MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF NEW YORK Providing Information to Assist Physicians in the State of New York

Volume 72 • Number 3 www.mssny.org March 2016

Why You Need to Take A Day Away From Your Practice to Lobby Albany on March 8, 2016

• Think you pay too much in malpractice insurance • The Proposed NYS Budget does nothing to com- costs? The Trial Bar doesn’t care. They have intro- pensate physicians for the unpaid care they have duced legislation that will certainly increase your provided to Health Republic insureds. premium costs. • New York State wants to enable Walmart and • If you practice in the Capital District, Southern Target to hire NPs to deliver care to the public to Tier, Central NY, or Western NY, New York State compete directly against you. wants to take away your Excess Liability Insurance • Countless non-physicians want to threaten patient Coverage. health by inappropriately expanding the scope of • New York State wants to enable NPs to deliver care they can provide, including dentists, optom- care to injured workers and take away County etrists and psychologists Medical Society review of authorized physicians • We need to prevent insurers from offering patients rather than fixing the broken Workers Compensa- narrow networks for Exchange plans and denying tion system. patient access to out of network physicians. PLEASE JOIN YOUR COLLEAGUES FROM ACROSS THE STATE TO LOBBY YOUR ELECTED LEADERS IN PERSON IN ALBANY, MARCH 8. Click here to register Medical Society of the State of New York Division of Governmental Affairs Physician Impact Day in Albany, Tuesday, March 8, 2016

Click icons REMINDER: All Prescriptions Must to follow MSSNY Be Sent Electronically Beginning March 27th on Facebook Tell your patients NOW that you will NOT be issuing papers scripts as of March 27. With the or Twitter. e-prescribing mandate quickly approaching, we at MSSNY are concerned about the lack of preparedness expressed by New York doctors. Our recent survey showed that more than 40% of responding physicians are not yet prepared to meet the e-prescribing mandate. We DO NOT expect an extension of the deadline, and urge you to ACT NOW to ensure you are compliant with the law. 17th Annual Bi-District Meeting in Lake Placid MSSNY held its 17th Annual Bi-District they can advocate together in those Meeting on Saturday January 23 at areas where they have common the Mirror Lake in Lake Placid, NY. ground. State Senator Little and Physicians from Districts III and IV Congresswoman Stefanik felt that (which encompasses most of the east- listening to and participating in the ern third of New York State) along with discussion was valuable as they the Society’s leadership, gathered to work to understand and represent discuss the issues currently facing the the needs of their districts. medical profession. The meeting was chaired by State Senator Betty Little and William R. Latreille, Jr., MD, FACP, Congresswoman Elise Stefanik MSSNY Chairman of the Board William Latreille, MD Chairman of the Board of Trustees participated in the meeting’s fea- and MSSNY President Joseph R. Maldonado, MD of MSSNY. Other meeting attend- tured discussion on Opportunities with Congresswoman Elise Stefanik (l) and Senator ees included Joseph R. Maldonado, Betty Little. for Collaboration with the Hospital Jr. MD, President of MSSNY, Association of New York State (HANYS) Philip Schuh, CPA, Executive Vice and other Healthcare Providers. As physicians increasingly President of MSSNY, William Streck, MD, Chief Medical and become employed by hospitals, the two organizations dis- Health Systems Innovation Officer at HANYS, and other area cussed areas in which their interests align, and ways that physicians.

REMINDER: All Prescriptions Must Be Sent Electronically Beginning March 27 Tell your patients NOW that you will NOT be issuing papers scripts as of March 27. With the e-prescribing mandate quickly approaching, we at MSSNY are concerned about the lack of pre- paredness expressed by New York doctors. Our recent survey showed that more than 40% of responding physicians are not yet prepared to meet the e-prescribing mandate. We DO NOT expect an extension of the deadline, and urge you to ACT NOW to ensure you are com- pliant with the law.

Poster Symposium Seeks Judges on April 15 in Tarrytown If you’re coming to the House of Delegates in Tarrytown – or just live in the neighborhood – and are free on Friday afternoon, April 15, from 2 – 4 pm, please consider par- ticipating as a judge at the MSSNY Resident and Fellow Section Poster Symposium. It’s always an exciting, lively event! Please contact sben- [email protected] or 516-488-6100 extension 383 if you’re interested.

Page 2 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 3 Endorsed by MSSNY

Page 2 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 3 PRESIDENT’S COLUMN MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF NEW YORK Take Control of Your Life, Your Career and Your Practice For over two centuries, the private practice to survive with Medical Society of the State the myriad of hurdles facing Medical Society of New York has served as the physicians? of the State of New York representative professional Joseph R. Maldonado, Jr., MD, President Options Are Limited William Latreille, MD, Chairman of the Board organization for the profes- For most physicians, the Philip A. Schuh, CPA, Executive Vice Presi- sion to our state’s residents, options are limited. Personal dent legislators, educators, regula- choices concerning prac- COMMUNICATIONS AND PUBLICATIONS tors and policy makers. Our tices and families govern our Joshua M. Cohen, MD, MPH, Commissioner diverse activities have varied in abilities to change where we their prominence with advo- practice and how we practice. News of New York cacy being the dominant task Joseph R. Personal and business debt Published by Medical Society over several decades. This Maldonado, Jr., as well as lifestyle and stan- of the State of New York has been the result of a grow- MD, MSc, MBA, dard of living choices often Vice President, Communications and Editor ing assault on the profession DipEBHC mean that physicians cannot Christina Cronin Southard, Editor which has sought to transform opt for their most desirable [email protected] delivery of healthcare from the domain choice; they must make personal and News of New York Staff of physicians to the domain of hospitals professional sacrifices in order to meet Manager, Communications Division and insurers. More recently, employ- the obligations for their lifestyle and Julie Vecchione DeSimone ers, patients, and other allied health standard of living. Such factors may [email protected] professionals have sought to change motivate a physician to sell their practice Roseann Raia, Communications Coordinator the scope of practice of physicians and to a hospital or seek employment with a [email protected] other healthcare providers as well as the hospital or group rather than downscale clinical decision-making role of physi- Steven Sachs, Web Administrator and practice independently on their own [email protected] cians. Corporate America and Wall Street terms. If you have a significant mort- have sought to shape the direction of gage to pay, you’re not going to drop Susan Herbst, Page Designer healthcare as bio and information tech- out of a particular plan which just cut News of New York nologies, pharmaceuticals, and delivery your reimbursements by 20%. Instead, Advertising Representatives venues (such as retail clinics, telemedi- you realize the threat to your standard For general advertising information contact cine, homecare, assisted living) change Christina Cronin Southard of living these cuts pose and – instead Phone 516-488-6100 ext 355 the care setting. Today, every aspect of – seek to increase volume, increase [email protected] physician care delivery workflow is regu- new revenue streams of income or cut lated by one or multiple external parties operational costs perhaps by joining a that claim their right to do so based on The News of New York is published monthly as hospital or group practice (economies of the official publication of the Medical Society of reimbursement arrangements and/or scale approach). the State of New York. Information on the publi- statutory/regulatory authority. How is (Continued on page 15) 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 New York State Earns On-Site Visits Increasing 11590. The acceptance of a product, service or com- Mixed Reviews in New Among Large Employers pany as an advertiser or as a membership benefit Tobacco Report of the Medical Society of the State of New York Question: What is behind the does not imply endorsement and/or approval of A report from the American Lung drive by large employers to this product, service or company by the Medical Association (ALA) titled “State of employ on-site or near-site doc- Society of the State of New York. The Member Ben- Tobacco Control 2016,” finds that efits Committee urges all our physician members tor visits? to exercise good judgment when purchasing any New York earned an “A” in 2015 “on Answer: Employers looking to product or service. policies that promote smoke-free reduce monthly healthcare premi- Although MSSNY makes efforts to avoid clerical air.” However, the ALA “called on ums are finding that operating clinics or printing mistakes, errors may occur. In no event New York officials to increase fund- on-site to provide primary and pre- shall any liability of MSSNY for clerical or printing ing for the state’s tobacco control mistakes exceed the charges paid by the advertis- ventive care, and encourage exercise, er for the advertisement, or for that portion of the programs by $10 million to $52 mil- are keeping workers healthier, reduc- advertisement in error if the primary or essential lion per year and expand New York’s ing absenteeism and cutting benefit message of the advertisement has not been totally altered or substantially rendered meaningless as a Clean Indoor Air Act to restrict the costs. Employers are finding that on- use of electronic cigarettes.” result of the error. Liability of MSSNY to the ad- site centers also reduce the amount vertiser for the failure to publish or omission of The smoking rate among the of time workers spend away from all or any portion of any advertisement shall in no state’s high school students has work visiting off-site healthcare pro- event exceed the charges paid by the advertiser dropped to 7.3 percent, while the for the advertisement, or for that portion of the viders. As an added bonus, on-site advertisement omitted if the primary or essential adult smoking rate has dropped to centers can help companies identify message of the advertisement has not been totally 14.5 percent, below the national occupational health and safety risks, altered or substantially rendered meaningless as average of 17.8 percent, according such as poorly designed worksta- a result of the omission. MSSNY shall not be li- to figures released by the state last able for any special, indirect or inconsequential tions that result in back and neck damages, including lost profits, whether or not year. problems. foreseeable, that may occur because of an error in any advertisement, or any omission of a part or (Continued on page 14) (Continued on page 12) the whole of any advertisement.

Page 4 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 5 MSSNY-PAC The Importance of Political Action Committees The importance of political action com- Government wants to mandate that mittees (PACs) cannot be overstated. every office based surgery practice and They constitute one mechanism through every urgent care have an EHR and con- which political candidates generate the nect with the state health information revenue needed to pay for the very sub- network (SHIN-NY) despite on-going stantial costs associated with political fears regarding whether patient records campaigns. are securely protected. Of great concern, a relative handful of physicians continue to Government wants to circumscribe the clinical decision-mak- bear the weight for all their colleagues, as MSSNYPAC’s contribu- ing authority of physicians and limit the number of opioids that tions have dipped considerably in recent years. The most recent can be prescribed initially to a 3-10 day supply. data show, MSSNYPAC cannot be found in the top twenty-five So much is happening on the state and federal levels. And spending PACs while groups with often diametrically opposed yet too few physicians are taking the necessary steps to assure agendas spend far more. Notably, the Trial Lawyers Association that medicine can remain at the table to prevent the bad and PAC is #2 contributing $687,740 in 2015. Following close advance sensible, evidence based reform. on their heels in #3 and #4 place was SEUI ($652,600) and Now is Your Time to Answer the Call the New York State United Teachers ($610,522) respectively. Yes, MSSNY has been able to shrug off these threats in the Greater New York Hospital Association, #6 with $528,700 in past. But this is a new day. It is a day wherein the Trial Lawyers contributions was neck to neck with the NYS Dental Association, and Dentists have positioned themselves well ahead of physi- #7 which contributed $528,450 in 2015. The Healthcare cians and their patients. MSSNYPAC cannot continue to achieve Association of NYS (HANYS) was ranked #15 with total con- these victories if we cannot secure the financial commitment tributions at $292,350. Rounding out the bottom 25 were #18 from each of you to become a member of MSSNYPAC. If each Communication Workers of America ($269,581); #22: NYS and every one of the approximately 70,000 practicing physi- Correction Officers PBA ($234,370); #23: Public Employees cians in New York gave just $100 to MSSNYPAC, medicine would Federation ($223,970) and #25: Verizon ($216,600). be a substantial force with which to reckon. Where was MSSNYPAC? Don’t say we didn’t warn you. MSSNYPAC’s total contributions in 2015 were well outside the range of the top twenty-five. Are you concerned with the consequences to your professional careers as a result of this discrepancy? Your PAC leadership cer- The Health Care Law Experts tainly is concerned. I would think you should be too. Representing Medical Professionals for More than 25 Years Issues that Threaten the Practice of Medicine It’s a real concern; one that we do not like to tout but feel we must discuss given the weight of what confronts organized medicine this year. We know that the Trial Lawyers are seeking enactment of new laws that will increase your medical liability premium costs either by virtue of enacting a date of discov- JEROME I. SAGER ery exception to your 2 ½ year statute of limitations thereby Attorney At Law increasing your potential liability exposure or by repealing current limits on the contingency paid for successful medical Former Assistant District Attorney liability claims. We know that the budget proposes to significantly reduce the amount of funding for the Excess medical liability program, See us for: which would eliminate coverage for 55% of physicians who currently have it. This means that all primary care physicians, • Professional Medical Conduct Defense ophthalmologists, otolaryngologists and most other specialists in upstate New York (except neurosurgeons, bariatric surgeons and OBGYNs) would lose this extra layer of coverage…at a time • Medicaid and Medicare Fraud Cases when their potential exposure to liability for failing to diagnosis cancer in a patient will increase. • DEA and Controlled Substance Issues We also know that the budget fails to establish a Guarantee Fund or to identify another source of funding to reimburse phy- • Third party insurance issues sicians for the care they provided to patients that were covered by the now defunct Health Republic. Dentists seek the authority to perform cosmetic surgery on the head and face. Nurse anesthetists want to administer anesthe- sia without the supervision of an anesthesiologist. Psychologists want to prescribe schedule 2-5 drugs. My firm can handle most legal matters. Government is advancing the concept of establishing limited Call us for a free consultation. service clinics in retail stores as a means by which to assure the provision of ‘primary care’ in underserved communities in New York; except the proposal exempts these clinics owned and 212-685-2333 • 917-312-6631 operated by publicly traded corporations from having to dem- [email protected] onstrate public need.

Page 4 • MSSNY’s News of New York • March 2016 Untitled-1 1 March 2016 • MSSNY’s News of New York • 11/13/14 Page 3:59 5 PM Medical Society of the State of New York 2016 LEGISLATIVE PROGRAM

Assuring Our Patients Can Receive Timely Quality Care THE NEED FOR LIABILITY REFORM: have risen more than 50% in the past decade, nearly twice as Many New York physicians continue to pay liability premiums much as inflation generally, and compared with a 3% increase that far exceed those in any other state. In fact, they often pay in Medicare reimbursement over the same time. And countless premiums that far exceed $100,000 and some even exceed physician practices are owed hundreds of thousands of dollars $300,000! The combined effect of reduced revenues and high as a result of the collapse of the health insurer Health Republic. overhead costs if unaddressed will exacerbate the already As such, New York can no longer sustain such an expensive unbearable financial strain for many practices and a continued and flawed medical liability adjudication system if we wish to erosion of our patients’ access to needed care. The cost of assure that our healthcare system will be able to accommo- medical liability coverage for the 2015-16 policy year is: date the patient demand that comes as our population ages, • $338,252 for a neurosurgeon in Nassau and Suffolk as well as the over 2,000,000 newly insured patients who are counties; starting to receive coverage through New York’s new Health • $186,630 for an obstetrician in Bronx and Richmond Insurance Exchange. counties; We need comprehensive reform of our flawed medical liabil- • $141,534 for an orthopedic surgeon in Nassau and Suffolk ity adjudication system to reduce these costs. MSSNY supports Counties; a number of reforms that have been enacted in many other • $132,704 for a general surgeon in Kings and Queens coun- states whose medical liability insurance costs are far less than ties, and New York’s. These reforms include: placing reasonable limits • $134,902 for a vascular surgeon or cardiac surgeon in on non-economic damages; identifying and assuring quali- Bronx and Richmond counties. fied expert witnesses; eliminating joint and several liability; strengthening our weak Certificate of Merit requirement; and assuring statements of apology are immunized from discov- ery. Other important measures we support include alternative systems for resolving Medical Liability claims such as Medical Courts or a Neurologically Impaired Infants Fund that applies to physicians.

Little wonder, as malpractice payouts in New York State continue to be far out of proportion to the rest of country. For example, in 2013, according to a report by Diederich Healthcare, New York State had by far and away the high- Given these real threats to our health care system, it is est cumulative number of medical liability payouts, nearly two also imperative legislators reject “stand-alone” measures to times greater than the state with the next highest amounts, expand medical liability that would most certainly exacerbate Pennsylvania, and far exceeding states such as California and these problems, such as legislation that would: Florida. • Change NY’s statute of limitations to a “date of discovery” Additionally, the report indicated that the New York per rule – Estimated 15% premium increase; capita medical liability payment of $38.83 was the highest • Expand “wrongful death” damages to permit “pain and suf- in the country, greatly exceeding the second highest state fering” – Estimated 53% premium increase; Pennsylvania by 57%, the third highest state New Jersey by • Permit the awarding of pre-judgment interest – Estimated 67%, and the fourth highest state Massachusetts by 74%. 27% premium increase; Remarkably, it was13 times greater than Texas! • Eliminate statutory limitations on attorney contingency Another recent article in OB-GYN News details that New York fees – Estimated 10% premium increase; State has by far and away the greatest number of medical • Prohibit ex-parte interview by defense counsel of the plain- liability awards of greater than $1 million (210), 3.5x high- tiff’s treating physician; est than Illinois (61), the state with the second highest total • Change loss share rules regarding non-settling defendants. and nearly 5x greater than California (43), a state with a far Efforts to reform our medical liability adjudication system greater number of physicians. must be comprehensive! Meanwhile, a recent study by the Medical Group Management Association concluded that practice expenses per physician

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ADDRESSING HEALTH INSURER ADMINISTRATIVE numerous other reforms to address pervasive insurer abuses, HASSLES: including the following: The increased availability of subsidized health insurance cov- Reduce Administrative Burdens to erage through New York’s Exchange and Basic Health Plan is a Delivering Care positive development for our patients, but more and more are • Require medical necessity determinations be made by phy- finding themselves underinsured due to the increasingly inad- sicians practicing in the same or similar specialty as the equate coverage and narrow networks offered by insurers. physician recommending treatment; Exacerbating these problems are the increasing administrative • Permit physicians to override a health plan step therapy burdens that health insurers impose that inappropriately delay prescription medication protocol; and deny needed care for patients, and the reduction and • Continuity in Prescription Drug Coverage when formular- unfair delays in payment to physicians when needed care is ies/prescription tiers change; delivered. These tactics can adversely impact patient care and • Reduce the time frame that health plans have to review make it harder and harder for physicians to remain in practice. physician-recommended patient treatment; For example, one MSSNY survey showed that 90% of phy- • Assure greater transparency when a physician contracts sicians indicated that health insurer step therapy protocols with a rental network entity; for prescription medications at least “sometimes” adversely • Require health insurers to use standardized prior authori- affected their patients and 45% indicated that it “frequently” zation forms and electronic PA platforms. adversely affected patients. Assure Fair Payment for Providing Needed Another MSSNY survey found that significant numbers of Patient Care patients are facing deductibles imposing huge out of pocket • Require insurers to offer patients coverage options for out costs before health insurers will even begin to pay for care. of network care; Nearly 21% of responding physicians indicated that ¼ - ½ of • Require insurer payment to physicians for advocating for their patients now face deductibles of $2,500-$5,000, and that patients to receive necessary care or testing; 32% of responding physicians indicated that up to 10-25% of • Reduce the time frame in which health plans may recoup their patients face deductibles of $2,500-$5,000. And while payments made to physicians, and prohibit extrapolation- insurers are reducing their physician networks, many are also generated repayment demands; refusing to offer patients out of network coverage options. • Prohibit health plan recoupment based where the plan pre- viously confirmed eligibility; • Assure fair payment for facility fees for physicians per- forming office-based surgical practices. Fair Workers Compensation/No-Fault Reform • Assuring fair payments for delivery of care to injured work- ers and opposing unfair cuts; • Reducing undue administrative burdens including stream- lining burdensome claim forms; • Assuring carriers pay claims timely; • Opposing carrier-driven efforts to impose overbroad restrictions on the ability of physicians to be paid fairly by No-Fault carriers for the care they deliver to auto accident Of perhaps greatest concern, health insurers are now being victims. incentivized by government to impose untested value based ADDRESSING HEALTH INSURER payment structures that will give them broad new powers to ADMINISTRATIVE HASSLES: further cut physician payments based upon hard to define The Center for Health Workforce Studies reported recently “quality” targets. These are particularly difficult to meet for that the instate retention of new physicians has gradually the tens of thousands of New York physicians who are strug- declined from a high of 54% in 1999 to the lowest since the gling to implement enormously expensive EHR systems into survey began of 45% in 2014. This is particularly troubling their practice workflow. At the same time, insurers are con- as demand for physician services continues to outpace physi- solidating and greatly enhancing their market share, such as cian supply, particularly in ophthalmology, urology, psychiatry, the recent announcements of the mergers between Aetna and pathology, general internal medicine, general/family medicine, Humana, and Anthem and Cigna. Most recently, Emblem in and otolaryngology. There are areas of the state and popula- effect severed the relationship of its insureds with 750 physi- tions that are already underserved by the current physician cians it arbitrarily decided to drop from its network. supply. The implications of the forecasts for these areas and There is a need to “level the playing field between mar- populations are dire. New York must do more to attract and ket dominant insurers and community physicians seeking to retain physicians, including advocacy to assure adequate fund- assure their patients can receive the care they need. Therefore, ing of the Doctors Across New York program. MSSNY will continue to strongly push for the enactment of ENHANCING QUALITY OF CARE THROUGH PEER REVIEW: legislation that would enable physicians to collaborate with Current law impedes peer review quality improvement efforts their colleagues to collectively negotiate relevant patient care by permitting attorneys access to statements made at a peer- terms with insurance companies. In addition, MSSNY supports (Continued on page 8)

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(Continued from page 7) either manually aggregated the data or purchased additional review meeting by a physician who subsequently becomes a software to do so. MSSNY will work to enhance the functionality party to a malpractice action which involves the conduct which of EHR technology and will work to identify resources to assist was the topic of discussion at the peer review meeting. physician adoption of such technology. MSSNY will also work MSSNY will work to enact legislation which would extend to protect patient information from unauthorized disclosure. existing confidentiality protections to all statements and ENHANCING QUALITY & INTEGRATION THROUGH HIT: information volunteered at peer-review quality assurance com- The State, through several initiatives, is taking steps to mittees within hospitals, in office-based settings and across encourage health insurers and HMOs to significantly change integrated care settings including multi-group and accountable the way in which physicians and other providers are paid, care organizations. moving away from traditional fee for service to payment based ENHANCING QUALITY OF CARE THROUGH eRx: on value. Under this paradigm, in order to leverage enhanced E-prescribing is one of several solutions advanced to payment, physicians and other healthcare stakeholders will improved patient safety and quality of care through clini- need to integrate their care settings, engage profession- cal decision support and ready access to patient medication als to coordinate care delivery and track patient outcomes. history. NYS has mandated electronic submission of all pre- Resources are needed to assist physicians in these efforts. scriptions by March 27, 2016. The law does provide certain The State Medicaid Program received approval from CMS exceptions to the e-prescribing mandate and allows for the to invest over $8B for comprehensive delivery and pay- issuance of a one-year renewable waiver to physicians who ment reform through the Delivery System Reform Incentive can demonstrate economic hardship, technological limitations Payment (DSRIP) program to promote community based col- that are not reasonably within the control of the physician, or laborations/integration with the goal of reducing avoidable other exceptional circumstance. MSSNY will work to assure hospital readmissions by 25% over five years. 25 Performing that the waiver process is available to physicians for whom Provider Systems (PPSs) have been established statewide to purchase and implementation of e-prescribing technology is achieve improved clinical health impractical. MSSNY will also work to assure that the technolo- Enhancing Quality of Care outcomes and population health gies used as part of the prescription drug monitoring registry goals. Under this initiative, the state is required to transi- are compatible with all e-prescribing systems so that physician tion traditional Medicaid managed care payment to a system consultation with the PMP registry is streamlined wherein by 2019 80-90% of MCO-physician payment contracts are based on value based payment (VBP) methodologies of ENHANCING EHR FUNCTIONALITY AND USAGE: which at least 35% involve health care providers sharing so- Response to MSSNY’s survey on EHR usage and functionality called “downside” risk. The design of the value based payment is consistent with results of other surveys which show a level methodologies will likely not just define a payment structure of dissatisfaction with regard to EHR systems. While 78% of for the Medicaid program; it may also be replicated in contracts respondents to MSSNY’s survey are using or plan within two with commercial payers. The State has received a SIM (State years to use EHRs in their practice or at their hospital, 53% Innovation Model) grant to transition 80% of the state’s pop- stated that they are either disappointed or very disappointed ulation receiving primary care services to advanced primary with their EHR. Notably, 38% of the respondents stated that care settings and that 80% of such care will be paid for under their EHRs cannot generate routine reports to help manage value based financial arrangements. The transition from fee their patient population, like diabetics, hypertension or ad hoc for service to value based payment is an enormous challenge reports like finding patients due for a flu shot and 29% replied for physicians many of whom currently lack the technologi- that their EHRs do not support meaningful use stage 2 (MU-2) cal, analytical and staffing resources needed to adjust their or provide guidance on how to achieve MU-2. 56% responded practice to this shifting paradigm. Data show that only 39.4% that their EHR did not have prompts to notify them of gaps in of New York physicians in private practice have adopted EHRs. patient care. Of the 45% of physicians who stated that they Unfortunately, limited monies targeted for DSRIP and the SIM were currently participating in pay for performance (P4P) pro- will go to support or incentivize physician adoption of this grams that require reporting from their EHRs, 32% stated that technology, even though physician care is the very heart of our their EHR did not give adequate support to collect data to sup- care delivery system. Without it, physicians will not be able to port their P4P program. Many stated that they or their staff demonstrate adherence to performance metrics and will expe- rience reduced revenue. Financially challenged practices will close over time dramatically impacting access to care. In addi- tion to seeking resources to enhance EHR adoption, MSSNY will explore methods to assist solo and small practice physicians not associated with ACOs, IPAs or other integrated systems to coordinate the care they provide, track performance and negotiate with insurers and HMOs. Moreover, MSSNY will also continue to urge state officials to prevent attempts by health insurers to condition participation in their networks on accept- ing unsustainable financial risk. Eliminating Health Disparities MSSNY’s long-standing commitment to finding real solutions to improve access to high-quality medical care for all New Page 8 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 9 Medical Society of the State of New York 2016 LEGISLATIVE PROGRAM

Yorkers is reflected in the work of its Committee to Eliminate in the New York City area, as much as $18 million per year to Health Care Disparities. This work includes attracting a more secure these slots to the detriment of U.S. medical students, diversified physician workforce, increasing the numbers who cannot secure clinical rotations in their desired locations, of minority faculty teaching in medical schools, expanding or possibly even in New York State. MSSNY will work with the medical school pipeline programs in rural and urban areas to Associated Medical Schools of New York (AMSNY) to secure address the shortage of physicians in medically underserved legislation to prohibit the sale of clerkship slots to medical areas of New York State, and, where appropriate, support for schools that are not LCME or COCA accredited. legislation that addresses the root problems of health care PROTECTING PUBLIC HEALTH: disparities. Cultural competence and health literacy are both The Medical Society of the State of New York believes that extremely important aspects of providing optimum health primary prevention of diseases is important to the health and care to minority populations. Securing reimbursement for lan- well-being of all New Yorkers and the best way to prevent guage services for patients with limited English proficiency is diseases is by immunizations. Vaccines are responsible for the essential. The collection and aggregation of health care and control of many diseases; however, New York State is expe- demographic data on a regional and institutional level is also riencing an outbreak of measles and pertussis due to many necessary to facilitate analysis by race and ethnicity. individuals choosing not to be immunized or have children QUALITY THROUGH PHYSICIAN-LED TEAM-BASED CARE: immunized. MSSSY will again place an emphasis on programs There are many different types of health care providers that will improve adult immunization rates and will continue to who each provide essential care for our patients. They are an advocate for use of the adult and child schedule for immuniza- important part of our health care system. However, patients tions as developed by the Advisory Council on Immunization benefit most from the combined care of a team, headed by a Practices. The Medical Society will support efforts to eliminate physician whose education and training enables them to over- all non-medical exemptions to New York State immunization see the actions of the rest of the team, to provide the patient law. The recent world outbreak of Ebola, measles, and the with optimal medical treatment. MSSNY supports this concept rapid spread of enterovirus-D68 (EV-D68) clearly shows the and will continue to work toward achieving this goal. MSSNY need to ensure that physicians and New York State residents opposes any expansion of the scope of practice of non-phy- are prepared for a public health emergency. sician health care providers that will enable them to practice Additionally, the state has seen large increases in hurricanes beyond their education and training, and/or without physician and flooding disasters that have caused severe disruptions in supervision, collaborative relationship, or required physician people’s lives and indeed, health. MSSNY remains commit- referral. Also MSSNY will oppose legislation to allow corpo- ted to preparing the public and physicians for the next public rately owned retail clinics and any alteration of the corporate health emergency. practice of medicine doctrine. MSSNY supports legislation to limit the promotion of tobacco MSSNY supports enactment of legislation or promulgation of products in the state by all tobacco companies; to prohibit the regulation to: sale of tobacco, e-cigarettes and nicotine dispensing devices • assure that the advertisements of all health care profes- and products to anyone less than 21 years of age; to increase sionals adequately inform the public of their professional penalties for the sale of tobacco, e-cigarettes and nicotine credentials and require that all health professionals wear dispensing devices to persons less than 21 years of age and badges which identify their professional title; and supports legislation that would ban smoking in pediatric set- • enable otolaryngologists to dispense hearing aids at fair ting. MSSNY is a strong proponent of including e-cigarettes market value. under the provisions of the Clean Indoor Air Act and supports ASSURING CLINICAL CLERKSHIP SLOTS FOR US MEDICAL having the Food and Drug Administration having the ability to SCHOOL STUDENTS: regulate e-cigarettes. The New York State Education Department has approved fif- The Medical Society of the State of New York’s House of teen “Dual Campus” International Medical Schools (DCIMS) Delegates in May 2015 adopted a revised policy on assisted to send their students to New York to perform mandatory suicide MSSNY Policy 95.989 Physician Assisted Suicide and long-term clinical clerkships. Seven of these are located Euthanasia: “Patients, with terminal illness, uncommonly in the Caribbean. In recent years the class sizes of LCME/ approach their physicians for assistance in dying including COCA accredited U.S. Medical schools in New York State have assisted suicide and euthanasia. Their motivations are most increased. At the same time the offshore schools, especially in often concerns of loss of autonomy, concerns of loss of dignity, the Caribbean, have proliferated and have experienced rapid and physical symptoms which are refractory and distress- increases in their class sizes as well. According to the NYS ing. Despite shifts in favor of physician-assisted suicide as DOH, approximately 4,000 clinical clerkship slots are needed evidenced by its legality in an increasing number of states, for U.S. medical school students. Offshore medical students physician-assisted suicide and euthanasia have not been part also need over 2,000 clinical clerkship slots. However, the of the normative practice of modern medicine. Compelling DCIMS have not been accredited by any national or interna- arguments have not been made for medicine to change its tional accrediting agency comparable to the LCME/COCA and footing and to incorporate the active shortening of life into do not have the infrastructure within their home country to the norms of medical practice. Although relief of suffering has provide clinical rotations to their students. Consequently, they always been a fundamental duty in medical practice, relief of rely on sending their students to the hospitals in the U.S., suffering through shortening of life has not. Moreover, the particularly to hospitals located in New York, to provide clini- social and societal implications of such a fundamental change cal rotations. The DCIMS pay hospitals in New York, especially (Continued on page 13) Page 8 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 9 Mssny and Oasas Cme Final Webinar On Opioid Use on Thursday, March 10 at 7:30 am Avoid Medicare The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present the final installment in a free webinar series on opioid prescribing. Entitled, “Revisiting the Role of Opioid Penalties Analgesics for Simple and Complex Patients with Chronic Pain,” the final webinar will be on Thursday, March 10 at 7:30 am. Physicians are urged to register! To register, please click here. A copy of the flyer can be foundhere . Thursday, March 10, 2016, 7:30 a.m. Reporting PQRS has never been more important. The penalty for not Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, reporting is, at a minimum, - 2.0% but it could be more. Understanding FAAFP, DABAM the rules can be confusing but is necessary. Educational Objectives: Attention MSSNY Members! Save $104 • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed. Use Code mssnypqrs • Discuss strategies to reduce risk of treating pain in patients with substance use disorders at the time of submission and receive a discounted This webinar has been accredited for one hour of continuing submission rate of $195 medical education credits. The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical edu- cation for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0AMA/PRA Category 1 credits™. Physicians should claim only the credit com- Visit Covisint at: www.pqrs.covisint.com or contact mensurate with the extent of their participation in the activity. them at 866.823.3958 for more information. For further information or assistance in registering for the pro- gram, please contact Pat Clancy at [email protected] or Terri Holmes at [email protected].

As a member of the From Socio-Med VP Regina McNally: Medical Society of the State of New York, you Go with Dr. First for E-Prescribing could receive exclusive savings on auto and home I have been receiving many calls from physicians regard- insurance from Liberty Mutual.1 ing the upcoming NYS e-prescribing mandate of March 27, 2016. We endorse DrFirst as a “stand-alone” e-prescribing product. I believe software would be added to the physician’s existing computer. This stand-alone product will also help those physicians who have an EMR or EHR that might not be ready by the 3/27/16 deadline. Please click here for more information. MSSNY members get a discount! DrFirst’s MSSNY hotline number is (866)980-0553. If a physician member can document either financial or Along with valuable savings, you’ll enjoy access to benefits like 24-Hour Claims Assistance. technical limits, s/he can apply for a waiver from electronic prescribing. The application for the waiver would apply for both controlled and non-controlled prescription drugs. Note, there’s no guarantee that the waiver will be granted. Please see the attached for waiver information. As a point of physician protection, a medical record for the patient (spouse, family, friends, etc.) must be For a free quote, call 800-524-9400 maintained (even if it is on an index card) for every pre- or visit https://www.libertymutual.com/mssny scription written in either paper or electronic mode. Client #2179 E-prescribing of both controlled and non-controlled sub- stances is currently permissible in New York. Practitioners This organization receives financial support for offering this auto and must ensure compliance with the requirement, including work- home benefits program. 1 Discounts and savings are available where state laws and regulations ing with their software vendors to implement the additional allow, and may vary by state. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify. security requirements needed for e-prescribing of controlled Coverage provided and underwritten by Liberty Mutual Insurance and substances, and registering their certified software applica- its affiliates, 175 Berkeley Street, Boston, MA 02116. ©2015 Liberty Mutual Insurance tions with the Bureau of Narcotic Enforcement. Valid through February 24, 2016. Below are highlights/key points that may be of particular (Continued on page 13)

Page 10 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 11 CDC Issuing Guidelines Urging Primary Care Physicians to Monitor Opioids In a research letter in JAMA Internal Medicine, investi- oids,” but because there are more family physicians than gators “examined Medicare claims from 2013 to see which specialists, as a group, “their number of painkiller prescrip- doctors prescribed opioids and how many prescriptions they tions was higher than for any other category of health care filled.” The analysis revealed that “the drugs are prescribed worker. by a broad cross-section of medical professionals – includ- In light of the findings, the Centers for Disease Control ing doctors, nurse practitioners, physicians’ assistants and and Prevention issued new guidelines on December 14, urg- dentists – rather than concentrated among a small group of ing primary-care physicians to closely monitor their patients’ practitioners.” use of opioids and take a more “conservative approach” to Moreover, the analysis also revealed that on a “doc- prescriptions in order to mitigate “a crippling epidemic of tor-by-doctor level, pain management specialists and addiction to the powerful narcotics.” anesthesiologists handed out the most prescriptions for opi-

Bill to Limit Opioid Prescriptions to Three- Ten Day Supply on Senate Health Agenda Senate Bill 6091A, which would limit the initial prescription of Schedule II $ or III Controlled Substances to a three 100 cash rewards to ten day supply, is on the Senate bonus offer* Health Committee agenda. Sponsored by Senator Kemp Hannon, the bill is intended to encourage patients whose acute pain lasts longer than initially expected to follow up with a physician and it lessens the number of the pills left in medicine cabinets and available for diversion. The bill does limit the number of co-pays for patients should The BankAmericard Cash Rewards™ credit card they need additional prescriptions. for Medical Society of the State of New York The Medical Society of the State of New York is opposed to this Get more cash back for the things you buy most. measure and believes that hav- Plus, a $100 cash rewards bonus offer. ing the New York State Legislature place an arbitrary limit on any type Carry the only card that helps support of prescriptions interferes with the Medical Society of the State of New York % practice of medicine. Its compan- 1 cash back on purchases • $100 cash rewards bonus if you make everywhere, every time ion measure, A. 8601, sponsored at least $500 in purchases in the first 90 days* by Assemblymember John T. % MacDonald III, is in the Assembly • Earn rewards automatically 2 cash back at grocery stores Health Committee. • No expiration on rewards Physicians are urged to contact • No rotating categories % Senators on the Health Committee 3 cash back on gas and urge defeat of this measure. Senate Health Committee mem- To apply for a credit card, Grocery store and gas bonus rewards apply bers are: Senators Kemp Hannon, visit newcardonline.com to the first $1,500 in combined purchases ▼ Hugh Farley, Simcha Felder, Martin and enter Priority Code VACFLO. in these categories each quarter. Golden, Ruth Hassell-Thompson, Brad Hoylman, William Larkin, Betty Little, Jack Martins, Velmanette Montgomery, Terrence Murphy, Roxane Persaud,

Gustavo Rivera, James Seward, Toby For information about the rates, fees, other costs and benefits associated with the use of this Rewards card, or to apply, go to the website listed above or write to P.O. Box 15020, Wilmington, DE 19850. Stavisky, David Valesky, and Catharine *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 Young. 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. ▼ The 2% cash back on grocery store purchases and 3% cash back on gas purchases applies to the first $1,500 in combined purchases in these categories each quarter. After that the base 1% earn rate applies to those purchases. By opening and/or using these products from Bank of America, you’ll be providing valuable financial support to Medical Society of the State of New York. Join MSSNYPAC today at This credit card program is issued and administered by Bank of America, N.A. Visa and Visa Signature are registered trademarks of Visa International Service Association, and are used by the issuer pursuant to license from Visa U.S.A. Inc. BankAmericard Cash Rewards is a trademark and Bank of America and the Bank of America logo are registered trademarks of Bank�of�America�Corporation. www.mssny.org ©2015 Bank of America Corporation ARPH45XW-05132015 AD-06-15-0544

Page 10 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 11 East Side, West Side, Bedbugs Are Everywhere On-Site Visits Increasing Among Large Employers The Wall Street Journal (2/3) reported that Nature Communications (2/2) published several research studies on the common bedbug, or (Continued from page 4) Cimex lectularius, that resulted in a fully-mapped genome of the species. This new area of healthcare has produced Two research groups determined that the bed bug is extremely resistant a growth market for companies that oper- to pesticides and chemicals not only because of a small cluster of genes ate clinics for employers, including Healthstat, identified among the total 36,985 mapped, but also because of inserted Marathon Health, Premise Health and QuadMed. DNA from roughly 400 different types of bacteria that live inside of it. Health systems also have jumped into the mar- One of the studies also focused on the link between genetic variations ket, operating about 18% of worksite clinics, of bedbugs in New York City anad the movement of people. According to according to benefits consultant Towers Watson, the study, bed bugs in northern Manhattan and southern Manhattan, con- which surveyed firms with clinics this year. nected by a heavily-trafficked subway, are genetically similar while bed Since employers believe in the cost-saving bugs between the Upper East Side and the Upper West Side, which are potential of on-site clinics, many employers not connected by a subway, are more genetically diverse. plan to continue investing in them even though the cost will likely be included in calculating the Affordable Care Act’s Cadillac tax on high-value Medical Society of the State of New York health plans starting in 2018. Earlier this year, the Internal Revenue Service said spending on 2016 LEGISLATIVE PROGRAM on-site clinics would be considered in the tax cal- culation unless the clinics offered only de minimis (Continued from page 8) care. Regardless, two-thirds of large employers cannot be fully contemplated. MSSNY supports all appropriate efforts with on-site health facilities say they plan to to promote patient autonomy, promote patient dignity, and to relieve expand such facilities in the future. suffering associated with severe and advanced diseases. Physicians In smaller communities, employers are cogni- should not perform euthanasia or participate in assisted suicide.” zant of the risk they run in upsetting independent Preserving the ability for women to have access to reproductive physicians and other providers in the community and sexual health care services is a key public health component that who may worry about losing patients to worksite MSSNY has long supported. Efforts must continue to help reduce the providers. Studies, however, show that 40% to rate of unintended pregnancy and maternal mortality in New York 60% of people who go to on-site clinics do not State. The Medical Society supports efforts to expand access to emer- have a personal doctor. gency contraception, including making the emergency contraception If you have any questions, please contact Kern pill more readily available and will continue to support sexual health Augustine Conroy & Schoppmann, P.C. at 1-800- education programs amongst adolescents. The Medical Society will 445-0954 or via email at [email protected]. oppose any legislation that criminalizes the exercise of clinical judg- ment in the delivery of medical care. The Medical Society of the State of New York (MSSNY) was McNally: Dr. First for created in 1807 to contribute to the professional and personal devel- opment of member physicians by representing the profession as a E-Prescribing whole and advocating health-related rights, responsibilities and issues (Continued from page 10) to promote a favorable environment for the practice of medicine and interest to prescribers and pharmacists: improvement of the health of the residents of New York State • A prescription generated on an electronic system that is printed out to the Official New Joseph R. Maldonado, Jr., MD, President York State Prescription form or faxed is NOT an Malcolm D. Reid, MD, President-Elect electronic prescription. Charles Rothberg, MD, Vice President • After March 27, 2016, a pharmacist is NOT Andrew Y. Kleinman, MD, Immediate Past President required to verify that a practitioner properly falls Gregory L. Pinto, MD, Commissioner, Governmental Relations under one of the exceptions from the require- Edward Kelly Bartels, MD, Assistant Commissioner, ment to electronically prescribe. Pharmacists Governmental Relations may continue to dispense medications from Paul A. Pipia, MD, Chair, Legislation and Physician Advocacy valid written, oral, or fax prescriptions that are Committee consistent with current laws, regulations, and Brian P. Murray, MD, Vice-Chair, Legislation and Physician Medicaid policies. Advocacy Committee A comprehensive list of FAQs can be found Phillip A. Schuh, CPA, Executive Vice-President here. Elizabeth Dears Kent, Esq., Senior Vice President & Chief The FAQs provide an explanation of the laws Legislative Counsel and regulations, pharmacy registration forms, Morris M. Auster, Esq., Vice President, Legislative and Regulatory registration for official prescriptions and e-pre- Affairs scribing systems (ROPES), software and data Patricia Clancy, Vice President, Public Health and Education requirements, waivers and exceptions, and For information or to get involved with MSSNY’s advocacy resource information and contacts. efforts, contact: MSSNY’s Division of Governmental Affairs Questions? Please contact the Bureau of at 518-465-8085 Narcotic Enforcement at 1-866-811-7957 or via e-mail to [email protected].

Page 12 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 13 member news

JOHN W. EPLING, MD, NAMED TO DAVID T. NEUMAN, MD LAUNCHES POP-DOC AS U.S. PREVENTIVE SERVICES TASK FORCE BRIDGE BETWEEN ORTHOPEDIC SURGERY AND John Epling, MD, has been named PHYSICAL THERAPY to the U.S. Preventive Services Task David T. Neuman, MD is co-author of a newly released Force, an influential 16 member panel book and website that bridges the gap between physi- of national experts that issues guide- cal therapy and orthopedic surgery for lines for medical screenings designed to patients post joint surgery. “For years I prevent illness and disease. Dr. Epling have been asked by patients and other was selected on the basis of his work medical professionals if there was a on evidence-based medicine, clinical comprehensive workbook of sorts that preventive services and the translation could really help guide patients through of research into practice and quality exercises that would help with recov- Dr. John Epling improvement. Members are appointed ery,” said Dr. Neuman. “It simply didn’t to serve four-year terms. exist. I wrote this book so patients The task force was created in 1984 don’t feel alone or confused about what to improve the health of all Americans by making evidence- Dr. David T. to do after surgery.” based recommendations about preventive services such as Neuman POP-DOC is an easy-to-follow, at- screenings, counseling services and medications. The group home recovery guide that allows recently recommended all adults be screened for depression. patients to achieve results on their own The panel also recently published controversial new guide- and focus on other aspects of their lives. Co-written by Dr. lines recommending that women from age 50 to 74 have Neuman and physical therapist Karena Wu, PT, MS, CSCS mammograms every two years. It also recommended earlier and CPI, POP-DOC brings a comprehensive regimen of joint screenings for women at high risk, like those with a family knowledge to the forefront. history of breast cancer, genetic factors or lifestyle factors A graduate of Cornell University, Dr. Neuman received such as obesity or smoking. his medical degree from the SUNY Downstate Medical A graduate of Brown University, Dr. Epling received his Center. He went on to complete his internship and resi- medical degree from Tufts University School of Medicine. dency in orthopedic surgery at Downstate and a fellowship He is currently Associate Professor and Chair of Upstate at Temple University, where he received specialty training University Hospital’s department of family medicine. He has in sports medicine and arthroscopic surgery. been a member of MSSNY since 1999. (Continued on page 14)

Page 12 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 13 NYS Connects with Other Prescription Monitoring Programs; Allows Prescribers to Assist Mixed Reviews in in Reducing Doctor Shopping Across State Lines Tobacco Report New York State has announced that it has joined the National Association (Continued from page 4) of Boards of Pharmacy PMP InterConnect hub, which will allow participat- The lung association raised concerns, ing states to share information from prescription monitoring programs to however, about an increase in the use of prevent consumers from “doctor shopping” for prescription drugs over products like e-cigarettes and hookahs. And state lines. it gave the state failing grades for funding New York’s Prescription Monitoring Program, (PMP) is an electronic sys- and providing access to programs that help tem that allows prescribers and pharmacists statewide to ensure patients people quit smoking. do not obtain multiple prescriptions for dangerous controlled substances. The advocacy group called on New York New York prescribers are required to check patient information on the PMP officials to increase funding for the state’s prior to issuing controlled substances, and this requirement was imple- tobacco control programs by $10 million to mented under the ISTOP law. New Jersey and Connecticut are both on the $52 million per year and expand New York’s NABP PMP Interconnet hub, though other neighboring states, including Clean Indoor Air Act to restrict the use of Massachusetts, Pennsylvania and Vermont, are not. electronic cigarettes. MSSNY strongly supports this move and believes it will give important information to physicians about their patients.

member news

(Continued from page 13) SUMIR SAHGAL, MD APPOINTED TO NEW YORK STATE A MSSNY member since 2003, Dr. Neuman is Board BOARD OF MEDICINE Certified by the American Board of Orthopedic Surgery and The New York State Education is the owner and clinical director of NY Sportscare in New Department recently announced the York City. appointment of Sumir Sahgal, MD, AUA NAMES THOMAS H. RECHTSCHAFFEN, MD, FACS AS Founder and Chief Medical Officer of 2016-2017 GALLAGHER HEALTH POLICY SCHOLAR Essen Health, to the State Board of The American Urological Association (AUA) has named Medicine. The selection, based on recom- Thomas H. Rechtschaffen, MD, FACS as its 2016-17 mendations by the Commissioner and by Gallagher Health Policy Scholar. The program is designed to the Board of Regents, is for a five-year train the next generation of urologists for leadership posi- term. Dr. Sahgal will serve as a Medical tions in health policy. Gallagher scholars spend a full year Board Member, assisting the board of regents and the department on matters engaged in critical seminars, conferences and meetings at Dr. Sumir Sahgal the national level, receive mentoring from AUA physicians of professional licensing requirements, in senior roles and participate in a week-long health policy examinations, and practice issues. seminar for surgeons sponsored by the American College “I’m honored to be a member of this esteemed board. The of Surgeons and held at Brandeis University. Scholars also opportunity to help guide the caliber of future colleagues and engage in other educational activities that ensure their practitioners in our State is a tremendous privilege,” said Dr. immersion in and understanding of health policy issues of Sahgal. As a board member, he plans to advocate for further importance to urology. improvements in patient care quality and workforce develop- “Dr. Rechtschaffen has a track record of advocating for ment especially to supplement physician shortages plaguing the AUA and is actively engaged in public policy. He has underserved communities. experience at a large practice, strong volunteerism at the A patient champion at his core, Dr. Sahgal established AUA, and has the passion to be a great leader within the Essen Medical Associates, P.C. 15 years ago to bring primary AUA,” said AUA Public Policy Chair Dr. David Penson. care to an underserved community in the Bronx. What was A graduate of Columbia University and the New York once a single primary care office has since evolved into Essen University School of Medicine, Dr. Rechtschaffen is a prac- Health, an integrated healthcare delivery organization, cater- ticing urologist at the Advanced Urology Centers of New ing to the diverse medical needs of New York City residents. York. He is on staff at Montefiore Medical Center, St. A 1991 graduate of Maulana Azad Medical College in New John’s Riverside Hospital, New York Presbyterian/Lawrence Delhi, Dr. Sahgal holds a Master’s degree in Health Policy Hospital Center, White Plains Hospital Center and is a con- and Management from New York University. He has been a sulting urologist at Keller Army Community Hospital. MSSNY member since 2000. Dr. Sahgal is currently the Chief Dr. Rechtschaffen is a member of MSSNY and the Medical Officer of Balance ACO, and also serves on a number American Urological Association and is a Fellow of the of committees including, the International Medical Graduates American College of Surgeons. He is a 2013 graduate of the Governing Council of the American Medical Association (AMA), AUA Leadership Program, and he is currently a member of and is the Chair of MSSNY’s Committee for International the AUA’s Legislative Affairs Committee. Dr. Rechtschaffen Medical Graduates. He also serves as Bronx District Councilor lectures local physicians and community groups about bet- for the American College of Physicians. ter ways to recognize and treat urological issues. Other MSSNY members on the New York State Board of Medicine are as follows: George Autz, MD, Lawrence J. Epstein, MD, Robert G. Lerner, MD, Mushtaq A Sheikh, MD, Ronald V. Uva, MD, and Robert R. Walther, MD.

Page 14 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 15 AMA: All Physicians Subject to 2015 Medicare MU Program Should Apply for Hardship Prior to adjourning for the holidays, Congress passed tion from the Medicare Electronic Health Records Incentive the Patient Access and Medicare Protection Act (PAMPA), Program 2017 payment adjustment are available here. which directed CMS to make AMA-supported changes to the This new, streamlined application process is the result of Medicare EHR Incentive Program hardship exception process PAMPA, which established that the Secretary may consider that allows physicians to avoid a Meaningful Use (MU) penalty hardship exceptions for “categories” of EPs, eligible hospi- in 2017. tals, and CAHs that were identified on CMS’ website as of CMS has stated that it will broadly accept hardship exemp- December 15, 2015. Prior to this law, CMS was required to tions because of the delayed publication of the program review all applications on a “case-by-case” basis. regulations. Applying for the hardship will NOT prevent a Importantly, EPs, eligible hospitals, and CAHs that wish to physician from earning an incentive. It simply protects a phy- use the streamlined application must submit their application sician from receiving an MU penalty. Therefore, physicians according to the timeline established in PAMPA: who believe that they met the MU requirements for the 2015 Eligible Professionals: March 15, 2016 reporting period should still apply for the hardship protec- Eligible Hospitals & CAHs: April 1, 2016 tion. Note that the program operates on a two-year look-back Please note: Following Congress’ efforts in PAMPA, we have period, meaning that physicians who are granted an excep- reviewed our administrative authorities and determined that tion for the 2015 program will avoid a financial penalty for groups of providers may apply for a hardship exception on a 2017. single application. Under the group application, multiple pro- Step-by-step instructions for completing the hardship viders and provider types may apply together using a single exception application are attached. submission. The hardship exception categories are the same The new applications and instructions for a hardship excep- as those applicable for the individual provider application.

PRESIDENT’S COLUMN NY Med Schools Seek Funding for Diversity The Associated Medical Schools of New York is lobbying the state leg- (Continued from page 4) islature to boost its funding for fiscal 2017. The organization, which Wrong Choices represents 16 public and private medical schools throughout the state, For many years, our membership has been most is requesting $2.4 million for scholarships and diversity initiatives, up representative of physicians in small independent from $1.6 million last year. The bulk of the money, $2 million, would fund private practices. As the challenges to continuing four post-baccalaureate programs that help students from underrepre- this style of practice mount, physicians who choose sented backgrounds get into medical school. An additional $400,000 is to continue to practice medicine must decide which for launching a new scholarship. African-Americans, Latinos and indig- direction to pursue. There is nothing more disheart- enous peoples make up 35% of New York’s population but only 9% of ening to see than physicians making suboptimal the physician workforce, according to a 2014 report from the SUNY clinical practice decisions. In my opinion, this occurs Albany Center for Health Workforce Studies. Funding for AMSNY’s diver- when physicians make choices they would pre- sity initiatives was slashed by about 20% after the 2008 financial crisis. fer NOT to make, but make because of financial The requested funding would help restore the programming that was and lifestyle obligations. To these physicians I say, work to divest yourself of financial constraints that dropped, said Jo Wiederhorn, the group’s president and chief executive. obligate you to make suboptimal or wrong choices. Look to other colleagues in our profession who have FDA Lifts Lifetime Ban on successfully downsized and opted out of the “rat race” to live more affordable lifestyles, which in Blood Donations from Gay Men On December 21, 2015, the Food and Drug Administration lifted turn, allow them to make the choices they want in terms of their practices. For younger physicians who a decades-old lifetime prohibition on blood donation by gay and want to consider private practice, this may mean bisexual men. The FDA will continue to ban “men who have had sex looking at more affordable lifestyles in communities with men in the past year, however, saying that the measure was outside the larger metropolitan communities in the needed to keep the blood supply safe.” Dr. Peter Marks, deputy direc- state. tor of the FDA’s Center for Biologics Evaluation and Research, spoke This year, MSSNY has focused a significant at a press conference and said that the 12-month deferral period was amount of its intellectual energies toward trying to “supported by the best available research,” and that the newest blood help physicians as they face difficult choices in the tests are “highly accurate but not perfect,” which is “why the elimina- practice of medicine. This means we are exploring tion of all deferrals is not feasible at this time.” However, gay rights the options of establishing a statewide IPA as well groups consider the lifting of the life time ban, “a major stride toward as promoting and advancing practice models that ending a discriminatory national policy, but had wanted blanket bans have enabled many of us to remain in personally for gay men to be removed entirely.” satisfying practices. In the ensuing months, you Dr. Marks said the policy change is “backed by sound scientific evi- will be hearing about physician practices that were dence” and will “continue to protect our blood supply.” The FDA had transformed. Physicians in these practices opted out “considered eliminating all restrictions on blood donations from gay of the rat race and took control of their lives. Read and bisexual men, but concluded that would increase the transmis- their stories and think about how you can continue sion of HIV through the blood supply by 400 percent.” Dr. Marks said to care for patients on your terms. Be inspired by Monday that “an increase of that magnitude is not acceptable.” Dr. the many voices of those who reinvigorated their Marks wrote in a statement that the FDA “will continue to actively practices and/or careers. conduct research in this area and further revise our policies as new If you think your practice is such a practice, let data emerge.” us know and we may spotlight your innovative idea.

Page 14 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 15 CLASSIFIED ADVERTISING OBITUARIES Classified ads can be accessed at BROD, James J.; Oneida NY. FLYNN, John Thomas; www.mssny.org. Click classifieds. Died December 31, 2015, age New York NY. Died January 90. Medical Society County of 17, 2015, age 97. New York APRIL 2016 ISSUE CLOSES March 15 Madison. County Medical Society. $200 per ad; $250 with Photo CHIBNIK, Joseph; Naples FL. GEFFEN, Abraham; Olney Died January 01, 2015, age MD. Died April 20, 2015, age PHYSICIANS’ SEARCH SERVICES 96. Medical Society County of 98. New York County Medical ALLIED MEDICAL PLACEMENTS • LOCUM TENENS St. Lawrence. Society. practice valuation • practice brokerage COHEN, Jules; Rochester NY. HOFFMAN, Burton Paul; practice consulting • Real estate Died October 09, 2015, age Milwaukee WI. Died December for help, information or to place your ad, 84. Monroe County Medical 14, 2015, age 95. Medical call 516-488-6100 x355 • Fax 516-488-2188 Society. Society County of Westchester. DAVIS, Martin Thomas; Troy KAMHI, Bernard; Boca Office RentalS NY. Died August 14, 2015, age Raton FL. Died December 01, 92. Medical Society County of 2015, age 91. Medical Society Office Space – Sutton Place Rensselaer. County of Kings. Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices avail- DE PINIES, Felix; Spring KANTOR, Howard L.; able, possible procedure room or gym. Separate reception and wait- Lake NJ. Died November Woodbury NY. Died August 13, ing area, use of 3 bathrooms and a shower. Central air and wireless. 27, 2015, age 90. New York 2015, age 90. Nassau County All specialties welcome.Public transportation nearby. Please call County Medical Society. Medical Society. 212-772-6011 or e-mail: [email protected] EDOUARD, Julio; Plattsburgh KRYNSKI, Boris; Flushing NY. Office Rental - 30 Central Park South NY. Died January 01, 2016, Died January 07, 2016, age Two fully equipped exam rooms, two certified operating rooms, age 88. Clinton County Medical 99. New York County Medical bathrooms and consultation room. Shared secretarial and waiting Society. Society. rooms. Elegantly decorated, central A/C, hardwood floors. Next to EHRLICH, Jerome A.; Rye LIEBERMAN, Philip H.; New Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468/[email protected]. Brook NY. Died October 12, York NY. Died December 2015, age 93. Medical Society 26, 2015, age 91. New York Want to Sublease Your Clinic Space or Rent Space County of Westchester. County Medical Society. to Expand Your Practice? EICHACKER, Walter C.; NICHOLS, Rufus A.; Clineeds is an online platform designed to help physicians find and sublease clinic space. Listing is completely FREE! Heathsville VA. Died November Bartonsville PA. Died January Click here to sign up today. We take care of the rest! 18, 2015, age 96. Suffolk 21, 2016, age 89. Medical County Medical Society. Society County of Kings Inc. Place Your Classified Ad In News Of New York! FLYNN, John Edward; YABLIN, Bernard A.; Leasing or Selling Space? Sarasota FL. Died July 02, Rochester NY. Died January Selling your practice or equipment? 2015, age 93. Suffolk County 17, 2016, age 87. Monroe All Ads $200; $250 with Photo • Call 516-488-6100, ext 355 Medical Society. County Medical Society.

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Page 16 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 17 Report of the House Committee on Bylaws To the House of Delegates, Ladies and Gentlemen: undergraduate and doctoral medical education, course curriculum, The members of the House Committee on Bylaws are as follows: and residency training necessary to receive a Doctor of Podiatric Steven M. Kaner, MD, Chair, Kings Medicine degree, as well as the many advocacy efforts put forth Sana L. Bloch, MD, Bronx by Podiatrists which are frequently aligned with that of organized Jerome C. Cohen, MD, Broome medicine, that Article II Section 1 of the Bylaws of the Medical Robert B. Goldberg, DO, New York Society of the State of New York, dealing with the different classes Robert A. Hesson, MD, Tompkins of membership, be amended as follows, by expanding the defini- William R. Latreille, Jr., MD, FACP, AME, Franklin tion of “Active Membership” to include Doctors of Podiatric Medicine Richard M. Peer, MD, Erie (additions underlined deletions lined through.) Arthur C. Fougner, MD, Ex-Officio, Secretary Kira A. Geraci-Ciardullo, MD, MPH, Ex-Officio, Speaker Article II, Section 1 Joseph R. Maldonado, Jr., MD, MSc, MBA, Ex-Officio, President The membership of the Medical Society of the State of New York Philip A. Schuh, CPA, Ex-Officio, Executive Vice President shall be divided into eight classes: (a) active, (b) life, (c) honorary, Donald R. Moy, Esq., General Counsel (d) resident and fellow, (e) student, (f) affiliate, (d) post-medical graduate, (h) retired. At the 2015 annual meeting of the House of Delegates Resolution Active membership shall be limited to (1) graduates of recog- 2015-1 was referred to the House of Committee on Bylaws. The nized medical or osteopathic schools who have completed not less House of Committee on Bylaws heard testimony from members of than four satisfactory years of at least eight months each, or the the House of Delegates and invited guests at the 2015 annual meet- equivalent, in a medical or osteopathic school in the United States ing, and your chair wishes to express his thanks to all the members of America or Canada registered as maintaining at the time a stan- and guests who provided testimony regarding the resolution. dard satisfactory to the medical school or osteopathic licensing Resolution 2015-1: Amend Bylaws to Include authorities of the State of New York, or in a medical or osteopathic Doctors of Podiatric Medicine school in a foreign country maintaining a standard not lower than Introduced by: The Suffolk County Medical Society that prescribed for medical schools in this State, (2), Doctors of Whereas, A 20-year membership trend conducted by the Medical Podiatric Medicine who have graduated from a recognized podiatric Society of the State of New York (MSSNY) has substantiated the school of medicine in the United States. unfortunate reality that membership in the state and county societ- And be it further ies has dramatically dropped, in many cases by well over 50%; and RESOLVED, That MSSNY component county medical societ- Whereas, The relatively few county societies that have seen an ies, modify their bylaws to reflect the above expansion of Active overall increase in membership have been where a hospital medical Membership, with the same rights and privileges as that of current staff institutional membership has been put in place; and members. Whereas, A career in podiatry begins in the same way as a medi- cal career, with a four-year undergraduate pre-medical degree; and The committee appreciates the intent of the sponsor of this reso- Whereas, After graduation, podiatric students typically take the lution. The relationship between the medical profession and other same exam, the Medical College Admission Test, or MCAT – that all health professions is one of mutual respect. It is recognized that medical students take; and the medical profession needs to work with the other health profes- Whereas, After successfully completing a pre-medical degree sions in order to promote the public welfare and improve the health and achieving a suitable score on the MCAT, aspiring podiatrists of the residents of the State of New York. The Committee urges move on to a four-year doctoral program in an accredited podiatric that MSSNY continue to seek ways to collaborate with other health college. Aside from its focus on the foot, coursework for a DPM pro- care professions when our interest are aligned, and where such col- gram is similar to that of any medical college and includes anatomy, laboration will enhance the delivery of quality health care to all the physiology and pharmacology, as well as sections on medical ethics people in the State of New York. and state laws governing the scope of podiatric practice, and Because the Mission, Vision and Purpose of MSSNY charges Whereas, Podiatric education also includes several clinical rota- MSSNY, among other core requirements, to promote the profes- tions, allowing students the opportunity to engage in hands-on sion of medicine; to represent the profession of medicine as a training; and whole through advocating health related rights, responsibilities and Whereas, Like medical doctors, newly graduated podiatrists issues, and to be the leading professional organization uniting all require further advanced training before they are ready to practice physicians (Article 1, MSSNY Bylaws), the committee recommends independently; and that Resolution 2015-1 not be adopted. Whereas, Podiatrists must serve a three-year residency in a hos- While the profession of podiatry is a recognized and respected pital setting, under the supervision of a resident director/staff; and profession, the profession of medicine and the profession of podia- Whereas, After completing an accredited residency, doctors of try are separate and distinct professions. The committee believes podiatric medicine must still pass a state-administered examination that providing for membership of other licensed professionals in to obtain a license to practice; and MSSNY is contrary to the Mission, Vision and Purpose of MSSNY Whereas, Podiatrists on staff at hospitals with institutional mem- and the component county medical societies, which is to organize bership initiatives are often aligned with MSSNY on many advocacy and represent the medical profession as a whole in the State of issues, i.e., I-STOP, e-prescribing, out-of-network, etc.; and New York. Whereas, Podiatrists at these institutions are already considered The Committee, accordingly, unanimously recommends that members of the healthcare team; and Resolution 2015-1 NOT BE ADOPTED. Whereas, The time has come when MSSNY and county societ- Your Chair wishes to thank the members of the House Committee ies finally acknowledge the qualifications and contributions made on Bylaws, the members of the House of Delegates who provided by podiatrists to the healthcare system, and allow them to join testimony and input, and the individuals who assisted in the prepa- with their medical colleagues as members of organized medicine, ration of this report, Ruzanna Arsenian, Eunice Skelly and Donald therefore be it Moy, Esq. RESOLVED, That in an effort to help increase membership in Respectfully submitted, the Medical Society of the State of New York and its component Steven Kaner, MD county medical societies, while also acknowledging the extensive Chair Page 16 • MSSNY’s News of New York • March 2016 March 2016 • MSSNY’s News of New York • Page 17