March 22, 2013
Weekly Update for New York State Physicians
Volume 13, Number 12
Christina Cronin Southard, Editor
Julie Vecchione DeSimone, Assistant Editor firstname.lastname@example.org
Click here if you would like to comment on the introduction below:
Your medical society physician leadership and staff have been hard at work fighting to protect our profession against an armada of adversaries.
Last week I referenced the DOH CON proposals that, if enacted, would destroy physician ownership of medical practices by expanding Certificate of Need processes.To view the letter the NYS DOH sent to stakeholders, click on this attachment.
New YorkState regulators are considering expanding the “reach” of Certificate of Need (CON) process, potentially enacting even greater restrictions on private practice small business medicine. We deserve the inalienable right and the ability of physicians to reinvest in their business in a meaningful way.In response (as noted below) your medical society has facilitated a number of meetings of all interested specialty and primary care medical societies, urgent care clinics and organizations representing office based surgical facilities to address issues raised concerning the access provided to and cost and quality of care delivered by physician practices in all settings.We have prepared a coordinated response letter, and will be meeting with DOH with representatives of the many physician specialties potentially impacted.
Let’s work together and educate regulators regarding the damage that a CON expansion would cause.Realities of unbridled hospital expansions and consolidation must be considered by regulators.Doctors want the right to be a business owners like every other American, and it is not an inherent conflict of integrity.In fact, many studies show procedures performed outside institutions save dollars rather than increase them.
Don’t expand CON.Instead, let’s eliminate CON.
Let us also remind legislators and regulators of the unfair advantages that health insurers are granted here in New York! They are allowed to monopolize markets and dictate payment and other practice terms to physicians.This action destroys free market competitive forces and harms our patients’ ability to obtain the care they need.Your medical society is working to advance legislation to counteract these market forces, including legislation that will force all insurers to have adequate networks and to not sell flimsy policies for out of network coverage.
Sometimes our biggest enemies are ourselves.Conflicts among specialty physicians and their associations exist, and too often these disputes become public. It is imperative that we work through these disputes as we have more than enough enemies looking to take advantage of our inability to remain unified.
Your medical society physician leadership and staff have been hard at work fighting to protect our profession against an armada of adversaries.We respect every member of this profession and we will represent the interest of every doctor.We remain dedicated to profession as a whole.With your unified assistance we will continue to do so for a very long time.
Robert J. Hughes, MD, FACS
STATE BUDGET PASSAGE CLOSE BUT NOT FINAL- LEGISLATURE TO BEGIN PASSAGE OF BILLS AS EARLY AS SATURDAY EVENING
As of this writing, the New York State Legislature still had not finalized several details in the state budget that is due April 1, particularly issues relating to health care spending and policy.Legislative leaders and staff will be working into the weekend to pass a complete package of budget bills by this Monday, March 25 before beginning a recess for the Passover/Easter holidays.
Legislative leaders and the governor held a press conference Wednesday evening to announce that they had reached a “conceptual framework” on a $136 million budget.The budget will close a $1.3 billion gap with no new taxes or fees, although it will extend marginal income tax rates enacted in a December 2011 special session. New YorkState has not had three consecutive on-time or early budgets since 1984. The budget will raise the minimum wage from $7.25/hour to $9.00/hour over three years, beginning with $8.00 by the end of 2013, $8.75 by the end of 2014, and $9.00 by the end of 2015.It also will include several hundred million dollars in tax reductions for small businesses.The budget will also include a third round of the SUNY 2020 program and launches the CUNY 2020 program to provide competitive grants for projects that connect economic development and academic excellence.
While several budget bills have been finalized and will be voted on at the State Capitol this weekend, the health care and education budget bills have not been completed.There were an extraordinary number of issues in this year’s budget discussions that impacted upon physician delivery of care to patients. Below is a brief update on several of the most critical issues where MSSNY has been advocating on behalf of physicians, as well as urged action steps for physicians.
·Excess Medical Malpractice Insurance coverage – Both the Assembly and Senate proposed to restore funding for the Excess program to $127.4M and rejected program changes which had been proposed in the executive budget proposal.
To send a letter to support continued eligibility for physicians who have traditionally received Excess coverage, click here.
·Out-of-Network Reform – The Senate included the out-of-network transparency and coverage reform proposal (S. 2551, Hannon) supported by MSSNY in its one-house bill. While the Senate has strongly urged that it be contained within the final budget, as with many other policy issues under consideration in the budget, it may be deferred to be addressed post-budget.To support enactment of this proposal, click here.
·Retail Clinics - the Assembly rejected the governor’s proposal to permit corporate-owned retail clinics to be established, while the Senate included the proposal in its one-house budget bill. To send a letter in opposition to legislation to permit the establishment of corporate-owned retail clinics, click here.
·Nurse Practitioners Scope - The Senate rejected the governor’s NP proposal in its one-house budget bill. The Assembly, while rejecting the governor’s NP proposal, instead included a modified version of the bill they passed last year, which MSSNY opposed. Specifically, the bill would require a written practice relationship with a physician for NPs in practice for less than three years. It would also allow collaboration with another NP who has been practicing for more than three years, where collaboration with a physician ends and the NP is unable to enter into a written practice agreement with another physician. NPs with more than 36 months must have collaborative relationship with physician or a hospital (no written practice agreement). They must complete a form which summarizes practice protocols to follow and provides the criteria to be used regarding consultation, including methods and frequency of how consultation is to be provided, collaborative management, and referral and emergency-referral plans.
The joint Higher Education Sub-Committee did not reach agreement on this issue.Therefore, it is likely to be out of the budget but could be brought up again post-budget.To send a letter in opposition to legislation to permit independent practice of NPs, click here.
·Prescriber Prevails - The Assembly rejected the governor's language for eliminating “prescriber prevails” for Medicaid fee-for-service and also rejected the governor's repeal of prescriber prevails for the atypical antipsychotic drug class in Medicaid Managed Care. The Senate embraced the Assembly’s action and, in addition, would restore “prescriber prevails” for Medicaid Fee-for-Service and Medicaid Managed Care for all drug classes. To send a letter in support of restoration of “prescriber prevails” to all patients enrolled in Medicaid and Medicaid Managed Care enrollees, click here.
·Physician Assistants – The budget includes language to enable physicians in private practice to increase the number of physicians assistants they supervise from two to four.
·Workers Compensation - Both houses included the governor’s proposal to permit a single arbitrator process (rather than three arbitrators) for Workers Compensation claims to determine disputed medical bills under $1,000, as well as disputed payments above $1,000 where physician requests. Under this initiative, the person to resolve the dispute will be a physician in good standing, as determined by MSSNY.
·CPH - The NYS Assembly agreed with the governor’s proposal to make the Committee for Physicians’ Healthprogram permanent. The NYS Senate would continue the program for five more years.
(DIVISION OF GOVERNMENTAL AFFAIRS)
CME TO BE OFFERED AT 2013 HOD
On Thursday, April 11 Noon-4pm (lunch provided), there will be a CME program offered at the Westchester Marriott in Tarrytown, in conjunction with the MSSNY House of Delegates: “Increasing Effectiveness of Physician Advocacy through Political Education & Running for Elected Office.”This course will help physicians:
1)Communicate more effectively with elected officials;
2)Recognize how public relations, advocacy, lobbying and politics impact the practice of medicine;
3)Increase your political effectiveness by understanding the role of PACs and the power of collective physician grassroots and political action;
4)Determine if running for political office is for you; and
5)Identify which tools you can incorporate into your practice to increase your own personal advocacy effectiveness.
Physicians from all localities will join forces in the state capital on April 23rd to advocate for their patients and profession during the New York Coalition of Specialty Physicians Annual State Lobby Day. The Coalition is a partnership of surgical and medical organizations committed to battling inappropriate allied-health provider expansion legislation and advancing bills of importance to all of medicine.
The day will kick off with a breakfast, legislative briefing, and Q&A session at in the EmpireStatePlaza. Immediately following, physicians will meet with their elected representatives in the Senate and Assembly. Attendees will be grouped with physicians of other specialties and provided with easy-to-understand talking points so they can effectively present their arguments and positions.
We hope that you will reaffirm your commitment to your colleagues, your profession and your patients by joining us in Albany on April 23. Please complete all sections of the below registration form and return as soon as possible. All registrants will be emailed a confirmation and additional details as we get closer to Lobby Day.
SPECIALTY COALITION LOBBY DAY
April 23, 2013
I have a personal or professional relationship with the following legislator(s):
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MSSNY President Dr. Hughes Interviewed for Newsday on Nurse Practitioners
MSSNY President Dr. Robert Hughes was quoted extensively in a 3/16/13Newsday article, NY’s Nurse Practitioners Want to Fill Void.“There is a huge disparity in training between nurse practitioners and physicians,” said Dr. Hughes. “I understand that they want to eliminate the collaborative agreement, but there are consequences for the public if that happens.” Dr. Hughes went on to say that the public has been led to believe the training for nurse practitioners and physicians is comparable, but nothing could be farther from the truth. “I understand that they want to eliminate the collaborative agreement,” Dr. Hughes said. “But there are consequences for the public if that happens.”
Three Seminars Open to All Physicians at MSSNY’s House of Delegates
Seminar: Practice Audits -- Your Turn is Coming – BE READY!
Physicians and Staff Urged to Attend to Avoid Big Headaches
Thursday, April 11, 2013Westchester Marriott, Tarrytown
Breakfast and 2 Hours of Category 1 CME or 2 AAPC CE Hours
Mike Schoppmann, Esq., and Jackie Thelian, CPC, CPC-I, are with us once again to prepare you for what’s become one of the greatest threats to physicians and practices today.
Physicians and office staffs are welcome.
Start with breakfast and registration at , and attend a lively session from to . Browse the exhibits following the program and find new ways to make your practice more productive. Light breakfast. Registration: Only $25 per person for MSSNY members and their staff; $50 per person for nonmembers and staff.
Antibiotics May Benefit Few With Respiratory Infections.
A study appearing in the Annals of Family Medicine was conducted at the University of Pennsylvania based on data from the UK covering over 1.5 million visits to physicians by over 800,000 patients with respiratory infections. It found that among those treated with antibiotics, 18 per 100,000 visits was followed by the patient being admitted to the hospital while among those not treated the rate was 22 per 100,000 visits. The researchers concluded that antibiotics should be prescribed only for a fairly small group of respiratory infections such as strep throat and pneumonia.
NEW! MSSNY Now Offers Website Design and Hosting Discounts for Members
MPS (Medical Practice Specialists), a web development and design firm, is MSSNY’s newest member benefit. MPS can deliver to our physicians an updated online presence at reasonable rates and expert technical support!
For a $79 start-up fee and $55 per month (for MSSNY members), MPS will provide:
a new design for your website (up to five pages)
24-hour technical support ($55 a month)
website hosting and 3 email accounts
2,800 royalty-free images
a personal account manager
For a $129 start-up fee and $85 per month (for MSSNY members), MPS will provide all of the above services PLUS:
up to 500 website pages
website hosting and 50 email accounts
500MB of email storage
MPS also offers, at a 20% discount (for MSSNY members), SEO (search engine optimization), medical content writing and social networking tools. Call them at 1-888-294-4473 or visit their website at www. medicalpracticespecialists.com
Merrill Lynch Mortgages Are a New Member Benefit
Merrill Lynch is proud to welcome The Medical Society of the State of New York (MSSNY) to its corporate rewards program for mortgages. MSSNY verified members can now receive thousands of dollars of savings in closing cost discounts for personal mortgages just like their counterparts at Fortune 500 companies. For mortgages over $417,000, we will provide a 0.50 % closing cost discount
(for a mortgage of $1 mil, we will provide a closing cost discount of $5,000 = $1,000,000 x 0.005%)
Medicare Pay Cut to Kick in April 1 under Federal Budget Sequester
The Centers for Medicare & Medicaid confirmed in a recent announcement that the two percent across-the-board cut to Medicare physician payments mandated by the federal budget sequester will begin April 1. Physicians will see the payment reduction applied to their fee-for-service claims with a date of service of April 1 or later. The 2 percent cut will apply to the payment amount after it has been adjusted for beneficiary coinsurance, deductibles and any applicable Medicare secondary payments. The allowed charge amounts remain unchanged.
MESF Announces Pain Management Cruise November 10-17
A cruise program focused on Pain Management for the Primary Care Provider has been scheduled for November 10-17 on the new Norwegian Cruise Line Breakaway. The cruise will depart and return to New York and will visit Florida and the Bahamas. Offering 14 CME credits™, the course will focus on the latest pain management techniques and pharmacology. It will also cover regulations on opioid prescribing regulations. The course will be led by Charles Argoff MD, Director of the ComprehensivePainCenter at AlbanyMedicalCollege and Christopher Gharibo MD, Medical Director of Pain Medicine at NYUHospital for Joint Diseases. For more information call 1-800-422-0711 or online at http://bit.ly/MESFPainManagementCruise
If You Are Applying for
Hurricane Sandy Grant, Apps Deadline Is March 31
The Physicians Foundation of Excellence has granted MSSNY $350,000; Henry Schein, Inc. has donated $10,000 to help physicians affected by Hurricane Sandy; and your colleagues have donated to the fund, too. The deadline for application submission is March 31, 2013.
The following areas have been identified by FEMA as disaster areas and are eligible for funding: Bronx, Kings, Nassau, Suffolk, New York, Queens, Richmond, Westchester, Orange, Putnam, Rockland, Sullivan and Ulster. We want to help physicians from these specific counties. MSSNY’s Medical, Educational and Scientific Foundation (MESF), nonprofit 501(c)(3) organization, is determined to disperse our grant funds in a fair and expedient manner. The grant can be used many ways including relocating or rehabilitating the physicians’ medical offices, replacing equipment, rebuilding patient records, and payment of temporary operating expenses. If you know physicians affected by the storm, please pass along the grant information.
Each physician is eligible for $5,000 in funds, and multiple-physicians offices are eligible for up to $10,000. To apply for a grant, please call Mary Rush at 516-488-6100 ext 351 and she will email the application to you. Details of the grants are available at www.mssny.org ; Click on “Hurricane Sandy Grant Details.” Applications will be vetted by an Advisory Committee dedicated to this effort so that funds can be granted in a timely fashion. The first round of applicants have already received their checks.
A patient who recently died of rabies in Maryland contracted the illness from a kidney transplant received over a year ago, the CDC reported on Friday. The lengthy incubation period, while longer than the typical 1 to 3 months, is unusual but not unprecedented.
Tests on tissue samples from the patient and donor confirmed that they were both infected with raccoon-type rabies. The three other patients who received organs from the donor have been identified and are receiving anti-rabies shots.
The CDC notes: "If rabies is not clinically suspected [in a potential donor], laboratory testing for rabies is not routinely performed, as it is difficult for doctors to confirm results in the short window of time they have to keep the organs viable for the recipient."
HCCS Expert Webinar: Top Ten Compliance and Enforcement Issues for Physicians: Part One March 27,
The Federal government continues to increase investigations and audits of physicians and physician practices. This is the first of two webinars on the subject. Each webinar will address five major issues in physician compliance and enforcement.
Issues to be covered include:
New strategies for regulating physicians through Pharma and device companies
Addressing new reporting requirements for physicians, including overpayments, payments from other insurance, and meaningful use of electronic records
New audit strategies deployed toward physician practices in Medicare and Medicaid
Compliance risks with managed care
Risks and practices associated with managing prescription drug samples
Innovations in False Claims litigation, including a new emphasis on individual defendants
Review of pending and recent settlements and CIAs involving physicians
This webinar will be presented by James G. Sheehan, Executive Deputy Commissioner / Chief Integrity Officer for the New York City Human Resources Administration. Mr. Sheehan is a former New YorkState Medicaid Inspector General and Associate U.S. Attorney for the Eastern District of Pennsylvania.
Poll: Three Years Later, Americans Still Don’t Understand Health Law
A recent poll by the Kaiser Family Foundation finds that although it’s been three years since President Barack Obama signed the Affordable Care Act into law, two-thirds of uninsured adults — the very people the law sets out to help — say they still don’t know what it means for them.
Sixty-seven percent of the uninsured younger than age 65 — and 57 percent of the overall population — say they do not understand how the ACA will impact them.The poll also found that Americans’ expectations of how the law will affect health care costs, quality and consumer protections are more negative than positive.
Enrollment for new coverage in the exchanges and Medicaid expansion is set to begin on October 1. That gives states and the federal government less than a year to educate consumers about signing up for coverage through online portals, by phone or with the help of in-person assistance.
Overall, the evidence suggests that the Obama administration, state governments, advocates and the health care industry have a big job ahead of them to educate the public by 2014. The stakes are high: In order for the financial structure of the ACA to hold up, a healthy cross-section of Americans must sign up for both Medicaid and the new exchanges. If they don’t, the pool will likely be filled with sicker individuals, and premium rates could skyrocket.
The poll surveyed 1,204 adults between March 5 through March 10 and has a margin of error of +/- 3 percentage points.
Physicians, Test Your Knowledge of the Affordable Care Act
As the three-year anniversary of the Affordable Care Act approaches, the Kaiser Family Foundation has updated its interactive quiz that allows users to test their knowledge about what’s in – and what's not in – the health reform law.
Response from the AMA to Dr. Hughes’ March 8 Enews Introduction
The March 8 column from Dr. Hughes does not accurately reflect the AMA’s perspective on changes that are taking place rapidly in private and public insurance programs.Click here to view.
The AMA is dedicated to ensuring better health outcomes for patients and rewarding practice environments for physicians. One size doesn’t fit all, and we have been working to ensure physicians can thrive in the evolving health care environment. The AMA and 110 other physician organizations endorsed a set of principles on how to transition Medicare to include an array of delivery and payment models, giving physicians the flexibility to choose options to help lower costs and improve the quality of care for their patients. We also worked to preserve physician leadership and assure a role for independent practices in new models like Accountable Care Organizations.
There are lessons, both good and bad, to be learned from experiences with models in the private insurance sector. The AMA is particularly interested in physician satisfaction as it relates to these new models – looking at a range of possibilities and understanding which are professionally rewarding for various specialties and practice settings, and why. It is critical that any new models include physician leadership, improve the quality of care for patients and block onerous burdens that saddle physicians with paperwork and reduce their ability to spend more time where it matters - with patients, discussing their care.
The AMA supports a pluralistic approach to payment and delivery that includes a viable fee-for-service option. The AMA does not “endorse” insurers’ physician rating systems. These systems are, unfortunately, a reality for physicians, and we are working to make significant improvements to them in the private and public sectors.
The status quo in Medicare is not working for physicians or their patients. We must move forward to improve the system, reduce administrative burdens and empower physicians to provide the kind of care that led them to choose medicine as a profession.