1. health and fitness

Workers’
Comp
Survey
MEDICAL SOCIETY OF THE STATE OF NEW YORK
NEWS OF NEW YORK
Volume 71 • Number 2 • www.mssny.org
pages 6-8
Providing Information to Assist Physicians in the State of New York
Results of MSSNY’s Workers’ Compensation Poll
MSSNY conducted a poll of physician members in December about the Workers’
Compensation Program. The purpose was to generate data that was incorporated into testimony delivered by Dr. Robert Goldberg – a member of MSSNY’s Workers’ Comp Committee
– to an Assembly committee hearing in December.
See page 6 for more poll results and physician comments.
High-Volume Hydraulic Fracturing
Will Not Move Forward in NY
The NYS Department of Health has completed its public health review
of high-volume hydraulic fracturing (HVHF) and DOH Commissioner
Dr. Howard Zucker recommended that high-volume hydraulic fracturing
should not move forward in New York State. DOH’s review can be found
at: www.health.ny.gov/press/reports/docs/high_volume_hydraulic_fracturing.pdf
“I have considered all of the data and find significant questions and
risks to public health which as of yet are unanswered,” said Dr. Zucker.
“I think it would be reckless to proceed in New York until more authoritative research is done. I asked myself, ‘would I let my family live in a
community with fracking?’ The answer is no. I therefore cannot recommend anyone else’s family to live in such a community either.”
DEC will incorporate the findings of the public health review into the
Final SGEIS, which will be released with a response to public comments
early next year. DOH’s review found significant uncertainties about: the
adverse health outcomes that may be associated with HVHF; the likelihood of occurrence of adverse health outcomes; and the adequacy of
mitigation measures to protect public health. DOH’s report concludes that
it will be years until science and research provide sufficient information
to determine the level of risk HVHF poses to public health and whether
those risks can be adequately mitigated. Given the red flags raised by current studies, absent conclusive studies that disprove health concerns, the
report states the activity should not proceed in New York State.
In conducting its public health review, DOH reviewed and evaluated
scientific literature, sought input from outside public health experts,
engaged in field visits and discussions with health and environmental
authorities in nearly all states where HVHF activity is taking place, and
communicated with local, state, federal, international, academic, environmental and public health stakeholders.
Join the White Coat
Armada on March 4
in Albany!
Call your County Executive for
more information today!
February 2015
MSSNY Urges Governor and Legislature to Delay
E-Prescribing Requirement; Physician Action Needed
MSSNY is urging that New York State delay
implementation of the E-prescribing requirement for all substances due to the fact that
several EHR systems currently used by physicians and hospitals have not yet been certified
by the DEA to enable electronic prescribing
of controlled substances. As such, MSSNY
has argued that it is unfair to hold physicians
responsible for the failure of vendors to meet
this deadline. MSSNY leadership and staff
have had discussions with the administration and some members of the Legislature to
request this delay. MSSNY is urging physicians to assist in this effort by sending a letter
calling for delay of the implementation date.
Physicians can send a letter to their legislators
and Governor Cuomo urging a postponement
of this mandate by going here. The E-prescribing requirement goes into
effect for non-controlled and controlled substances on March 27, 2015. This requirement
was part of the I-STOP law that was approved
unanimously by the Legislature. MSSNY has
had numerous discussions with state officials
and key legislative leaders to make them fully
aware of the significant obstacles many physicians of all practice configurations will face
in complying with this law, and the potential
medication disruptions patients could face as
a result. MSSNY, along with various medical
specialties, will be sending a letter to Acting
Commissioner Howard Zucker, MD, JD
also asking for delay. MSSNY has also had
extensive discussions with the state to assure
that the process for physicians to apply for a
waiver of this requirement will not be unduly
burdensome. The law provides that physicians
may apply for a waiver of this e-prescribing
requirement as a result of a) economic hardship b) technological limitations that are not
reasonably within the control of the physician,
or c) other exceptional circumstance. MSSNY
is encouraging that DOH consider including
– as an example of an acceptable exigent circumstance which qualifies for a waiver – those
instances where the physician prescribes less
than 25 prescriptions per year. Send a letter to your legislator and Governor
Cuomo urging a postponement of this mandate
by clicking on this link http://bit.ly/1CZHBVE.
Governor Cuomo Appoints Howard Zucker, MD
Commissioner of NYSDOH
Governor Cuomo recently appointed
Howard Zucker, MD to serve as
Commissioner of the State Department of
Health. The appointment requires Senate
confirmation.
Previously, Dr. Zucker served as
Acting Commissioner of the Department
of Health as well as First Deputy
Commissioner. Prior to that, he was a professor of Clinical Anesthesiology at Albert
Einstein College of Medicine of Yeshiva
University and a pediatric cardiac anesthesiologist at Montefiore Medical Center
Howard Zucker, MD
in the Bronx. He was also an adjunct
professor at Georgetown University Law
School, where he taught biosecurity law.
His public policy experience began as a
White House Fellow under then-Health
and Human Services Secretary Tommy
Thompson. He then became the Deputy
Assistant Secretary of Health where he
developed the nation’s Medical Reserve
Corps.
Dr. Zucker has also served as an
Assistant Director-General of the World
(Continued on page 2)
Commissioner’s Grand Rounds: Ebola Past & Present
(l-r): Katherine Hawkins, MD, NYSDOH;
Anthony Shih, MD, Executive Vice
President, NYAM; Hedva Shamir, MD,
NYSDOH; Daniel S. Chertow MD,
Department of Critical Care Medicine,
National Institutes of Health; Lauren
Johnston RN, Senior Vice President/
Chief Nursing Officer, NYCHHC; Charles
Gonzalez, MD, NYSDOH; Andrew
Kleinman, MD, MSSNY President
Inside News
E-prescribing:
Use MSSNY-approved
DrFirst.............page 2
Dr. Kleinman:
“You can make
a difference”....page 4
New Legislative
session: meet your
local rep..........page 4
DFS out of network
proposal for
resolution........page 5
Save the Dates for Legislation Day and AMSSNY Membership Meeting
Join us in Albany on March 4th for Legislation Day as
we lobby our legislators on behalf of our physician spouses.
And mark your calendars for April 30 and May 1, when we’ll
hold our 79th Annual AMSSNY Membership Meeting in
Saratoga Springs in conjunction with the MSSNY House of
Delegates. We ask your involvement in both of these events
as a show of support to your physician spouse. We will provide further information in the next issue of News of New
York.
Over the last few months, Alliance members have been
fundraising all across the state for scholarships for students
entering health careers and for local community organizations. Some highlights include Richmond County Alliance
members, who held a cocktail party December 7. Members
and guests also brought unwrapped toys for the Salvation
Army to distribute. In Onondaga County, Alliance members
made a donation to the Athletic and Education Center on
behalf of inner city youth and ARC of Onondaga County,
which serves mentally handicapped children. Their holiday
luncheon raised over $1500 for scholarships.
AMSSNY is proud to support the New York State
Physicians Home, an organization that helps physician
families in need when a life crisis occurs. Please send contributions to Physicians Home, care of Dr. Joseph B. Cleary,
President of the Physicians Home, 445 Park Ave, 9th Floor,
NY, NY 10022 to honor a friend or family member or as a
memorial to a family member, physician or friend. Our state
Alliance contributes a portion of the funds raised at our Fall
Leadership Conference and our Spring Annual Membership
meeting to this worthy cause. We are grateful to our Kings
County Member, Mrs. Betti Jabbour, who has been our
liaison to the Physicians Home for the past ten years. Our
organized counties in the state still contribute annually to the
Physicians Home.
Please check out the AMA Alliance online newsletter,
The Alliance in Motion and the online resource Physician
Family, edited by Donna Rovito with topics relating to physicians and spouses from residency to retirement.
Not a member of AMSSNY? Please contact our Executive
Director, Kathleen Rohrer at [email protected] or phone
1-800-523-4405 for an application. We welcome all spouses
and domestic partners of physicians. See you in Albany and
Saratoga Springs!
Howard Zucker, MD Named
Commissioner of NYSDOH
(Continued from page 1)
Health Organization and as an Institute of Politics Fellow at
Harvard Kennedy School. He is a pediatrician, anesthesiologist, intensive care specialist and pediatric cardiologist
trained at Johns Hopkins, University of Pennsylvania and
Harvard, respectively, and has held faculty appointments at
Yale, Columbia and NIH.
Dr. Zucker has a B.S. from McGill University, an M.D.
from George Washington University, a J.D. from Fordham
University Law School, an LL.M from Columbia Law
School and a postgraduate diploma in global health policy from the London School of Hygiene and Tropical
Medicine.
Comply with the DOH E-prescribing
Mandate: Special Discount for
MSSNY Members
All Physicians Must Prescribe Electronically
by March 27, 2015! Be Ready!
MSSNY announced a new member benefit that will support you and your practice in complying with the new DOH
mandate for e-prescribing. Through a special partnership
with DrFirst, the industry leader in e-medication management, MSSNY members can receive a discount on Rcopia®
and EPCS GoldSM, which will allow providers to e-prescribe
both legend drugs and controlled substances in a single
workflow. The software also includes real-time prescription monitoring, instant access to medication histories for
patients, patient-specific formulary data, and clinical alerts
such as drug-drug and drug-allergy interaction warnings. In addition, DrFirst will guide MSSNY members through
the identity proofing and authentication processes that are
required by the Drug Enforcement Agency to allow doctors
to prescribe controlled substances electronically.
For more information, and to receive your special MSSNY
member discount, visit www.drfirst.com/MSSNY, or call the
special MSSNY E-prescribing Hotline at 866-980-0553.
Non-Acute Pain Treatment
Guidelines for Workers
Compensation Go Into Effect
The New York State Workers Compensation Board
issued a Bulletin in December (www.wcb.ny.gov/content/main/SubjectNos/sn046_742.jsp) noting that the
new Non-Acute Pain Medical Treatment Guidelines, as
well as the revisions to the existing Medical Treatment
Guidelines, went into effect on December 15, 2014.
To view the guidelines, click here: www.wcb.ny.gov/
content/main/hcpp/MedicalTreatmentGuidelines/NonAcutePainMTG2014.pdf.
An online program to assist physicians and their staff
in learning these new guidelines, which provides CME
credit, are available on MSSNY’s website.
The pain treatment guidelines were developed by a
13-member committee that included 11 physicians representing various specialties. These physicians included
MSSNY Board of Trustees member and Touro College
of Osteopathic Medicine Dean Robert Goldberg, MD
and former MSSNY Board member and Rochester
orthopedic surgeon Ted Tanner, MD as well as WCB
medical directors Jamie Szeinuk, MD and Elaine Sobol
Berger, MD, JD. To read a full list of the physicians on
the committee, click here: www.wcb.ny.gov/content/
main/hcpp/MedicalTreatmentGuidelines/CoverltNonAcutePainMTG.pdf.
Are you ready to e-prescribe
on March 27, 2015?
You will not be able to prescribe for your
patients on March 28 if you do not have
an electronic prescribing system in place.
Page 2 • MSSNY’s News of New York • February 2015
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February 2015 • MSSNY’s News of New York • Page 3
MEDICAL SOCIETY OF THE STATE OF NEW YORK
NEWS OF NEW YORK
Medical Society
of the State of New York
Andrew Y. Kleinman, MD President
Michael Rosenberg, MD Chairman of the Board
Philip A. Schuh, CPA
Executive Vice President
COMMUNICATIONS AND
PUBLICATIONS
L. Carlos Zapata, MD, Commissioner
News of New York
Published by Medical Society of the State of New York
Vice President, Communications and Editor
Christina Cronin Southard, Editor
[email protected]
News of New York Staff
Julie Vecchione DeSimone, Assistant Editor
[email protected]
Roseann Raia, Communications Coordinator
[email protected]
Steven Sachs, Web Administrator
[email protected]
Susan Herbst, Page Designer
News of New York
Advertising Representatives
For general advertising information contact
Christina Cronin Southard
Phone 516-488-6100 ext 355
[email protected]
The News of New York is published monthly as the official publication of
the Medical Society of the State of New York. Information on the publication
is available from the Communications Division, Medical Society of the State
of New York, 865 Merrick Avenue, P.O. Box 9007, Westbury, NY 11590.
The acceptance of a product, service or company as an advertiser or as a
membership benefit of the Medical Society of the State of New York does not
imply endorsement and/or approval of this product, service or company by
the Medical Society of the State of New York. The Member Benefits Committee urges all our physician members to exercise good judgment when
purchasing any product or service.
Although MSSNY makes efforts to avoid clerical or printing mistakes,
errors may occur. In no event shall any liability of MSSNY for clerical or
printing mistakes exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement in error if the primary or essential message of the advertisement has not been totally altered or substantially
rendered meaningless as a result of the error. Liability of MSSNY to the
advertiser for the failure to publish or omission of all or any portion of any
advertisement shall in no event exceed the charges paid by the advertiser for
the advertisement, or for that portion of the advertisement omitted if the primary or essential message of the advertisement has not been totally altered
or substantially rendered meaningless as a result of the omission. MSSNY
shall not be liable for any special, indirect or inconsequential damages, including lost profits, whether or not foreseeable, that may occur because of
an error in any advertisement, or any omission of a part or the whole of any
advertisement.
MEDICAL SOCIETY OF THE STATE OF NEW YORK
AT YOUR SERVICE
MSSNY’S WESTBURY OFFICE
Main Phone Number......................................516-488-6100
Toll Free Number...........................................800-523-4405
Main Fax Number..........................................516-488-1267
MSSNY Website......................................... www.mssny.org
Extensions for specific services
Alliance.. ........................................................................396
Communications............................................................ 351
Computer Information Systems..................................... 361
Member Benefits/Marketing.......................................... 424
Membership Information............................................... 336
Medical, Educational & Scientific Foundation.............. 350
Office of the Executive Vice President.......................... 397
Ombudsman Claims Assistance..................................... 318
Physician Records/Credentials....................................... 367
Socio-Medical Economics............................................. 332
albany office
Continuing Medical Education...........518-465-8085 ext.17
Public Health Committees.................518-465-8085 ext. 11
Governmental Affairs.....................................518-465-8085
Fax..................................................................518-465-0976
Other Numbers
Committee for Physicians’ Health.................800-338-1833
Dispute Resolution Agency............................516-437-8134
Kern, Augustine, Conroy & Schoppman.......516-294-5432
Page 4 • MSSNY’s News of New York • February 2015
PRESIDENT’S COLUMN
You Can Make A Difference
Can you really make a difference in
the future of medicine?
Absolutely.
Can taking one day away from your
practice to lobby in Albany really have
a meaningful impact on the development of policy?
You bet it does.
I implore you to join the hundreds
Andrew Y.
of your physician colleagues from
Kleinman, MD
across the State on Wednesday, March
4 in Albany to advocate on behalf of our patients so they
can continue to receive the timely quality care they need
and deserve.
Contact your county medical society today to make
arrangements to attend! With the endless array of issues we
face this year, it is more important than ever for physicians
to be seen and heard.
And with government officials discussing profound
changes to how health care is paid, it is essential that physicians have a major part in these discussions rather than only
health insurance companies and large institutions.
We have a talented and dedicated group of lobbyists
fighting on our behalf every day in Albany, but there is
nothing that can quite replace the impact of your legislators
hearing directly from you on their “home turf,” preferably
in your white coat, about the concerns that impact your
patients and their constituents.
It is so important that the legislators and staff who shape
our health care policy see an armada of white coats walking through the Capitol and through the Legislative Office
Building so they have an immediate and clear reminder
of the impact that their proposed policies will have on the
delivery of care to the patients in their districts.
This year, we will be returning to the format we used in
previous years where hundreds of our physician colleagues,
medical students, medical staff, spouses and physician
association staff gather in “The Egg” to hear from our top
legislative leaders and key committee chairs as to how they
plan to address our concerns, and respond to our questions.
After this program, you will then have the opportunity to
meet with your local legislators, arranged by your county
medical society.
Our Fight
Among the many issues we will be fighting for is fixing
narrow physician networks, addressing excessive roadblocks imposed by greedy insurance companies standing in
the way of our patients receiving needed care, and assuring
our patients can purchase comprehensive out of network
coverage.
We will be fighting State Budget proposals that would
impose heavy-handed regulation of physician owned urgent
care centers and office-based surgery sites.
We will be fighting to prevent legislation to expand
non-physicians’ scope of practice that threaten our patients’
health.
We will be fighting to assure fair and flexible implementation of the new e-prescribing mandate that
potentially threatens our patients’ ability to receive needed
medications.
And we will, of course, continue to fight for needed
reforms to bring down our exorbitant medical liability
costs.
I know many of you visit with your local legislators
back in their district office, and that is extremely important
as well. However, every week in Albany legislators hear
from numerous interest groups with legislative agendas
that directly conflict with ours and our patients. Insurance
companies and business groups argue why there should be
(Continued on page 12)
mssnypaC
Legislative Session Begins Anew:
Great Opportunity to Weigh in With New Members
While the unfortunate passing
of former Governor Mario Cuomo
temporarily delayed the official start
of the Legislative Session, we’ve
now received the Governor’s State
of the State Message and proposed
budget for 2015-16 and work in
Albany has spun up to a fever pitch.
There is no shortage of issues that your MSSNY and
MSSNYPAC are working on your behalf. We need your continued support and help.
In his State of the State, the Governor presented his vision
for 2015 entitled the ‘Opportunity Agenda’ designed to restore
economic opportunity, create the best education system in the
nation, and restore the public’s confidence and trust in our justice
system.
The Governor’s $142B proposed state budget sought to
advance private capital investments to assist in supporting the
restructuring of the health care delivery system and to empower
the development and reimbursement for integrated care delivery systems such as the DSRIP Performing Provider Systems
(PPSs). He also, however, proposed to enable the development
of corporately owned care settings such as clinics in retail spaces
while also proposing significant new regulation of the care
which can be delivered by certain urgent care and office based
surgical physician practices. Much attention will now focus on
the details of these proposals. MSSNY will deliver its budget
testimony to the Joint Hearing of the Assembly Ways & Means
and Senate Finance Committee on February 2nd. The testimony
will be accessible through the MSSNY website.
We are also faced with the implementation of the e-prescribing mandate enacted into law without one negative vote two
years ago. MSSNY has joined with 17 other prescriber and long
term care organizations to request a
delay in the implementation of this
law. Moreover, MSSNY has invited
its physicians and their patients to
weigh in with the legislature on this
request. Patients need to know what
will happen in the event that their
pharmacy does not have on hand the specific controlled substance prescribed to them because once the e-script is received
by a pharmacy, the pharmacist may not send it on to another
pharmacy. In addition, patients like to shop around for the lowest cost drugs, particularly when medication is in short supply.
The e-prescribing law will now prevent them from doing so.
In total, 27 new state lawmakers were elected in the November
elections. There are 10 new state senators, among them seven
Republicans who helped the party seize outright control in the
upper house. In the Assembly there are 17 new members, including a number of Democratic pickups expanding the Democratic
super majority to 106. It is important for organized medicine to
get to know these new members and to inform them of our concerns regarding the important issues we confront. Please take
time to reach out to your elected officials.
It is also more important than ever before for physicians to join
MSSNYPAC. If you are a member of MSSNYPAC, thank you!
You have shown true dedication to your profession and patients.
But we need so many more to also contribute. If you haven’t yet
joined, please do so immediately by going to MSSNYPAC under
the Governmental Affairs Tab on MSSNY’s new website.
Together all of medicine can achieve tangible objectives which
protect physician practices and the patient’s they serve.
Please contribute now. Unless we play our fair part in political
action, we risk losing further ground to those who seek to take
away our ability to control the care we provide to our patients.
Join MSSNYPAC today at www.mssny.org
Regulations to Implement Independent Dispute Resolution for ER and “Surprise” Out-Of-Network Bills Proposed By DFS
The New York State Department of Financial Services has
formally proposed regulations to implement the Independent
Resolution Dispute (IDR) component of the comprehensive
out-of-network reform legislation enacted last year. To read
a summary of the regulations, click here: http://dfs.ny.gov/
insurance/r_prop/rp200u.pdf. MSSNY has been engaged in
substantial discussions on this proposed regulation with top
DFS staff throughout the fall. If you have any comments on
these proposed regulations, please contact [email protected] or
[email protected].
As a reminder, the new law provides that, as of April 1, 2015,
all bills for emergency care and other “surprise bills” for care
by out-of-network physicians can be brought for resolution to
an IDR entity after an insurer makes an initial “reasonable payment” for such care, and efforts to informally settle the payment
dispute have been unsuccessful. Either the physician or insurer
can apply for resolution by the IDR entity. The statute requires
the IDR entity to choose between the plan’s payment or the
out-of-network physician’s fee (“baseball arbitration”). Only in
the rare instances where the reviewer believed that a settlement
is reasonably likely or both the physician fee and insurer payment represent unreasonable extremes, the reviewer can give
the parties 10 business days to negotiate a compromise. Claims
for certain CPT codes under $600 are exempted from the IDR
altogether. A physician of the same or similar specialty as the
physician providing treatment is required to be involved in the
review of the fee (the physician shall be licensed to practice in
this state, to the extent practicable). The IDR entity is required
to consider:
• Whether there is a “gross disparity” between the fee charged
by the out-of-network physician as compared to what they
usually charge in other non-par situations
Regressive Liability Bills
Re-Introduced
Among the first batch of bills re-introduced in the 2015 legislative session are a group of bills that MSSNY has strenuously
opposed in previous legislative sessions that would impose huge
new liability costs on physicians at a time when, as a result of
significant Medicare, Medicaid, and commercial insurance company payment cuts, no increases in liability costs can be tolerated. These bills include:
• A.164 (Weinstein)/S.336 (DeFrancisco) – would expand the
nature of damages in wrongful death actions to include “pain
and suffering” – estimated to increase premiums by 53%;
• A.242 (Weinstein)/S.287 (DeFrancisco) – would prohibit “ex
parte” interviews by defense counsel of plaintiff’s treating
physicians in medical liability actions – estimated to increase
premiums by 5%;
• A.244 (Weinstein) – changes loss share rules regarding non-settling defendants – estimated to increase premiums by 5%; and
• A.285 (Weinstein) – changes the existing 2.5-year statute of
limitations for medical liability actions to a “date of discovery”
rule – estimated to increase premiums by 15%. • Whether there is a “gross disparity” between the fee charged
by the out-of-network physician as compared to other fees
paid to similarly qualified non‐par physicians in the same
region
• The non-par physician’s usual charge for comparable services
• Individual patient characteristics
• The level of training, education and experience of the
physician
• The circumstances and complexity of the case, including the
time and place of the services; and
• The usual and customary cost of the service
All decisions by the IDR entity, including those involving
claims which the reviewer requests the parties to renegotiate, are
required within 30 days of the application for decision by the
IDR entity.
Numerous Insurance Reform Bills
Re-Introduced Including Top-Priority
Collective-Negotiation Legislation
Numerous pieces of legislation strongly supported by
MSSNY in previous legislative sessions to address a wide
variety of health insurer abuses have been re-introduced. These bills include:
• A.355 (Gottfried)/S.1157 (Hannon) - enables independently practicing physicians to jointly negotiate patient
care terms with health insurance companies under close
supervision by the state;
• A.368 (Pretlow) - requires health insurers to issue joint
checks for payment to an insured and their treating physician for payments for out-of-network care;
• A.443 (Gottfried) – requires health insurers to use uniform
credentialing and re-credentialing forms;
• A.445 (Gottfried) – requires health insurers to use physicians of a same or similar specialty as the treating physician
before denying coverage for such care;
• S.695 (Avella) - requires health insurers to assure continuity of coverage of necessary for prescription drugs for
patients when formularies/tier status changes. Proposed Regulations on
Marijuana Use for Treatment
of Certain Conditions
Governor Andrew Cuomo recently released regulations on the use of marijuana for certain medical
conditions. The regulations are now subjected to a
45 day public comment period. A. 6357E/S.7923 was sponsored by Assembly
member Richard Gottfried and Senator Diane Savino. Under the bill’s provisions (A.6357E/S.7923), the
New York State Department of Health will operate
the program and physicians will need to register with
DOH to be able to “certify” that the patient meets the
criteria for medical use of marijuana. A copy of the
regulations is posted here.
MSSNY will be submitting comments and
MSSNY physicians are encouraged to submit these
comments to Pat Clancy, MSSNY’s vice president
for Public Health and Education at: pclancy@mssny.
org. Comments will be organized into a letter and
submitted to the state. February 2015 • MSSNY’s News of New York • Page 5
Results of MSSNY’s Wor
(Continued from page 1)
Anesthesiologists
Money needs to be earned a minimum of
4 times: once to see the patient; another
to deal with paperwork/forms/work notes/
disability paperwork; another to bill it; and
another to collect it again and again. Then
we need time to call patient’s attorneys to
get it collected, plus time to review guidelines to determine if testing or procedures
can be done. Oops, if we mess up, we may
do diagnostic studies on a patient whose
insurance requires them to go somewhere
else and we will never get paid.
Rates are dismally low for anesthesiologists.
If I had a choice, I would never treat a WC
patient.
If cuts go through, I will not be able to maintain office salaries needed to process and
care for WC patients.
If these changes are made, we will not be
able to afford to take care of WC patients
and will withdraw from WC.
Emergency Physicians
In light of more time consumption in
administrative process, physician time, etc.,
deserved compensation to pay for office
expenses should be not curtailed.
Family Practitioners
If payments are decreased, or even stay the
same, I will soon stop treating WC patients.
The main problem with Workers’
Compensation patients is the tendency of
the patient to become manipulative with
regard to their return to work status, and
employer’s unwillingness to accept work
restricted employees.
Private insurers deny the claims and give
strange and novel reasons.
If rates are cut, we will drop our remaining
workers comp patients. We already have
stopped accepting new Workers’ Comp
patients because of the headaches involved.
WC should provide in service training for
providers with very clear guidelines for
treatment of WC patients. (needs clarity and
simplicity).
I no longer participate in Workers’ Comp.
I currently do NOT take new WCB patients
because of the low reimbursement and
paperwork required.
We need an increase, at least to the
Medicare rate.
Payment is not the issue. Comp fails to
provide good care for patients. Patients are
very stressed by the delays in approval for
testing, therapy and medications.
I would appreciate emails from WCB
regarding guidelines, statistics, education,
etc.
General Surgeons
This is another insurance company plan
to increase their profit bottom line at the
expense of physicians.
Worker’s Compensation Board should
be abolished. Lot of folks (MDs, patients,
PTs, OTs, pharmacists, lawyers, etc.) take
advantage.
Internal Medicine Physicians
Before working for a hospital, WC cases
represented a significant drain on resources
without commensurate compensation.
Services were performed as a service to
the patient. It was generally looked on as a
money-losing situation.
I rarely accept WC because of these issues.
I hate when I have a WC case – I hate the
form – it can turn a simple visit into a long
visit just so I can get the form done.
I avoid WC patients.
Neurologists
If cuts of this magnitude are instituted I will be
forced to leave practice in NY State and look
for employment in another part of the country.
Page 6 • MSSNY’s News of New York • February 2015
If there are cuts I will no longer accept WC
patients. There should be an increase in the
compensation, not a decrease!
I have decreased the number of Comp
cases that I see due to the fact that I have to
literally fight to get paid by insurance companies at NYS comp rates. The work that
goes into a Comp claim is far beyond that
which any person should have to tolerate. I
get upset once the patient gets validity to a
comp claim and then goes to an “under the
table” type of job. It happens more often
than you think.
physician who is willing to treat them for
fewer reimbursements. Some of these
reasons are also the reason why more and
more physicians are opting out of Medicare
as well. To follow in Medicare’s footsteps
will be detrimental to workers and physicians. In this specialty the annual overhead
including malpractice is well over $250,000.
You would need to treat many, many, many
workers to break even and exhausted physicians are not good physicians.
If anything, an increase in reimbursements is
overdue.
Would be a huge burden.
Opthalmologists
I dropped my WC load to near zero because
of the paperwork hassle, the low frequency
of payments and the low payments. The fee
schedule has not changed in more than 10
years.
Very hard system to deal with.
Neurosurgeons
I am clinical director of a Level 1 trauma
center in Buffalo. I always treat Workers’
Compensation patients, and make
great efforts. The hospital expects no
less. Recently I have declined to accept
non-emergency WC cases because of
anticipated legal/insurance disputes.
If they lower the fees then I will resign from
seeing WC patients. It will not be cost
effective.
WC patients take up a substantial amount
of time with accident history, physical
exams, administration (forms, authorizations, reports, disability, hearings, medical
records, depositions, letters to employers).
If the reimbursements were to decrease, the
patient (workers) will suffer greatly because
providers will no longer want to participate
with WC and it would be harder for the
patient (worker) to find a board certified
The workers comp system is so bad that
lots of patients prefer to be treated under
their own insurance for an injury sustained
at work, rather than WC.
Orthopedic Surgeons
I spend a considerable amount of time
dealing with Workers’ Comp patients. It is
fair to say that these patients are the most
challenging to deal with because of their
work related issues that I need to sort out.
They represent a significant increase (at
least double) in the amount of time my staff
and I deal with them in the office as well as
the post clinic administrative expenses they
present.
Comp injuries need to be treated in a timely
matter but it is significantly more cost
intensive to the practice. A decrease in payment will definitely force us to stop or limit
compensation patients.
If WC compensation decreases, we will stop
seeing those patients.
Patient care is slowed down due to paper-
rkers’ Compensation Poll
work processes. Authorization processes
cause delays. Paperwork delays cause
patient care delays.
If the proposed reimbursement changes go
through, I would be unable to add any new
WC patients to my practice.
I am looking at unpaid claims for greater
than 6 months. This is not sustainable for
my practice.
This would affect no-fault fees, which have
their own problems.
I would be inclined to stop taking care of
WC patients if the proposed adjustment
goes forward.
If WC decreases their fee schedule, I will no
longer accept WC patients. Too much work
and risk for already low compensation.
My practice is talking about no longer
seeing Workers’ Comp patients.
If the fees are reduced to 130% of Medicare
then I will no longer treat WC patients.
We are eager to drop WC from our practice.
Too much of a headache.
Changing the fee structure using the
Medicare RBRVS will negatively and critically impact the ability for the orthopedic
practice to continue to treat Workers’
Compensation patients.
If the proposed changes are enacted, I will
no longer accept WC patients.
We would like to continue to take care of
our WC patients, but the administrative
burden of treating these patients continues
to grow. All we ask for is a fair reimbursement for the significant amount of time and
manpower this requires.
I would not accept or treat WC patients if
they were reimbursed at the Medicare Fee
schedule. The combination of the administrative burden, authorization and complex
pre-op and post-operative complaints
would make it impossible from a time/economic standpoint.
As an orthopedic surgical practice, my staff
and I tolerate the WC paperwork because
payment for surgery cases is higher than
commercial. Pick a state that has a WC
system that works for patients and doctors
and copy that.
I will stop seeing WC patients if paid as
Medicare.
When we call for non-payment of bills,
insurance carriers do not return our calls
or say they have nothing on file. Very
frustrating,
If rates are dropped, I, along with my 15
partners, will no longer be able to see WC
patients. It would be too taxing on our
office staff/bottom line without appropriate
reimbursement.
If there are significant cuts I just won’t do
any Workers’ Compensation.
If the fee schedule is inappropriately reduced,
we will anticipate cutting back on the number of Workers’ Compensation patients that
we see, and may need to discharge patients
given the administrative burden that WC
patients place on our practice.
I have one full time employee and one
part-time employee whose only job is just
dealing with WC paper work and issues. If
WC decreases their fees I will stop seeing
these patients and not waste my time. It is
much more expensive to provide care for
WC patients in terms of money and time.
I will not accept WC patients at the
Medicare fee schedule.
Will VERY strongly consider discontinuing seeing WC patients if reimbursement is
decreased. It is simply not cost effective and,
quite frankly, not rewarding. The ‘hassle factor’
is barely offset by the present reimbursement
rates. Add in the across-the-board poorer
outcomes in this population and it is, generally
speaking, an undesirable duty to provide care
to these patients. Secondary gain is rampant.
There will continue to be an exodus of caregivers if reimbursement is decreased and that
is a cold, hard fact. It will simply be ‘not worth
it’ on many levels.
If the rest of my group would allow it, I
would refuse to see Workers’ Comp patients
because the administrative burdens are
enormous.
I will no longer see WC patients if fees are
reduced as planned.
I will probably not take care of Workers’
Compensation patient’s issues if there is
a payment reduction. I will not be able
to survive in my practice in Workers’
Compensation rates.
Reimbursement needs to be increased;
otherwise, we will drop it.
The changes to the WC program have made
it a HUGE administrative burden. Many
of my colleagues quit taking WC patients
altogether. The reimbursement verses the
expense is grossly disproportionate and I
too am on the verge of saying NO to NYS
WC patients.
We will stop seeing any WC patients if this
change goes through.
The paperwork burden is much too large.
If reimbursement decreases, I will definitely
see less WC patients, and I may simply give
up my WC number.
State insurance fund is the worst!
If there are any reductions in payments for
WC patients, I will no longer be able to provide care for these injured workers. It simply
would not be feasible.
I will not be able to continue to see WC
patients if this change is made.
If the present rates for WC are cut to the
proposed level, then it will no longer make
any sense to employ the extra staff or deal
with the administrative burden and inefficient
WC system. All that will change will be the
reimbursement. I will no longer participate
in WC as it will be work that will occur at a
loss financially. This will also affect NF rates
potentially and that will put further strain on
fragile office expense/profitability issues.
I am considering non-participation in WC if
these changes occur.
We plan to strongly consider dropping WC if
the proposed new fee schedule is adopted.
Orthopedic surgeons treat most workers
comp patient. Reducing the reimbursement
rate to help primary MDs will not aid W/C
patients, as primary MDs will not fill the
deficits of lost orthopedic surgeons.
Demands on the office are overwhelming
with MTGs causing constant time spent
complying.
loss of income benefits for the patient who
has his/her recovery delayed by the system.
I have been semi-retired for 2 years, enjoy it
and feel I provide a service of non-op ortho,
but must fully retire because of increased
cost, EMR, CME, document requirements
and malpractice.
Would not consider treating WC at anywhere
near the Medicare fee schedule. WC patients
are taxing to myself and my staff and I cannot
treat them at a lower fee schedule.
Reducing payments to the level of normal
insurance reimbursement will make it less
likely that I would care for a WC patient.
Without the shadow of a doubt I will withdraw from Workers’ Comp if any such fee
change occurs. We have one of the worst
paying and broken WC systems in the
country. We should be using a percentage of Fairhealth, not Medicare. This is
outrageous. Medicare is a government run
charity. Workers’ Comp should be paid like
Illinois or New Jersey. It’s time consuming
with the most challenging patients. This is
where doctors must unite and we need a
fee increase as a percentage of Fairhealth.
I know a survey conducted by the NYSOS
revealed that over 85 percent of orthos will
withdraw from Workers’ Comp. This is truly
an all-out assault on our value as physicians
in NY state.
Will probably not take WC patients if proposed fee schedule is implemented.
If the proposed fee schedule is adopted,
there will be significant access issues. I have
made plans to significantly limit the number
of new WC patients I see. Probable reduction
of at least 75% of the numbers I see now.
Workers’ Comp cases are harder to treat
because there are challenges and questions
that slow things down every step of the way.
We use more phone and staff time on WC
than any other carrier. We are asked to justify
the work-relatedness (which is understandable) and we are often trapped between the
carrier and the patient whom we are trying to
help. Orthopedics (my specialty) is especially
important in treating WC patients and needs
to be able to make decisions.
If this goes to Medicare equivalent rates
I will no longer participate in Workers’
Compensation.
If Worker’s Compensation rates do not
increase there will be no treatment of these
patients.
If cuts are made, I will ration access to comp
patients significantly. It is just not worth my
time, if I am not adequately reimbursed.
Instead of 4-6 new comp patients per day, I
envision allowing one appointment per day.
They will just have to wait or find someone
else.
Pain Management Physicians
NY State WC expenses are so much higher
because the doctor’s decisions for tests and
surgery can be challenged. The expense is
not only from lawyer and court costs and
increased administrative costs for the doctor’s office, but also from the huge increase
of costs to the employer for the amount of
extra time the patient is out of work and the
WC patients require significantly more time,
patience and medical care compared to the
non-WC patients. WC administrative tasks
are very burdensome, time consuming and
full of loopholes. Even after completing all the
requirements, payments are low and often
not made at all. Then there’s the administra-
I have stopped taking new WC patients
because of all the aggravation there is in
trying to treat these patients. Time spent,
slow or no pay, hearings and paperwork, etc.
Will stop accepting WC patients if this is
passed.
I have considered not seeing WC patients
because of the amount of work needed and
the poor reimbursement offered.
(Continued on page 8)
February 2015 • MSSNY’s News of New York • Page 7
Workers’ Compensation Survey
(Continued from page 7)
tive burden, time and resources to follow up
on all the non-payments and under payments. A small practice cannot sustain itself
with a Medicare-based WC fee schedule.
Ultimately these WC patients will not have
any physicians to see as we will most likely
stop participating with WC, which is most
likely the outcome WC wants in the end,
at the expense and detriment to their own
patients.
Physical Medicine &
Rehabilitation Physicians
The paperwork associated with WC is
excessive. Carriers use of out of state
reviewers who use non-NY guidelines to
down code and apply edits, reducing or
denying payments. There is no recourse
without needing additional manpower
and time to appeal the denials. Invariably,
the additional overhead cost negates any
additional reimbursement that may be
received. We end up writing off amounts
rather than spending additional time and
money trying to fight the carrier. The burden of documentation required for office
visits is much more than that required for
non WC patients as the narrative requires
additional medical/legal documentation to
support the multiple issues that need to be
addressed in addition to the medical care.
Medicare already underpays. But with the
additional administrative burden of WC
cases, my practice is very likely to stop
seeing WC patients if the fee schedule
changes for Electro diagnostic testing (my
primary focus). Unfortunately, we already
have a severe deficit of providers willing
to see these patients and the fee schedule
change will make it less likely that specialists like me will see them at all.
Need payment increases; if it goes down, I
will definitely stop taking Workers’ Comp.
Plastic Surgeons
The costs of practicing medicine have
gone up. Rent, utilities, supplies and equipment, employee salaries (other than me)
and malpractice until last year. Reducing
already low fees makes no economic
sense. Ask the legislators to consider how
they would cope with a cut in their salaries
by the same percentage as they will be
cutting our reimbursements. How would
they deal with the shortfall in income?
How is it fair by any standard?
Workers’ Compensation patients are
often more complicated than the typical
Medicare patient with complex injuries.
Also, the expectations of the patients are
different and can be more difficult and time
consuming to manage. Every intervention
requires an exhaustive approval process
and my staff spends a significant amount
of time with c4 forms, etc. I often need to
have extra visits for no other reason than to
document degree of disability.
As Workers’ Compensation has been
developed over the years, the reporting
requirements have become more and more
onerous. The most burdensome part of the
program is the need to use their unique
forms for almost all cases. For most of my
40 years in practice, I have written WCB
patient reports with all the relevant WCB
information in the report, including date of
injury, employer, insurance, WCB #, Carrier
Case#, etc., and have carefully outlined
what we see on exam, hear on history
and what we plan to do in response. To
have to then repeat this same information
repeatedly to justify a medication, to get a
test or treatment and then to have to wait
for, and often again protest, a response, is
absurd. The system has been built to make
it easy for the claims examiners, not for the
patients and providers.
Psychiatrists
1. Fees for psychiatry are totally inadequate. 2. No provisions to have effective
punishment or fines for companies who are
chronically very late in payment. 3. I have
been told that I am the only psychiatrist
in the area who still accepts WCB cases.
I may change my policy unless the above
two elements are remedied.
We find these claims so time-consuming
we outsource to eliminate the hassle, so it
costs us more to see WC patients.
Sports Medicine Physicians
If the board elects to change reimbursement to a Medicare-like model, I believe
this will cause a mass exodus of physicians due to the reality of not being FAIRLY
compensated for all the work involved with
taking care of each WC patient. Medicare
doesn’t require constant requests for treatment, constant denials, and the stress of
constant depositions which involve review
of records and time taken outside of the
practice for excessive paper work.
Thoracic Surgeons
I will no longer accept Workers’ Comp
patients if the proposed changes go into
effect.
Urgent Care Physicians
Workers’ Comp favors the insurance companies and is not fair to the patients or the
doctors.
We are one of the few practices taking it
and are thinking of dropping it...major pain
to deal with, no control of paper, fees, etc.
I can no longer accept any new WC
patients unless they dramatically increase
the payments and adhere to the current
CPT codes in use by all insurers including
Medicare, not the outdated improper one.
Vascular Surgeons
Radiologists
The denial rate for imaging services is
close to 50% and it can take close to two
years for the cases to be closed out. Cases
are denied for no medical reason, but at
the discretion of the carrier.
Insurmountable paperwork now – everything is in favor of the carriers. LPNs and
RNs dictating care along with deviant IME
physicians providing opinions without
proper exams.
Dermatologists
WC is a huge burden. If rates are cut, we
will no longer agree to provide care to WC
patients.
Webinar on E-Prescribing Requirements
Free To MSSNY Members
An archived webinar on “New York State
Requirement for E-Prescribing of ALL
Substances” is now available free of charge
to all MSSNY members. This program has
been accredited for 1 AMA PRA Category 1
Credits™ and the educational objectives are
to describe the following:
• E-prescribing mandate, to whom it
applies, when it becomes effective, and
how physicians can comply with its
requirements
• the practitioner electronic prescribing
of controlled substances registration
process, to whom it pertains, and the
information required to be provided
by physicians in order to register eRX
software with the Bureau of Narcotics
Enforcement
• exceptions to the e-prescribing mandate
and any additional requirements associated with those exceptions
• application process and criteria for a
waiver from the e-prescribing mandate
• rules that pertain to physicians who only
prescribe non-controlled substances
MSSNY physicians may register and
access the archived webinar on the MSSNY
website at: www.mssny.org/MSSNY/Public_
Health/Eprescribing.aspx
The course is available to non-MSSNY
physicians for $125 which can be applied to
a MSSNY membership.
Medical Society of The State of New York
2015 Albion O. Bernstein, MD Award
The Medical Society of the State of
New York is accepting nominations
for the 2015 Albion O. Bernstein, MD
Award. This prestigious award is given
to “…the physician, surgeon or scientist
who shall have made the most widely
beneficial discovery or developed the
most useful method in medicine, surgery or in the prevention of disease in
the twelve months prior to December
2014.” This $2000 award was endowed
by the late Morris J. Bernstein in memory of his son, a physician who died in
an accident while answering a hospital
call in November 1940.
The award will be presented to
the recipient during a MSSNY
Page 8 • MSSNY’s News of New York • February 2015
Council Meeting.
Nominations must be submitted on
an official application form and must
include the nominator’s narrative description of the significance of the candidate’s
achievements as well as the candidate’s
curriculum vitae including a list of publications or other contributions.
To request an application, please contact: Committee on Education, Joanne
Wise, Manager, Continuing Medical
Education, Medical Society of the State
of New York, 99 Washington Avenue,
Suite 408, Albany, NY 12210 Call 518465-8085 or email [email protected]
DEADLINE FOR NOMINATIONS:
May 31, 2015.
257,000 Physicians Will Have Payments Cut
in 2015 for Not Adopting EHR
More than 257,000 U.S. doctors will see
their Medicare payments cut by 1% this year
because they didn’t meet federal goals for
using electronic medical records, said the
Centers for Medicare and Medicaid Services.
Some 28,000 providers will be docked
another 1% of Medicare pay for not prescribing medications electronically. About 200
hospitals were informed in October that they
also will lose 1% of their Medicare payments
in 2015 for missing a deadline for EMR use.
The rules, part of the 2009 stimulus package, were designed to spur the health-care
industry’s transition from paper files to
electronic record keeping. Initially the law
offered lucrative incentive payments if providers could demonstrate “meaningful use”
of EMRs.
Payment Adjustments Summary
Applied to all Medicare reimbursement
+As of April 1, 2013. ^Only groups with 100+ eligible professionals in 2015, and >10 in
2016. ~Penalties reported as maximums.
Competency-Based Admissions: A New Initiative at the
Albert Einstein College of Medicine
Siobhan M. Dolan, MD, MPH, Noreen
Kerrigan, MPA, and Michael J. Reichgott,
MD, PhD, Albert Einstein College of
Medicine, Bronx, NY
The Association of American Medical
Colleges (AAMC) has spearheaded two initiatives over the past 5 years that are having
a strong effect on medical school admissions committees. These are holistic review
of applicants and competency-based admissions. Together, these initiatives share the
overall goal of assuring a diverse student
body that will be capable of meeting the
nation’s health care needs in the 21st century. These needs have been characterized
as: access for all to preventive care; appropriate intervention when disease exists; and
removal of disparities based on age, gender,
ethnicity, disability, sexual orientation or any
other personal characteristic.[1]
While admissions standards for medical
school have not changed over many years,
the health care system has certainly changed
in recent years to emphasize, “…greater
integration across the medical education
continuum, highly networked teams in discovery research, and inter-professionalism in
clinical care[2].” These changing characteristics of the health-care system impact which
candidates might be best suited to a successful career in medicine.
Medical school admissions processes
have historically placed greatest emphasis
on measures of academic performance such
as grades and standardized test scores. Now
AAMC leaders are suggesting that fundamental change is needed in order to, “…
select physicians with both the academic
and interpersonal and intrapersonal competencies necessary to operate in the health
care system of the future [3].” One means
of achieving this is through holistic review
of applicants, defined as a “flexible, highly
individualized process by which balanced
consideration is given to the multiple ways
in which applicants may prepare for and succeed as medical students and doctors[4].” This
holistic approach requires consideration of
the many personal characteristics and abilities in addition to academics that best define
a physician.
Competency-Based Admissions
In order to prepare applicants for a review
that will evaluate, equally, their personal
characteristics as well as their academic
readiness for medical school, the Albert
Einstein College of Medicine has developed
a Competency-Based Admissions (CBA)
process. This approach identifies for candidates the full set of skills and abilities they
must have achieved at an acceptable, entry
level, rather than just a checklist of courses
that must have been completed. CBA provides applicants with greater flexibility, for
example, by allowing scientific experience
gained while employed, to be substituted for
laboratory and/or course requirements taken
in school. It also allows students the option
of meeting academic expectations through
appropriate work experiences, or by taking
online courses, thereby freeing up time to
pursue activities and interests that enhance
an applicant’s level of maturity, cultural
awareness, ability to work in team settings
and other elements of readiness for medical
practice in the 21st century. CBA supports Einstein’s explicit mission
to identify matriculants who will undertake
state-of-the art scientific inquiry while serving the need of the Bronx community by
providing the highest quality clinical care.
CBA promises to minimize obstacles to
admission and supports the goal of educating
physicians that are representative of and who
will ultimately work in our Bronx community of over 1.4 million residents, 43.3% of
whom identify as Black or African American
and 54.6% who report some Hispanic or
Latino ancestry[5].
(Continued on page 12)
Suffolk County Announces Partnership with
Adelphi University for MBA Program
The Suffolk County Medical Society
has announced a partnership with Adelphi
University to offer its members an accelerated MBA program. The MBA program is
designed to provide physicians with the tools
necessary to run a more cost-effective practice, as well as become proficient in business
strategies and acquire the skills necessary to
become effective leaders in the rapidly-changing business of health care delivery.
The program offered is 42 credits (14 threecredit courses), and will be taught by Adelphi
University’s Robert B. Willumstad School of
Business faculty. In addition, guest speakers
will be invited to lecture which will bring
added value to the program on updated busi-
ness principles and how they affect healthcare.
The program will be held in Islandia in the
Suffolk County Medical Society Board Room
one night a week. The projected start date of
the program is February 2015.
Maria A. Basile, MD, SCMS President and
recent MBA graduate stated: “All around me I
see strong physician leaders, members of our
Medical Society and ‘The House of Medicine.’
You are a leader, just as I am, because of the
trusted role we all play every day in people’s
lives – trust, compassion, stability and hope
are qualities people seek from their leaders.
Aren’t these also traits that define ‘A True
Physician’?”
Special Discount for MSSNY Members: Comply with
New York’s E-prescribing Mandate:
Get Started with eRx Today
NY Law: All Physicians Must Prescribe
Electronically by March 27, 2015! Buy
E-prescribing at a Reduced Rate
The Internet System for Tracking OverPrescribing Act (I-STOP) was passed by the
New York State legislature to help combat
the rising rates of prescription drug abuse. On March 27th, all New York providers will
need to electronically prescribe all legend
drugs and controlled substance prescriptions. Complying with New York’s e-prescribing
mandate is easy, and as a special member
benefit, you will receive a reduced rate on
DrFirst’s industry leading Rcopia® with
EPCS GoldSM, which allow providers to
e-prescribe both legend drugs and controlled
substances in a single workflow.
In addition, DrFirst will guide MSSNY
members through the identity proofing and
authentication processes that are required
by the Drug Enforcement Agency to allow
doctors to prescribe controlled substances
electronically.
DrFirst and MSSNY are hosting e-prescribing webinars to help you learn more
about I-STOP and how you can become
compliant by March 27th. Sign-up today
using the registration links below:
1/27 @ 10:30am ET - http://bit.ly/1JtZX3s 2/4 @ 2pm ET - http://bit.ly/1JtZfDl 2/12 @ 4:30pm ET - http://bit.ly/188CUzF For more information, and to receive
your special MSSNY member discount,
visit www.drfirst.com/MSSNY, or call the
special MSSNY E-prescribing Hotline at
866-980-0553.
February 2015 • MSSNY’s News of New York • Page 9
MSSNY’s Socio-Med Division
Helped Members to Recover
over $168K
MSSNY’s Division of Socio-Medical Economics
was successful in helping MSSNY member physicians recover over $168K from various health plans
during 2014. This activity was done for MSSNY
members who availed themselves of the services of
the Ombudsman Program. The Socio-Medical Economics Division is, for
the most part, able to reach appropriate health plan
staff to have claims paid, appealed and/or re-evaluated for proper reimbursement for services rendered
to patients. If you have a claim problem, please call
516-488-6100 ext. 334.
Resident/Fellow/Student Poster Symposium
Abstract Submissions Now Open
OBITUARIES
MSSNY announces its next Resident/Fellow/Medical Student Poster
Symposium, to be held Friday, May 1, 2015 at the Saratoga Hilton in Saratoga
Springs, New York, from 2-4:30 pm. The deadline for abstract submission
is 4 pm, February 15, 2015. Up to 70 abstracts will be chosen for poster
presentation.
Participants must either be a medical student or active in a residency/fellowship training program and they must be able to attend the meeting to
present and discuss their entry. Additionally, they must hold current MSSNY
membership. Membership is free for first-time resident/fellow members.
Nonmember students and resident/fellows may join online at www.mssny.
org.
Detailed guidelines are available at http://tinyurl.com/q6gnknk or by contacting [email protected],516-488-6100 x 383.
We are also seeking abstract scorers. If you are interested, please contact
[email protected] or call 516-488-6100 x 383.
ANLLO, Victorino; North Tonawanda NY.
Died December 02, 2014, age 91. Erie
County Medical Society
BRICKNER, Merol Ernest; Gloversville NY.
Died December 09, 2014, age 102. Medical
Society County of Fulton
CHRISTIE, Joan Ann; Gloversville NY.
Died December 09, 2014, age 82. Medical
Society County of Fulton
ELLISON, John Bingham; Middletown
NY. Died March 22, 2014, age 86. Medical
Society County of Orange
FUCHS, Magdalena; New York NY. Died
July 06, 2014, age 91. New York County
Medical Society
GLENN, Morton Bernard; West Palm Beach
FL. Died March 01, 2014, age 91. New York
County Medical Society
KAPLAN, Norman Lionel; New York NY.
Died November 14, 2014, age 81. New York
County Medical Society
LEPKO, Ervin Eugen; Englewood Cliffs
NJ. Died May 03, 2014, age 86. New York
County Medical Society
MATTIMORE, Joseph M.; Hamburg NY.
Died November 27, 2014, age 86. Erie
County Medical Society
MELAMED, Myron R.; Valhalla NY. Died
December 15, 2014, age 87. New York
County Medical Society
POINTON, David Samuel; Johnstown NY.
Died December 09, 2014, age 84. Medical
Society County of Fulton
RANDALL, Frederick R.; New York NY.
Died March 29, 2014, age 91. New York
County Medical Society
SAMUELLY, Israel; Brooklyn NY. Died
December 11, 2014, age 87. Medical Society
County of Kings
SAXE, David H.; Centereach NY. Died
December 13, 2014, age 101. New York
County Medical Society
SAYOC, Oscar Z.; Orchard Park NY. Died
December 13, 2014, age 77. Erie County
Medical Society
SHANBHAG, Madhukar A.; East Amherst
NY. Died December 06, 2014, age 79. Erie
County Medical Society
SLOAN, Don; New York NY. Died December
16, 2014, age 85. New York County Medical
Society
WALKER, Leslie Allan; Fredericksburg VA.
Died November 01, 2014, age 90. Monroe
County Medical Society
WHELAN, Joseph R.; Great Neck NY. Died
December 22, 2014, age 89. Nassau County
Medical Society
Save the Date:
MSSNY STATE
LOBBY Day
is March 4, 2015
Not a MSSNY
Member?
Join Now:
516-488-6100
Page 10 • MSSNY’s News of New York • February 2014
Members in the News
Dr. William Spencer Named
Long Islander News’
2014 Person of the Year
Long Islander News
recently named Suffolk
County Legislator William
R. Spencer, MD, its 2014
Person of the Year for
his “significant contributions to the Town of
Huntington.” Each year,
the newspaper honors
William R.
Spencer, MD “a dynamic force who
has made history, gone
above and beyond a call of duty and made
Huntington a better place.”
Now in his third year as a Suffolk County
Legislator, Spencer has waged major
battles to pass legislation—including a firstin-the-nation law that banned the marketing
of energy drinks to minors; barring dangerous
fracking byproducts from being used in the
county; and raising the tobacco-buying age in
Suffolk from 19 to 21. He serves as Chair of
the Health Committee for the Suffolk County
Health Department.
A member of MSSNY since 2010, Dr.
Spencer currently serves as the Presidentelect of the Suffolk County Medical Society
and President of the Suffolk Academy of
Medicine. He received his undergraduate degree from Wesleyan University and
his medical degree from the University
Of Connecticut School of Medicine. After
completing his internship and residency in
surgery at St. Vincent’s Hospital, Dr. Spencer
completed a residency in otolaryngology at
New York Eye and Ear Infirmary and a fellowship in pediatric otolaryngology at the
University of Miami. In 2000, he opened his
private practice, Long Island Otolaryngology
and Pediatric Airway in Huntington. He currently serves as the Chief of Otolaryngology
at Huntington Hospital.
Dr. Victor Filadora Named
Chief of Clinical Services
at Roswell Park Cancer
Institute
Roswell Park Cancer
Institute (RPCI) has
named MSSNY member Victor Filadora,
MD, as Chief of
Clinical
Services.
In this new role, Dr.
Filadora, an anesthesiVictor
ologist first appointed
Filadora, MD to the Institute’s medical staff in 2003, is
responsible for managing the com-
prehensive cancer center’s Ambulatory
Services, Perioperative Services, Sterile
Processing, Pharmacy, Patient and Family
Experience, Endoscopy Services and
Therapeutic Services programs, and will
also provide leadership and guidance to
clinical department administrators throughout the Institute.
Dr. Filadora joined RPCI in 2003 from
Brigham and Women’s Hospital in Boston,
an affiliate of Harvard Medical School,
where he served as Chief Resident for the
Department of Anesthesiology. He served
on the staff of Newton-Wellesley Hospital
and the Tufts University School of Medicine
The Health Care Law Experts
Representing Medical Professionals for More than 25 Years
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Attorney At Law
Former Assistant District Attorney
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CDC’s Ten Most Challenging
Public Health Threats of 2014
faculty from 2004-05, at which point he
returned to RPCI as Chief of Perioperative
Medicine and Director of the Center for
Preoperative Evaluation
After earning his undergraduate degree
in psychobiology from the State University
of New York at Binghamton, Dr. Filadora
went on to earn his medical degree, a master’s degree in natural science/biochemistry
and an MBA from University of Buffalo.
In addition to MSSNY, he is a member
of the American Medical Association,
American Society of Anesthesiologists,
Massachusetts Medical Society and New
York State Society of Anesthesiologists.
Untitled-1 1
business showcase
11/13/14 3:59 PM
The CDC has released its list of the 10 most
challenging public health threats of 2014:
1. Ebola
2. Antibiotic resistance
3. Enterovirus D-68
4. Middle Eastern Respiratory Syndrome
coronavirus (MERS-CoV)
5. HIV/AIDS
6. Polio (with this caveat: “The world is on the brink
of eradicating polio, but we risk losing valuable
ground.”)
7. Laboratory safety
8. Cardiovascular disease
9. Cigarette smoking
10. Prescription drug overdose
February 2014 • MSSNY’s News of New York • Page 11
PRESIDENT’S COLUMN
(Continued from page 4)
even narrower networks and even greater
limitations on the care that physicians can
provide to their patients. Non-physician
groups like dentists, nurse anesthetists,
optomoetrists, podiatrists and psychologists argue that their training enables
them to provide patient services currently
only provided by physicians. And health
insurers and large health systems want
to profoundly change how payments for
care will be made without your input.
Doctors Need to Be
Seen and Heard
That’s why they need to see you, in
your white coat, on their “home turf.”
I know many physicians wish this was
not the case, but the delivery of care is
inexorably linked to public policy. So we
have an obligation – to ourselves, to our
colleagues, and to our patients – to make
sure that these policies further enable our
patients’ ability to receive quality care
from appropriately trained physicians,
instead of hindering our patients’ ability
to receive this care.
I look forward to seeing you all in
Albany on March 4. And make sure you
urge your colleagues to come to Albany
as well.
Our future depends on it.
Competency-Based Admissions
(Continued from page 9)
In order to transition CBA, the
Committee on Admissions in September,
2011 began a four-year process by participating in an AAMC full day Holistic
Review in Admissions workshop on site
in the Bronx. This workshop identified a
need to clarify the Admissions Committee
Mission Statement. This was revised to
read as follows:
“The Albert Einstein College of
Medicine strives to matriculate a diverse
group of outstanding students whose
academic accomplishments, clinical experiences, community service and research
indicate that they will become exceptional
healers, educators, colleagues, patient
advocates, scientists, role models and
life-long learners. We are committed to
identifying individuals who already have
demonstrated the qualities of compassion,
empathy, kindness, creativity, professionalism, leadership and maturity. A diverse
student body is consistent with the history
and mission of Einstein and supports a key
educational objective which is to raise the
cultural awareness and competence of our
graduates.” [6]
Four Major Competencies
Subsequently, using an iterative process
the Committee established four major competencies that applicants must demonstrate
in order to be considered for admission.
These are:
1. Co-Curricular Activities and
Relevant Experiences • Clinical experiences, community
service and research
2. Communication Skills
• Excellent spoken and written English
language skills, ability to connect
interpersonally, show empathy and
demonstrate cultural competence 3. Personal and Professional
Development • Ethical behavior, teamwork, leadership, maturity, ability to handle stress
and show resilience
4. Knowledge 1. Chemistry/Biochemistry
2. Biology
3. Physics
4. Mathematics
5. Humanities, Social and Behavioral
Sciences
A detailed description of these competencies is available on the Einstein
website[7].
Beginning with the 2014-2015 applicant class, the Committee on Admissions
is using CBA by specifically searching
the entire application to ensure that the
candidate has demonstrated reasonable
accomplishment of all of the identified competencies. We read in detail the AMCAS
application, academic record, personal
comments, roster of experiences, letters of
recommendation, the Einstein secondary
application, and written and verbal communication with the Admissions Office.
We ask students to tell us how they have
achieved the knowledge competencies on
our secondary application. Interpersonal
interaction and communications skills are
evaluated during the interview.
Einstein has used this broad review of
applicant characteristics for many years,
and our graduates historically have met our
goals of being both well-trained in medical science and highly effective in clinic
practice. Implementation of CBA provides
a more explicit and transparent approach
to the holistic review process. We will be
tracking outcomes over the next several
years to assure that our selection process
continues to be successful, and to determine whether this approach actually results
in the training of a physician workforce
best able to serve the nation’s health.
REFERENCES
[1] Koop, C.E., Health and Health Care for the
21st Century: For All the People. Am. J.
Public Health, 2006; 96: 2090-2092
[2] Kirch DG. The Flexnerian Legacy in the
21st Century. Academic Medicine. 2010;
85:190–192.
[3] Mahon KE, Henderson MK, Kirch DG.
Selecting tomorrow’s physicians:
the
key to the future health care workforce.
Academic Medicine. December 2013. Vol
88(12):1806-11.
[4] Addams AN, Bletzinger RB, Sondheimer
HM, White SE, Johnson LM. Roadmap
to Diversity: Integrating Holistic Review
Practices Into Medical School Admission
Processes. Washington, DC: Association
of American Medical Colleges; 2010.
https://members.aamc.org/eweb/upload/
Roadmap%20to%20Diversity%20
Integrating%20Holistic%20Review.pdf.
Accessed January 8, 2015.
[5] United States Census Bureau. http://quickfacts.census.gov/qfd/states/36/36005.
html. Accessed January 8, 2015.
[6] Albert Einstein College of Medicine Website.
http://www.einstein.yu.edu/education/
md-program/admissions/admissions-mission-statement/. Accessed January 8, 2015.
[7] Albert Einstein College of Medicine Website.
http://www.einstein.yu.edu/education/
md-program/admissions/applicationprocedure/course-requirements.aspx.
Accessed January 8, 2015.
Page 12 • MSSNY’s News of New York • February 2014
AMA: Top 10 of What You Need to Know
About the 2015 Medicare Fee Schedule
Chances are you haven’t been able to read
through the nearly 1,200 pages that constitute
the 2015 Medicare Physician Fee Schedule
final rule released Oct. 31 and published in the
Federal Register. Here are the 10 top payment
policy changes discussed in this mammoth document that you need to know about:
1. The sustainable growth rate (SGR) formula calls for a 21.2 percent cut to physician
payments, effective April 1. While this is a
steep reduction, it is a considerable drop from
the nearly 30 percent cut projected just a few
years ago. The reduction is thanks to nearly flat
growth in utilization of physician services over
the past several years. The AMA continues to
press Congress to repeal the SGR formula to
eliminate the perennial payment cut threats and
temporary legislative patches.
2. Continuing Medical Education (CME) will
not be reported under the Physician Payments
Sunshine Act. The Centers for Medicare &
Medicaid Services (CMS) proposed including
CME activities in reports of physicians’ financial interactions with medical device and drug
manufacturers in the new “Open Payments”
public database. The AMA led dozens of other
medical associations in calling on the agency
to eliminate this requirement because it would
“chill physician participation in independent
[continuing education] programs.”
3. Proposed penalties under the value-based
payment modifier (VBM) will be scaled back.
CMS intended to increase payment penalties
under the modifier from 2 percent to 4 percent,
beginning in 2017. The AMA strongly objected
to this proposal, noting in a comment letter on
the proposed rule that some physicians would
be vulnerable to payment cuts totaling more
than 11 percent as a result of the VBM and other
Medicare reporting programs – a move that
could mean some of Medicare’s sickest patients
would lose access to their doctors. While the
final rule still maintains a potential pay cut of 4
percent for larger medical groups, practices with
fewer than 10 physicians will not be subject to
more than a 2 percent VBM penalty.
4. The Physician Quality Reporting System
(PQRS) becomes a penalty-only program next
year. Physicians must successfully report in
2015 to avoid PQRS and VBM penalties in
2017. Among other things, they’ll have to report
on at least nine quality measures that cover three
“domains.” In addition, the final rule requires
physicians to report on at least one of the 18
new “cross-cutting measures.” CMS originally
said physicians would be obligated to report on
at least two cross-cutting measures but cut that
requirement in half after the AMA urged the
agency not to create additional mandates that
physicians would struggle to meet. The agency
also had planned to shorten the period physicians have to review their feedback reports to
just 30 days. Following AMA lobbying, CMS
decided to leave the review period at 60 days.
5. The Physician Compare website will continue to expand – but not as much as planned.
Continued pressure from the AMA has led CMS
to commit to better prevention and correction of
errors on this website that has been riddled with
problems. The agency also will notify physicians when they can preview their reports.
While the agency’s plans to post benchmarks
to the site have been put aside for now, the website will show physicians’ performance under
PQRS, the electronic health record meaningful
use program and Medicare Accountable Care
Organizations.
6. Chronic care management services will be
supported by a monthly payment. Beginning next
year, CMS will pay $42.60 per month for these
services when CPT code 99490 is reported. This
policy change reflects several years of advocacy
by the AMA, the CPT Editorial Panel and the
AMA/Specialty Society Relative Value Scale
Update Committee (RUC). The groups will
continue to urge the agency to also adopt higher
values and pay for multiple complex chronic
care coordination services so that patients have
ongoing access to this important care.
7. Four services now are eligible for telehealth
payment. These services are Medicare’s annual
wellness visit (coded with HCPCS G0438 and
G0439), prolonged evaluation and management services (reported with CPT codes 99354
and 99355), family psychotherapy (CPT codes
90846 and 90847) and psychoanalysis (CPT
code 90845).
8. Surgical global periods will change from
10-day and 90-day periods to 0-day periods.
Despite strong opposition from the AMA and
many medical specialty societies, CMS will be
transitioning all services with a 10-day global
period to a 0-day global period by 2017. All
90-day global periods will be shifted to 0-day
global periods by 2018.
9. There are 350 CPT codes identified as new,
revised or potentially misvalued—318 of these
changes were based on physician input. These
changes represent 86 percent of those recommended by the RUC, a group of more than 300
participants that includes physician advisers
from every medical specialty and a dozen other
health care professionals. The group provides
input on values based on their highly technical
expertise.
10. The timeline for submitting new codes and
revaluations of services will shift. The deadline
for receiving all code and value recommendations for the following year’s payment policies
will be February to allow more time for public comment. This change will take place for
the 2017 Medicare Physician Fee Schedule.
CPT and RUC timelines will be modified to
accommodate the new process, thereby ensuring physicians continue to have strong input on
appropriate values for services.
Physicians prefer facts to speculation.
These are the facts.
• The actions of New York State Government deeply affect the professional
practice of every single New York physician and the thousands of patients
to whom they provide care. • You can substantially influence whether this effect is positive or negative
through engaging in collective political action with your colleagues by joining
MSSNYPAC – the physician’s political action committee. Every physician in New York State CAN AND SHOULD JOIN MSSNYPAC.
Join online or find out more by visiting www.mssnypac.org.