MEDICAL SOCIETY OF THE STATE OF NEW YORK

NEWS OF NEW YORKProv id ing In format ion to Ass i s t Phys i c ians in the State o f New York

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Volume 74 • Number 1 www.mssny.org January 2018

Take Diabetes Awareness Survey ........page 2

What is your New Year’s resolution? ..page 4

You must register for Workers’Comp ..........page 5

MSSNY’s 2018 Legislative Program ......page 6

Who Is Your “Harvey Weinstein”?: The High Cost of Letting Sexual Harassment

Go Unchecked in the Medical ProfessionBy Andrew L. Zwerling, Esq.

The news is rife with allegations against celebrities such as Harvey Weinstein and Bill O’Reilly accusing them of being serial sexual predators. People are aghast at the breadth and longevity of the acts underlying these allegations.

Critically, the medical profession has its share of sexual harassment issues. In a 2016 study, one-third of female physicians reported being sexually harassed. In another study, 54% of medical students stated that they had experienced some form of sexual harassment. And juries across the country are responding with a certain fury to such allegations. For example, a $168 million verdict awarded to a California physician assistant; a $1 million award to a physician who was found to have been wrong-fully terminated for complaining about the existence of sexual harassment; and a $1 million award to a nurse who was terminated after complaining about an affair between a hospital’s chief medical officer and a hospital

Want to Learn More about New York’s New Step Therapy Override Law?

Click here to view a webinar discussing New York’s new law that gives physicians a stronger ability to override a health insur-er’s step therapy protocol when seeking to assure their patients can receive coverage for necessary prescription medications. Among the faculty for the program are MSSNY President-elect Dr. Thomas Madejski and MSSNY Senior Vice President Moe Auster. The webinar, sponsored by the National Psoriasis Foundation, will provide physicians with 0.5 hours of CME credit.

The new law will be applicable to all NY-regulated health plans as of January 1, 2018. However, since the law applies to health insurance plans “delivered, issued for delivery issued or renewed” after January 1, 2017, many group health insurance plans across the State are already required to follow the new law.

MSSNY has created a template for physicians and their sup-port staff to use in requesting a step therapy protocol override, available here.

Enforcement is the key to assuring that the law is working as intended. Therefore, please let us know if you see instances where health insurers are not following the law.

Governor Again Vetoes Legislation to Permit Prescription Refills Longer than

Original PrescriptionGovernor Cuomo vetoed legislation (A.6731-B/S.5171-B)

that would have authorized pharmacists to refill non-con-trolled substance prescriptions in a quantity greater than that set forth in the prescriber’s original prescription. In effect, it would have enabled pharmacists to provide 90-day refills of particular prescription medication even if the original pre-scription called for a shorter refill duration, such as 30 days.

While there were some changes to a similar bill that was vetoed last year, Governor Cuomo noted in the veto mes-sage his concerns that “the bill retains the provisions that would risk contributing to the distribution of larger quantities of prescription medications than may be necessary for a spe-cific patient.” Moreover, he noted his concern that “it would still allow the pharmacist to infringe on the physician-patient relationship” because the notification to the prescriber would not occur until after the prescription is filled.

MSSNY Phone Number for Garfunkel WildOur new law firm, Garfunkel Wild, has established

a phone number for exclusive use by MSSNY mem-bers: 516-393-2230. The firm has a group of attorneys dedicated to receiving the phone calls to ensure that any MSSNY member who calls will receive prompt service. They want to hear from you!

Resolutions for 2018 House of Delegates Due by February 9, 2018Be advised that the deadline for resolutions will be

FRIDAY, FEBRUARY 9. The Speaker has established a window during which resolutions are to be submitted: from Monday, January 22 until 5 PM on February 9. The 5 PM deadline is a hard deadline.

The resolutions must be researched utilizing both the MSSNY Position Papers and the Legislative Agenda. Resolutions that are not substantively different from existing policy or initiatives will be recommended for reaffirmation.

(Continued on page 5)

Page 2 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 3

The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York. MSSNY has developed a short survey to sample physician’s knowledge of the National Diabetes Prevention Program (DPP) and the Prevent Diabetes STATTM program. This survey can be taken by clicking here.

The AMA previously rolled out the pro-gram through partnerships with state medical societies in California, Michigan and South Carolina. New York is one of eight states where the AMA is extending the program. The DPP model encourages physicians to screen patients for predia-betes, a condition in which blood glucose

levels are higher than normal, but below the threshold for a diabetes diagnosis. Patients identified as pre-diabetic are referred to diabetes prevention programs that meet certain criteria established by the Centers for Disease Control and Prevention.

This initiative will help bridge the gap between the clinical care setting and com-munities to reduce the incidence of Type 2 Diabetes by educating and connecting more patients to evidence-based lifestyle change programs that are available in their communities, including programs offered where they work, through com-munity and faith-based organizations, and online.

“MSSNY’s partnership with the AMA is

a key step towards making an immedi-ate impact on the health of New Yorkers,” said Dr. Geoffrey Moore, Chair of MSSNY’s Preventative Medicine and Family Health Committee and a lifestyle medicine phy-sician based in Ithaca, NY. “The Centers for Disease Control and the American Medical Association have developed a great educational toolkit and, through our partnership, we seek to extend the benefits of these tools to all physicians and patients throughout New York State.”

In the coming year, MSSNY will be developing education sessions and arti-cles outlining important information about diabetes in the MSSNY Daily and E-News. Educational webinars and pod-casts tailored to both physicians and patients on prediabetes and diabetes are also being developed. MSSNY’s website includes a diabetes webpage and physi-cians are encouraged to visit for more information about Type 2 Diabetes and to learn more about MSSNY’s partnership with the AMA.

MSSNY to Implement National Diabetes Prevention Program; Physicians Encouraged to Take Diabetes Awareness Survey

NYS Has Lowest Opioid Prescribing Rate in Nation

under Medicare Opioid Prescribing Mapping ToolNew York State has the lowest opi-

oid prescribing rates in the country for Medicare Part D prescriptions, as reported under Medicare’s new opioid prescribing mapping tool. According to the Centers for Medicare and Medicaid Services (CMS), the 2015 national average percentage for prescribing opi-oids to the Medicare population stands at 5.52 percent, while New York’s is 3.05 percent. Nevada has the highest prescribing rate with 7.66 percent.

The Centers for Medicare and Medicaid Services (CMS) has updated its Medicare opioid prescribing mapping tool and this tool is an “interactive, web-based resource that visually presents geographic comparisons of Medicare Part D opioid prescribing rates.” It also identifies county-level hot-spots and outliers, which “may identify areas that warrant attention.” The updated version of the mapping tool presents Medicare Part D opioid prescribing rates for 2015 as well as the change in opioid prescribing rates from 2013 to 2015; it also includes additional information on extended-release opioid prescribing rates. The Medicare Part D Opioid Drug Mapping Tool can be found here.

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Page 4 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 5

As we look forward to a New Year, it’s a fine time to reflect on the past year and make some predictions going forward. Under challenge for a number of years, 2017 was certainly no exception for physicians. AdvocAcy

Despite having been besieged by numerous adverse proposals in the final weeks of the legis-lative session, I am happy to report that the Session ended with MSSNY, along with other pro-physi-cian allies, securing the defeat of many adverse legislative proposals, including legislation that would have:

• Enabled corporate-owned Retail Clinics staffed by physician extenders (rather than by physicians),

• Significantly expanded the informa-tion required to be included in the Physician Profile

• Limited injured worker choice of physician in Workers Compensation, expanded the role of Non-Physicians under Workers Compensation, and eliminated the county medical soci-ety role in processing Workers Comp applications

• Imposed burdensome new require-ments on the prescribing of pain medications to patients;

• Required urgent care office – based surgery centers to use electronic health records

• Expanded the scope of practice of numerous non-physicians, including

podiatrists, nurse-anesthetists, optometrists, psychologists, chiropractors, and naturopaths.

In the public health arena MSSNY, along with other pub-lic health groups, scored an important public health victory by assuring that e-cigarettes are regulated similarly to other tobacco products.one-Sided Bill

Despite these successes, I cannot fully express my dis-

appointment over the one-sided liability expansion bill passed by the legislature last June. While its fate with the gover-nor remains uncertain at the time of this writing, this imperfect bill comes at a time when physicians and hospitals, already facing exorbitant liability costs, are nearly certain to face significant cuts from Washington. I, along with our health care coalition partners, continue to urge the governor to seek comprehensive rather than lop-sided liability reform.

MSSNY thanks all physicians who responded to our call throughout the Session to contact your legislators when requested. Physicians who wish to contact their elected officials on the issues, may find links under ‘Government Affairs’ and ‘Grassroots Action Center’ on the MSSNY.org homepage. These links provide a sim-ple means for one to craft and to send a letter to state and federal officials.Three PillArS

When I was installed as MSSNY presi-

MEDICAL SOCIETY OF THE STATE OF NEW YORK

NEWS OF NEW YORK

Medical Societyof the State of New york

Charles Rothberg, MD, PresidentPaul Hamlin, MD, Board of Trustees Chair

Philip A. Schuh, CPA, Executive Vice President

coMMUNicatioNS aNd PUBlicatioNS Maria Basile, MD, MBA, Commissioner

NewS of New yorkPublished by Medical Society

of the State of New York

Vice President, Communications and EditorChristina Cronin Southard

csouthard@mssny.org

News of New York StaffManager, Communications Division

Julie Vecchione DeSimonejvecchione@mssny.org

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Susan Herbst, Page Designer

NEWS of NEW YoRkADVERtiSiNg REPRESENtAtiVES

for general advertising information contactChristina Cronin Southard

Phone 516-488-6100 ext 355csouthard@mssny.org

the News of New York is published monthly as the official publication of the Medical Society of the State of New York. information on the publi-cation is available from the Communications Di-vision, Medical Society of the State of New York, 865 Merrick Avenue, P.o. Box 9007, Westbury, NY 11590.

the acceptance of a product, service or com-pany as an advertiser or as a membership benefit of the Medical Society of the State of New York does not imply endorsement and/or approval of this product, service or company by the Medical Society of the State of New York. the Member Ben-efits Committee urges all our physician members to exercise good judgment when purchasing any product or service.

Although MSSNY makes efforts to avoid clerical or printing mistakes, errors may occur. in no event shall any liability of MSSNY for clerical or printing mistakes exceed the charges paid by the advertis-er for the advertisement, or for that portion of the advertisement in error if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the error. Liability of MSSNY to the ad-vertiser for the failure to publish or omission of all or any portion of any advertisement shall in no event exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement omitted if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the omission. MSSNY shall not be li-able for any special, indirect or inconsequential damages, including lost profits, whether or not foreseeable, that may occur because of an error in any advertisement, or any omission of a part or the whole of any advertisement.

PreSidenT’S colUMn

Charles Rothberg, MD

MSSny-PAc

Meeting All Our Challenges; Win Some…

Many people resolve to eat healthier, exercise more, or to develop stronger coping skills to more easily withstand little daily annoyances.

As a primary care physician, I can cer-tainly testify to the importance of these action steps, all the more important now that the American College of Cardiology and American Heart Association have significantly lowered the threshold for what is considered hypertension.

One more item should be on your reso-lution list – to make time to advocate for your profession and your patients.

And if you are already among the many physicians who make time for this, then resolve to encourage other physicians to

make time for advocacy, and to support MSSNY and MSSNYPAC.

I know how time-crunched we all are. There are constant demands: to see more patients; to complete more forms; to learn the new EHR system; to participate in medical staff meetings to improve patient care delivery. However, advocacy is something we cannot leave “to the other guy” anymore. Our profes-sional future depends on it.

What Is Your New Years’ Resolution?

(Continued on page 13)

(Continued on page 20)

Page 4 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 5

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director. What is the takeaway message from these

facts? First, beyond the obvious need to have a written sexual harassment policy, make sure your supervisory staff is qualified and trained to detect the more subtle signs of potential sexual harassment – for example, the phy-sician who constantly hugs or touches, or stands excessively close to members of your staff.

Secondly, have a zero tolerance policy for any forms of sexual harassment, no matter how slight, and do not trivialize complaints of harassment. Complaints that go ignored or are dismissed without a full investigation typically translate into large jury awards or settlements.

Thirdly, strictly enforce your organization’s anti-retaliation policy so that members of your staff feel safe in reporting sexual harassment regardless of the identity of the accused.

And finally, confirm that you have sufficient insurance coverage against such lawsuits, including Employment Practices Liability Insurance (which covers harassment).

Andrew L. Zwerling is a Partner-Director at Garfunkel Wild P.C. and a member of the firm’s Litigation and Arbitration, Employment Law and Compliance and White Collar Defense practice groups, and Co-Chair of the firm’s Appellate Practice Group. His direct line is 516-393-2581.

The NYS WCB issued their notice and instructions for re-registration for the WC authorized physicians who bill WC. Any physician who has an individual WCB authoriza-tion number must register. PAs and NPs are not authorized to bill so the registration is for the physician(s). The updated list will ensure that an injured worker can easily identify Board authorized providers.

The goal of this process is to enable an injured worker to easily and accu-rately identify Board-authorized medical providers.

Registering. Authorized pro-viders are asked to register with the Board and update their office address (es) and contact information by January 15, 2018. This regis-tration process will be an ongoing initiative every two to three years.

Medical providers who have not registered by January 15, 2018 will:

• be removed from the public directory of Board autho-rized providers, and

• become ineligible for the

Board’s disputed bill process.creating an Account in

the new york State health commerce System (hcS)

The Board will use the existing New York State Health Commerce System (HCS) for this registration process. For the initial registra-tion and for future updates to your practice information, you will need to have an HCS account. If you don’t already have one, you can view directions to create an account on the New York State Department of Health website.

Need Help? If you are not sure if you already have an HCS account, contact the Commerce Account Management unit (CAMU) at (866) 529-1890 and select option 1. For general questions about health care provider registration, please contact the Board’s Customer Support at (844) 337-6305.

Worker Comp Questions? Email us or call Customer Service at (877) 632-4996

Workers Comp Registration Is Open; Physicians Must Register by Jan. 15, 2018(Continued from page 1)

Your “Harvey Weinstein”

Page 6 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 7

OverviewAccess to quality and timely physi-

cian care has become more difficult as the practice climate for physicians in New York State has deteriorated. Due to an untenable economic squeeze between rising practice costs and reductions in payments, more and more physicians are being forced to close their practices and join large health systems to be able continue to delivering patient care. According to a recent Avelere study, the number of physicians who have become hospital employees in New York nearly doubled from 2012-2015.

Patients benefit most when physi-cians have a real choice as to which practice setting is best suited to them, whether that is a small group, large group, or employed by a health sys-tem. However, too many physicians who have dedicated their professional lives to caring for their communi-ties are finding that they have no real choice. While in some cases admin-istrative burdens may be reduced, this trend can also result in reduced patient options, elimination of jobs for non-physician support staff, and reduced physicians’ ability to be patient advocates. Worse still, many expe-rienced physicians have indicated they may retire from practice early, further exacerbating barriers to care.Action need to improve ed care

Wait times for needed patient care, including in the emergency depart-ments (ED), will only get worse unless action is taken to improve New York’s practice climate. For example, a recent HANYS study indicated that, across upstate New York, 86% of hos-pitals EDs indicated there were times when a patient needed to be trans-ferred because a needed specialist was not available.

New York was recently ranked by Wallet Hub as the WORST state in the country to be a physician, due to its low payments for care combined with exorbitant costs. One of the reasons for this designation is the extraor-dinarily expensive cost for medical liability insurance in New York State.

rePorT: new york worST STATe For docTorSSource: whec news 10 Article, April 10, 2017

At the same time, health insurers continue to shrink their networks and cut payments for care delivered, reduc-ing the ability of physicians to pay these exorbitant premiums. Moreover, Medicaid, Medicare and other payors are demanding participation in various

value-based payment programs which require extensive infrastructure invest-ment such as upgraded EHR systems. Failure to meet these criteria could result in significant payment cuts.

Exacerbating these problems is the sig-nificant increase in patient cost sharing requirements including increasingly unaf-fordable deductibles. A MSSNY survey reported that nearly 21% of responding physicians indicated that 25-50% of their patients now face deductibles of $2,500-$5,000. And just when it couldn’t get any worse, the New York State Legislature

passed one-sided malpractice expansion legislation in 2017 that will drive up exor-bitant liability premiums by an additional 10%. Its little wonder that “physician burnout” is on the rise.

Physicians need legislation to preserve their ability to deliver care to patients, and they need rejection of legislation that would make existing problems even worse. The goal of MSSNY’s 2018 Legislative Program is to assure the enactment of policies that enable New Yorkers to continue to have meaningful access to New York’s world-class doctors and healthcare institutions.Physician Collective Negotiation and

Other Insurance ReformsMSSNY supports legislation (A.4472

and s.3663) that would permit inde-pendently practicing physicians to collectively negotiate patient care terms with market dominant health insurers.

Due to market concentration in most regions of the State, most physicians have no choice but to participate with market-dominant insurers. If they don’t, they risk losing the ability to treat many patients altogether. Exacerbating this dynamic is the fact that many physi-

cians have been dropped from networks of insur-ers, severing long-standing patient-physician treatment relationships. For instance, in the fall of 2015 and again in 2017, Emblem Health decided to pare hundreds of physicians from their network, with virtually no ability of these physicians to challenge these patient care disruptions.

A recent MSSNY survey reported that over 25% of the responding physicians were completely dropped from an insurer’s network in the past 2 years; and over 40% indicated that

they had not been asked to participate in a new product offered by that insurer over the same time. Of greatest con-cern, nearly 80% of physicians reported situations where their patients could not receive care promptly because the insurer lacked an adequate network.

And for those who remain in the net-work, physicians face steep payment cuts and untenable administrative burdens. For example, a recent study by Milliman noted that insurers’ use of burdensome prior authorization and step therapy

Best/Worst States to Be a Doctorstate rankIowa 1Minnesota 2Wisconsin 4Colorado 13Arizona 14Texas 16Florida 24Pennsylvania 31California 40Massachusetts 46New York 51

Have you had the experience where one of yourpatients could not quickly receive the care they needdue to the inadequacy of a health insurer’s network?

Yes 78.65%

21.35%No

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

(Continued on page 14)

MSSNY’s Legislative Program for 2018 Session

MSSNY Survey 2017

Page 6 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 7

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Page 8 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 9

In May of 2016, the Medical Society of the State of New York (MSSNY) cre-ated a Stress and Burnout Task Force. This Task Force was charged to formu-late a strategy and plan of action to fight burnout and reduce stress among the constituents of MSSNY. The follow-ing article is the fifth of a miniseries that addresses the following topics: the problem of burnout, current state of the State (burnout survey), solutions at the individual and organizational level, and opportunities for advocacy. inTrodUcTion

The present crisis of burnout faced by physicians – along with many individuals in all aspects of our society – negatively impacts work performance and general health. A 2014 survey found that health care professionals – and physicians in particular – are affected by a reported range of burnout of more than 50% in almost every medical specialty.1

In a recent survey of NYS physicians conducted by MSSNY, this same sta-tistic was confirmed among physicians at various points in their careers.2 The characteristics of burnout include emo-tional exhaustion, depersonalization with loss of empathy, and the feeling of lack of worth in one’s job performance. This creates an environment where public safety is affected, as burnout may lead to an increase in medical errors.3 To help reverse this trend and improve physician wellness, we need a better understand-ing of the issue. In addition, increased advocacy by - and for - physicians is necessary.

This article seeks to provide both insight into the problem of burnout and the motivation for individual physicians to become involved in helping to effect change.diScUSSion

Studies show that all physician prac-tice models are affected by burnout, and the loss of autonomy and control to other authorities has a very deleterious effect on physicians’ job satisfaction. These factors also dramatically increase the stress level in all aspects of the delivery of care. It is also recognized that 80% of the stressors are organizational/system-ically based, as opposed to individually generated.

We have been living in a medical culture where time and effort is spent creating steps to maintaining our ability to cope with the increasing burden of regulation and practice change, rather than finding ways to improve the system. We have allowed other organizations to decide

our career paths and take the joy out of medicine.

MSSNY and County Medical Societies have been actively involved with the state legislature, insurance carriers, reg-ulatory authorities and society to look for ways to decrease the mushrooming burdens of approval and documentation, most with no proven benefit. We need to strive to have the recognition of the “Quadruple Aim” where the care pro-vider takes equal recognition with cost, quality, and patient satisfaction in the goals of health care.

Accomplishing these goals will require all New York State physicians to become involved with MSSNY and other influen-tial organizations. A PerSonAl PerSPecTive

During my years in medical school and residency, my lack of knowledge and understanding brought about feelings of inadequacy. I had colleagues who were not able to admit weakness and did not know where to look for help and sup-port. I witnessed addictive behaviors in my peers and inappropriate treat-ment of them by superiors and did not know where to turn to get help or sup-port for those individuals. Tragically, one colleague in particular died by suicide several years later as a result of some of these circumstances.

As a result of these experiences, I made the decision to become actively involved in advocacy for physicians. I saw the need to help my peers find balance and wellness in their lives. All physicians should know they are given a very important privilege in the social contract they receive from society to care for their patients` health and well being. This requires a commitment by the profession of self regulating their performance and conduct and when we breach that oath, we have a duty to report the misconduct or behavior.

Although I provided extensive mentor-ing over the years, my formal advocacy began when I was asked to serve on the Board of Professional Medical Conduct. Six years ago, I took over Chairmanship of the Board. Although there are board members who keep their positions quiet, I have believed it is important to acknowledge my role. It is a way of showing New York State physicians that there are those who not only accept the position to protect the public, but are there to see they receive due process and care about their wellness. The goal is to keep physicians in active practice if their behavior and performance permit.

This work has offered me the oppor-tunity to meet with the MSSNY Board several times to address their concerns and work to improve the understand-ing and relationship between the two entities.

Commitment to this issue has brought new opportunities, including my increased responsibility at the Federation of State Medical Boards (FSMB). As chair, I selected burnout and wellness as my platform for the FSMB to engage and help state boards become involved in addressing their role and making an impact. It also afforded me the oppor-tunity to work with the leadership of the Federation of State Physician Health Programs to learn of their methods to encourage physician wellness. The addi-tional activity that has opened for me is the inclusion as the FSMB representa-tive to the National Academy of Medicine Action Collaborative for Physician Wellness and Resilience. This is a major national effort to address the crisis and find potential solutions.

Nationally, FSMB is involved with the ACGME, AMA, AAMC and their physi-cian wellness initiatives that support the state board’s involvement. Additionally, there is an FSMB workgroup meeting and pending report that addresses the states’ perspectives on burnout issues. There are 14 national organizations, each of whom gives guidance to state medical boards’ involvement in this workgroup that will produce additional suggestions for improving the working environment for physicians.

MSSNY is very active at the state level, following a successful survey of over 1,500 physicians in NYS that helped iden-tify the top 10 stressors to physicians. Through this work it was recognized that 80% of the stressors are systemic, which strengthens the importance of strong advocacy engagement and PAC support for all physicians. MSSNY is also developing a peer support program as a resource to physicians who could find relief in the support of colleagues with a shared experience. Finally, the Monroe County Medical Society, of which I am a member, has developed a compen-dium of resources to support physicians and is available on their website. This includes: free Android/iPhone appli-cations for guided meditation; books, videos, podcasts and articles related to stress/anxiety/burnout; a partnership with local wellness centers that offer drop in yoga and meditation programs

Burnout: Advocacy Efforts, Solutions and Opportunities

(Continued on page 12)

Page 8 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 9

MEdical diREctOR

BiNghaMtON UNivERSitY cOllEgE PhYSiciaN (Sl-6)

The Decker Student Health Services Center at Binghamton University (The State University of New York at Binghamton) invites New York State Medi-cal or Osteopathic Board Certified Physicians (Internal Medicine, Family

Practice) to apply for a full-time, twelve-month position. This position plans, directs, supervises, and participates in the outpatient medical care of un-

dergraduates and graduate students of a diverse student base. The person will have excellent, primary care diagnostic skills as well as experience and proficiency in common outpatient surgical procedures, EKG and pulmonary function study interpretation, office laboratory and clinical microscopy. This position functions as an on-site medical consultant and collaborative physi-cian to the professional staff that includes 10 nurses, 5 nurse practitioners and 7 physicians. The individual will have five years of clinical experience

after residency training and experience with staff oversight and leadership. The Medical Director provides the university campus with infectious dis-ease direction (e.g. meningitis, measles and tuberculosis) and emergency

management; participates on the Crisis Response Team; provides direction and consultation to the Dean of Students, University Counseling Center

and Residential Life. This person will be responsible for accreditation activi-ties including; completion of internal and external benchmark studies peer chart review; completion of assessment plans, survey and risk manage-ment reports; meeting with site visitors; and following through on recom-mendations. Requirements: Required qualifications: NYS Board Certified

Medical or Osteopathic Physicians (Internal Medicine, Family Practice) from an accredited institution; 5 years of clinical experience after residency; NYS

medical license and DEA certificate that are free from special conditions or limitations. Salary: commensurate with qualifications and experience. Preferred qualifications are, but not limited to: college health familiarity;

experience with diverse populations; electronic health record navigation; quality assurance, and continuous quality improvement; public health and

policy experience. Payroll information can be found on our website http://www.binghamton.edu/human-resources/payroll/

Cover letters may be addressed “To the Search Committee.” Postings active on the website accept applications until closure.

For information on the Dual Career Program, please visit: https://www.binghamton.edu/human-resources/dual-career-program/

Application Instructions:Deadline for Internal Applicants: 11/07/2017

Deadline for External Applicants: Open until filledReview of applications will begin immediately and continue

until the vacancy is filled. Persons interested in this position should apply online.

Please submit: 1. Resume 2.Cover letter, and 3.Contact information for three professional references

You may add additional files/documents after uploading your resume. After you fill out your contact information, you will be directed to the upload

page. Please login to check/edit your profile or to upload additional docu-ments: http://binghamton.interviewexchange.com/login.jsp

Payroll information can be found on our website http://www.binghamton.edu/human-resources/payroll/

Additional Information:Offers of employment may be contingent upon successful completion of a pre-employment background check and verification of degree(s) and

credentials.Binghamton University is a tobacco-free campus.

Pursuant to Executive Order 161, no State entity, as defined by the Execu-tive Order, is permitted to ask, or mandate, in any form, that an applicant

for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a condi-tional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at info@goer.ny.gov

Equal Opportunity/Affirmative Action Employer The State University of New York is an Equal Opportunity/Affirmative Action Employer. It is the policy of Binghamton University to provide for and pro-mote equal opportunity employment, compensation, and other terms and conditions of employment without discrimination on the basis of age, race, color, religion, disability, national origin, gender, sexual orientation, veteran or military service member status, marital status, domestic violence victim

status, genetic predisposition or carrier status, or arrest and/or criminal conviction record unless based upon a bona fide occupational qualification

or other exception.As required by title IX and its implementing regulations Binghamton Univer-sity does not discriminate on the basis of sex in the educational programs and activities which it operates. This requirement extends to employment and admission. Inquiries about sex discrimination may be directed to the

University Title IX Coordinator or directly to the Office of Civil Rights (OCR). Contact information for the Title IX Coordinator and OCR, as well as the

University’s complete Non-Discrimination Notice may be found here. The State University of New York is an Equal Opportunity/Affirmative Action

Employer. As required by title IX and its implementing regulations Binghamton University does not discriminate on the basis of sex in the educational programs and activities which it operates. This requirement

extends to employment and admission. Inquiries about sex discrimination may be directed to the University Title IX Coordinator or directly to the

Office of Civil Rights (OCR). Contact information for the Title IX Coordinator and OCR, as well as the University’s complete Non-Discrimination Notice

may be found here.

13TH ANNUAL POSTER SYMPOSIUM AT MSSNY HOUSE OF DELEGATES MARCH 23

Deadline for Abstract Submission: 4:00 pm, Friday, January 5, 2018

To: Residents, Fellows, Medical Students and New York State Program Directors

The Medical Society of the State of New York is very pleased to announce the 13th Resident/Fellow/Medical Student Poster Symposium.

When: Friday, March 23, 2018Where: Adam’s Mark Hotel Buffalo, New YorkTime: 2:00 pm – 4:30 pmClick here for detailed guidelines.We welcome the participation of your residents and fellows.

Participants must be MSSNY members, and membership is free for first-time resident members. Join online.

Share Your Personal Stories About Challenges You Face as a Medical StudentMSSNY wants legislators to hear directly from medical students

about the challenges they face as future physicians. Personal sto-ries are vital for enhancing our messages on issues of concern to the medical professionals, particularly to legislators who represent the area where those professionals practice.

We plan to gather personalized stories from physicians and med-ical students to print as flyers and articles that can be distributed to legislators and journalists. Opting in to share your stories is entirely voluntary. We value and respect your privacy, which is why your permission is needed for us to share these stories. Please click here to fill out the brief Medical Student Questionnaire.

Share Your Personal Stories About Challenges You Face as a Physician

MSSNY wants legislators to hear directly from New York Physicians about the challenges they face as medical practitio-ners. Personal stories are vital for enhancing our messages on issues of concern to the medical professionals, particularly to legislators who represent the area where those professionals practice.

We plan to gather personalized stories from physicians and medical students to print as flyers and articles that can be dis-tributed to legislators and journalists. Opting in to share your stories is entirely voluntary. We value and respect your pri-vacy, which is why your permission is needed for us to share these stories. Please click here to fill out the brief Physician Questionnaire.

New Medicare Card: Provider Ombudsman Announced

The Provider Ombudsman for the New Medicare Card serves as a CMS resource for the provider community. The Ombudsman will ensure that CMS hears and understands any implementation problems experienced by clinicians, hospitals, suppliers and other providers. Dr. Eugene Freund will be serving in this position. He will also communicate about the New Medicare Card to providers and collaborate with CMS components to develop solutions to any implementation problems that arise. To reach the Ombudsman, contact: NMCProviderQuestions@cms.hhs.gov.

The Medicare Beneficiary Ombudsman and CMS staff will address inquiries from Medicare beneficiaries and their represen-tatives through existing inquiry processes. Visit Medicare.gov for information on how the Medicare Beneficiary Ombudsman can help you.

Page 10 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 11

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† You will qualify for $100 bonus cash rewards if you use your new credit card account to make any combination of Purchase transactions totaling at least $500 (exclusive of any fees, returns and adjustments) that post to your account within 90 days of the account open date. Limit one (1) bonus cash rewards offer per new account. This one-time promotion is limited to new customers opening an account in response to this offer. Other advertised promotional bonus cash rewards offers can vary from this promotion and may not be substituted. Allow 8-12 weeks from qualifying for the bonus cash rewards to post to your rewards balance.

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How do you know if the signature on your health records is valid? Before working in medical coding, I had assumed that all signatures, even the most ill-defined, were valid. We all know too well the jokes about doctor’s handwriting. However, the Center’s for Medicare and Medicaid Services (CMS) has certain requirements for physician signatures to be valid.

Signatures can be either handwritten or electronic. Signature stamps are only permissible if the provider suffers from a physi-cal disability and can prove that they are incapable of signing a patient note due to disability.

Handwritten signatures must be legible. If the signature is not legible, it should be accompanied by the provider’s name either printed, typed, or on the letterhead. Providers may have a sig-nature log on file with their name typed and signed to show that the signature is their own or attest their signature if required for purposes of review.

Electronic signatures must protect against modification and have certain administrative safeguards. Once the note is signed with the electronic signature, the note should be locked and any

changes and updates would have to be made with addendums. If the system does not protect the notes against modifica-tion, then the signature is invalid. Electronic signatures can be digitized (the provider’s signature in an electronic image) or statements indicating the note was signed electronically. The signature usually has a date and time stamp. It is important to note that as per the guidance provided by Palmetto GBA, “Indication that a document has been ‘signed but not read’ is not acceptable…”

It is important to remember that signatures are required to authenticate treatment/surgical notes, procedures and orders for diagnostic testing and labs. The signature must be by the treating or ordering healthcare physician.SoUrceS• Medicare Program Integrity Manual, Chapter 3.3.2.4- Signature Requirements,

http://ow.ly/Tojl30fsL0A • Complying with Medicare Signature Requirements, http://ow.ly/lQdP30fsKPh • Medicare Medical Records: Signature Requirements, Acceptable and

Unacceptable Practices, http://ow.ly/W2dl30fwsSI

CMS Signature Requirements: Must Be Treating or Ordering ProviderBy Lorna Simons, CPC, Medco Consultants, Inc

Onondaga County Medical Society Installs New President

Dr. Brian Johnson, M.D., a Syracuse psychiatrist and addiction specialist, was installed as the 190th president at the Onondaga County Medical Society’s annual dinner meeting on Thursday, November 9 at the Holiday Inn in Liverpool, NY.

Dr. Johnson’s inaugural speech addressed the opioid and addiction crisis affecting our community, and called the physician community to action.The following Medical Society service awards were presented at the dinner meeting:

Distinguished Service Award: Jeffrey Kahn, M.D.

Physician Service to the Medical Society:

Mitchell R. Lebowitz, M.D.Physician Service to the

Medical Society: Adrienne D. Allen, M.D.

Physician Service to the Community:

Indu Gupta, M.D.Individual Service to Medical Care:

Ronald Fish, Ph.D.Individual Service to Medical Care:

Pamela J. Hunter, N.Y.S. Assemblymember

Community Organization Service to Medical Care:

Syracuse Behavioral HealthCommendable Service by a

Retired Physician: Brian Y. Changlai, M.D.

Jerry Hoffman Advocacy Award: Jeffrey S. Sneider, M.D.

Page 10 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 11

MEDICAL SOCIETY OF THE STATE OF NEW YORK2017 ALBION O. BERNSTEIN, MD AWARD

The Medical Society of the State of New York is accepting nominations for the 2017 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, 2017.”This 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 $2,000 award will be presented to the recipient during a MSSNY 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 Continuing Medical Education Miriam Hardin, PhD, Manager, Continuing Medical Education

Medical Society of the State of New York99 Washington Avenue, Suite 408

Albany, NY 12210518-465-8085

mhardin@mssny.org

DEADLINE FOR NOMINATIONS: May 31, 2018

Clinton County Medical Society Hosts Nursing Scholarship Fundraiser

On Friday, November 17, the Clinton County Medical Society (CCMS) hosted a fund-raising reception for the CCMS Nursing Scholarship program at Clinton Community College in Plattsburgh. The evening featured dining and dancing, with live music provided by the PHS Jazz combo.

The nursing scholarship was the inspiration of Dr. Soham Patel and Dr. George Boolukos. Impressed by the caliber of nurses graduating from the nursing program at the col-lege, Dr. Patel and Dr. Boolukos

approached the Clinton Community College Foundation in 2007 with the idea of establishing a scholarship to help train and retain highly skilled nurses in Clinton County. The two organizations collaborated on several successful fundrais-ing events and created The Clinton County Medical Society Nursing Scholarship, a full-tuition scholarship that includes text books and program related supplies.

This important partnership between the Clinton County Medical Society and the Clinton Community College Foundation remains strong and the students and community continue to benefit from this important scholarship fund. To date, a total of nine students have benefited from this scholarship program.

Dr. Joseph Arguelles, President of the Clinton County Medical Society

(left) and Dr. Diego Grinberg-Funes

Page 12 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 13

Burnout: Advocacy Efforts

as well as access to acupuncturists, nutritionists and natu-ral food selections; and private practice therapists who have marked experience in working with physicians and who will prioritize scheduling for physicians who reach out in need.

Now is the time to engage. Now is the time to support the work of the State and County medical societies and join other physicians to amplify our voices. The more voices at the table, the louder we are, and easier we are to hear. MSSNY has estab-lished a Physician Advocacy Network but it only operates with our support. We as physicians must own the following items:1. Encourage colleagues to join (and perhaps re-join) MSSNY.

Membership is everyone’s job. If you aren’t sure what to say, call Eunice Skelly: (516) 488-6100 ext. 389 or your County Medical Society Executive Director.

2. Keep an eye out for Advocacy Alerts from MSSNY and/or your County Medical Society and communicate with your legislator’s office. MSSNY’s Grassroots Action Center is easy to use and in less than 3 minutes you can send well written letters to your legislators. Phone calls are just as simple – and if you prefer to leave a voicemail, call in the evening and leave a message. They keep track of the calls and let-ters they receive, and it really does make a difference.

3. Meet with your legislators, share your concerns and educate them on what is important to physicians and our patients. If you aren’t sure where to start, call Moe Auster at (518) 465-8085 ext. 319 and ask how you can get started. Depending on your County, the Executive Director may join you in those meetings. Remember that even if you meet with staff of the legislator these meetings are reported back to them. Every contact with your legislator’s office makes a difference. We want to encourage physicians to understand the oppor-

tunities that exist to help fulfill not only their own goals-- but also to assist in maintaining the health and wellness of the profession. In so doing, we are protecting the public by provid-ing quality health care for all of society.

MSSNY and the County Medical Societies all have multiple ongoing initiatives to address all of the points made in this arti-cle. We require your backing and active involvement to make the necessary changes – and to bring the joy back to medicine!

Consider identifying ways that you can personally monitor your own wellbeing leveraging measurements discussed in the previous article. We encourage you to reach out to your county or state medical society to get involved, and further encourage you to share this article with just one of your colleagues who is not a MSSNY member. You are the best communicator of the value of our work.

Arthur S. Hengerer, MD, FACS Immediate Past Chair, Office of Professional Medical Conduct, NYChair of Federation of State Medical Boards 2016-2017Chair of NYS Board of Professional Medical ConductChristopher Bell, MS, MBAExecutive DirectorMonroe County Medical Society, NY

(Continued from page 8)

1 Shanafelt TD, et al. “Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014.” Mayo Clinic Proceedings. 90(12): 1600 – 1613.

2 Atallah F, Privitera MR. Physician Burnout - The State of the State. MSSNY Talk Force on Physician Stress and Burnout Survey Findings. Medical Society of the State of New York’s News of New York. Vol 73 (8): 6-8.

3 Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele Det al. Burnout and medical errors among American surgeons. Ann Surg. 2010 Jun;251(6):995-1000.

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Mobile Medication Management: Holding Your Practice’s Future in

Your Fingertips – LiterallyThink about the last time you logged into your computer

just to check the weather or determine what movie you want to see. For most of us, mobile devices have replaced PCs as our go-to devices for information. Smartphones and tablets are incredibly powerful, in many cases even more power-ful than our old PCs. They are also portable and convenient, which means the information we want is always at our finger-tips, no matter where we are.

The exception, of course, is in most healthcare offices, where PCs still rule the day. However, that is changing. Clinicians now look to obtain a quick, consolidated views of critical information while also ensuring the technology enhances the provider-patient relationship rather than getting in its way.

Nowhere is this more evident than with mobile medication management. Rather than going to a PC to work through tedious steps to log in to multiple systems, mobile medi-cation management makes the full suite of solutions for e-prescribing legend drugs and controlled substances, medi-cation history, drug price transparency, financial assistance, medication adherence monitoring available with a few finger swipes or pokes. The result is fast access to needed infor-mation while delivering a single, streamlined workflow for physicians conducting patient rounds or those on-call after hours and on weekends.

Mobile technologies have changed the way we work and play significantly over the last few years. Now it’s time to put them to better use in healthcare. To learn more about mobile medication management for your practice, visit drfir.st/grab-control-mssny.

Page 12 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 13

As a result of debates at the federal level whether to keep, discard, or revise the Affordable Care Act, the subject of health care was in the news perhaps more than ever in 2017.

Those discussions will continue into next year. As will the potential impact to New York State. With Congressional action and/or inaction likely to exacerbate an already $4.6 Billion Budget hole that New York State is facing, cuts to the health care system will likely be on the table. Once again, we will have to face numerous proposals to impose new mandates on physician practice, expansions for scope of practice for many non-physicians. These threats just add to our already enormous liability burden.

When the medical community takes the time to participate in the policy making process by meeting or calling their leg-islators – or taking the time to write a letter to the editor – legislators and the public really do care what we say.

But we must make the time to make these contacts. And be sure our colleagues do the same.

MSSNY and MSSNYPAC have all kinds of tools to better assure physician involvement.

We have created template grassroots letters where you can easily send a letter on key issues to your local legislators.

We have Twitter and Facebook pages that send updates on key issues several times per day. If you do not already follow us through these social media outlets, please do.

And please make it a point to be in Albany on Wednesday March 7, 2018, for MSSNY’s Annual Physician Advocacy Day. It is essential for legislators to see hundreds of white coats walking the State Capitol to know that what they do in Albany will impact our patients, and their constituents back home.

To register, click here. new AdvocAcy ProgrAM

And, new for 2018, we have created the Physician Advocacy Liaison (PAL) program for a more organized grassroots phy-sician presence. Physicians will be “assigned” to specific legislators, and plan to communicate with them throughout the year.

Many physicians have joined, but we need more. To join our efforts, please e-mail jbelmont@mssny.org

Last but not least, please support MSSNYPAC. 2018 is a year when the Governor, Attorney General, Comptroller and all 213 state legislative seats are up for grabs, and the physi-cian community will be besieged by requests from candidate committees for support. It is a tremendously important opportunity to help elect candidates who will understand the concerns of both the physician community and our patients.

To join or to increase your contribution, click here. For 2018, please resolve to make advocacy a habit. And

please resolve to make sure your colleagues are joining you in this effort.

The future you save may be your own.

MSSny-PAc(Continued from page 4)

• Albany Times Union – 10/17/17 “Date of discovery” bill could harm medicine in N.Y(Op-Ed by MSSNY member Dr. Robert J. Rapoport)

• Lohud.com – 10/21/17 Attack the opioid crisis from all angles (MSSNY mentioned)

• NY Daily News – 10/23/17 Patients rights groups push Cuomo to back Lavern’s Law (MSSNY President Dr. Charles Rothberg, MD quoted)

• NY Law Journal – 10/23/17 The Missing Link in Lavern’s Law (MSSNY President Dr. Charles Rothberg, MD quoted)

• Politico New York Healthcare – 10/24/17 Cuomo extends Clean Indoor Air Act (MSSNY President Dr. Charles Rothberg, MD quoted)

• Behavioral Health News – Fall 2017 The NYSPA Report: Medication Assisted Treatment (MAT) for Opioid Use Disorder - Effective but Still Underutilized (MSSNY Secretary Dr. Frank Dowling, MD quoted)

• Crain’s Health Pulse – 10/30/17 MSSNY president denounces potential CVS/Aetna merger (MSSNY President Dr. Charles Rothberg, MD quoted)

• RomeSentinel.com (AP) - 10/30/17 Siddiqi joins Family Medicine Residency fac-ulty (MSSNY member Donish Siddiqi, MD mentioned)

• Oswego County News Now - 1/6/18 Hats off to Dr. Corey Varnum (MSSNY delegate Dr. Corey Varnum mentioned)

• Long Island Weekly – 11/7/17 Draw The Line

At Ingesting Toxins (MSSNY mentioned)• Crain’s Health Pulse – 11/16/17 New York

medical society to implement national diabetes prevention program (MSSNY President Dr. Charles Rothberg, MD & VP and Education director for Public Health, Pat Clancy quoted)

• Rochester Democrat & Chronicle – 11/21/17 Doctors deserve the right to collectively negotiate (Op-Ed by Monroe County Medical Society President, Dr. Peter Ronchetti)

• Politico Pro - 11/27/2017 Nurse practitio-ners await Cuomo’s action on two bills, hope for new tax credit in budget (MSSNY President Dr. Charles Rothberg, MD quoted)

• Utica Observer-Dispatch – 11/28/17 Sharing Electronic Health Records Growing (MSSNY President Dr. Charles Rothberg, MD quoted)

• Albany Times Union – 12/01/17 NYC Plastic Surgeon, Dr. Douglas Senderoff to Speak at “The Aston Baker Cutting Edge Aesthetic Surgery Symposium 2017 (MSSNY mem-ber Dr. Douglas Senderoff metioned)

• Newsday – 12/02/17 Tiny eye implant with titanic impact helps glaucoma patients (MSSNY President Dr. Charles Rothberg, MD quoted)

• Albany Times Union – 12/04/17 Medical soci-ety worries about CVS Aetna deal (MSSNY President Dr. Charles Rothberg, MD quoted)

• CBS New York – 12/04/17 CVS-Aetna Deal: What It Could Mean For Consumers Nationwide (MSSNY President Dr. Charles Rothberg, MD quoted)

MSSny in The newSGARSON, Samuel; Boca Raton FL. Died July 28, 2017, age 104. Onondaga County Medical Society KANICK, Virginia; New York NY. Died November 15, 2017, age 91. New York County Medical SocietyO’BRIEN, Joseph L.; Wil-liamsburg VA. Died Septem-ber 17, 2017, age 90. New York County Medical Society

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Page 14 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 15

requirements for prescription medica-tion nearly doubled between 2010 and 2015. And a recent Annals of Internal Medicine study reported that physicians spend two hours on administrative work for every hour with a patient.

Patient care time is being taken away as a result of cumbersome requirements to use electronic medical records, and burdensome insurer pre-authorization requests. Physicians must be given a realistic opportunity to negotiate these patient care delivery terms with insurers on a level footing.other needed insurance reforms

In addition to the collective negotiation legislation, MSSNY also supports legisla-tion that would:

• Protect against unfair insurer nar-rowing of networks by providing due process protections for phy-sicians whose contracts are not renewed by insurance companies (S.3943/A.2704);

• Requiring health insurance com-panies to make out-of-network coverage options available for patients who want to purchase such coverage (S.5675/A.7671);

• Prohibit health insurers and hospitals from requiring board certification as a condition of network participa-tion and medical staff membership (A.4914);

• Require payment parity between services provided via telemedicine (S.834/A.1421); and

• Enact numerous reforms to reduce insurer-imposed hassles experi-enced by physicians as articulated in the American Medical Association’s Prior Authorization principles.

Each of these concerns could also be resolved if New York were to enact a physician collective negotiation bill.

Medical Liability ReformMSSNY continues to support legislation

to enact needed reforms to New York’s grossly dysfunctional medical liability adjudication system. As noted above, New York was recently named the worst state in the country to be a physician, in large part due to our overwhelming lia-bility costs. Moreover, New York already has by far and away the highest liability costs in the country, nearly double the total payouts of the second highest state Pennsylvania and far exceeding states such as California, Florida and Texas—not only cumulatively, but also on a per-person basis!

Remarkably, the total payouts from New York were greater than the entire 12-state mid-western region! In some cases, physicians (obstetricians and neurosurgeons on Long Island) pay more than $200,000 per year for their premiums. MSSNY supports a number of legislative initiatives, including many that have proven successful in reducing costs in many other states. These legislative proposals include:

• Placing reasonable limits on non-economic damages (such as A.4913 and S.6781);

• Assuring qualified expert witnesses in trials and for signing Certificates of Merit (A.4913);

• Promoting statements of apology from a physician to a patient by pro-tecting them from admission at a medical liability trial (A.2372);

• Alternative systems for resolving lia-bility claims including medical courts or a Neurologically Impaired Infants Fund; and

• Continued funding for the Excess Medical Malpractice Insurance Program.

At the same time, it is imperative leg-islators reject “stand-alone” measures to expand medical liability that would most certainly exacerbate these problems, such as legislation that would:

• Eliminate statutory limitations on

attorney contingency fees (such as A.8466/S.6738) – Estimated 10% premium increase.

• Expand “wrongful death” dam-ages to permit “pain and suffering” (A.1386/S.411) – Estimated 53% premium increase.

• Permit the awarding of pre-judgment interest – Estimated 27% premium increase.• Prohibit ex-parte interview by

defense counsel of the plaintiff’s treating physician (A.1404/S.243).

• Change loss share rules regard-ing non-settling defendants (A.1500/S.412)

Perserving Access to Care for Injured Workers

MSSNY continues to work proactively with groups representing injured workers to reduce the hassles they face in receiv-ing need care and treatment. Legislation enacted in 2017 requires stronger cri-teria for those to serve as Independent Medical Examiners and efforts to hasten the resolution of Workers Compensation claims. MSSNY also continues to work closely with the WC Board on efforts to minimize the administrative has-sles associated with implementing a drug formulary and implementing new impairment guidelines. However, MSSNY continues to strongly oppose over-reaching efforts that would marginalize physician participation in the WC sys-tem, such as legislation (A.8319 and S.5344) that would make it harder for injured workers to receive needed care from their treating physicians by:

• Inappropriately expanding PPOs and Limited choice of physician in Workers Compensation;

• Inappropriately expanding the role of physician extenders under the WC program without sufficient physician oversight, and

• Inappropriately eliminating the

(Continued from page 6)

$299,161,500

$315,578,800

$274,866,750

$700,817,750 $222,949,600

$90,582,500

$235,180,950

NJ (pop. 9 M)

PA (pop. 12.8 M)

IL (pop. 12.9 M)

NY (pop. 19.8 M)

FL (pop. 20.3 M)

TX (pop. 27.5M)

CA (pop. 39.1 M)

2016 Total Malpractice Payouts Source: Deiderich Healthcare

MEDICALLIABILITY AWARD

CURRENTALLOWABLEATTORNEYFEE

ATTORNEYFEE IFSTATUTORYLIMITSREPEALED

POTENTIALATTORNEY FEE %INCREASE

$500,000 $137,500 $166,666 21%

$1,000,000 $237,500 $333,333 40%

$5,000,000 $650,000 $1,666,666 156%

$10,000,000 $1,150,000 $3,333,333 190%

Figure: Attorney Contingency Fees If StatutoryLimit Were To Be Repealed

(Continued on page 15)

MSSNY’s Legislative Program for 2018 Session

Page 14 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 15

role of county medical societies in reviewing applications to become authorized WC providers.

Instead, efforts should be undertaken to reduce administrative hassles that discourage physicians’ participation in the WC program.

Improving Care QualityMSSNY physicians are involved in

numerous efforts to improve care quality across our state. These include leadership roles within the various regional DSRIP Performing Provider Systems as well as extensive participation in New York’s numerous value-based payment work-groups. As these efforts are undertaken with the best intentions of improving care quality, however, it is important that such programs not overreach and create unreachable tasks or goals that interfere with the timely delivery of care.improving electronic health record Functionality

Electronic health records systems were intended to improve care qual-ity and enhance care management. At the same time, many physicians believe that the cumbersome nature of these systems is actually disruptive rather than helpful to patient care delivery. For example, a recent Annals of Family Medicine study reported that, during a typical 11.4-hour workday, primary care physicians spent nearly six hours on data entry and other tasks with EHR systems, instead of time spent with patients. Moreover, a recent AMA study reported that, compared to five years ago, more physicians are “dissatisfied” or “very dissatisfied” with their EHR system. Furthermore, these systems are extraordinarily expensive. An AHRQ study reported that the real-life cost of implementing an EHR system within a five-physician practice exceeded $160,000. And physicians face payment penalties from Medicare even if they routinely use EHR in their practices. Therefore, it is not surprising that, to date, only 57% of New York physicians have been able to connect to the State Health Information Network (SHIN-NY).

While much of the policies regarding the interoperability and usability of EHR system are driven by federal law and regulations, it is imperative that New York not make these problems worse. Until these problems are adequately resolved, MSSNY will continue to oppose requirements to connect to the SHIN-NY, including legislation that would require urgent care or office-based surgery cen-

ters to adopt EHR and connect to the SHIN-NY (S.2248/A.8077)e-prescribing

As of March 27, 2016, the ISTOP law required electronic transmission of all prescriptions. The law provided limited exceptions to this mandate and allows for the issuance of a one-year renewable waiver to physicians who can demon-strate economic hardship, technological limitations that are not reasonably within the control of the physician, or other exceptional circumstance. MSSNY will advocate revising New York’s Prescription Monitoring Program (PMP) so that it can be checked directly from their EHR or e-prescribing systems. Currently, the systems do not interface with one another, which adds more unnecessary administrative burden to the delivery of care. While New York has for many years led the nation in PMP checks, in 2016 it was surpassed by Ohio in large part due to the seamless connection between Ohio’s PMP and the EMR systems of Ohio physicians and prescribers. MSSNY will work towards a similar interoperable system in New York.Assuring Participation in Peer review

Current law impedes peer review qual-ity improvement efforts by permitting attorneys access to statements made at a peer-review meeting by a physi-cian who subsequently becomes a party to a malpractice action. To enhance the free discussion of quality improvement, MSSNY supports legislation to extend existing confidentiality protections to all statements at peer-review quality assurance committees within hospitals, in office-based settings and across inte-grated care settings (A.2460/S.3661).Truth in Advertising

Public advertisements for health-care services will sometimes contain misleading terminology regarding the specific qualifications of those who claim to be “doctors” and “board certified”. Therefore, MSSNY supports legislation that would ensure appropriate identi-fication for all health care professionals in their interactions with patients, and to require that advertisements for ser-vices identify the license type of the health care provider, and place appro-priate qualifications around the use of the term “board certified” (such as S.5870/A.560)Protecting Physician Peer Support efforts

MSSNY supports legislation to extend

the existence of MSSNY’s Committee for Physicians Health (CPH), and to clarify the scope of its existing statutory liability protections (S.2245/A.2703). The CPH program was developed over 30 years ago to provide needed peer counseling services to physicians thought to be suffering from alcoholism, drug abuse or mental illness. Hundreds of physicians are served by this pro-gram each year, which helps to return these physicians to care delivery once healthy. However, the very existence of this extraordinarily beneficial program is threatened by a recent judicial inter-pretation that limits the scope of CPH’s immunity. Moreover, with increasing reports of physician “burnout”, MSSNY also supports legislation to provide lia-bility protection for organizations that facilitate physician peer support, similar to protections already provided to bar association peer support activities.eliminating health care disparities

Many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. MSSNY Committee to Eliminate Healthcare Disparities seeks to increase awareness of how factors such as race, ethnicity, cul-ture and religious beliefs, sexual orientation; gender and gender iden-tity contribute to both health and healthcare disparities and to ensure that all New Yorkers receive the best pos-sible care. Committee goals include:

• Working to prevent and man-age diseases that are prevalent in underrepresented groups, including diabetes, hypertension, and cancer, through educational programming for physicians; and

• Working to promote and expand pro-grams that attract a more diversified physician workforce, increasing the numbers of minority faculty teach-ing in medical schools, expanding medical school pipeline programs in rural and urban areas to address the shortage of physicians in medically underserved areas of New York State.

Preserving Physician-Led Team Based Care

There are many different types of health care providers who each provide essential care for our patients. However, patients benefit most from the combined care of a team, headed by a physician whose education and training enables them to oversee the actions of the rest of

(Continued from page 14)

(Continued on page 16)

MSSNY’s Legislative Program for 2018 Session

Page 16 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 17

the team, to provide the patient with opti-mal medical treatment. MSSNY continues to support legislation that would enable otolaryngologists to dispense hear-ing aids at fair market value (A.195). However, MSSNY opposes any expansion of the scope of practice of non-physician health care providers that will enable them to practice beyond their education and training. These bills include:

• Opposing legislation to Inap-propriately expand the ability of podiatrists to treat up to a patient’s knee (A.1881/S.4734)

• Opposing legislation to provide “title protection” for nurse-anesthetists, which could pave the way for inde-pendent practice (A.442/S.1385)

• Opposing legislation to per-mit optometrists to use and prescribe a wide variety of oral drugs (A.6751/S.5235)

• Opposing legislation to grant pre-scribing privileges to psychologists (A.2851/S.4498)

• Opposing legislation expand the scope of den-tists beyond restoring and maintaining dental health (A.4543/S.3551)

• Opposing legislation to permit corporately owned retail clinics (A.958)

Promoting and Preserving Public Health

Addressing the opioid Abuse crisis

New York’s physicians have worked assiduously to respond to the opioid and heroin abuse epidemic that has ravaged this state and country. As a member of the American Medical Association’s Opioid Task Force, MSSNY has worked to increase physician awareness and leadership to promote and amplify best practices to respond to this crisis. To that end, MSSNY has educated over 11,000 prescribers since January 2017 regarding best prac-tices for assuring responsible patient pain management. Moreover, in 2016, physi-cians and other prescribers made over 18 million checks of New York’s PMP – a 9% increase from 2015. As a result, the pre-scribing of opioids in New York State has decreased 13%. Physician efforts have also led to a 90% decrease in so-called “doctor shopping” of patients inappropri-ately seeking opioid medications. MSSNY has also worked with the AMA to address concerns with policies imposed on hospi-tals that may contribute to this problem

Equally important is assuring proper treatment for those facing addiction. There has been an increase in the use of Medication Assisted Treatment (MAT) and naloxone by physicians and other pre-scribers in New York. Moreover, MSSNY supports legislative efforts to enhance insurance coverage for treatment beds; strongly encourages all physicians and hospitals to advocate to patients vari-ous substance abuse treatment options available to them in treating addiction, including buprenorphine; encourages physicians and other medical staff to become voluntarily certified to prescribe buprenorphine and encourages collabora-tion with multi-stakeholders for integrated MAT for the management of addictions. However, MSSNY remains concerned about legislative efforts to place arbitrary limits on prescribing of controlled sub-stances or limitations on medical decision making by minors (such as S.5949 and S.5670). MSSNY also supports changes in state and federal law that allow for the safe disposal of medication and supports

the concept of pharmaceutical companies paying for these disposal costs.Addressing Tick Borne illnesses

Each year, more than 30,000 cases of Lyme disease are reported nationwide, and studies suggest the actual number of people diagnosed with Lyme disease could actually be about 300,000. Despite these numbers, a recent national sur-vey reported that nearly 20% of people surveyed in areas where Lyme disease is common were unaware that it was a risk. MSSNY will continue to educate its physicians on tick-borne illnesses and will work with the NYS DOH on creat-ing awareness for both patients and physicians. As a member of the DOH Antimicrobial Resistance Prevention and Control Task Force, MSSNY continues to be concerned, however, about inappropri-

ate antibiotic prescribing which leads to drug resistance. Furthermore, MSSNY is gravely concerned about the appearance of Candida auris, emerging multidrug-resistant yeast in New York State causing invasive healthcare-associated infections with high mortality.disease Prevention

Prevention of diseases continues to remain a top MSSNY priority and the best way to prevent these diseases is through immunizations. MSSNY sup-ports legislation or regulation that would remove religious exemptions for immu-nizations and would also oppose any additional exemptions for immunizations (A.8123A/S.6141A). MSSNY supports efforts to require pharmacies to inform adult patients that they have the option of having the immunization recorded into the registry. MSSNY also continues to strongly support legislation (A. 273/S. 3945) to prohibit the sale of tobacco, e-cigarettes and nicotine dispensing devices and products to anyone less than 21 years of age.

women’s healthPreserving the ability for

women to have access to repro-ductive and sexual health care services is a key public health component. MSSNY supports efforts to expand access to emer-gency contraception, including making emergency contracep-tion pill more readily available and will continue to support sex-ual health education programs amongst adolescents. MSSNY will oppose any legislation that criminalizes the exercise of clini-cal judgment in the delivery of medical care.

other important Public health issues• MSSNY supports legislation to pro-

hibit the sale or distribution of Kratom in New York State. (A.231)

• MSSNY supports efforts to prohibit the use of so-called “conversion therapy“ (A. 3977/S.263).

• MSSNY supports background checks for firearm purchases, advocates for firearm safety education in all settings and will also advocate for expansion and implementation of technologies to improve gun safety.

• MSSNY will conduct a survey of its membership to ascertain its attitudes toward the issue of death and dying.

• MSSNY supports insurance coverage for PSA testing

02,000,000

4,000,0006,000,0008,000,000

10,000,00012,000,00014,000,00016,000,00018,000,00020,000,000

9,581,280

974,815

8,454,622

2,768,130

18,365,222

2,486,000 1,086,373

Prescription Drug Monitoring Program Queries 2016by Prescribers

MSSNY’s Legislative Program for 2018 Session(Continued from page 15)

Page 16 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 17

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The Medical Society of the State of New York’s Annual H ouse of Delegates Meeting & Vendor Expo isthe society’s only annual event for hundreds of physician leaders - including medical students, residentsand young physicians. These physician leaders - from Montauk to Buffalo - come together to deliberatelegislative policy, to attend educational seminars, to network with colleagues, and to visit the Vendor Expo.The Expo features carefully vetted vendors that showcase their companies and services, which enhancephysicians’lives as well as their practices.

MSSNY H ouse of Delegate attendees are decision makers. They represent the full spectrum of New York State medicalprofessionals, including all specialties and sub-specialties. These attendees represent the specific interests of group medicalstaffs, small practices, IPAs and single practitioners. County medical societies and specialty societies also participate in thedeliberations, and send members of their executive staffs to seek out and recommend new and improved benefits for theirmembers.

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Page 18 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 19

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spend more on prescription drugs than people in any other country: some $45 billion in out-of-pocket dollars in the last year alone. With that in mind, the New York Rx Card is reminding physicians that their patients who aren’t insured or who take prescription drugs that aren’t covered by their health insurance plans, can use the New York Rx Card to obtain discounts of up to 75 percent off the retail price for FDA-approved medications.

New York Rx Card has been working closely with Medical Society of the State of New York, as well as numerous clinics and hospitals around the state to distribute free discount prescription cards so that all New York residents will have access to this free program. New York Rx Card was launched to help the uninsured and underinsured residents afford their prescription medications. The program can also be used by people that have health insurance coverage with no prescription benefits, which is common in many health savings accounts (HSA) and high deductible health plans.

Another unique component of the program is their preferred pharmacy option. New York Rx Card has chosen CVS as their preferred pharmacy so that residents who don’t have access to a computer and can’t obtain a hard card, can visit any CVS to have their prescriptions processed through New York Rx Card. Residents can simply reference “New York Rx Card” to have their prescription processed through the program. New York Rx Card is accepted at over 68,000 participating regional and national pharmacies.

New York Rx Card has helped residents save over $143 million since its inception in 2010. You can help by encouraging your patients to print a free New York Rx Card at www.newyorkrxcard.com. New York Rx Card is also available as an app for iPhone and Android. You can search “Free Rx iCard” in the app store. Any physicians who are interested in ordering free cards for their clinic/hospital can email Chez Ciccone, New York Rx Card Program Director at fciccone@nyrxcard.com.

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Page 18 • MSSNY’s News of New York • January 2018 January 2018 • MSSNY’s News of New York • Page 19

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dent, I identified three pillars for physician leaders to focus upon. I am proud to report on the progress we’ve made thus far:

Wellness: Our Burnout Task Force has completed its eighteenth month of work. They have produced educational pro-grams, are preparing scientific papers and will be seeking funding and legislative relief to implement a Physician Peer program, modeled after the ones for uniformed officers and lawyers. At MSSNY we rec-ognize that physician stress and ‘burnout’ is related to institutional stressors. Thus successful programs must be physician (and not institution) centered. But make no mistake – while it’s vitally important to assist physicians that have experi-

enced these stressors, the most effective assistance will be include prevention – advocacy for administrative simplification, reduced requirements such as reporting, preservation of physician autonomy and preservation of a meaningful physician-patient relationship.

Engagement: The MSSNY Council and Board have approved an exciting new group membership that will begin imple-mentation during the first quarter of 2018. Negotiations with other groups, large and small, are currently underway. We are engaging physicians where they work and how they work. When I meet these prospective new members I’m constantly impressed by the excellence and ingenu-ity they bring to their clinical solutions.

It makes me especially proud to be a physician.

Disparities: apart from the work of our newly revitalized disparities committee, the AMA has reconstituted its disparity work through creation of a task force. As this was a MSSNY initiative, two New York physicians serve on this AMA task force.

Finally, my wish list for 2018:comprehensive liability reform

I hope the governor does not enact the date of discovery bill (Lavern’s Law) and instead convenes a blue-ribbon panel to devise comprehensive solutions – ones that provide fair compensation to victims but at a more reasonable cost than the current patchwork solutions that costs more than any other in the nation.Administrative Simplification/ collective negotiation

Because of market dominance by the payers, physicians increasingly need to level the playing field when negotiating contract provisions including network ade-quacy, due process for physicians whose contracts are non-renewed and reducing pre-authorization burdens and drug for-mulary issues.

Physicians also need relief from regu-latory burdens such as MIPS/MACRA, recertification by high stakes exams and the Rube Goldberg inspired but ever changing ICD-10.continuation of the excess insurance Program

This program is always important but particularly so in light of uncertainty relating to the Governor’s disposition of Lavern’s law.

Creating interoperability between I-STOP database and EMRs. Wouldn’t it be grand to streamline physician work-flow when the prescription of a controlled substance is under consideration? Perhaps compliance with the lookup requirement would improve.

My predictions for 2018 center on con-tinued financial challenges for all health care stakeholders. As a result of these challenges, non-physician stakeholders will increasingly attempt to consolidate in order to secure their positions in this mar-ketplace. Physician practices (and thus their ptients) may become collateral dam-age as a result – no matter whether they are vertical or horizontal mergers. I hope that the regulators will view vertical merg-ers as critically as they do horizontal ones. The impact on health care consumers can be as adverse.

PreSidenT’S colUMn(Continued from page 4)

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