medical society of the state of new york news of …page 4 • mssny’s news of new york •...
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Medicaid Fee-For-Service (FFS) to Enforce Legislation Limiting Initial Opioid Prescribing
to Seven-Day SupplyIn accordance with New York State Public Health Law, effective
August 24th, 2017, the Medicaid FFS program will be implement-ing a seven (7) day supply limit on initial opioid prescribing for acute pain.
This is a change from the current editing, implemented on December 5, 2013, which set the limit to a fifteen (15) day supply on initial opioid prescriptions.
Prior authorization (PA) will be required for claims that do not meet the above criteria.
To obtain a PA, please contact the clinical call center at 1-877-309-9493. The clinical call center is available 24 hours per day, 7 days per week with pharmacy technicians and pharmacists who will work with you, or your agent, to quickly obtain a PA.
The most up-to-date information on the Medicaid FFS Pharmacy Prior Authorization (PA) Programs and a full listing of drugs subject to the Medicaid FFS Pharmacy Programs can be found here and here.
Medicaid enrolled prescribers can also initiate PA requests using a web-based application. PAXpress® is a web based pharmacy PA request/response application accessible here.
MEDICAL SOCIETY OF THE STATE OF NEW YORK
NEWS OF NEW YORKProv id ing In format ion to Ass i s t Phys i c ians in the State o f New York
INSIDE NEwSCLICk ICONS tO FOLLOw MSSNY ON
FACEbOOk Or twIttEr.
Volume 73 • Number 9 www.mssny.org October 2017
DFS announces group premium rates ...........page 2
Pharmacies can’t demand copays ..................page 2
Autumn is Legislative Agenda time ...........page 4
Burnout III for the Individual Clinician ......page 6
top New York Court rejects right to Physician-Assisted Suicide
On September 7, the New York Court of Appeals ruled that physician-assisted suicide is not a fundamental right, and that it would not block the New York Legislature from passing legislation banning physician-assisted death. Physician-assisted suicide is illegal in most states, but in recent years, Colorado, California, Oregon, Vermont, Washington and the District of Columbia have approved legislation allowing people to request life-ending medication from physicians. No state court, however, has recognized assisted suicide as a fundamental right.
The case was brought by three people with terminal illnesses. Two have since died. The plaintiffs had argued that the state’s existing ban on assisting a suicide should not apply to those seeking merciful ends to incurable illnesses. The court disagreed, noting that while state law allows terminally ill patients to decline life-sustaining medical assistance, it does not allow anyone to assist in ending patients’ lives. “The assisted suicide statutes apply to anyone who assists an attempted or completed suicide,” the court wrote in its unanimous decision. “There are no exceptions.”
In their lawsuit, the plaintiffs argued that New York’s prohibition on assisted suicide violated guarantees of equal protection under the law. They alleged
Oct. 10-14: Free Vets Health Care training Program
Conference in Niagara FallsThe Medical Society of the State of
New York, the New York State Psychiatric Association, and the National Association of Social Workers – New York State Chapter are hosting a two- day conference on Friday, 10/13 Saturday, 10/14 at the Niagara Falls Conference Center, 101 Old Falls St, Niagara Falls, NY.
The conference will consist of interactive
DFS Issues transgender Health Guidance to Health Plans
NYS DFS issued guidance on transgender health in a circular letter to health plans. The letter advises plans to request additional information before denying benefits for pro-cedures that are not routinely provided to a specific gender. Insurers may not discriminate against transgendered or gender non-con-forming individuals who file health claims for conditions that are not normally associated with the gender with which they identify. The circular letter is here.
Gov. reduces Health Insurance barriers to Substance
Abuse treatment CoverageIn September, Governor Andrew
Cuomo announced new regulatory guid-ance to better assure New Yorkers can more readily overcome insurance coverage bar-riers to receiving medications necessary to treat a substance abuse disorder. It was part of a series of initiatives announced by the Governor to facilitate new addiction treatment, recovery and support services to residents suffering from substance use disorders in underserved communities throughout New York City and Long Island.
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Page 2 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 3
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Individual health insurance premium rates will increase 14.5%, and small group premiums will increase 9.3%, according to an announcement from New York Financial Services Superintendent Maria Vullo. The DFS press release noted that it reduced the insurers’ requested 2018 rate increases by more than 3.8 % overall for the 300,000 enrolled in individual plans. For small group plans, with more than 1 million insureds, DFS reduced insurers’ requested 2018 rate increases by 2.4%.
The press release noted that the pre-miums were set despite the uncertainty regarding the continued availability of
the ACA’s Cost Sharing Reduction (CSR) subsidies for insurers. Specifically, it was noted that “DFS will continue to fight for payment of the CSRs so that consumers are not further harmed by federal gov-ernment actions. However, in light of the ongoing uncertainty regarding CSR pay-ments by the federal government… DFS is granting an additional rate factor based on information that insurers had pro-vided to DFS in May 2017 that estimated potential funding loss. The additional fac-tor only applies to the individual rates of silver plans.”
The press release further noted that “Underlying medical costs continue to
be the main drivers of premium rate increases, reflecting a nationwide trend. For the 2018 individual rates announced today, drug costs account for the largest share (26 percent) of all medical costs, with specialty drug costs increasing about 49 percent. Inpatient hospital costs account for the second largest share of medical expenses (19 percent), followed by physician specialty services (12 per-cent) and diagnostic testing/lab/x-ray (10 percent).”
For a full listing of the premium rates requested and approved on a company by company basis, please view the press release here.
DFS Announces Insurance Premium rates for 2018; Slight Decrease from Insurers requests
DOH: DSrIP Program reduces Potentially
Preventable readmissions and Er Visits
New York Medicaid Director Jason Helgerson recently announced the progress that New York’s Medicaid Delivery System Reform Incentive Program (DSRIP) has made, not-ing that New York had closed its second year with a 14.9% reduction in Potentially Preventable Readmissions and an 11.8% reduction in Potentially Preventable ER Visits.
The report also noted that, if the cur-rent reduction rates are maintained,
the Law: Pharmacy Provid-ers Cannot Demand Copays from those who Cannot Pay
The NYS Medicaid Pharmacy Program has been notified that some pharma-cies are refusing to dispense medications to patients for their inability to pay the copayment. Social Security Act §1916 specifies that no Medicaid enrolled pro-vider may deny care or services to an individual eligible for such care or ser-vices on account of such individual’s inability to pay a deduction, cost shar-ing, or similar charge. The September 2011 Special Edition Medicaid Update cover-page and the March 2012 Medicaid Update page 15, confirm this Federal law applies to all Medicaid providers, both fee-for-service and managed care. Providers may attempt to collect out-standing copayments through methods such as requesting the co-payment each time the member is provided services or goods, sending bills or any other legal means.
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Page 4 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 5
In 1990, the World Health Organization (WHO) approved the 10th Revision of the International Clas-sification of Diseases (ICD), known as ICD-10. All HIPAA-covered entities must use ICD-10 on the health insur-ance claims.
CMS adopted October 1, 2015 as the compliance date for use of ICD10.
During the first year of the transition from ICD-9 to ICD-10, CMS allowed for flexibili-ties. Then, with the update of revised, modified and/or discontinued ICD-10 codes that became effective October 1, 2016, ICD-10 flexibilities expired.
As of October 1, 2016, physicians have been required to code to accu-rately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. According to the government, many major insurers did not choose to offer coding flexibility; so, many physicians were already using specific codes.
Insurers not ready eIther
However, we at MSSNY found that many insurers were unaware of the October 1, 2016 update. A few weeks into October 2016, several plans were still trying to ensure that their systems could accept the new ICD-10 codes. This delay was costly for physician practices that had claims denied and, then, had to resubmit. In many
instances, our Ombudsman assisted our members with several appeals in order to get paid.
ICD 10 is an important stressor contributing to burnout. It’s absurd that’s it’s been imposed upon physi-cians - allegedly to provide consistency with the rest of the world, and to pro-mote public health initiatives. It has failed both objectives, but physicians pay dearly. The ever changing codes (every October since its adoption) cre-ates confusion and redundancy in the medical record, delays payment, and
MEDICAL SOCIETY OF THE STATE OF NEW YORK
NEWS OF NEW YORK
Medical Societyof the State of New york
Charles Rothberg, MD, PresidentPaul Hamlin, MD, Board of Trustees Chair
Philip A. Schuh, CPA, Executive Vice President
coMMUNicatioNS aNd PUBlicatioNS Maria Basile, MD, MBA, Commissioner
NewS of New yorkPublished by Medical Society
of the State of New York
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the News of New York is published monthly as the official publication of the Medical Society of the State of New York. information on the publi-cation is available from the Communications Di-vision, Medical Society of the State of New York, 865 Merrick Avenue, P.o. Box 9007, Westbury, NY 11590.
the acceptance of a product, service or com-pany as an advertiser or as a membership benefit of the Medical Society of the State of New York does not imply endorsement and/or approval of this product, service or company by the Medical Society of the State of New York. the Member Ben-efits Committee urges all our physician members to exercise good judgment when purchasing any product or service.
Although MSSNY makes efforts to avoid clerical or printing mistakes, errors may occur. in no event shall any liability of MSSNY for clerical or printing mistakes exceed the charges paid by the advertis-er for the advertisement, or for that portion of the advertisement in error if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the error. Liability of MSSNY to the ad-vertiser for the failure to publish or omission of all or any portion of any advertisement shall in no event exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement omitted if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the omission. MSSNY shall not be li-able for any special, indirect or inconsequential damages, including lost profits, whether or not foreseeable, that may occur because of an error in any advertisement, or any omission of a part or the whole of any advertisement.
PresIdent’s CoLuMn
Charles Rothberg, MD
Autumn in the New York State brings colorful leaves, the return of school buses and crisp foot-ball afternoons.
It is also the time when MSSNY’s Legislative & Physician Advocacy Committee meets to discuss organized medicine’s priorities for the upcoming legislation session.
There are literally hundreds of discreet legislative initiatives that physicians and physician associations across our State both support and oppose. However, there are key issues, such as reducing health insurance hassles, reducing our choking liability costs and protecting our public health, that unite all physicians.tIMe for strategy
Perhaps more important than any specific issue, the Committee strat-egizes regarding the means by which physicians across the State – from every region, every specialty and every type
of practice setting – can work together to enact these key goals, and to prevent the enactment of adverse measures.
One of the key themes that was emphasized at our September meeting was the critical need to increase physi-cian grassroots efforts in every corner of the State.
It was noted that decision-making in the Legislature has become much more decentralized in recent years. With major leadership changes in the Senate and Assembly, individual leg-islators within each of the Legislative Conferences have assumed a much greater involvement in decisions regard-ing which bills will be considered.you are Part of the ProCess
Therefore, it is essential that physi-cians take the time to regularly meet and contact their local Senators and
Mssny-PaCAutumn in New York is Legislative Agenda time!
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ICD-10 and You
Page 4 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 5
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CareConnect, which includes 22 hos-pitals, including North Shore University Hospital, Northern Westchester Hospital and Lenox Hill Hospital, reported that they will exit the insurance market in 2018 “because of the uncertainty of the Affordable Care Act’s future” and costs. About 126,000 CareConnect poli-cyholders “would remain covered while they transfer to new health providers.” CareConnect parent Northwell Health highlighted a $112 million payment into the ACA’s risk-adjustment pool this year, which represented 44 percent of CareConnect’s 2016 revenue from its
small group health plan. CareConnect faced another such payment and “said it never received $150 million from the federal government in risk-corridor pay-ments.” (Newsday)
Northwell CEO Michael Dowling said in a NY Times interview that the poli-tics are “so poisonous at the moment that nobody wants to sit down collec-tively and, in my view, do their duty to fix the things that need to get fixed…It has become increasingly clear that con-tinuing the CareConnect health plan is financially unsustainable, given the fail-
Northwell to Shutter CareConnect in 2018 Over ACA Uncertainty, Costs
September 14 Council Notes• MSSNY’s VP of Legislative and Regulatory Affairs John Belmont presented
information on Physician Advocacy Network (PAL), an initiative aimed at get-ting MSSNY’s message out to legislators in an innovative new way. MSSNY recognizes that many physicians have relationships with various legislators and others activists. The goal would be to have at least two or three members assigned as a liaison to each state legislator and for these PALs to meet per-sonally with their assigned legislator at least twice a year to develop or further solidify relationships with elected officials. MSSNY is currently in the process of updating and retooling our key contact list to assist in our legislative advocacy and is looking for assistance from members in reaching out and identifying physicians who have close relationships with legislators. For more informa-tion, contact John Belmont at [email protected] or 518-465-8085.
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Explanation of CMS’ Special Status
CalculationCMS has introduced new infor-
mation on www.qpp.cms.gov that indicates whether clinicians have “special status” and can therefore be considered exempt from the Quality Payment Program.
To determine if a clinicians’ par-ticipation should be considered as special status under the Quality Payment Program, CMS retrieves and analyzes Medicare Part B claims data. A series of calculations are run to indicate a circumstance of the clinician’s practice for which special rules under the Quality Payment Program will affect the number of total measures, activi-ties or entire categories that an individual clinician or group must report. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), Rural, Non-patient facing, Hospital Based and Small Practices.
For more information, please visit the Quality Payment Program website.
Page 6 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 7
In May of 2016, the MSSNY created a Stress and Burnout Task Force. This Task Force was charged with formu-lating a strategy and plan of action to fight burnout and reduce stress among the constituents of the MSSNY. The fol-lowing article is the third of a miniseries that addresses the following topics: the problem of burnout, current state of the State (burnout survey), solutions at the individual and organizational level and opportunities for advocacy.
Many professions experience burnout from occupational stress, especially in healthcare.
Specific sources of occu-pational stress differ by profession. Our focus in this article is on clinician burnout. Burnout is defined on sev-eral realms: 1) Exhaustion, physical and/or emotional, 2) Depersonalization/cal- lousness, which is a dysfunctional coping mech-anism that distances you from patients and others, and 3) Lack of efficacy, which can be imagined or real, and as it progresses, it contributes to a loss of self-confidence and sense of purpose.
Occupational stress is de-fined as the harmful physical and emotional responses that occur when the require-ments of the job do not match the capabilities, resources, or needs of the worker. Job stress is a work-place hazard that can lead to poor health and even injury. Most dedICated at rIsk
It has been noted by researchers that those clinicians at greatest risk for burnout are those most dedicated and committed to their work, who may get consumed by their job, and have difficulties draw-ing healthy boundaries between work and home. Society would consider these individuals our “ideal doctors.” However, in today’s culture of medicine with over-expectations becoming an unsustainable norm (roll out of numerous compliance and quality initiatives), no central agency or office looks after the wellbeing of the individual clinician. Therefore, being able to recognize how occupational stress is affecting you as a clinician is critical for your wellbeing.
Numerous and complicated factors
discourage clinician wellness. Some are internal and many are external (Figure 1). Caring for yourself was challenging enough in our old culture of medicine where we had more autonomy in deci-sions and intrinsic motivation was the driver of our workload. “Working hard” and choosing to stay late to take care of patients felt much different in the old culture than our current culture of medi-cine where it is considered an expectation from any clinician. Currently, major driv-ers of overwork are imposed extrinsically. Clinicians find themselves staying late
due to administrative obligations or man-dates, technology challenges, or other logistical intrusions that actually unin-tendedly interfere with our care of and relationship with the patient. ruLes Made By non-CLInICIans
Over 75% of physicians in the United States are now employed. Many deci-sions about compliance with the tsunami of regulations are made by people who are far removed from the clinician-patient interface and often, are not clinicians. Each law, regulation, or mandate may individually be well-meaning and sold as “quality-” or “safety-” related. Hence, enforcement can make sense to those whose job it is to do so. What is not included in the current calculations is the human effort required to achieve compliance when coming from disparate
authorities in healthcare. The airlines industry has to report to one authorita-tive agency, the FAA (Federal Aviation Administration). Healthcare has to report numerous siloed authorities, each with their own set of regulations, laws, or mandates, without one authority that oversees it all. Full additive compliance is neither humanly possible to do, nor safe for clinicians or patients. More national awareness about this paradoxical back-fire from over regulation has occurred.reward and PunIshMent
Rapid roll out of numerous federal, state, certification and industry initiatives tended to focus upon ‘carrot and stick’ methods of reward and punishment for desired behaviors in healthcare practice. Hence decision-makers concerned about the bottom line of the institution or practice naturally insist upon compliance to different agencies. More big-picture thinking healthcare adminis-trators are picking up on this human factor gap. However, until your institution begins to recognize this fact, or even while they are in the process of addressing these human factor issues, this article is for your self-care.
Different forms of stress need to be differentiated (Figure 2). Hypostress is a state of abnormally low stress. Then boredom and restlessness occur. Eustress is a state of being energetic, inspired, or motivated and
helps peak our functionality. Distress is a state of either acute intense severe stress, or chronic intense severe stress, and it begins to demonstrate break-down in human functionality. Hyperstress occurs when this intense severe distress becomes chronic and actually starts to deplete coping mechanisms. At this point, small triggers may send you “over the edge” to mini breakdowns (see “Point A”), and continue to progress to signifi-cant impairments in human function. The clinician who looks OK to his or her staff at the start of a procedure, then with some stress “loses it”, is likely living at this “Point A” and may not realize it. This is dangerous to the clinician and his patient.
The external healthcare environment
burnout reduction for the Individual Clinician
External world environment‘Hidden curriculum’ in training Medical Culture of Endurance and Silence
Everybody has to do it. New regulations say this is ‘good care’, but they don’t see
the unique situations of the patient in front of meGroup Think Bias. ‘Everyone’ is following these authorities.
Significant penalties if I don’t followYou are a ‘professional’ and supposed to suppress
how you feel (instead of acknowledging feelings but choosing behaviors).
You are lucky to be working/ training here.Don’t be ‘weak’. Don’t be a ‘fanatic’.
Internal world:Altruism, workaholism, perfectionism, obedience to authority.These numerous regulations are impossible and aren’t good care
Ultimately, it is my fault if there is a bad outcomeI don’t want them to think I can’t handle this
Everybody else keeps showing up for work, is it just me? I wonder if anyone else feels this way?
My family is depending upon me
Figure 1. Strong Forces that Discourage Physician Self-‐Care in the Culture of MedicinePhysician External and Internal Scripts
figure 1. strong forces that discourage Physician self-Care in the Culture of Medicine Physician external and Internal scripts
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still may drive unrealistic expectations (see “fantasy” endpoint). We, individual clinicians, have the responsibility to take care of ourselves. Healthcare institutions are slowly coming to understand that the fourth aim (the experience of providing care) is critical to patient care and safety, to the health of individual practitioners and to the healthcare system as a whole. The fourth aim is essential to the success of the usual Triple Aim of reducing costs, improving quality of care and patient experience of receiving care.MedICaL students too
Physicians start off more resilient than the general population. Two years into medical school this relative relation-ship reverses with more burnout and depression in medical students than in the general population of same age and education.
Yet the “hidden culture” in training
programs dictates that clinicians main-tain a ‘stiff upper lip.’ Therefore, it is imperative to recognize signs of stress and burnout in self and others (such as feeling drained, or easily frustrated with people, or becoming careless) as well as unhealthy strategies (like self-medicating with alcohol, drugs, or stress eating).
Hence, individual interventions must be paired with organizational interven-tions. Reduce the stress organizationally while working on individual interventions. In this paper, we will focus on individual interventions. Our subsequent article will focus on organizational interventions.IndIvIduaL InterventIons
The following have been accumu-lated from many sources, several of which are listed in websites or refer-ences below. In our experience, there is no one size that fits all. Clinicians need to determine which best fit their needs, their personality, and their time.
I general stepsMany overall steps to promote personal
well-being have been suggested:1. Identify personal and profes-
sional values and priorities. Consider ranking each group in order. This may help to determine where to focus when managing con-flicts of time or other priorities.
2. Enhance areas of work that are most meaningful.
a. What is your ideal practice, the Blue-sky version?
b. How can you maximize the over-lap between your current job and your blue-sky version?
3. Identify and nurture personal wellness strategies of impor-tance to you.
a. Protect and nurture your relation-ships, and spirituality practices.
b. Respect basic human needs such as sleep, nutrition or exercise.
burnout reduction for the Individual Clinician
Patientin need!!
THE HUMPFantasy,Expectation
ComfortZone
Exhaustion
Ill Health
Breakdown
Health
BoredomHypostress
FatigueFatigueEustress Distress
Per
form
ance
Point A
Hyperstress
•Cognitive processing capacity compromised[1]
•Less cognitive capacity available for needed brain functioning in medical care[2]
• Degeneration of cognitive performance, increase risk of poor medical decisions, poor quality and medical error [1,2,3]
• High occupational stress is financially costly to institution [4,5]
• Less compassion, self effacement, empathy and ability to listen the patients.• Higher risk of being victim of workplace violence from patients.[6]
• Poor patient satisfaction rating [7]
• Irritability, incivility, reactive patient abuse• Provider/staff burnout, leave medicine, retire early[8]
Due to ‘Culture of Endurance’ in training, persistent self-challenge,clinicians think theyare pushing to “ The HUMP”as if Eustress
…..not realizing they are actually pushing into Distress
Medical or PsychiatricBreakdown Medical Death or Suicide [9]
Arousal stress, pressure, increased expectations on clinician
Multiple work stresses from uncoordinated sourcesEach small alone but incrementally accumulate.1 + 2 + 3 + 4 + 5 + 6……………………….
Point A = even minimalarousal can precipitatebreakdown
Stress
Adapted from: Nixon PGF. The Practitioner. (217):765-770. 1976
figure 2. human function Curve in average Clinician
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MSSNY Counsel Don Moy: Please read the 2018
Family Leave LawVirtually every employer in NYS must
start preparing for phased in implemen-tation of the NYS Paid Family Leave law, which begins in 2018. The State of New York website gives detailed summaries regarding the law, and the obligations of employers and employees under the law. The attached information may be helpful in the event a medical practice or county medical society is not aware of this website.
Governor Cuomo has signed into law legislation (S.6078, Valesky/A.7842, Gottfried) that prohibits health care pro-viders and facilities from charging patients for copies of medical records when such records are needed “for the purpose of supporting an application, claim or appeal for any government benefit or program”.
While existing law already prohib-its charging for medical records when a patient is unable to pay, the purpose of the new law is to respond to numer-ous complaints lodged by patients where they were charged for medical records necessary to assist applications and appeals for government programs assist-ing lower income patients such as Social
Security Disability Insurance (SSDI) and the Supplemental Nutritional Assistance Program (SNAP), or other government benefit program such as those for 9/11 first responders. While noting that it did not condone the actions of health care providers who were charging low-income patients for medical records, MSSNY did express concerns that the terminology “any government benefit or program” in the legislation was too broad, and suggested that the bill be amended to specifically enumerate in the law those low-income government benefit pro-grams to which this fee charge prohibition should apply. However, that change was not made.
New Law to Prohibit Medical record Charges when Needed to Support a Patient’s Government Benefit Application
Eugene E. Weise, MD, is the recipient of the 2017 Nicholas
Romayne, MD Lifetime Achievement Award . Dr Weise (left) and Michael G. Goldstein, MD, JD, Past Society
President (right).
MSSNY travel Discount Program
MSSNY is pleased to offer an exclu-sive worldwide travel discount service to our members. Savings average 10-20% below-market on all hotels and car rental suppliers around the world.
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Join MSSNYPACtoday at
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Lifetime Achievment Award
Page 8 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 9
Page 10 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 11
Assemblymembers. We thank all those physicians who have regularly responded to our calls for “grassroots action” to send letters to their legislators. Please keep it up.
But we really need physicians across the State to do even more. And our pro-fessional future depends upon it.
MSSNY is urging physicians to join its new “key contact” program called the “Physician Advocacy Liaison” or PAL, where physicians will be “assigned” leg-islators with whom they will be asked to regularly contact. Staff will host regular legislative update calls with PAL mem-bers to assure they are fully informed for their meetings.
Your efforts, when multiplied many times over across the State of New York, can really be the difference between leg-islative success and failure.
We know many of you already enjoy good working relationships with your local legislators. Please let us know with whom you have these contacts and you will be added to our list.
We strongly encourage you to join us in these efforts. Please become a “PAL” by e-mailing [email protected].
At the same time we also need you to support MSSNYPAC. And for those who already provide support we need you to prod other physicians to join.PuLLIng our weIght?
Our PAC is being badly outspent by other groups whose interests are often diametrically opposite to the physicians’ agenda. For example, in the most recent state filings, both the Dental PAC and the Trial Lawyers PAC spent more than 3x greater than MSSNYPAC.
This despite the fact that there are a fraction of dentists and trial lawyers in
New York State compared to the number of doctors.
Please join our efforts. Join our PAL program. Join MSSNYPAC. And most importantly, make sure your colleagues do the same. Physicians cannot afford to stay on the sidelines anymore. Our advocacy on behalf of our patients is being drowned out by competing voices.
Your professional future and your patients’ ability to obtain needed care is at stake.
We need to be more involved. We are confident we can do this.
Dr. Joseph Sellers, Chair, MSSNYPAC at [email protected]
Dr. Rose Berkun, Vice-Chair, MSSNYPAC at [email protected]
Dr. Michael Brisman, Vice-Chair, MSSNYPAC at [email protected]
Dr. Nabil Kiridly, Vice-Chair, MSSNYPAC at [email protected]
Mssny-PaC(Continued from page 4)
MeMBers In the newsnorth shore unIversIty hosPItaL honors faMed oLyMPIC antI-doPIng doCtor
Gary I. Wadler, MD, one of the driving forces behind the formation of the World Anti-Doping Agency and a longtime physician at Northwell Health’s North Shore University Hospital, had a dialysis unit named in his honor. The Gary I. Wadler, MD and Nancy R. Wadler, Esq. Dialysis Unit was dedicated last month at Monti Pavilion at North Shore University Hospital (NSUH).
“We are very proud to recognize the Wadlers’ enormous contributions to North
Shore University Hospital,” said NSUH Executive Director Alessandro Bellucci, MD. “In response to a patient’s life or death situation in 1971, Gary spearheaded the beginning of the hos-pital’s inpatient dialysis unit.”
Dr. Wadler, an internist with special expertise in exercise sci-ence and sports medicine, received the International Olympic Committee President’s Prize for his groundbreaking 1989 book, Drugs and the Athlete. He served as chairman of the Prohibited List Committee after the World Anti-Doping Agency was founded in 1999.
“Dr. Wadler’s influence on the effort for clean sport has been enormous. He has been an instrumental leader in the early effort to establish independent anti-doping organizations sepa-rate from sport, which is now recognized as the gold-standard model,” said Travis T. Tygart, US Anti-Doping Agency CEO. “He has been a true pioneer in this regard.”
An influential figure in sports, Dr. Wadler has served as a vice president of the Women’s Sports Foundation, was found-ing chairman of the Nassau County Sports Commission and the Taylor Hooton Foundation, and currently serves as chairman of the College Council at SUNY Old Westbury. Dr. Wadler also worked closely with the US Open Tennis Championships for more than a decade.
Dr. Wadler is a Cornell University Medical College graduate, performed his post-graduate work at The New York Hospital
and was chief resident in medicine at North Shore University Hospital. He is a fellow of the American College of Medicine, the American College of Preventive Medicine, the American College of Clinical Pharmacology and the American College of Sports Medicine where he served as a trustee and chairman of the College’s communication and Public Information Committee. Dr. Wadler was also chairman of the American Ballet Theatre’s Curriculum Medical Advisory Board, where he created and over-saw the development of the medical guidelines for the health and sound training of ballet dancers across the United States.
At presstime, MSSNY was informed that Dr. Wadler died on September 12. PauL haMLIn, Md naMed MedICaL dIreCtor for MeMorIaL sLoan ketterIng CanCer Center
Paul Hamlin, MD has been appointed MSK’s Medical Director for the David H. Koch Center for Cancer Care and will transition into that role in January 2018. The David H. Koch Center for Cancer Care will expand MSK’s inpatient and outpatient footprint with a new, state-of-the-art clinical facility. The dis-ease management teams to be housed there include our Phase I unit for patients on early stage clinical trials, thoracic and head and
neck outpatient clinics, and a large hematologic oncology pres-ence, which will include leukemia, lymphoma and bone marrow transplant clinics.
Dr. Hamlin joined MSK as a fellow in Medical Oncology in 2001. He previously served as the Clinical Director for the 64th Street Outpatient facility and ran the Innovation Lab for the Lymphoma service. He also maintains a lymphoma clinic and conducts research related to novel biologic and immunothera-peutic agents for the treatment of hematologic malignancies. Currently, he is the Department of Medicine Service Chief at Basking Ridge.
Dr. Hamlin is the son of the current MSSNY Chairman of the Board and MSSNY Past President, Dr. Paul Hamlin.
Dr. Gary I. Wadler
Dr. Paul Hamlin
Page 10 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 11MSSNY-ad-141211.indd 1 12/11/14 5:16 PM
The NYS Department of Health has an Office Based Surgery (OBS) Advisory Committee. In July of 2017, the NYS DOH decided it would conduct a voluntary pilot with OBS practices requiring them to report the number of cases they perform and the CPT codes of these cases. This was to be done via the Health Commerce System (HCS). no Longer voLuntary In January 2018
The first foray by the DOH to mine data was voluntary. Starting January 2018, the DOH has indicated that they will make the provision of this information mandatory by all NYS OBS practices. They feel that they have the authority to require this because of the following wording in the OBS law:
Reference: PHL § 230-d, 4. (b): “The department may also require licensees to report additional data such as proce-dural information as needed for the interpretation of adverse events.” Click here.
Dr. William Rosenblatt, a plastic surgeon, is MSSNY’s repre-sentative on the OBS Advisory Committee. There are a few other practicing office-based physicians. However, the practic-ing OBS physicians are outnumbered by the significant amount of state employees and full-time hospitalists. He has been speaking against this requirement as it represents another unfunded intrusive mandate for practicing physicians and he does not agree that the law allows the DOH to ask all OBS facilities for this information. He states “If I have a complica-tion or an adverse event that needs to be reported, I will give the DOH the information they need, but to do this for all cases is intrusive and not needed.”
Much of the data that the DOH is seeking and asking to be reported is public information that can be found if the agency knows where to look. Quad A already provides the number of cases done per six-month period to the DOH.adverse events
The law requires an OBS to report certain types of Adverse Events (AE). NYSDOH is working on a process to require AEs to be reported electronically. Click here. This is not an issue as it will simplify reporting.
For many surgeons who provide OBS, many procedures are not reimbursed by insurance. Therefore, AMA-CPT codes are not used for recording those procedures.
In NYS there are over 990 OBS facilities. Click here for list. To locate a specific OBS site, click on Number of accredited practices by county and select the county of your choice.
Effective July 14, 2009, physician offices that perform surgi-cal or invasive procedures using more than mild sedation or liposuction over 500cc under straight local, must be accredited by one of these agencies:
• Accreditation Association for Ambulatory Health Care (AAAHC)
• American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF)
• The Joint Commission (TJC)In NYS, there are about 650 OBSs that are certified by
AAAASF, which provides the NYS DOH with the number of cases done. Neither AAASF nor the Joint Commission ask their facili-
Looking for ObS Physician Support
(Continued on page 16)
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c. Develop hobbies and interests outside of medicine.
II resources from state and national organizations:
1. American Medical Association (AMA)
The AMA has set up the resource website called STEPS Forward that helps with individual and organizational/practice methods that can reduce burnout.
STEPS Forward™ offers inno-vative strategies that will allow physicians and their staff to thrive in the new health care environ-ment. It includes modules on physician burnout and resilience.
2. Medical Society of the State of New York (MSSNY)
The MSSNY Task Force for Physician Stress and Burnout has developed a resource library geared for individuals, those that help individuals, and those who are administrators hop-ing to improve the situation at their institution. Visit the MSSNY Physician Burnout Library.
III Peer support ProgramsPeer support is the existence of
positive psychosocial interactions with others with whom there is mutual experience, trust, concern and empa-thy. These relationships contribute to positive adjustment and may buf-fer against stressors and adversities. Peers, because they have undergone and survived relevant experiences, are credible supports for others. Interactions with peers who are suc-cessfully coping with similar situations are more likely to result in the devel-opment of resilience. MSSNY Burnout Task Force is currently working on ways to help make this means of sup-port more available in our state.
Becoming burned out can be an iso-lating experience. Social support and community can mitigate stressors that contribute to burnout. Consider community building activities such as meet and greets, journal clubs, book clubs, etc. Iv Institution-based efforts to
help individuals.Some institutions are offering a
series of wellness seminars that would qualify for CME and if attend enough seminars would qualify for malpractice reduction.
Wellness seminars, when offered at
an institution, can be a safe place to start to address self-care. Volunteer faculty may not be experts in cer-tain areas but may be able to have an interest to learn more and be able to teach others on various topics for seminars and be the new local expert. The discussions that come from the assembly around the topic itself can be therapeutic and the beginning of a safe space to begin to deconstruct the culture of endurance and silence. Many suggestions can begin to give form to organizational interventions that need to be done. These seminars became an invaluable intervention by creating a safe space to open up the topic of occupational stress and the toll that it takes. Even the process of advertising the seminars is a powerful supportive intervention by means of their stress-validating topic titles promoted from a ‘mainstream’ institution-based entity like a Faculty Development Office. Examples of seminar titles: Overview of Burnout: Causes, Mechanisms and Reduction; Put Your Oxygen On First as You Take Care of Others; The Emotional Life of the Clinician; Finding Meaning in Medicine and Healthy Approaches to Clinician Stress.v Mindfulness Based stress
reduction (MBsr)MBSR training can occur in person, if
arrangeable in your schedule, or some are online. Here are some resources:
1. UrMC Mindful Practice2. Ohio State University Center
for Integrative Health and wellness (online)
3. Mindful.org (online)vI web-based Cognitive Behavio-
ral therapyFor busy practitioners or those in
training who find it difficult to make it to outside appointments, a web-based program of Cognitive Behavioral Therapy was studied in interns to help reduce depression and suicidal ide-ation. Click here. vII time Management
Example of time management would be:
1. E-mail grouping in batches during the day (e.g.11:30 and 4:30 PM). This reduces the unnecessary expenditure of your brain’s neural resource that gets used up, just in the process of starting and stop-ping one activity, recovery after interruptions, etc.
2. Documentation in charts: re-think
burnout reduction for the Individual Clinician(Continued from page 7)Other Personal tools or Pearls
gratefulness/3 good things Journaling: Gratitude has been defined as a warmly or
deeply appreciative attitude for kindnesses or benefits received. It may be helpful in reducing duress and reframing a personal sit-uation. Check this link to a review article that explores gratitude at work further, and on this YouTube link to learn more about the Three Good Things Intervention at Duke University. the happy Md:
Dike Drummond, MD provides a rich resource of short helpful videos, book avail-able, free personal discovery hour to set up your plan to address burnout. He has been a consultant to physicians for many years and has gone through burnout himself twice. He gives an individual and organizational model of reducing stress and improving recharge. Click here.yoga Better nutritionsustainable amount of exercise:
Start small and simple, frequent and funnarrative medicine:
To vent past traumas in training and practicePersonal trainer/coach (fitness, communication, performance, lifestyle)honoring self:
You are the only one that can take care of yourself, and it is not only OK to do so, but necessary for being the best physician, col-league, spouse, friend, parent, you can be.set a boundary ritual between work and home:
As an example, listening to relaxing music or doing mindful breathing during the car ride home, or doing a Mr. Rogers routine (yeah, the sweater, the sneakers!)Bucket list activities:
Write them down and start doing the list.regular vacation:
Don’t run yourself ragged before you decide to take off.Important relationships:
Prioritize and invest adequate time to strengthen emotionally important relationshipsadvocacy or volunteerism for something that you are passionate aboutspirituality:
Put work within the larger context. Try to get back in touch with the original reasons that motivated you along this road to become a clinician.Check your institution or community resources on stress reduction or wellness offerings
(Continued on page 13)
Page 12 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 13
burnout reduction for the Individual Clinician
how much you need to document. Write smart, not write long. The EMR templates promotes obsessiveness and over-docu-mentation. Use the clock to limit the time you will spend on each note.
3. Schedule the things you are going to do outside of work. Get them on your calen-dar that you can see at work.
Consult this link for further information on time management.vIII Learning ways of dealing with upset
patients and upsetting situationsSee if local mental health colleagues can pull
together a seminar on de-escalation, dealing with angry, demanding patients and families. These skills are not taught in medical school yet are dealt with on an almost daily basis. It does not help to talk over them, recite rules, etc. Learn when listening, understanding words and empathy can help, and when situations go beyond empathy and words no longer can help, and you have to think of your own well-being. People can also advocate for discussion programs within their own institutions such as psychological first aid, multi-perspective pro-grams like Schwartz Center Rounds.IX employee assistance Program (eaP) or
private therapist, psychotherapy and/or medication
Psychotherapy and or medication can be life-saving when burnout gets to the level of depression and having someone else to help you find strategies to take back the life and self-care needed to sustain the practice of medicine.ConCLusIon
No matter what method(s) you choose that best appeal to you, try to follow through. Persistence in the resolve to take better care of yourself in this very chaotic healthcare work environment is the first step. Just keep moving in a better direction, no matter how slow the progress. It is not part of our DNA to take care of ourselves, so this requires practice until our work environment starts catching on to how important this is, and just maybe the environ-ment will become less stressful. As we tell our patient, you need to care for yourself to be able to care for another. Self-care requires practice and maintenance.
Stay tuned for the next MSSNY article which will focus upon organizational/Systemic inter-ventions to reduce clinician burnout.
authorsMichael r. Privitera MD, Chair, MSSNY Physician Stress and Burnout Task Force, Director, Medical Faculty and Clinician Wellness Program, University of Rochester Medical CenterCaroline gomez-diCesare, Md, Member, MSSNY Physician Stress and Burnout Task Force Bassett Healthcare Network – Middleburgh, NYterrance bedient, FACHE CPH Vice President and Director, MSSNY
The following Q&As – prepared by Terrance Bedient, FACHE, Vice President/Director of Committee for Physician Health of MSSNY—relate to attending physicians, residents, medical students and physician assistants in New York State:
Q1. Does it affect my license to have seen a mental health provider?
A1. No. When an attending physician, resident, medical student or physician assistant (physician) is applying for initial licensure or biennial re-registration, the forms include NO question about having been seen by a mental health provider. Further, any information learned by a physician while providing treatment to another physician is considered absolutely confidential. NYS Public Health Law §230-11e.
Q2. Does it affect my malpractice to have seen a mental health provider?
A2. Applications to the state’s major medical malpractice carriers typi-cally do not query if an applicant has seen a mental health professional. CPH’s experience with all the medical malpractice carriers have been very physician-friendly.
Q3. Do I need to declare this on my license renewal application?A3. No. When a physician applies for biennial re-registration, the forms
include NO question about having been seen by a mental health provider.Q4. Does it make a difference for any of the above, whether I
see a Lifestyle professional (EAP) compared to a Disease manage-ment specialist (behavioral Health Partners, private therapist, or psychiatrist, etc.).
A4. No. The confidentiality provisions apply equally to employee assis-tance, Behavioral Health Partners, private therapist or psychiatrist.
Q5. Does it make a difference as to whether I had psychotherapy or whether medications were needed?
A5. The confidentiality of treatment remains for all diagnoses and treatments.
Q6. Can it be considered misconduct by having the diagnosis of a mental disorder, even though it is stable?
A6. It is not misconduct to be maintained on an approved therapeu-tic regimen that does not impair the ability to practice. NYS Education Law §6530-8. It would be misconduct if practicing the profession while impaired by alcohol, drugs, physical or mental disability. NYS Education Law §6530-7.
(Continued from page 12)
rEFErENCES 1. National Institute of Occupational Safety and
Health (NIOSH): https://www.cdc.gov/niosh/docs/99-101/pdfs/99-101.pdf. Last accessed 09/14/2017.
2. Scudder L, Shanafelt T. Two sides to the physician coin: Burnout and Wellbeing. Medscape. February 09, 2015. Last accessed 09/14/2017.
3. Kabat-Zinn J. Full Catastrophe Living (Revised Edition) Bantam Books, New York. 2013.
4. Balch CM, Copeland E. Stress and burnout among surgical oncologists: a call for personal wellness and a supportive workplace environment. Ann Surg Oncol. 2007 Nov;14(11):3029-32
5. Hammond, K. R. Judgments under stress. Oxford University Press, New York. 2000.
6. Paas F, Renkl A, Sweller J. Cognitive Load Theory: instructional implications of the interaction between information structures and cognitive architecture. Instructional Science 2004;32:1–8,
7. Collie D. Workplace Stress: Expensive Stuff. http://www.emaxhealth.com/38/473.html (July 7, 2004). Last accessed 09/14/2017.
8. Cotton P, Hart PM. Occupational wellbeing and performance: a review of organisational health re-search. Australian Psychologist 2003;38(2):118-127.
9. Design Council. Reducing violence and aggression in A & E through a better experience http://www.designcouncil.org.uk/Docu-ments/Documents/OurWork/AandE/Reduc-ingViolenceAndAggressionInAandE.pdf. Last accessed 09/14/2017.
10. Tubbs SL, Husby B, Jensen L. Ten common misconceptions about implementing continuous improvement efforts in health care organiza-tions. The Business Review, Cambridge (JAABC). Summer 2011;17(2):21-27.
11. Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc Sci Med. 2001 Feb;52(3):417-27.
12. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012 Oct 8;172(18):1377-85.
13. Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. Gen Hosp Psychiatry. 2013Jan-Feb;35(1):45-9.
14. Gazelle G, Liebschutz JM, Riess H. Physician burnout: coaching a way out. J Gen Intern Med. 2015 Apr;30(4):508-13.
Page 14 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 15
the law unlawfully discriminates between terminally ill patients who have the option of dying by declining life-sustaining medical assistance and other ter-minally ill patients who are unable to hasten their deaths simply by rejecting medical assistance.
MSSNY’s Bioethics Committee is working on an Aid to Dying survey to gather New York physicians’ positions on this topic.
seminars and panel discussions focusing on the current and evolving healthcare needs of veterans. MSSNY and NYSPA will be conducting three CME accredited trainings for primary care physicians and specialists. The CME programs are “Invisible Wounds of War: PTSD, TBI & Combat-Related Mental Health Issues,” “Recognition, Management and Prevention of Veteran Suicide,” and “Substance Use Disorders among Returning Veterans.”
There is no cost, but separate registration will be required for both the trainings and conference. More information will be coming shortly.
Specifically, a new regulation was issued by the New York Department of Financial Services (DFS) that will require insurers who offer large group coverage to allow consumers to appeal coverage denials for medi-cally necessary addiction medications when they are not on the list of covered drugs.
The regulation calls for an insurer to notify the patient and the pre-scribing physician within 72 hours of the request, and provide coverage of the non-formulary medication for the detoxification or maintenance treatment of a substance use disorder for the duration of the prescrip-tion, including refills. Furthermore, the regulation requires an expedited appeal process for “exigent circumstances” where notification of the determination must be provided to the patient and the prescribing phy-sician no later than 24 hours following receipt of the request.
Moreover, DFS issued a “circular letter” to New York insurers designed to eliminate impediments to addiction services coverage, “to prevent insurers from excessively reviewing the medical necessity of opioid treatment, and to bar the inappropriate delay of coverage.”
New York will achieve its goal of a 25% reduction in avoidable hospital use by DSRIP Year 5. The report also noted that New York’s Performing Provider Systems (PPS) have earned a total of $2.4 billion, which is 95% of all available funds.
While these are important achievements for New York’s DSRIP pro-gram, MSSNY continues to raise concerns to state officials that funds allocated to many of these PPS across the State are not ultimately being distributed to the downstream PPS participating providers to support their efforts in helping to bring about these important reductions.
• Speaker Kira Geraci-Ciardullo, MD announced key information and deadlines for the House of Delegates meeting, which will begin on Friday, March 23, 2018 and will adjourn on Sunday, March 25, 2018. All activities will take place at the Adam’s Mark Hotel in Buffalo. The win-dow for submitting Resolutions is January 22, 2018-February 9, 2018 at 5 pm.
• A letter signed by MSSNY (and by 40 other state medical societies and 33 National Medical Specialty Societies) was sent to Dr. Nora of the American Board of Medical Specialties regarding the ongoing contentious issue of MOC. The letter informed ABMS about both a high-level summit that recently took place regarding MOC, and an upcoming meeting in December with the ABMS, the Council of American Specialty Societies and state medical societies to share physician views and seek agreement on how to reshape the MOC process. Dr. Madejski will represent MSSNY at the December meeting.
• Council reconsidered Resolution 2017-157: Development and Promotion of Evidence-based Ultrasound –First Radiation Mitigating Protocols, and voted to Not Adopt Resolution 157.
• MESF will present Physicians Leadership Seminar on October 20-21, 2017 at the Albany Hilton. Topics include Where the NYS Legislature is Leading Us in Health Care; Strategic Leadership of the Health Care Enterprise: Creating Value in Turbulent Times; and Blue Ocean Thinking: Focusing on Where the Fish are Swimming. Featured speakers include Jon Chilingerian, Ph.D, Carole Carlson, MBA.
September 14 Council Notes(Continued from page 5)
reduced Health Insurance barriers(Continued from page 1)
(Continued from page 1)
Health Care training Program(Continued from page 1)
Physician-Assisted Suicide(Continued from page 1)
DSrIP Program
ure of the federal government and Congress to correct regulatory flaws that have destabilized insurance markets and their refusal to honor prom-ises of additional funding.”
CareConnect was started in 2013 as a way for Northwell to direct patients to its hospitals and doctors, promising a simple, limited network of health providers and lower prices. But the business faced the same pressures many other insurers faced in the Affordable Care Act marketplaces. dfs re CareConneCt’s wIthdrawaL froM ny heaLth In-suranCe Market
“While it is unfortunate that the continued uncertainty across the nation due to the repeated actions of the federal government to undermine the Affordable Care Act at this time in the insurance cycle has caused CareConnect to begin an orderly wind down from the market, we recognize that this decision will help Northwell focus on its core mission to deliver healthcare services to New Yorkers. In spite of recent federal efforts to destabilize markets and threats to dismantle or not enforce the ACA, New York’s healthcare market remains robust and consumers across New York have real choice of coverage.
DFS will work with CareConnect on an orderly transition to ensure that all of its members know their full options and continue to receive health-care coverage without interruption. Once again we call on the federal government to end this continued uncertainty, immediately act to protect our markets by fully paying the cost-sharing subsidies for good and not piecemeal, making the overdue risk corridor payments, fully enforcing the individual mandate, and stopping once and for all the partisan attacks on healthcare for all Americans. We appreciate that some members of Congress are seeking to turn this corner in a bipartisan manner and to maintain the ACA’s protections to stabilize markets.”
Northwell to Shutter CareConnect(Continued from page 5)
Page 14 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 15
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Page 16 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 17
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ties for those numbers; and therefore, doesn’t supply that information to the NYS DOH. If the DOH wants the number of cases, they should ask the two other certifying agencies to provide them the data and not hassle the doctors. onLy 179 of 900 rePorted
So far during the voluntary reporting, only 179 of the over 900 OBS facilities in NYS reported. When the DOH leaders were asked what will occur if facilities do not report in 2018, their answer was that the OBS sites would be reported to the OPMC. Can you imagine what the OPMC would do with the report of hundreds of non-reporting facilities? They are overburdened by the current workload.
MSSNY and Dr. Rosenblatt are looking for support from all the NYS OBS Facilities. We need to mobilize the NYS Plastic Surgical Society, NY Regional Society of Plastic Surgery, Gastroenterology, invasive radiology and any other special-ties who work in their own office-based surgical facilities to urge the NYS DOH to obtain whatever data they seek from all of their OBS certifying agencies, rather than hindering patient care with another intrusive unfunded mandate.
If you feel that the DOH is overstepping their charge, feel free to call the health department or contact Rosemarie Casale at (518) 408-1219 or [email protected] and express your displeasure at having to fill out more forms.
If you have any more ideas, please email William Rosenblatt MD, Past President of MSSNY, at [email protected].
Election time!It’s that time of year when everyone over the age of 18
should go to the polls to exercise their right to vote for the people they believe are the best to run our government. The General Election is Tuesday, November 7, and all phy-sicians and their spouses/significant others/adult children should vote. Absentee ballots are available for those who cannot vote in person.
If you are not registered to vote, registration forms are available from the Board of Elections. There is a deadline to register, so do it soon. If you don’t vote, you relinquish your right to complain about what is being done by gov-ernment officials. Voting is a privilege that many people in other parts of the world do not have. It does, however, come with a price – you need to make the effort.
Your Alliance members will be voting in November for those people running for office who have similar views on the practice of medicine and preserving the ability of our physicians to make medical decisions for their patients, as well as relieving those physicians of myriads of paperwork and time-consuming requirements that limit the time they can spend with their patients. We hope to see our physi-cian spouses, friends and neighbors at the polls.
The Alliance’s fall teleconference/webcast will be held on Monday, October 16 at 10:00 AM. Please encourage your spouse/significant other to join in. Contact Kathy Rohrer at [email protected] for additional information.
aLLIanCe
Looking for ObS Physician Support(Continued from page 11)
Page 16 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 17
• Albany Times Union – 08/19/17 Prisoners deserve proper legal, health care (MSSNY mentioned)
• Poughkeepsie Journal - 8/21/17 Reform needed in medical lia-bility system to keep physicians from leaving the state (Letter to the editor from President-elect, Dutchess County Medical Society, Jai Jalaj, MD)
• Newsday – 08/23/17 Solar eclipse: Docs say eye damage could reveal itself later (MSSNY President Dr. Charles Rothberg, MD quoted)
Also appeared in True Viral News• New York Amsterdam News -
08/24/17 Color your diet healthy with fresh fruits and vegetables (MSSNY mentioned)
• Albany Times Union – 09/06/17 Dr. Alexios Apazidis Completes Successful Discectomy & Fusion Surgery Using SpineFrontier’s A-CIFT SoloFuse™ Less Exposure Surgery Technology (MSSNY Member, Dr Dr. Alexios Apazidis mentioned)
Mssny In the news
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DAVIDSON, Hugh Clark; New York NY. Died August 19, 2017, age 93. New York County Medical Soci-ety.DOUST, Brewster C.; Skaneateles NY. Died August 14, 2017, age 90. Onondaga County Medical Society. FISHMAN, Irving M.; New Hyde Park NY. Died March 17, 2017, age 97. Nassau County Medical Society.FLEMING, William A.; Buffalo NY. Died July 28, 2017, age 84. Erie County Medical Society.GANZ, Aaron; Boca Raton FL. Died February 03, 2017, age 89. Nassau County Medical Society.GITLOW, Stanley Edward; Naples FL. Died June 19, 2017, age 91. New York County Medical Society.GOLDFARB, Norman; Sarasota FL. Died Janu-ary 20, 2017, age 95. Medical Society County of Queens .GOTTFRIED, Simon Peter; Fishkill NY. Died Febru-ary 04, 2017, age 90. Dutchess County Medical Society.HATCHFIELD, Harvey J.; Wilmington NC. Died April 10, 2017, age 94. Dutchess County Medical Society.ROTHE, Irving A.; Binghamton NY. Died August 23, 2017, age 90. Broome County Medical Society.SANESI, Lorenzo A.; Boca Raton FL. Died July 26, 2017, age 85. Nassau County Medical Society.SCAL, David R.; New York NY. Died July 28, 2017, age 88. New York County Medical Society.WALSH, Joseph Brennan; New York NY. Died Au-gust 30, 2017, age 76. New York County Medical Society.
oBItuarIes New York State FairDr. Michael Duffy
(Ononandaga) with (R) State Assemblywoman
Pamela Hunter (D-Syracuse)
Onondaga County President Dr. Mary Abdulky
Dr. Shaign Iqbal (anesthesia
resident) and Dr. Michael Duffy.
MSSNY EVP Phil Schuh with Dr. Jerry Clausen (Onondaga)
Page 18 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 19
is expensive and time consuming for clinicians. And to top it off some payers have not kept up with the changes resulting in pay-ment denials.
Well, it is getting close to that time of year again. The NYS Medicaid program made the following announcement:
Important ICD-10 changes effective October 2017:As you may be aware, there will be approximately 3392
new ICD-10 codes coming in October 2017 for fiscal year 2018. Information is available on https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
However, MSSNY’s Ombudsman suggests that you view this site: https://www.cms.gov/Medicare/Coding/ICD10/Medicare-Fee-For-Service-Provider-Resources.html
On this page you will be able to see the ICD-10 CM (physician bill-ing) and the ICD-10 PCS Procedure Code System more often used by facilities) code sets. MSSNY has asked the plans if they, in fact, will be ready for the new codes on October 1, 2017.
We need simplicity and consistency. This should be stabilized or abandoned.
We will let you know how they are doing. We will keep you posted.
PresIdent’s Message(Continued from page 4)
Check Out MSSNY’s New CME website and Listen to Our Many
Podcasts!Did you know that we recently updated and
completely revamped the MSSNY CME web-site? Check it out here (Note: new users to the site will need to create an account). You can earn free CME credits on emergency preparedness topics that range from our four-part Physician’s Electronic Emergency Preparedness Toolkit to Ebola, a Perspective from the Field or Mosquito Borne Diseases. We also have a module on concus-sion in pediatric and adult patients as well as a CME accredited podcast on the same topic.
MSSNY also has more than ten informative podcasts that you can listen to here. There are multiple brief podcasts on immunizations as well as others on Zika virus and MSSNY’s Physician’s Emergency Preparedness Toolkit. Each podcast offers insight from medical experts on topics they are extensively well versed on.
Emergency visits climbed to a record high of 141.4 million patient visits in 2014, according to new data from the Centers for Disease Control and Prevention (CDC). This confirms that visits have increased substan-tially since the implementation of the Affordable Care Act (ACA) – equivalent to the entire U.S. population visiting an emergency department every two and a half years.
This is a 10-million visit increase over 2013 when there were 130.4 million visits, according to the CDC.
The data also reveal an increasing severity and complexity of emergency visits likely related to the growth of retail clinics, urgent care centers and other venues for treating non-urgent medical problems. Only 4.3 percent of emergency patients had non-urgent medical symptoms.
“What other doctor will see you at 2 am — no appointment necessary? Nearly two-thirds of visits occurred after business hours. The highest users of emergency care include patients over age 75, infants and nursing home resi-dents,” said Becky Parker, MD, FACEP, president of the American College of Emergency Physicians.
The top reasons for emergency vis-its include chest pain, stomach pain, shortness of breath, injury and pain. Chronic disease was a factor in many emergency visits, with hypertension
being the most frequent condition (21.1 percent), followed by diabetes (9.8 percent) asthma (8 percent), depres-sion (8 percent), substance abuse (5.6 percent) coronary artery disease (5 percent), and COPD (4.9 percent). Injuries accounted for an estimated 40 million visits, with the highest injury rates among those aged 75 and older. However, this represents a decrease since 2009, when there were 45 million visits, reflecting the success of many injury prevention programs.
“A growing number of patients also are coming to emergency departments with mental health problems and opi-ate overdoses,” said Dr. Parker. “While overall admission rates to the hospital have fallen, it’s a different story for mental health patients, with more than a million of them needing admission to the hospital in 2014.”
Waiting times continued to improve, with 32 percent of patients waiting less than 15 minutes to see a medical provider, and 68 percent being seen in under an hour. An estimated 10 percent of patients spent more than 6 hours in the emergency department.
This is the first year that Medicaid and CHIP accounted for the largest expected source of payment, at 34.9 percent.
Next was private insurance (34.6 percent), Medicare (17.5 percent) and no insurance (11.8 percent).
Er Visits Increase Since ACA Implemented State Offers Loan repayments for
Primary Care CliniciansThe NY State Department of Health is
requesting applications for its Primary Care Service Corps Loan Repayment Program, which aims to increase the sup-ply of clinicians in underserved areas.
The program will pay back up to $60,000 in education loans for health practitio-ners including dentists, dental hygienists, nurse practitioners, midwives, physician assistants and clinical psychologists.
In return, the program requires that these primary-care clinicians commit to work for at least two years in a state-designated Health Professional Shortage Area or at a state correctional facility.
This is the third funding round for the program. The state has allocated up to $1 million for fiscal 2017 to 2018 for renew-als of existing contracts and for new awards.
Practitioners must demonstrate that they are or will be working in primary care or behavioral health and in an outpatient or other eligible setting. Applications get higher scores based on their site’s HPSA score. Applicants also get extra points for practicing in sites that encourage a diverse work environment and support patients of diverse ethnicities, people with disabilities and other underserved populations. Assuming funding continues, practitioners can extend their contract for three renewal periods of one year each.
Questions must be submitted by 4 p.m. Sept. 28, and final applications are due at 4 p.m. Nov. 1.
Page 18 • MSSNY’s News of New York • October 2017 October 2017 • MSSNY’s News of New York • Page 19
Classified ads can be accessed at www.mssny.org. Click classifieds.NOVEMbEr 2017 ISSUE CLOSES OCtObEr 15 $200 PEr AD; $250 wItH PHOtO
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