The BulletinSpring 2014

Medical Society of the County of Erie and
The Medical Society County of Chautauqua
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Buffalo, NY 14206
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The Medical Society Bulletin - Counties of Erie and Chautauqua
Spring 2014
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Spring 2014
The Medical Society Bulletin - Counties of Erie and Chautauqua
Page 3
A Message From the President
By: Thomas A. Lombardo Jr., M.D.
The
Bulletin
Medical Society, County of Erie
“Better Health Through Advocacy” ™
“If Not You...Who” ™
OFFICIAL PUBLICATION
Medical Society of the County of Erie
& Medical Society of the County Chautauqua
State of New York
OFFICERS – ERIE COUNTY
2013-2014
Thomas A. Lombardo Jr., M.D. President
John B. Wiles, M.D. President-Elect
Charles E. Wiles III, M.D. Vice-President
Timothy F. Gabryel, M.D. Secretary/Treasurer
Raymond V. Paolini Jr., M.D. Past President
What is happening? Malpractice insurance carriers are
reporting an increasing number of claims stimulated by a
physician criticizing the care rendered by another physician. Often the “bad mouthing” physician is being seen for
a second opinion by an already unhappy or disappointed
patient.
Most physicians who are confident in the treatment they
provided, encourage patients to seek a second opinion. The advice of a colleague removed from the care can be refreshing and perhaps more objective. Furthermore, the kind words of a colleague can often defuse a conflict
and help a patient to gain insight into the complexity of their respective care.
Finally, the encounter may help restore the patient’s confidence in the treating physician.
The second opinion is a valuable tool when utilized properly. The care provided by the initial physician may have been exemplary. However, a careless comment by another physician may ultimately cause the patient to file
a lawsuit.
OFFICERS – CHAUTAUQUA COUNTY
Brian D. Meagher, M.D. President
Bert W. Rappole, M.D. Past President, Treasurer
During training our mentors emphasized professionalism and respect. Of
late there has been a profound change. Doctors frequently are quick to
assign blame either verbally or by body language.
OFFICERS – 8th DISTRICT BRANCH
2013-2014
Philip J. Aliotta, M.D. President
ERIE
President-Elect
Open
Edward Kelly Bartels, M.D., Secretary/Treasurer
and Councilor
ERIE
Brian D. Meagher, M.D. District Delegate
CHAUTAUQUA
A recent study reports that 54% of lawsuits were filed in part because of the
comments of a physician. Critical comments about care may be based on
incomplete knowledge of the facts or unreal expectations by the patient.
OFFICERS – MSSNY
Thomas J. Madejski, M.D. Asst. Treasurer
Medical Society Web Sites:
www.eriemds.org
www.chautdocs.org
E-mail Addresses:
Medical Society – [email protected]
I do not suggest that we are not obligated to be truthful and fair to our
patients. However we are not obligated to criticize a colleague for a less that
satisfactory outcome. Even an innocuous comment such as “I wouldn’t have
done that” or “what was your doctor thinking” or shaking one’s head while
looking at an x-ray can lead to medical legal consequences.
Malpractice attorneys do not need our help. Patients are aware of the
potential for big pay days and only need to go to the internet to learn what
constitutes ideal care.
Criticizing another physician’s care leads to increasing distrust within the
medical community and can create a concept of injury when no actual
Continued on page 4
Christine Nadolny, Executive Director –
[email protected]
[email protected]
Emily McMullen, Editor –
[email protected]
Editorial Offices:
1317 Harlem Road Buffalo, NY 14206
(716) 852-1810
All opinions expressed in the Bulletin are those
of the authors or editors. Statements contained in
articles do not represent the policies or opinions
of the Medical Society of the County of Erie, the
Medical Society of the State of New York or the
American Medical Association unless expressly
stated as such. The Medical Society of the County
of Erie reserves the right to refuse any advertisement. Acceptance of any advertising does not in
any way constitute endorsement or approval by
the Society of any product or service.
Annual Subscription is $70.00
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TABLE OF CONTENTS
A Message from the President ................3
EHRs and Cloned Data.............................4
Retiring Early? Mind the Gap..................5
Treatment of Minor Patients....................6
From the Executive Director ....................7
The New York State
Physician Profile ..................................11
Meaningful Use: Criminal Penalties
and Recent Updates ............................12
MSSNY Editorial......................................12
Comparing Insurance ...............................8
In Memoriam............................................12
Councilor Connect.....................................9
Resident Fellow or
Medical Student Award .....................13
Welcome New Members ........................10
The Medical Society Bulletin - Counties of Erie and Chautauqua
Page 4
EHRs and Cloned Data
By: Beverly Welshans, CHC, CPC, CPCI, CPCH, CCSP – Coding Consultant
Today more than ever, physicians are
facing increasing administrative burdens. Initiatives such as Meaningful
use, PQRS, and pay-for-performance
are all eating into the amount of time a
physician actually has to spend with
patients and documenting the encounters. Electronic Health Records
(EHRs) have been accepted by medical professionals who appreciate their
time-saving features. The ability to
automatically generate a patient’s history, or even to cut and paste the findings of previous exams with a single
click, allows the time-crunched physician to spend more time on patient
care and less time hunched over a
computer screen.
These shortcuts in EHRs have made it
easier for physicians to intentionally or
unintentionally document and bill for
services, regardless of whether or not
that level of care has been provided,
leaving them susceptible to potential
risks of up-coding. Claim submissions
to Medicare have increased dramatically since the advent of EHRs, raising
CMS concerns of fraudulent billing. On
the other hand, EHRs can provide better documentation of patient care and
thus justify higher payments. This is a
systemic dilemma and the Office of the
Inspector General (OIG) is now studying the link between electronic records
and increased billings.
National Government Services (NGS)
our regional Medicare contractor,
released a memo in September 2012
addressing cloned documentation.
Here is an excerpt from that.
…Documentation is considered cloned
when it is worded exactly like or similar
to the previous note. It can also occur
when the documentation is exactly the
same from patient to patient.
Individualized patient notes for each
patient encounter are required. And …
whether the documentation was the
result of an Electronic Health Record,
or the use of a pre-printed template, or
handwritten documentation, cloned
documentation will be considered misrepresentation of the medical necessity requirement for coverage of the
serviced due to lack of specific individual information unique patient.
Identification of this type of documenwww.eriemds.org
tation will lead to denial of services for
lack of medical necessity and the
recoupment of all overpayments made.
These are strong words and a policy
that should not be taken lightly by any
provider. AHIMA (American Health
Information Management Association)
printed the following article in their
recent E Alert. It echoes these same
concerns with some EHR documentation. It is worth taking a few minutes to
review the OIG report.
Report: EHRs lack CMS fraud
safeguards
Wednesday, the Office of the Inspector
General (OIG) issued a report concluding the Centers for Medicare &
Medicaid Services (CMS) have not
done enough to safeguard against fraud
in electronic health records (EHRs). The
report echoed concerns in a December
report over "copy-paste" and potential
EHR fraud. In the current report, CMS
agreed with OIG's recommendation that
contractors should receive guidance on
detecting fraud in EHRs and partially
agreed with a recommendation to use
providers' audit logs, saying they may
not be appropriate in every situation.
Spring 2014
A Message
from the President
Continued from page 3
injury exists.
Dr. Thomas B. Fleeter, the Chairman
of the AAOS Medical Liability
Committee, advised that “even worse
than commenting on care provided by
another physician during a patient
visit is documenting it in the medical
record.” He further states “subjective
comments do not belong in the medical record. Remember that medical
records are the news, not the editorial page.”
Substandard care, professional incompetence or misconduct, should
not be covered up, but treatment variations and less than satisfactory outcomes do not constitute malpractice.
Not all physicians will agree with a
specific plan of care for a specific
problem. A seemingly harmless comment by a physician can lead to a frivolous lawsuit resulting in unnecessary pain and suffering for a another
physician.
In a New York Times article, AHIMA
Senior Director of Research and
Development, Michelle Dougherty,
MA, RHIA, CHP, commented that clinicians use cut-and-paste because "it is
one of the only ways they can manage
the documentation process," but there
is potential for copied information "that
is not relevant or even erroneous." You
can access the OIG report using the
following link: http://oig.hhs.gov/oei/
reports/oei-01-11-00571.pdf.
Rather than discouraging the use of
EHRs, these revelations should serve
to reinforce the importance of adequate documentation. The temptation
to use shortcuts is strong, but the
advantages of a properly utilized EHR;
efficiency, patient safety and improved
reimbursement, are stronger still.
These are useful tools provided they
are used responsibly. Please be certain to review the data entered carefully and make any necessary corrections
and/or additions to ensure complete
and accurate documentation of each
individual patient encounter.
www.chautdocs.org
Spring 2014
The Medical Society Bulletin - Counties of Erie and Chautauqua
Page 5
Retiring Early? Mind the Gap!
Courtesy of: Peter J. Walsh, Senior Vice President, Investments - The Walsh Group of Raymond James
and Lisa J. Walsh, Senior Vice President, Investments - The Walsh Group of Raymond James
Thinking of an early retirement? You’ll first
want to consider how you intend to pay for
health care costs, when you should begin
collecting Social Security and how an
early retirement might impact your longterm retirement investing strategy.
According to a recent Gallup poll, the average American
retires at age 61.1 That’s at least five years away from collecting full Social Security retirement benefits, not to mention pensions, which typically begin at age 65, when available. Collectively, these programs can account for a significant share of retirement income. According to the Social
Security Administration, Social Security and public and private pensions make up 54% of an average retiree’s
income.2 What’s more, Medicare coverage does not begin
until age 65, leaving early retirees with potentially hefty
monthly premiums until Medicare kicks in.
Anyone contemplating an early retirement will want to plan
carefully and ask himself several important questions.
How Will You Fund Health Care Costs?
One of the biggest obstacles to early retirement is health
insurance. If you are working for a company that pays all or
most of your health insurance, you could face an added
monthly expense of $500 or more if you retire before age
65.3 What’s more, most companies no longer offer retiree
health benefits, and if they do, the premiums can be high or
coverage low.
A 2012 survey by the Employee Benefit Research Institute
(EBRI) indicated that health care costs account for 10% of
total spending for individuals between ages 50 and 64.4 In
addition to health insurance premiums, there are also copays, annual out-of-pocket deductibles, uncovered procedures or out-of-network costs to consider--not to mention
dental and vision costs.
On the positive side, the Affordable Care Act (ACA) works
to the advantage of early retirees. It prohibits insurance
companies from discriminating because of pre-existing illnesses, and beginning in 2014, limits how much they can
charge based on age*. The recently opened national and
state-run insurance exchanges may also bring down premiums over time. For those with lower incomes, government
subsidies may be available. People earning less than 400%
of the federal poverty level--about $46,000 for a single person or $94,000 for a family of four--will be eligible for a tax
credit as long as they do not have access to affordable and
comprehensive coverage through their employer and do not
participate in government health programs like Medicaid.5
www.eriemds.org
When Should You Begin Collecting Social Security?
You can begin collecting Social Security retirement benefits
as early as age 62. But you will face a significant reduction
if you start before your normal retirement age: 66 or 67,
depending upon when you were born. Those choosing to
collect before that age face a reduction in monthly payments
by as much as 30%. What's more, there is a stiff penalty for
anyone who collects early and earns wages in excess of an
annual earnings limit ($15,120 in 2013).6
What age is best for you will ultimately depend upon your
financial situation as well as your anticipated life expectancy. For most people, waiting until normal retirement age is
worth the wait. But you may want to consider taking your
benefits earlier if:
• You are in poor health.
• You are no longer working and need the benefit to help
make ends meet.
• You earn less than your spouse and your spouse has
decided to continue working to help earn a better benefit.
If you think you may qualify for a health care subsidy under
ACA, you may want to delay collecting Social Security until
at least age 65 (when Medicare kicks in), as Social Security
benefits are fully counted as income in determining your eligibility for subsidies.
What Will Early Retirement Mean for Your Investing and
Withdrawal Strategies?
Perhaps the most significant concern for early retirees--and
one that is often overlooked--is how retiring early will impact
their investing and withdrawal strategies. Retiring early
means taking larger distributions from your retirement savings in the early years, until Social Security and pension
payments begin. This can have a significant impact on how
long your savings last, much more so than if larger distributions are taken later in retirement. Consider the following:
• Delay withdrawals from taxable retirement accounts,
such as IRAs or 401(k) plans. The longer this money can
grow tax-deferred (or tax free for Roth accounts), the more
you will save in taxes. Instead, tap into after-tax accounts
first.
• Adjust your withdrawal rate to assure your savings
last throughout a lengthened retirement. Financial
planners typically recommend a 4% annual withdrawal
rate of principal at retirement, but you may want to lower
this since you will need your savings to last longer.7
• Structure your investments to include a significant
growth element. Since your money will have to last
longer, you will want to make sure to include stocks or
Continued on page 10
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Spring 2014
Treatment of Minor Patients: Delegated Consent by Parents
By: Frances A. Ciardullo, Esq., Fager & Amsler LLP, Counsel to Medical Liability Mutual Insurance Company
One of the quandaries facing medical
offices today is what to do when a
minor patient comes to the office for
treatment accompanied by a person
who is not his or her parent or legal
guardian. Sometimes, the child is
brought in by a relative, a spouse of a
parent who has remarried, or simply a
friend. Since only certain legally
authorized individuals may give consent for general medical treatment for
a minor, the provider must decide
whether to proceed with the visit or
reschedule the patient. Often, the
provider will attempt to contact the parent or legal guardian by telephone at
the time of the visit, but this may not
always be successful.
Fortunately, New York law provides a
mechanism by which a parent may designate another person to make healthcare decisions for minors and even
incapacitated adult children. Under New
York General Obligations Law § 5-1551,
a parent of a minor or incapacitated person may designate another person as a
“person in parental relation for purposes
of consenting to immunizations and
other health care treatment.” A designation may specify the treatment or diagnosis for which consent is authorized,
may limit any treatment or diagnosis for
which consent is authorized, and may
contain other restrictions on the authority of the designee. Even if a parent has
appropriately designated another person to consent to health care treatment,
the parent still retains ultimate authority.
The statute provides that any decision
that a designee makes can be superseded by a contravening decision of a
parent.
sions, both parents must sign the
designation.
If these requirements are met, then a
written designation will be valid for 30
days. Note, however, that there are
additional requirements for a designation to be valid beyond a 30-day period. The document must include:
a. An address and telephone number
where the parent can be reached;
b. An address and telephone number
where the designee can be reached;
c. The date of birth of each person
with respect to whom the designation is made;
d. The date or event upon which the
designation commences;
e. The written consent of the designee;
f. A statement that there is no prior
order of any court prohibiting the parent from making the designation;
and,
g. All signatures must be notarized.
If all of the above requirements are
met, a designation may be valid up to
six months. It automatically will expire
at the end of the six-month period.
Once a designation has expired, a new
form must be completed.
The law also contains a process for
revoking a designation of authority. A
parent may revoke a designation of
authority. A parent may revoke a designation at any time by notifying the
healthcare provider either orally or in
writing, or by any other act showing a
specific intent to revoke the designation.
It may also be revoked if the parent
signs a subsequent designation. If both
parents originally signed the designation, the later revocation by one parent
is enough to be a complete revocation
of the authority of the designee. A
designee is required to notify a healthcare provider of any revocation of
his/her authority. A designation is automatically revoked upon the death or
incapacity of the parent who signed it.
The statute provides protection for a
healthcare provider who relies upon a
written designation of another person
to give consent. The law states that a
person who acts reasonably and in
good faith in reliance upon a designated consent is not deemed to have
acted negligently, unreasonably or
improperly, as long as he or she has no
knowledge of any facts indicating that
Continued on page 12
The designation of another person
must be in writing. In order to valid:
1. There must be no court order prohibiting the parent from himself or herself
exercising the right to consent on
behalf of the minor. If a court has
issued an order granting only one parent the right to make medical decisions for the minor, then the other parent cannot sign a designation.
2. If a court has ordered that both parents must agree on health care deciwww.eriemds.org
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Spring 2014
The Medical Society Bulletin - Counties of Erie and Chautauqua
Page 7
From the Executive Director
By: Christine Ignaszak Nadolny, Executive Director
Apples to Apples
Since I like to bake and cook, one of my
habits is to collect recipes. My collection
includes cookbooks from cities and
countries I’ve visited, from my grandmothers and aunts, from friends and
those that I have liberated from magazines and newspapers. Sounds great, except that every so
often I find that I’ve accumulated enough to fit in a shoebox
(actually shoeboxes)! With a few days off over the holidays
and one snow day, I decided it was time to start weeding
them out; actually I had some apples that were calling out to
me and I wanted to try something different from the usual
pies, tarts, breads and muffins. What I found were apple
recipes for everything from “soup to nuts,” but those hand
written from family and friends seemed to caution about the
variety of apples. Notes admonishing me either to only use,
or not use, varieties such as Northern Spy, Russet, Winesap
and Pippin, were often written in beautiful cursive.
Why am I telling you this?
Recently it has come to my attention – with calls from you
and your staff – about offers that other organizations and
vendors have made which will certainly make your life (personal and professional) better, easier or less costly. As we
are always looking to enhance our member benefits and to
challenge those vendors that we currently have collaborative relationships with, I am always intrigued when someone
says that the vendor, product or resource we have is lack-
www.eriemds.org
ing or not in the best interest of our members. I appreciate
those calls and those suggestions from you, so please keep
sending them our way, because in some cases we have
enhanced our resources and benefits.
However, I’ve also received some reports of situations
where vendors have said they can match the product/service the Society offers without membership or at a lower
cost. Some members have reported that they’ve found that
when a change was made to this new vendor – in some
cases a contract signed – only later did they learn that this
new “apple” is not exactly the same as the previous “apple”.
While both were apples, the resultant product did not provide the same taste and texture.
I’m hoping that as you are made aware of any entity offering
a “twist on, or newer, or better “ benefit or service currently
offered by the Medical Society, you take a moment to study
both products or services before you make any decision.
And, if you believe that this vendor has a better product or
service, I’m asking you to call me at the Society, as well as
your current vendor. Both of us need to know if there is
something better on the market. We also need to know if the
preferred product does not meet the standards of our current product.
PS – If anyone knows where a Pippin or Winesap apple tree
can be found, please let me know; I still want to try a few of
those treasured recipes.
Best wishes,
Chris
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The Medical Society Bulletin - Counties of Erie and Chautauqua
Spring 2014
Comparing Insurance
We frequently speak
with customers who
are comparing various insurance policies to determine
which one to purchase. Comparing
proposals for different policies can be
more difficult than meets the eye.
Personal disability income policies can
be challenging to compare because of
the many variables involved. Among
other things, the following major parts
of the policy may vary: (1) the monthly
benefit amount that you would be paid
if disabled, (2) the elimination or waiting period (the amount of time after you
become disabled before benefits
become payable), and (3) the benefit
period, or length of time for which a
benefit is potentially payable. All of
these variables affect the premium
and, more importantly, how that benefit would actually be paid if you became
disabled.
For example, I worked with a surgeon
who was comparing the disability policy I proposed with another policy.
When we met and he showed me the
other proposal, I saw that it proposed
benefits payable to age 65. My proposal was for benefits payable to age 67.
Because the policy benefit amounts
were about $10,000/month, there was
the potential for $240,000 more in benefits with the policy I was proposing.
While this may sound basic, there were
so many factors being considered, this
difference was easy to overlook.
We also offer Group Long Term
Disability insurance, which can cover
the physicians and/or employees in a
practice. Comparisons of those policies offer additional challenges. As
with a personal Disability Income policy, the first step is to make sure the
benefit levels are the same (benefit
amount, elimination period, and benefit
payment period). You also need to
compare whether the same individuals
in the practice are being insured, and
at the same levels. We have seen
practices that are evaluating proposals
for this coverage compare premiums
without first making sure that the basic
benefits offered were comparable.
Life insurance can also be tricky to
www.eriemds.org
By: Kate Sellers, JD, CLU
compare. I had a physician customer
tell me that he found a less expensive
term life insurance option than the proposal I had presented. It turned out that
the seemingly lower-cost option did not
include a disability waiver of premium
benefit. This allows you to stop paying
premiums if you become disabled for a
certain length of time. (We strongly
recommend this benefit to make sure
you never need to let life insurance
coverage lapse because you can’t
afford the payment when disabled).
The proposal he was looking at did not
specify that waiver of premium was not
included, but when the physician asked
the broker who had provided him with
the quote, it turned out that it did not.
Once the physician had proposals that
provided similar benefits, the premiums were comparable.
Another challenge can be comparing
package policies, such as a Business
Owners Package or your Homeowners
Policy. These policies bundle many different coverages together. This can
make comparison more difficult. For
example, two Homeowners Policy proposals might provide the same amount
of property coverage on the dwelling
itself and the same amount of personal
liability protection. But one policy could
provide coverage for backup of sewers
and drains up to the policy limit, while
the other policy might not offer any of
this coverage. While that difference
might seem minor when you are looking
at proposals on paper, it’s a difference
you would feel if a sewer backup inundated your finished basement and
ruined carpet, furniture, and electronics.
Of course, no one has unlimited time to
research the differences between policies, especially a physician facing
many professional and personal
demands. This is why we recommend
that if you are comparing policies, you
work with an agent whom you trust or
who is recommended to you by a trusted source. A good agent will help you
compare policies and make an
informed decision. It is important that
you share the proposals you are comparing with the agent, as he or she has
the experience to identify key distinctions between policies. Sometimes a
practice business manager or a physician is reluctant to share a competing
proposal with an agent, thinking that
will keep the practice from getting the
lowest possible premium the agent can
offer. But without the ability to see
exactly what is being proposed, it is
very difficult to know if a particular
comparison is based on the same benefits, and the differences may be difficult to detect if you aren’t working with
insurance policies on a regular basis.
Physicians may sometimes be asked
by an agent to consider replacing existing policies. When it comes to replacing policies such as life and disability
insurance, which require satisfactory
health status and medical history to be
issued, special care should be taken.
You should never cancel an existing
policy until you are certain that a new
policy has been issued. There may be
other drawbacks to replacing existing
life or disability coverage that should
be discussed with a trusted agent.
Although it is against New York State
law for an insurer or agent to make
misrepresentations about insurance
policies or incomplete comparisons,
this conduct does unfortunately occur.
Finally, while cost is an important factor, the focus should be on value –
what are you getting for your premium
dollars? There can be important intangible factors, such as the quality and
continuity of the service the agent or
broker provides. Will your agent review
your coverage with you periodically
and suggest updates and changes so
that you are properly insured? If you
have a question, will someone be there
to answer your call and help you? And
if you have a claim, will your agent help
you through the process? We recommend that in selecting insurance coverage you consider the premium, of
course, but in the context of the overall
value offered by the policy, the insurance company, and the agent selling it
to you.
Article submitted by Kate Sellers, JD, CLU,
Assistant Vice-President & Counsel of
Charles J. Sellers & Co., Inc. Sellers & Co.
has provided insurance benefits to
Members of the County/District Medical
Societies since 1941 and is the Administrator of Endorsed Insurance Programs for
the Medical Society County of Erie and the
Eighth District Branch.
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Spring 2014
The Medical Society Bulletin - Counties of Erie and Chautauqua
Page 9
Councilor Connect
By: Edward Kelly Bartels, M.D., Councilor, Eighth District Branch, MSSNY
As your Councilor I wanted to give you a
brief update on some of the issues that
have been discussed at our recent meeting, and may affect us and our colleagues across the State.
MSSNY recently signed on to a lawsuit
attempting to stop certain Medicare
advantage plans from removing physicians from their panels. At the time of writing this article, the judge has granted
a temporary halt to decertification of physicians. The lawsuit's outcome ultimately will depend on the contract language between physicians and health insurers. I would like
to encourage you to take a moment to review your provider
agreements with insurers, since many of these contracts
call for binding arbitration and preclude legal remedies. Let
this be a lesson to all of us that we have kept, and know
where a copy of every contract we have signed is located.
MLMIC has just announced they will pay 5% dividend to
Insured physicians this coming year. This is certainly welcome news to those of you insured by MLMIC. This does not
lessen the need for tort reform as New York State continues
to have some of the highest malpractice burdens in the
country. MSSNY and MSSNYPAC continue to fight on your
behalf to block regressive tort laws and call for meaningful
tort reform in our state.
Medical marijuana is an issue of the day. Governor Cuomo,
in his State of the State address called for New York State
to investigate the possibility of allowing medical marijuana.
Current state and federal laws seem to preclude loosening
www.eriemds.org
of marijuana laws as has been seen in other states such as
Colorado, California, and Washington. MSSNY supports
current legislation. This is expected to be a subject for discussion at the house of delegates meeting this spring.
MSSNY leadership has been active in discussing the implications of the Affordable Care Act. MSSNY President
Doctor Sam L. Unterricht has been interviewed on numerous national television shows. As further disruptions occur
to the healthcare system expect MSSNY to be at the forefront in educating the public and our membership.
Locally the Eighth District Branch as well as Erie and
Niagara County leadership have met with United
HealthCare regarding managed Medicaid in our region,
specifically in Niagara County. Our discussions were open
and frank, and will continue to address issues of mutual concern. Erie County leadership continues to meet with local
insurers to discuss the ongoing audits and reviews of our
medical records,
Finally I would like to urge you to contribute to MSSNYPAC.
The PAC is the life blood, the political arm of our organization. This is the only way we have to gain access t, and influence our legislators to vote responsibly when issues regarding healthcare, licensure and education reach their desks.
Currently the total State budget for the PAC is in the
$300,000 range – certainly not enough to be successful. We
must do better. If you have already contributed please consider increasing your contribution. This is an election year, a
critical year for our work.
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The Medical Society Bulletin - Counties of Erie and Chautauqua
Spring 2014
Welcome New Members!
Bernard Beaupin, M.D.
David Cuthber, M.D.
Teresa Danforth, M.D.
Steven Dina, M.D.
Ellen Fitzgerald-Farkas, M.D.
Roland Honeine, M.D.
Travis Mastroianni, D.O.
Nalini Namassivaya, M.D.
Elizabeth Nolan, M.D.
James Peppriell, M.D.
Aaron Powell, M.D.
Laura Rayner, M.D.
Cameron Saber, M.D.
Scott Sobieraj, M.D.
Christopher Tanski, M.D.
Retiring Early? Mind the Gap!
Continued from page 5
other assets that carry high growth
potential. Stocks are typically more
volatile than bonds or other fixedincome investments, but have a better long-term record of outpacing
inflation.
The first place to start early retirement
planning is with a detailed plan that
includes estimated income and
expenses. Let me work with you to put
in place a plan that factors in all the
necessary elements you will want to
consider.
Footnotes/Disclaimers
Source: Gallup Economy, May 15, 2013;
http://www.gallup.com/poll/ 162560/average-retirement-age.aspx.
1
Source: Social Security Administration,
Fast Facts and Figures About Social
Security, 2013; http://www.ssa.gov/policy/docs/chartbooks/ fast_facts/2013/fast_
facts13.pdf.
2
Source: AARP Public Policy Institute,
Health Insurance Coverage for 50- to 64Year-Olds, 2011, http://www.aarp.org/content/dam/aarp/ research/ public_policy_
institute/health/Health-InsuranceCoverage-for-50-64-year-olds-insightAARP-ppi-health.pdf.
3
Source: Employee Benefit Research
Institute, Expenditure Patterns of Older
Americans, 2001-2009, February 2012;
http://www.ebri.org/ pdf/briefspdf/ EBRI
_IB_ 02-2012_No368_ExpPttns.pdf.
4
Source: AARP Blog, Will You Get an
Insurance Subsidy? How Much? August
2013; http://blog. aarp.org/2013/08/15/willyou-get-an-insurance-subsidy-how-much/.
5
Source: Social Security Administration,
http:// www.ssa.gov/oact/cola/ rtea.html.
6
Source: Wall Street Journal, March 4,
7
www.eriemds.org
2013, Say Goodbye to the 4% Rule
http://online.wsj.com/news/articles/SB100
0142412788732416230457830 449149
2559684
totally eliminate their dividends without
notice.
Tax laws are complex and subject to
change. Morgan Stanley Smith Barney LLC
(“Morgan Stanley”), its affiliates and
Morgan Stanley Financial Advisors and
Private Wealth Advisors do not provide tax
or legal advice and are not “fiduciaries”
(under ERISA, the Internal Revenue Code
or otherwise) with respect to the services or
activities described herein except as otherwise agreed to in writing by Morgan
Stanley. This material was not intended or
written to be used for the purpose of avoiding tax penalties that may be imposed on
the taxpayer. Individuals are encouraged to
consult their tax and legal advisors (a)
before establishing a retirement plan or
account, and (b) regarding any potential
tax, ERISA and related consequences of
any investments made under such plan or
account.
Article by Wealth Management Systems,
Inc. and provided courtesy of Morgan
Stanley Financial Advisor.
*As of this writing revisions within the
Affordable Care Act are pending
The strategies and/or investments discussed in this material may not be suitable
for all investors. Morgan Stanley Wealth
Management recommends that investors
independently evaluate particular investments and strategies, and encourages
investors to seek the advice of a Financial
Advisor. The appropriateness of a particular investment or strategy will depend on an
investor’s individual circumstances and
objectives.
Equity securities may fluctuate in response
to news on companies, industries, market
conditions and the general economic environment. Companies cannot assure or
guarantee a certain rate of return or dividend yield; they can increase, decrease or
If you’d like to learn more, please contact
The Walsh Group at 716-849-4856, or see
our website: http://www.morgan stanleyfa.com/ walsh/
The author(s) are not employees of Morgan
Stanley Smith Barney LLC ("Morgan
Stanley"). The opinions expressed by the
authors are solely their own and do not
necessarily reflect those of Morgan
Stanley. The information and data in the
article or publication has been obtained
from sources outside of Morgan Stanley
and Morgan Stanley makes no representations or guarantees as to the accuracy or
completeness of information or data from
sources outside of Morgan Stanley. Neither
the information provided nor any opinion
expressed constitutes a solicitation by
Morgan Stanley with respect to the purchase or sale of any security, investment,
strategy or product that may be mentioned.
Morgan Stanley Financial Advisor(s)
engaged The Bulletin to feature this article.
Peter and Lisa Walsh may only transact
business in states where they are registered or excluded or exempted from registration http://www.morganstanleyfa.com/
walsh/. Transacting business, follow-up
and individualized responses involving
either effecting or attempting to effect transactions in securities, or the rendering of
personalized investment advice for compensation, will not be made to persons in
states where Peter and Lisa Walsh are not
registered or excluded or exempt from registration.
© 2013 Morgan Stanley Smith Barney LLC.
Member SIPC.
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Spring 2014
The Medical Society Bulletin - Counties of Erie and Chautauqua
Page 11
The New York State
Physician Profile
NYS Department of Health Reminds
Physicians of Profile Requirements
PENALTIES FOR NOT COMPLYING
WITH NYPP REQUIREMENTS
Physicians who are required to complete or update their profile and do not
do so, or who knowingly provide materially inaccurate information to the
NYPP, may be guilty of professional
misconduct. The OPMC seeks to work
with physicians to ensure compliance
and avoid any misconduct issues.
The OPMC receives a monthly report
that identifies physicians who were
required to initialize or update a profile
during the previous month, but did not
do so. When the report is received,
OPMC will contact the physician, notifying him/her of the current failure to
comply, with the hope of resolving the
matter. The physician will have 30
days to come into compliance with the
profile requirements. Physicians who
www.eriemds.org
fail to comply within 30 days of notification from OPMC will be referred to
by the Board for Professional Medical
Conduct for disciplinary action.
The OPMC encourages physicians to
comply with the profile requirements,
to advance our common goal of providing the public with current, accurate
information that can be used to inform
patient decision-making.
QUICK LINKS:
Department of Health, Office of
Professional Medical Conduct:
http://www.health.ny.gov/professionals/doctors/conduct/
To apply for a Health Commerce
Account:
http://apps.health.ny.gov/pub/top.html
To access your Health Commerce
Account:
https://commerce.health.state.ny.us
d
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The Medical Society Bulletin - Counties of Erie and Chautauqua
Meaningful Use:
Criminal Penalties and Recent Updates
Stat Law Q&A: Late Breaking News on Medical-Legal Developments Affecting
Physicians and Health Care Professionals
Question: Are there any penalties
for a failed audit other than the
financial penalties of which we are
already aware?
Answer: Yes. In past years, the
Centers for Medicare and Medicaid
Services (CMS) have attributed most
attestation errors to the learning
curve that comes with the implementation of any new system such
as Certified Electronic Health Record
Technology (CEHRT). However, with
the increase in the number of audits—
particularly failed audits—CMS has
started to take a closer look at the
reasons for such failures. If CMS
determines that audit failure is due to
an Eligible Professional (EP) making
knowingly false statements in his or
her attestation, they have the ability to
seek an indictment against the EP.
Although we do not yet know of any
such cases that involve EPs, the Chief
Financial Officer of Shelby Regional
Medical Center (an Eligible Hospital
or “EH”) was indicted by a federal
grand jury on January 22, 2014 for
making false statements to CMS in
connection with the EH’s meaningful
use attestation. CMS alleges that the
CFO took advantage of the “honor
system” methodology of meaningful
use attestation to knowingly attest
that the hospital was meaningfully
using CEHRT when
it was not.
Specifically, the hospital allegedly
continued to use and maintain its
paper records but attempted to give
the appearance of achieving meaningful use by entering the data from
the paper records into the CEHRT on
dates far beyond the relevant treatment dates.
CMS recently also announced that
they have pushed back the deadline
for the Medicare EHR meaningful use
attestation for the 2013 reporting year
from February 28, 2014 to 11:59 p.m.
on March 31, 2014. The extension
does not change the reporting deadlines for an EP attesting for the
Medicaid EHR Incentive Program or
the Physician Quality Reporting
Systems Incentive Pilot Program.
In light of the potential for criminal as
well as financial penalties after a failed
audit, all EPs are advised to use this
extra time to carefully review and
confirm the accuracy of all data that
is being attested to for meaningful use.
If you have any questions, please contact our Managing Partner, Michael
J. Schoppmann, Esq at 1-800-4450954 or via email at MSchoppmann@
DrLaw.com.
Treatment of Minor Patients
Continued from page 6
the designation was not valid.
A sample designation form may be
obtained from Fager & Amsler, LLP. If
you have any questions regarding this
information, please feel free to call
Fager & Amsler in Syracuse (315-4281380 or 877-426-9555), Latham
(518-786-2880). Or Long Island (516794-7340).*
1. The word “parent” is specifically used in
the statue, and therefore it is questionwww.eriemds.org
able whether a non-parent legal
guardian has the power to delegate this
authority under the law.
This article has been reprinted with permission from: MLMIC Dateline, published by
Medical Liability Mutual Insurance Company, 2 Park Avenue, Room 2500, New
York, NY 10016. Copyright ©2012 by
Medical Liability Mutual Insurance Company. All Rights Reserved. No part of these
articles may be reproduced or transmitted
in any form or by any means, electronic,
photocopying, or otherwise, without the
written permission of MLMIC.
Spring 2014
MSSNY Editorial
5% Dividend
I am pleased to report that our
endorsed carrier, Medical Liability
Mutual Insurance Company (MLMIC),
has declared another policyholder dividend for 2014. The dividend is 5% this
year, and will be applied on July 1 to all
physicians who are policyholders on
May 1 and maintain continuous coverage through July 1.
This is the second consecutive dividend MLMIC has declared (3% last
year), and one of several it has
declared in its nearly 40 year history.
Most other medical liability insurers
operating in NYS lack the financial
strength or the policyholder-first mission to declare such dividends.
MLMIC puts your needs first, giving
you the service and protection you
deserve. It’s at-cost, long-term focus
ensures that you won't overpay for
quality protection, nor worry about the
Company being there when you need
them. And, their unparalleled claims
and risk management expertise provides superior protection, with high
success rates, and very satisfied policyholders.
All of this is why MSSNY has exclusively endorsed MLMIC as the medical
liability insurer for its members. For
more information on MLMIC, including
how to become a policyholder in time
to qualify for the 2014 dividend, please
visit www.mlmic.com or call your nearest MLMIC underwriting office: New
York City: 800.275.6564, Long Island:
877.777.3560, Latham: 800.635.0666,
or Syracuse: 800.356.4056.
In Memoriam
Frederick Beerel, M.D.
Vincent Controneo, M.D.
Michael McConnell, M.D.
Joseph Wechter, M.D.
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The Medical Society Bulletin - Counties of Erie and Chautauqua
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Medical Society of the County of Erie Resident Fellow or Medical Student Award
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Spring 2014
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Spring 2014
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