIE. The
LEIE provides information to the health care industry
and public regarding individuals and entities currently
excluded from participation in Medicare, Medicaid and
all other Federal health care programs. The effect of an
exclusion is that no payment will be made by any Federal
health care program for any items or services furnished,
ordered or prescribed by an excluded individual or entity.
No program payment will be made for anything that an
excluded person furnishes, orders, or prescribes. This payment prohibition applies to the excluded person, anyone
who employs or contracts with the excluded person, and
any hospital or other provider for which the excluded person provides services. The exclusion applies regardless of
who submits the claims and applies to all administrative
and management services furnished by the excluded person. A medical practice or other health care provider that
employs or enters into contracts with excluded persons to
provide items or services under Federal health care programs may be subject to civil monetary penalties.
For information on the LEIE, go to the OIG website
http://ow.ly/AeXec. Also, see the OIG Special Advisory
Bulletin on the Effect of Exclusion from Participation in
Federal Health Care Programs http://ow.ly/AeXr8. The
NYS Office of the Medical Inspector General (OMIG)
website provides a list of Medicaid program terminations
and exclusions http://ow.ly/AeXZv.
If you have any questions, please contact our Managing
Partner, Michael J. Schoppmann, Esq at 1-800-445-0954
or via email at [email protected].
Pertussis on the Rise, Too
Vaccines have brought a dramatic reduction of
new cases of infectious diseases and their devastating effect over the last 100 years. However, vaccine
preventable diseases, such as measles, mumps, and
whooping cough are on the rise in this country due
to lack of immunization. “Whooping cough or pertussis is a highly contagious respiratory tract infection
caused by bacteria and is on the rise in this country and
state,” said Mark Josefski, MD, FAAFP, president of
the NYS Academy of Family Physicians. “Many older
New Yorkers are susceptible to whooping cough and
once they have it, they can transmit the disease to their
grandchildren who have not yet been immunized.”
The importance of vaccines begins in infancy and
continues right through adulthood. “A vaccine stimulates your immune system to produce antibodies,
exactly like it would if you were exposed to the disease. After getting vaccinated, you develop immunity
to that disease, without having to get the disease first,”
said Andrew Dunn, MD, FACP, president of the New
York Chapter of the American College of Physicians.
“Vaccines are powerful medications. Unlike most
medicines, which treat diseases, vaccines prevent
them.”
And according to a recent report by Pfizer, there’s
an economic value in disease prevention as well. The
CDC found that timely use of vaccines and adherence
to the recommended vaccination schedules prevent
morbidity and mortality, and save millions of dollars
in direct and indirect costs to the health care system
each year.
MSSNY, along with the New York Chapter of
American College of Physicians, the NYS Chapter
of the Academy of Family Physicians, and the NYS
Association of the County Health Officials, supports
New York State’s Prevention Agenda 2013-17, the blueprint for state and local action to improve the health of
New Yorkers in five priority areas and to reduce health
disparities for racial, ethnic, disability, socioeconomic
and other groups who experience them.
BACKGROUND INFO AND RESEARCH:
www.cdc.gov/vaccines/schedules/hcp/adult.html
www.cdc.gov/measles/cases-outbreaks.html
www.cdc.gov/vaccines/imz-managers/coverage/nis/
adult/index.html
www.vaccines.gov/basics/
www.health.ny.gov/prevention/prevention_agenda/
2013-2017/plan/stds/
ALLIANCE
Workers’ Comp Survey Comments
(Continued from page 10)
means going before the judge, which can
take months to do and delays patient care.
Also, being called for depositions – the time
taken during workday to prepare and testify
often exceeds the payment and payment
often is very delayed despite judge’s order.
I still have outstanding deposition fees after
6+ months. The paperwork for routine comp
issues takes an inordinate amount of time for
my staff, costs to me again exceeding payment. Carriers often deny medications and
require approvals which take more time than
reasonable. Some carriers take a managed
care reduction and pay under the WC fee
schedule, meaning we get significantly less
than the already low payments.
Family Practice, Bath
Eliminate C-4 forms completely and allow a
normal note to suffice for the visit.
As with most government insurance, reduce
the hassles of seeing patients.
Otolaryngology, Bayside
I don’t like working with Workers’ Comp.
They delay evaluation and treatment, torture
patients, and communicate poorly.
Family Practice, Hermon
Guidleines are out of date. Confusion on
part of patients and physicians what the
responsibility of the treating physician vs. the
Workers’ Comp board. WC telling patients
that “paperwork” never received from
physician.
Plastic and Hand Surgery, Newburgh
It is almost impossible to work with Workers’
Compensation program when they are
the ones that call the shots. There is over
regulation on their part and the pay is outrageously low.
Neurosurgery, New York
Family Medicine, Clifton Park
The current paperwork does not effectly
enable the provider to given the approriate
findings on Hx, ROS and PE and Plan.
Family Medicine, New Hartford
The largest barrier in my experience is not the
fees, but rather the significant difficulty with
obtaining proper treatment for patients due
to trying to navigate the confusing guidelines,
filling out forms, and waiting for approvals for
sometimes weeks to months on end while
patients are stuck doing nothing.
Physical Medicine and Rehabilitation,
Williamsville and Orchard Park
The new C4 and C4.2 forms and guidelines
with variance forms do nothing but increase
the burden of work for practicing physicians
while paying less than what it costs us to do
business.
The only reason I accept comp cases is out
of a courtesy to my existing patients to take
care of their work-related injuries when they
need me.
Family Practice
It’s a terrible system. It pays people to stay
sick and penalizes them if they get better.
Perverse incentives.
Allergy/Immunology/Rheumatology,
Rochester
It shouldn’t be so difficult to provide efficient and good care fairly to this group
of patients...should it?...i.e. authorization
request approvals, acknowledging and
respecting treating physicians management/
care decisions, etc.
The current system is such a burden for
the patients. The delays in care often cause
temporary problems to become permanent
disabilities.
Neurosurgery, Commack
I TAKE WORKERS’ COMPENSATION
BUT…
I only do WC as a service to my already
established patients.
Family Practice, Lowville
As we have a corporate commitment to seeing WC patients and our advertising indicates
we do, we will most probably continue
seeing WC patients regardless of changes
made.
Family Medicine, Hartsdale
We take WC patients regardless of fee
schedule because that is our mission.
However, there are many problems with the
current system that should be addressed if
you are interested in attracting more physicians to practice. The subjective nature of
temporary impairment assignment at each
visit without any guidelines is inappropriate and should be discarded. Impairment
should only be addressed at the conclusion of the case, as it is done in most other
states. This would also help limit the amount
of legal involvement in these cases, which
is unprecedented in New York compared to
other states.
Occupational Medicine, Elmira
Neurology, Tompkins
MSSNY Members Invited to
The Economist’s Health Care Forum
The globalization of health care has provided opportunities for organizations to
expand their network of customers. But globalization also brings significant economic
and public health concerns.
MSSNY members are invited to join
The Economist’s Health Care Forum on
September 17 in Boston to address the critical questions facing American health-care
companies today. Register with our special
MSSNY discount to save $400 on the standard rate.
Speakers include:
• Bruce Broussard, Chief Executive,
Humana
• Jonathan Bush, Chairman and Chief
Executive, athenahealth
• John Castellani, Chief Executive
Officer, Pharmaceutical Research and
Manufacturers of America
• Dr. Victor Dzau, President and Chief
Executive, Duke University Hospital
System
• Sandra Fenwick, Chief Executive,
Boston Children’s Hospital
• Helena Foulkes, President, CVS
Pharmacy
• Osnat Levtzion-Korach, Chief executive, Mount Scopus Hospital, Hadassah
Medical Center
In addition to globalization of health
care, the forum will address finding market
gaps, price transparency, product innovation, hospitals and health care of the future,
Obamacare and the next wave of US regulation. View the full agenda.
Save $400 on the standard rate.
Sign-up on http://bit.ly/1w77gHF with
code: EMPMPMSS.
MSSNY Alliance to Host North East Regional Meeting
The Genesee Grande Hotel in Syracuse, New York will be the venue for the AMA
Alliance Northeast Regional Leadership Conference September 26-28, 2014.
AMSSNY President Joan Cincotta (Onondaga) is working with AMA Alliance
members and State Alliance members to structure an informative event that will
include excursions to local attractions.
Registration fee for the entire conference is $175. (This does not include hotel
accommodations). Please make your hotel reservations directly through the Genesee
Grande Hotel at 315-476-4212 or www.geneseegrande.com. You are welcome to
select events based on your availability. (Fees can be paid per event).
Registration for this Conference can be made on line at our AMA Alliance web
site: http://www.amaalliance.org/site/event-details/?event=8.
All physician spouses and domestic partners are welcome and invited to attend.
Conference schedule
Friday, September 26, 2014
Registration: 1:00-3:00 pm
Stickley Tour: 4:00-6:00 pm
(leave hotel at 3:30)
Cocktails: 6:30 (at hotel - cash bar)
Dinner: 7:00 pm (at hotel)
Speaker: 8:00 pm, Michael
Saccocio, Executive Director and
CEO of City Mission will be discussing Leadership.
Cost for Friday: $40, if attending dinner
(tour and speaker - no cost) Saturday, September 27, 2014
Continental Breakfast: 8:00 am
Speakers: 8:30 am, Barbara Ellman, Associate Director for Policy for
MSSNY, AMSSNY Past President;
Donna Rovito, Editor, Liability
and Health Reform Update and
Physician Family magazine
Gage House Tour: 10:00 am -12:00 pm (leave hotel at 9:30)
Cost for Saturday morning: $20,
if attending breakfast (tour and
speaker - no cost)
Lunch & Winery: 1:00-3:00 pm
Cost of Saturday afternoon: $30 (includes lunch and wine tasting)
Cocktails: 6:30 pm (at hotel - cash bar)
Dinner: 7:00 pm (at hotel)
Choice of entrees
Speaker: 8:00 pm – Claudine Ward, MD and Cheryl Stier, AMSSNY Past
President and Health Promotion
Co-Chair discuss Sports Concussions
Cost for Saturday evening: $40,
if attending dinner (speaker only no cost)
Sunday, September 28, 2014
Continental Breakfast: 8:00 am
Speaker – Medical Marriage
8:30-11:30 am
Closing Brunch: 11:30 am
Cost of Sunday morning: $35,
if attending Continental Breakfast
only $10, if attending Brunch only
$25 (speakers only - no cost)
AMSSNY Fall Conference meetings
will begin at 12:30 pm and finish by
4:00 pm. (Free)
Supreme Court This Fall
Question: How can the Supreme Court’s
decision in North Carolina Board of
Dental Examiners v. the Federal Trade
Commission potentially affect my State’s
Medical Board?
Answer: This fall, the United States
Supreme Court will hear oral argument
in the case of North Carolina Board of
Dental Examiners v. the Federal Trade
Commission, which will seek to strike
a balance between medical professionals’ power to regulate their peers and the
potential effect that may have on competition that benefits consumers. The
Court’s ruling in this case has the potential to affect healthcare pricing, balance
billing and scope of practice.
In this case, the Federal Trade
Commission (“FTC”) accused the North
Carolina Board of Dental Examiners
(“Board”) of essentially exercising
monopoly power by forbidding hygienists in places such as spas and mall kiosks
from using hydrogen peroxide solutions
to whiten teeth. The FTC argues that
since the removal of stains from teeth
can be a lucrative business for dentists,
the Board sent out numerous cease-anddesist orders to competitors who were
accused of illegally practicing dentistry.
In 2011, the FTC sought to encourage
price competition for peroxide treatments
by forbidding the state dental board from
taking action against lower-cost providers that offer teeth-whitening services.
A federal appeals court upheld the FTC
decision in 2013.
In its opposition, the Board argues that
the FTC does not have the power to force
its will on state medical boards, especially since antitrust law should not trump
public health considerations. If the FTC’s
power to influence state medical boards is
upheld, that would likely cause states to
interfere with the makeup of their medical boards by having fewer members who
are practicing doctors or dentists.
This could have a further chilling effect
in that doctors’ and dentists’ participation
on boards could decrease, particularly
if their participation could also expose
them to legal liability under federal antitrust law.
The American Medical Association,
the American Dental Association and the
Federation of State Medical Boards have
filed brief amicus curiae in support of
the North Carolina Board of Dentistry.
We will be following this litigation
closely and providing updates in future
publications.
If you have any questions, please contact our Managing Partner, Michael J.
Schoppmann, Esq at 1-800-445-0954
or via email at MSchoppmann@DrLaw.
com.
OBITUARIES
Past MSSNY Chairman Randall Bloomfield Dies at 91
We regret the passing of MSSNY’s Past Chairman of
the Board, Randall Bloomfield, a devoted member and
an activist, not only in his Brooklyn community, but
everywhere he went. After serving his country honorably
in World War II, he graduated from City College and
received his medical degree from the State University of
New York, Downstate Medical Center, followed by a residency at Kings County Hospital Center and a fellowship
at Memorial Sloan Kettering.
Some of the many achievements and appointments
in his illustrious career are Director of Obstetrics and
Gynecology at Kings County Hospital, President of
the Alumni Association of Downstate Medical Center,
President of the Medical Society of the County of Kings,
and delegate to the American Medical Association. He
was thrust into the leadership of many professional, political and community organizations through which he was
a voice for his concerns about the need for opportunities
for disadvantaged youngsters. He actively and successfully encouraged inner-city youth to consider careers in
medicine. He was a member of the faculty and the alumni
association at Downstate Medical Center.
Dr. Bloomfield was predeceased by his wife of 61
years, Edris. He is survived by his children, Diane and
Robert, his son-in-law, Sam and his granddaughter,
Alicia.
ABRAMO, Arnold Aloysius; Orchard Park NY. Died June 15, 2014,
age 84. Erie County Medical Society.
BALES, Gertrude M. A.; Pittsford NY. Died May 18, 2014, age 88.
Monroe County Medical Society.
FAVINI, Josephine; Rochester NY. Died May 28, 2014, age 86.
Monroe County Medical Society.
FINKELSTEIN, Paul; New York NY. Died June 20, 2014, age 94.
Medical Society County of Kings.
MICHALEK, Claudia F.; Hamburg NY. Died May 24, 2014, age 61.
Erie County Medical Societ.y
STAHMAN, Albert William; Brookhaven NY. Died June 10, 2014,
age 91. Suffolk County Medical Society.
WALTZ, Joseph M.; Rye NY. Died June 16, 2014, age 82. Bronx
County Medical Society.
CLASSIFIED ADVERTISING
MSSNY’S CLASSIFIED HAS GONE GLOBAL
business showcase
Classified ads can be accessed on MSSNY’s website at
www.mssny.org.
Click classifieds.
OCTOber 2014 ISSUE CLOSES SEPTEMBER 17 • $150 per ad; $200 with Photo
PHYSICIANS’ SEARCH SERVICES • ALLIED MEDICAL PLACEMENTS • LOCUM TENENS • practice valuation • practice brokerage
practice consulting • Real estate
for help, information or to place your ad, call 516-488-6100 x355 • Fax 516-488-2188
Office Rentals
Office space available in upscale Carroll Gardens, Brooklyn.
Modern office sublet with multiple specialties (PM&R, Plastic surgery, Phys.
Therapy). Three exam rooms and up to 2 office/consultation rooms, reception/
waiting area. Large facility. Rental includes all utilities, wifi, phones, storage room,
housekeeping services, etc. Perfect for start-up, relocation or office expansion.
Call (917)589-4482
––––––––––––––––––––––––––––––––––––––––––––––––––––
Centereach, NY-Professional Office
1,500 Sq Ft; five 9x12 Rooms; Reception Area; Waiting Room & Consultation
Room; Basement,; One Storage Room,; Parking for approx 9 cars; building &
parking handicap accessible. Attached Colonial Style home consists of
4 Bedrooms, 3.5 Full Baths, Living Room, 15x25 Den, Fireplace, Kitchen, Sun
Room, In-Ground Sprinklers, In-Ground Pool with Child Safety Fence. Total with
Office Approx 4,200 Sq. Ft. $499,900 RE/MAX Integrity Leaders-Rita Tsoukaris: (631) 332-7897 or
Email: [email protected]
––––––––––––––––––––––––––––––––––––––––––––––––––––
Great Midtown Office Space Available with In House Referrals
W. 40’s between 5th & 6th Aves. Near all transportation. Upscale, beautiful
windowed offices. Entire floor with private bathrooms and kitchen. Reception
available. Excellent in-house referrals. Must be seen. Call 646 242 4742.
––––––––––––––––––––––––––––––––––––––––––––––––––––
physician opportunities
Unique Private Pediatric Practice Opportunity
Summerwood Pediatrics is a very progressive and large community-based private
practice and Certified Medical Home in the Syracuse, New York area, which
provides care for over 25,000 children from birth to 21 years of age. The practice
is also involved in clinical research for the benefit of our patients. In addition to our
main location we have a satellite office in Camillus, New York. Finally, the practice
operates adjacent to an independent outpatient infusion practice, which is also
owned and operated by the medical director of Summerwood Pediatrics, which
has been of great benefit to our patients.
We are currently looking to employ a bright, energetic and enthusiastic general
pediatric or subspecialty-trained physician in our practice. Presently the practice
employs six physicians and six pediatric nurse practitioners. All providers share
on-call responsibilities on a one-day per week basis. Weekend coverage and
office hours are performed on a rotational basis by the physicians. Our offices
encompass over 28,000 square feet of state of the art clinical space and provide
on-site laboratory services.
The position, either full or part-time, include applicable benefits inclusive of health
care, malpractice insurance, CME expenditures and retirement plan. If you or your
colleagues are interested in discussing this opportunity further, please contact
either Dr. Robert A. Dracker (Medical Director) or Mr. Warren Ford (Office Manager)
at 315-457-9914…9-5 EST.
Practice for Sale
Allergy/Asthma Practice for Sale- Brooklyn NY
Practice located in modern medical building
in residential area of South Brooklyn (Marine Park).
Board eligible/board certified allergist preferred.
Allergy practice long established and reputable. Call 516-569-1967.
Place Your Classified Ad In News Of New York!
Leasing or Selling Space? Selling your practice or equipment?
All Ads $150; $200 with Photo • Call 516-488-6100, ext 355

NEWS OF NEW YORK - Medical Society of the State of New York

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NEWS OF NEW YORK - Medical Society of the State of New York