MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF NEW YORK Volume 70 • Number 4 • www.mssny.org HOD April 11-13 Providing Information to Assist Physicians in the State of New York April 2014 Legislature Developing One-House Budgets – Physicians Should Weigh In Now! Regarding your practice’s transition to ICD-10, how far along are you and your staff? We have not begun the transition We know we have to do it and are attempting to schedule training We have started training but have a way to go We have completed training and feel we are ready for the transition This is not a concern because my employer is handling the details My hospital is providing training which includes training for my office Don’t know A quick survey by MSSNY of physicians in New York State indicates that a total of two thirds of responders have not begun their transition to ICD-10 or are still attempting to line up training. With a hard deadline of October 1 for the switch, many physician practices are facing potential cash flow issues. MSSNY will be offering information on ICD-10 training programs in the coming weeks. Government Affairs Doctors Across New York Expansion Bill Moves In Senate S.2190-A (Young), a bill that would expand the Doctors Across New York program, which is currently for physicians only, to include dentists without increased funding, was reported to the Senate Finance Committee. The program, which has provided physicians to underserved areas of New York State since its inception in 2008, is already seriously underfunded and needs additional funding just to bring additional physicians to areas of New York State which desperately need them. By stretching the existing funding to include dentists, this bill would decrease the number of physicians who could be approved for loan repayment for a commitment to practice in an underserved area of New York State for five years, or practice support for agreeing to serve in an underserved area for two years. MSSNY strongly opposed this bill and has been working to have the funding for the program increased. In the latest funding cycle, only half of the qualified applicants were able to be accepted because of lack of funding. Physicians are urged to contact their senator to oppose this bill (Continued on page 11) Each house of the New York State Legislature is developing their one-house budgets to set the stage for negotiations of the budget for FY 201415, which will begin in earnest next week. There are many issues in the proposed budget which will impact upon physicians and their practices. Please assure that your representatives know your perspective on these issues. To send a letter to your representatives on any of these issues, please visit MSSNY’s Grass Roots Action Center on the MSSNY website at www.mssny.org. 1. Support Continuation of a Fully Funded Excess Medical Liability Program We are grateful that Governor Cuomo has proposed to continue the Excess Medical Liability Insurance Program and to fund it at its historical level of $127.4M.The Excess Medical Liability Insurance Program provides an additional layer of $1M of coverage to physicians with hospital privileges who maintain primary coverage at the $1.3 million/$3.9 million level. Until such time as meaningful liability reform is enacted, we must protect and continue the Excess program so as to assure that physicians can remain in practice in New York State. We urge that the Legislature include this funding and continue the Excess program in the final budget adopted for 2014-2015. 2. Support Measure to Assure Patient Access to Physician of Choice The proposed budget contains provisions similar to legislation (S. 2551 and A. 7813) sponsored respectively by Senator Hannon and Assemblymember Gottfried to provide greater transparency of a health insurer’s out-of-network coverage and to broaden availability of a patient’s right to go out of network if the insurer’s existing network is insufficient. These proposals also seek to assure that out-of-network benefits are more com- prehensive, transparent and accessible. We urge enactment of legislation which will assure that our patients have meaningful coverage of and access to out-of-network care. We are also urging changes to the governor’s proposal to assure that insurers do not force physicians to go through burdensome procedures in order to be paid fairly for providing needed emergency care and other critical hospital care. 3. Prevent the Imposition of Burdensome and Unnecessary Regulations on Private Physician Urgent Care and Office Based Surgical Practices The proposed budget would define and regulate urgent care practices and would require that they comply with costly and burdensome accreditation requirements. The proposed budget also seeks to impose considerable reporting requirements concerning findings of surveys or complaint investigations conducted by accrediting agencies at the behest of the Department of Health of office based surgical practices without protecting against the release of physician identifiable information to the public. We urge the defeat of burdensome and unnecessary regulations and reporting requirements on urgent care and office based surgical physician practices. 4. Reject Proposal to Allow Corporately Owned Retail Clinics in NYS The limited service retail clinic model raises a number of concerns, including the potential conflict of interest posed by pharmacy chain ownership of retail clinics which provides implicit incentives for the nurse practitioner in these settings to write more prescriptions or recommend greater use of over-the-counter products than would otherwise occur. Urge your legislators to reject the retail clinic initiative. (Continued on page 9) MLMIC Announces 5% Dividend I am pleased to report that our endorsed carrier, Medical Liability Mutual Insurance Company (MLMIC), has declared another policyholder dividend for 2014. The dividend is 5% this year, and will be applied on July 1 to all physicians who are policyholders on May 1 and maintain continuous coverage through July 1. This is the second consecutive dividend MLMIC has declared (3% last year), and one of several it has declared in its nearly 40 year history. Most other medical liability insurers operating in NYS lack the financial strength or the policyholder-first mission to declare such dividends. MLMIC puts your needs first, giving you the service and protection you deserve. It’s at-cost, long-term focus ensures that you won’t overpay for quality protection, or worry about the company being there when you need them. And, their unparalleled claims and risk management expertise provide superior protection, with high success rates and very satisfied policyholders. This is why MSSNY has exclusively endorsed MLMIC as the medical liability insurer for its members. For more information on MLMIC, including how to become a policyholder in time to qualify for the 2014 dividend, please visit www.mlmic.com or call your nearest MLMIC underwriting office: New York City (800-275-6564); Long Island (877-777-3560); Latham (800-635-0666); or Syracuse (800-356-4056). Sam Unterricht, MD Liz Dears, MSSNY Senior Vice President, Legislative and Regulatory Affairs, welcomes participants to Lobby Day on March 11. Seated are MSSNY President Sam Unterricht, MD (left), and Paul Pipia, MD (right) Inside News ICD-10 FAQs����������������page 2 HOD Resolutions������page 3 Lobby Day Photos�������������page 8 Council Notes���������������page 9 eMedNY ICD-10 FAQ General 1. Where can I find information about ICD -10? Visit the CMS ICD-10 web site www.cms.gov/icd10 for the latest news and resources. Providers may also wish to sign up for CMS ICD-10 Industry Email Updates. 2. What is the compliance deadline for ICD-10? The ICD-10 deadline is October 1, 2014. For services provided on or after October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. eMedNY is on track to meet the deadline, and we expect providers and vendors to be on track as well. 3. What if I do not switch to ICD-10 or the ICD-10 codes submitted are invalid? Electronic claims including ePACES, without ICD-10 coding or that have invalid ICD-10 diagnosis and inpatient procedure codes for dates of service on or after October 1, 2014, will be rejected with a pre-adjudication edit. Paper claims with the same errors will be denied. 4. Will the eMedNY Call Center assist with ICD-10 coding? It is the provider’s responsibility to transition and train their staff on ICD-10 coding. The eMedNY Call Center will assist callers with rejected or denied claims, due to coding issues. However, the Call Center will be unable to check ICD-10 codes to determine validity prior to submitting claims. 5. Can submitters transition to ICD- 10 earlier than October 1, 2014? Page 2 • MSSNY’s News of New York • April 2014 No. The ICD-10 code sets are effective for dates of service on or after October 1, 2014. ICD-10 cannot be used on claims with a date of service or end date of service/discharge date prior to October 1, 2014. 6. Will submitters use both ICD-9 and ICD-10 codes during the transition? All systems must be able to accommodate both ICD-9 and ICD-10 codes for all claims. ICD-9 coding is used for claims with dates of servicer prior to October 1, 2014 and ICD-10 for claims with dates of service on or after October 1, 2014. 7. Can ICD-9 and ICD-10 be sent on the same claim? No. Claims must be submitted according to the guidelines in this FAQ. Claims containing both ICD-9 and ICD-10, where the Primary Diagnosis, based on Service Date, is not found in the ICD diagnosis group will edit 00146. Claims containing both ICD-9 and ICD-10, where the Secondary Diagnosis, based on Service Date, is not found in the ICD diagnosis group will edit 00148. Claims with procedure codes containing both ICD-9 and ICD-10 codes will edit 02087. 8. Are there any changes to the 5010 format for the ICD-10? Yes. The ICD-10 value is entered in the same loop and segment as the ICD-9; however the code is identified as ICD-10 using a different qualifier than has been used for ICD-9. The decimal continues to be implied for ICD-10 as it is in ICD-9 coding. The qualifiers for ICD-10 are listed below. 9. Does eMedNY have any kind of conversion crosswalk? QualifierDescription ABK International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis ABFInternational Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis ABJInternational Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis APRInternational Classification of Diseases Clinical Modification (ICD-10-CM) Patient’s Reason for Visit ABNInternational Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code BBR International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Procedure Codes BBQInternational Classification of Diseases Clinical Modification (ICD-10-CM) Other Procedure Codes eMedNY does not publish ICD-9, and will not publish ICD10. NY Medicaid will not crosswalk ICD codes. There is ICD conversion information on the CMS website: www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10 Billing 10. What if a claim spans the date of service of October 1, 2014? a. Institutional Claims If the claim is for Clinic APG Episode of Care or CHHA Episodic services with multiple dates of service where the through date is on or after October 1, 2014, the claim must be coded as ICD-10 for all dates of service - even if the episode started before October 1, 2014. For other types of Rate Based Institutional claims that do not bill using from and through dates of service, providers must split their claims to separate ICD-9 claims (prior to October 1, 2014) from ICD-10 claims (on or after October 1, 2014). For those Institutional providers who bill the first of the month subsequent to when the service was rendered - the coding used is determined by the date of service as it appears on the claim. Therefore, services rendered in September 2014 that are billed as date of service October 1, 2014 must use the ICD-10 code set. b. Professional Claims Professional claims must be split to separate ICD-9 claims (date of service prior to October 1, 2014) from ICD-10 claims (date of service on or after October 1, 2014). All paper claim forms must conform to the same instructions set forth for electronic claims. 11. How should a DRG Inpatient claim be coded if the admission is prior to October 1, 2014 but the patient is discharged on or after October 1, 2014? DRG Inpatient claims which are rate codes 2946/2953 and GME 3130, should be coded according to the discharge date. If the discharge date is on or after October 1, 2014, the diagnosis and procedure codes must be ICD-10 regardless of the date of admission. 12. How should non-DRG Inpatient claims (ALC, Detox, etc.) be coded? If the non DRG claim will be interim billed with no discharge date and the end date of service is on or after October 1, 2014, the coding must be ICD-10. NOTE: This could result in a DRG claim coded as ICD-10 when the discharge date is on or after October 1, 2014 while the ALC portion of the stay is coded as ICD-9 because the ALC occurred prior to October 1, 2014. 13. How should an Inpatient claim for Psychiatric services (rate code 2852) be coded? An Inpatient claim for Psychiatric services should be coded according to the discharge date. If the discharge date is on or after October 1, 2014, the diagnosis and procedure codes must be ICD-10 regardless of the date of admission. If the claim is to be interim billed and does not have a discharge date, then the coding is dependent on the end date of service. NOTE: When adding interim periods, if the original claim is coded as ICD-9 and the interim period to be added has an end date of service on or after October 1, 2014, then the adjusted claim with the added interim period will be coded as ICD-10. 14. Do pharmacy providers billing via NCPDP D.0 need to notify their software vendors to make any changes for ICD-10 Diagnosis codes? Yes, the Diagnosis Code qualifier field will need to allow for the qualifier for either an ICD-9 or ICD-10 Diagnosis code to be reported according to the Date of Service. Trading Partners should refer to the NCPDP D.0 Companion Guide for further guidance. 2014 Medical Society of the State of New York Annual House of Delegates Resolutions Availability Of Self-Injectable Epinephrine Devices In New York State Schools In an effort to prevent deaths from children and adults having a severe allergic reaction in a school setting, MSSNY will work to support and develop legislation that requires all schools, both private and public to stock auto-injectable epinephrine devices in standardized dosage formulations and to train personnel for administration of this medication. The auto-injectable epinephrine devices will be used on children or adults that have a severe allergic reaction, regardless of whether there is a patient specific prescription. The treating individual will be covered by the New York State “Good Samaritan” Statutes as regards to legal liability. OPMC Inform Physicians Of Unintended Consequences Physicians need to be made aware that an Office of Professional Medical Conduct (OPMC) investigation may result in an “OPMC order” of conditions or restrictions on a physician’s license to practice medicine. The New York State Office of Medicaid Inspector General (MIG) has the ability to exclude a physician from Medicaid participation, and possibly Medicare, Tri-Care and Veteran affairs as well as nongovernmental programs on the basis of an OPMC licensure order. An OPMC licensure restriction may affect a physician’s ability to obtain medical malpractice coverage and may well make the physician unemployable. MSSNY will seek regulation to require that the Office of Professional Medical Conduct (OPMC) inform physicians regarding potential practice-altering consequences, intended or unintended, that may result from an OPMC order. Retirement Of A Physician Medical License There is currently no way for New York state physicians to “retire” their medical license with the dignity and respect they have earned. A retiring physician may only “give up” his/her license by temporary or permanent surrender. MSSNY will seek legislation to provide for the nondisciplinary retirement of a physician license. MSSNY To Partner With The “ Choosing Wisely” Program Choosing Wisely (www.choosingwisely.org) is an initiative of the American Board of Internal Medicine Foundation (ABIM) that promotes conversations between patients and physicians about unnecessary medical tests. MSSNY wishes to encourage all physicians to practice medicine in a responsible manner using available scientific evidence to determine best practices. The New York delegation to the American Medical Association will encourage the AMA to also sign on as a partner with the ABIM’s Choosing Wisely program. Medical Malpractice Insurance Education For Employed Physicians As the number of employed physicians increase, so does the need for education on physicians having adequate medical malpractice insurance. MSSNY, in collaboration with the Medical Liability Mutual Insurance Company and the State Insurance Department will seek to develop a program for employed physicians to inform them about the importance of adequate malpractice insurance coverage. Meeting Management Education For Physician Leaders MSSNY will develop a meeting management program for physician leaders at all levels so that they have the ability to run meetings efficiently. MSSNY will encourage all new appointed/elected leaders to participate in meeting management training. MSSNY Committee Structure MSSNY needs to find areas of savings to pass on to members and eliminate multiple and duplicated committees. MSSNY will analyze its committee structure with an intention to eliminate any committee not felt to be contributing directly to MSSNY’s mission and to combine committees wherever possible. SHIN-NY Connectivity The State Health Information Network-New York (SHIN-NY) is the vehicle developed by the state to be the vehicle of connectivity for all the health information networks in the state. At this time, only a few Electronic Medical Records (EMR) vendors are capable of meeting the SHIN-NY standards for connectivity. NYS physicians have already made a significant commitment to purchase and use EMRs to comply with existing Federal and organizational mandates. EMR vendors will want to charge NY physicians for the development of new services so that they can connect to SHIN-NY. MSSNY will work with the New York eHealth Collaborative and the SHIN-NY to make sure that physicians do not have to pay any of the costs associated with connecting to, accessing or downloading data from the SHIN-NY network. Encourage Use Of NYS Record Release Form Medical practices frequently request patient medical records from other medical practices. MSSNY recommends to physicians that their office staffs utilize the New York State Authorization for Release of Health Information Pursuant to HIPAA form (OCA Office Form No. 960). Patient Consent For Uploading Patient Records To The SHIN-NY And Rhios In order to protect a patient’s electronic medical records, MSSNY will seek legislation that requires patient consent for uploading patient records to Regional Health Information Organizations (RHIOs) and the Statewide Health Information Network of New York (SHIN-NY). MSSNY will also seek legislation to tighten access to patient records so as to restrict access without patient consent, only when the patient is not in a conscious or rational state of mind or their legal representative is unable to provide consent and the healthcare provider documents the life-threatening reason for having to access the patient record. Correct Record Access The State of New York should promote patient record access in accordance with patient/custodial rights and healthcare efficiency through paper records, digital copies, patient portals, Surescripts Direct, and/or SHIN-NY; and that the cost of such record access be borne by the payor of the healthcare at rates sufficient to cover the costs of the technology, employees and office overhead used to provide the record access. Regulation Of Marijuana Sale And Use In New York State Due to the addictive nature of marijuana, and the selling and marketing of addictive drugs to children, MSSNY resolves that the sale of marijuana only be transacted by the State of New York at State Addictive Drug Centers (SAD Centers); that it only be sold at SAD Centers by drug counselors; that buying marijuana require a SAD license, issued only to those over 18 years of age that have completed a four hour course on the effects of marijuana and have participated in a one hour motivational interview conducted by a drug counselor. NYS law should be changed so that the only infraction regarding marijuana that is punishable by law is to make marijuana available to an unlicensed user or to sell it outside of a SAD Center. De-Couple No Fault Fee Schedule New York State No-Fault rates represent some of the lowest reimbursement rates in the US. This is due to the fact that the No-Fault rates are based on the Workers Compensation fee schedules. No-Fault insurance is a commercial insurance product and there is no justification in tying the No-Fault fee schedule to the Workers Compensation fee schedule. By doing this, physicians are prevented from negotiation with commercial carriers for their usual and customary rates. MSSNY will seek legislation to be introduced and signed into law in New York State to decouple the No-Fault fee schedule from the Workers Compensation fee schedule in order to allow NYS physicians caring for No-Fault recipients to be paid their usual and customary rates by insurance carriers. Affordable Care Act And NYS Medical Tort Reform The new health care exchanges are now covering people previously uninsured/underinsured. Due to the practice of defensive medicine, the cost of health care will increase, while physicians are reimbursed at lower rates under the new healthcare exchanges. Comprehensive tort reform in New York State (NYS) is needed to reduce excessive malpractice rates and improve access to care in NYS. Comprehensive tort reform will reduce the practice of defensive medicine and offset the lower payments physicians will receive through the exchange insurance policies. Support Of Athletic Trainer Legislation Athletic Trainers (ATs) are often the only medical personnel on sight to provide emergency first aid in schools and athletic facilities. MSSNY supports legislation requiring ATs to obtain mandatory CME acquisition and update their medical competencies commensurate with their skill and training, all while under the supervision of physicians. Use Of CT Scans For Early Detection Of Lung Cancer The United States Preventive Services Task Force (USPSTF) has determined that there is a high certainty that the net benefit of annual low-dose CT screening for individuals at high risk for lung cancer-current/former smokers aged 55-79 years, who have significant cumulative tobacco smoke exposure and have smoked within the last 15 years would be effective in detecting early lung cancer. MSSNY will support the USPSTF Grade B recommendation to offer low dose helical CT screening for lung cancer to patients between 55 and 80 years old who have a 30 pack per year smoking history and currently smoke or have quit smoking within the past 15 years. DVT And Air Travel Deep vein thrombosis (DVT) is a serious medical condition that is associated with long distance air travel. Many passengers, unbeknownst to themselves, may be at risk for developing DVT while flying. MSSNY will request that the American Medical Association (AMA) encourage the Federal Aviation Administration (FAA) and the airline industry alert passengers to the flight associated risk of deep vein thrombosis (DVT). MSSNY will also request that the AMA work with the FAA and the airline industry to provide recommendations to passengers to reduce their risk of developing DVT. Internet Review Of Physicians Currently, patients are able to post physician reviews on websites anonymously. This anonymity makes it possible for abuse of reviews by people who may not even be a patient. Even one negative review can have a profound negative impact on a physician’s reputation and practice. MSSNY asks that the American Medical Association seek legislation and /or regulation that would require websites that host reviews of physicians to obtain the name of the person posting the review, that this information will be kept on file, and the website inform the poster that a physician requesting this information from the website in regard to a review must be provided with the name of the person writing the review. Medical Licensing Medical licensing has been under the control of the New York State Department of Education since 1843. Assuming the roles of physician credentialing and discipline should once again be handled by the Medical Society of the State of New York (MSSNY), as it had been from the time of the inception of the county and state medical societies. This would increase the unity and purpose of MSSNY and would positively promote membership in our society. MSSNY, by any and all means should endeavor to resume the function of physician licensing registration and discipline in New York State. Protection For Licensed Physicians Not Participating In Government Healthcare Plans MSSNY should reaffirm Policies 2012-60, 2013-53 and 2013-54. These policies will protect the rights of New York State physicians who are not participating in government healthcare plans as well as ban discriminatory increases in their license taxes, fees, supplements, investments, increments etc. as well as protect licensed, non-practicing and privately practicing physicians from governmental regulations aimed at infringing upon their full rights of medical licensure. Restriction Of Certifying Boards The NY State Department of Health and the Accreditation Council for Graduate Medical Education (ACGME) have a vigorous licensing process in place for physicians. Specialty Board Certification and MOC (Maintenance of Certification) by a medical specialty board is voluntary. MSSNY should take action against payors and hospitals attempting to limit their physician panels based on specialty board certification. MSSNY should urge the credentialing committees of payors and hospitals to use specialty board recommendations on practice limitations as no more than a suggestion or reference, as opposed to guidelines or policy. MSSNY should also take action to oppose any measure that would require state licensure to be in any way based on specialty board certification. MSSNY should also take action to oppose any attempt by a specialty board or payor to restrict the practice and or reimbursements of any physician based on specialty board certification. MSSNY Single-Payer Healthcare Survey The state of healthcare insurance is changing rapidly in New York State as well as in the United States overall. In an effort to gage the support/opposition of its members, MSSNY should design and conduct an objective poll of the collective opinion of the MSSNY members ascertaining both their knowledge of the single payer health care system and their support/opposition of such a system in the State of New York. e-Cigarettes To Be Treated The Same As Tobacco Products e-Cigarettes are marketed as a safe and healthy alternative to smoking. However, the FDA states that e-cigarettes may contain ingredients that are known to be toxic and unsafe. There is also the concern that young adults could become addicted to e-cigarettes, thus opening the door to tobacco addiction. There is much still unknown about the longterm health risks of e-cigarettes. MSSNY should urge that e-cigarettes be treated the same as tobacco products, that the State Health Department, or other appropriate entities, conduct research into the possible risks associated with the use of e-cigarettes on a long-term basis, that there be strict quality control/ oversight as to the actual ingredients, i.e., nicotine, by products, etc., which are being inhaled an that these ingredients be printed on each e-cigarette package and that appropriate warning labels be included. Amendment To OPMC Reporting Requirement Associated With Physician Profile Updates The New York State Physician Profile website (www.nydoctorprofile. com) was created after former Governor George Pataki signed the New York Patient Health Information and Quality Improvement Act of 200 to make it possible for all citizens of New York to obtain information about physicians. Physicians are required to update their New York State Physician Profile within 6 months prior to the expiration date of the physician’s registration period. Failure to do so could result in a referral to the Office of Professional Medical Conduct (OPMC). MSSNY will seek legislation/regulation to allow a 60-days grace period for physicians to comply after receiving a warning letter. If a physician still does not comply after the 60 days grace period, then and only then should it be considered a reportable event. MSSNY, county and specialty societies should immediately begin to notify their members about the importance and urgency of updating their profiles in a timely manner. When a physician registers online to renew his/her license, there be a notification with a direct link to www.nydoctorprofile.com which must be completed prior to submission of the registration renewal. For those physicians who register via paper, a copy of their updated profile must be included and sent together with the registration renewal. Raising The Legal Age To Purchase Cigarettes, Cigars And Electronic Cigarettes To Age 21 In New York State On November 19, New York City Mayor Michael Bloomberg singed legislation banning the sale of tobacco products to anyone under the age of 21 in New York City. Suffolk County Medical Society President and Suffolk County Legislator William Spencer, MD has introduced a bill in (Continued on page 5) April 2014 • MSSNY’s News of New York • Page 3 MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF NEW YORK Medical Society of the State of New York Sam Unterricht, MD President Ted Tanner, MD Chairman of the Board Robert B. Goldberg, DO Vice-Chairman of the Board Philip A. Schuh, CPA Executive Vice President COMMUNICATIONS AND PUBLICATIONS COMMISSION Art Fougner, MD, Commissioner Kira Geraci-Ciardullo, MD, Assistant Commissioner Paul A. Hamlin, MD Leah McCormack, MD News of New York Published by Medical Society of the State of New York Vice President, Communications and Editor Christina Cronin Southard, Editor csouthard@mssny.org News of New York Staff Julie Vecchione DeSimone, Assistant Editor jvecchione@mssny.org Janice Morano, Marketing Relations jmorano@mssny.org Steven Sachs, Web Administrator ssachs@mssny.org Susan Herbst, Page Designer News of New York Advertising Representatives For general advertising information contact Christina Cronin Southard Phone 516-488-6100 ext 355 csouthard@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 publication is available from the Communications Division, Medical Society of the State of New York, 865 Merrick Avenue, P.O. Box 9007, Westbury, NY 11590. The acceptance of a product, service or company as an advertiser or as a membership benefit of the Medical Society of the State of New York does not imply endorsement and/or approval of this product, service or company by the Medical Society of the State of New York. The Member Benefits Committee urges all our physician members to exercise good judgment when purchasing any product or service. Although MSSNY makes efforts to avoid clerical or printing mistakes, errors may occur. In no event shall any liability of MSSNY for clerical or printing mistakes exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement in error if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the error. Liability of MSSNY to the advertiser for the failure to publish or omission of all or any portion of any advertisement shall in no event exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement omitted if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the omission. MSSNY shall not be liable for any special, indirect or inconsequential damages, including lost profits, whether or not foreseeable, that may occur because of an error in any advertisement, or any omission of a part or the whole of any advertisement. MEDICAL SOCIETY OF THE STATE OF NEW YORK AT YOUR SERVICE MSSNY’S WESTBURY OFFICE Main Phone Number......................................516-488-6100 Toll Free Number...........................................800-523-4405 Main Fax Number..........................................516-488-1267 MSSNY Website......................................... www.mssny.org Extensions for specific services Alliance.. ........................................................................396 Communications............................................................ 351 Computer Information Systems..................................... 361 Member Benefits/Marketing.......................................... 424 Membership Information............................................... 336 Medical, Educational & Scientific Foundation.............. 350 Office of the Executive Vice President.......................... 397 Ombudsman Claims Assistance..................................... 318 Physician Records/Credentials....................................... 367 Socio-Medical Economics............................................. 332 albany office Continuing Medical Education...........518-465-8085 ext.17 Public Health Committees.................518-465-8085 ext. 11 Governmental Affairs.....................................518-465-8085 Fax..................................................................518-465-0976 Other Numbers Committee for Physicians’ Health.................800-338-1833 Dispute Resolution Agency............................516-437-8134 Kern, Augustine, Conroy & Schoppman.......516-294-5432 Page 4 • MSSNY’s News of New York • April 2014 PRESIDENT’S COLUMN It Has Been A Very Good Year This year as MSSNY President has been one of the most challenging since I graduated from medical school. I was forced to learn new things, expand my knowledge on issues I thought I knew a lot about and change my point of view on several controversial topics, as I Dr. Sam Unterricht developed a wider scope of information. As a dyed-in-the-wool New Yorker, I thought I knew a lot about the state. Now that I have actually visited every sector, I can echo the spirit of that 1990’s ad campaign – I Love New York. This year has been both the best and worst of times. Being the head of such an august organization while the field of medicine has been turned on its head due to the confluence of historic health care legislation and a “perfect storm” of socioeconomic forces, has been most exciting yet perplexing. Because of the high regard in which MSSNY is held, I have been afforded tremendous respect, but have also seen the low tactics that our enemies employ. The ACA , despite all the delays and controversies, continues to ooze forward, like “The Blob,” a disgusting, ever-changing monster from some C grade horror movie. One of the few positives of the ACA is that MSSNY has received much press exposure, but the horrors of the ACA continue to unfold, guaranteeing interviews for years to come. The media attention that has been given to the physician disenrollment and patient disenfranchisement, particularly in the downstate area, finally shined a spotlight onto a serious problem for physicians and patients alike. This scandal, for once, clearly demonstrated that carriers not only bullied us, but also our beloved patients. Finally, our plight was exposed in every medium and in the courts – and many physicians were reinstated. Oh, what a sweet victory! Even as we recoil from the ACA, we are reminded of the nine-headed “Hydra” that lurks ever-present, waiting for us to slay, like Hercules: 1. Fair physician payment so that Medicare and Exchange patients have access to quality and timely health care by the most qualified physicians in adequate networks 2. Adapting to ICD-10 3. Making sense of ACAs, IPOs, risk-sharing and new practice models 4. Achieving meaningful medical liability reform 5. Protecting our patients from scope of practice threats 6. Controlling ever-mounting, unfunded mandates and legal pitfalls 7. Fighting for Collective Negotiation 8. Protecting a transparent, useful out-of-network option 9. Fighting the MOC and MOL machine that is sapping our strength and resources Where is Hercules When You Need Him? In November, MSSNY conducted a survey with over 800 physicians responding. Over one-third of the respondents indicated that they were “seriously considering” retiring from practice over the next two years; over 37% indicated that they plan to reduce the services they deliver over the next two years; and, over 16% indicated that they were “strongly considering“ leaving the state in the next two years. You are Hercules! You are Iolaus, without whose help Hercules could not have defeated the Hydra. You are the key component in medicine. You command the respect of your patients and legislators. You are becoming angrier and more militant every day. Don’t retire; don’t slow down; and definitely, do not leave New York. We have just begun to fight, and, increasingly, win. We need you now more than ever. My best wishes to Dr. Andrew Kleinman as our new president. He is a warrior and a leader of warriors. I wish him the same exhilarating experience I enjoyed so thoroughly, but may Dr. Kleinman’s year and yours be a bit less “interesting” than this last one. myssny paC Lobby Day and the Importance of Political Action The Medical Society conducted its Physician’s Capitol Forum on the evening of March 10 and its Lobby Day briefing and visits on March 11. Countless numbers of physicians, alliance members and staff from across the state representing every major specialty participated in each event. Hundreds more watched our Capitol Forum webcast from their offices and home computers. Many more are able to view the program by visiting MSSNY’s website at www.mssny.org. If you haven’t yet done so, you should view the program. MSSNY and its members are well-known to regulators and legislative leaders who participate in forums we sponsor because of the thoughtful feedback they receive from the organized medical community. This year we were fortunate to have Donna Frescatore, Executive Director of New York’s Health Benefit Exchange and Troy Oechsner, Deputy Superintendent for Health to discuss issues related to the implementation of the Exchange and the policies associated with the ACA. MSSNY, through its President, President-Elect, Vice-President and governmental affairs staff have been engaged in regular discussion with Ms. Frescatore and her staff concerning issues related to the: federally required 90 day grace period; unreliability of physician participation information on plan sites and resulting questions regarding network adequacy; and the difficulties presented to physician offices by newly insured patients who either haven’t yet received their plan identification card or have a card with incomplete information on it so that the physician office is unsure of which plan the patient is enrolled with and the plan coinsurance requirements. Because of MSSNY’s involvement, it was recently announced that the Exchange is proposing to change its policies to require that plans update their physician participation information monthly and offer access to products which provide coverage for out of network services, despite strong opposition by the health insurance industry. Also at the Capitol Forum was a panel comprised of legislative leaders in the health and insurance arenas including Senator Kemp Hannon, chair of the Senate Health Committee, Richard Gottfried, chair of the Assembly Health Committee and Assemblyman Kevin Cahill, chair of the Assembly Insurance Committee. Each of these presenters provided a thumbnail sketch of the direction they were taking on notable issues including out of network transparency and coverage; enabling corporate-owned retail clinics; regulation of urgent care and OBS practices and other issues of importance to all of organized medicine. The debate was lively and provocative, often eliciting opposing points of view from each of the speakers. Again, you should really watch the recording when you get the chance. I am sure that you are thinking that this sounds very interesting but “How does a Capitol Forum relate to Political Action”? Political action is but one component to a three legged stool which includes knowledgeable lobbyists, effective grassroots and a political action campaign all of which help to assure that physicians have a seat at the table as critically important health care policy is being developed. Your help is desperately needed to assure that we continue to have the ability to educate our elected representatives on the importance of our many issues with a view toward securing our objectives in the future. The NEWS of NEW YORK ISSN 0028-9264, Periodical POSTAGE PAID at Westbury and other additional mailing offices. The NEWS of NEW YORK is published monthly by the Communications Division, Medical Society of the State of New York, 865 Merrick Avenue, Westbury, NY 11590. Please address all correspondence to the Editor. POSTMASTER: Please forward all change of address forms to the Editor, NEWS of NEW YORK, Medical Society of the State of New York, 865 Merrick Avenue, Westbury, NY 11590. Subscription, $36.00 non-members, $18.00 members. 2014 Medical Society of the State of New York Annual House of Delegates Resolutions (Continued from page 3) Suffolk County seeking to raise the legal age to purchase cigarettes from 19 to 21. MSSNY should seek similar legislation/regulation for the State of New York, and a similar resolution should be forwarded to the American Medical Association (AMA) for consideration at its annual 2014 meeting for implementation on a national level. American Board Of Medical Specialties Should Adhere To Its Mission The American Board of Obstetrics & Gynecology, issued a statement that gynecologists should not be allowed to treat men and that if they did, they could potentially lose their certification. The statement was issued in order to protect patients from doctors who may have begun to practice types of medicine for which they were neither appropriately trained for nor certified in. MSSNY seeks to adopt as its policy that any American Board of Medical Specialties (ABMS) Specialty Board should not attempt to define or to constrain a physician’s professional activity beyond that which the board may certify. MSSNY should submit a resolution to the annual meeting of the AMA urging that the ABMS notify all of its member organizations that they should adhere to their mission as a credentialing body, establishing educational and evaluation standards for certification in a particular specialty and that scope of practice issues are not within their purview. Maintenance Of Licensure (MOL) The rationale for Maintenance of Licensure (MOL) is that the medical profession is facing increasing demand from the public and health policy makers for greater accountability and transparency. Although, MOL is several years away from completion, MSSNY shall oppose any MOL initiative that creates barriers to practice, is administratively unfeasible, is inflexible with regard to how physicians practice, that does not protect physician privacy, and is used to promote policy initiatives (rather than competence) such as participation in health plans, subscription to data exchanges and specially board certifications. MSSNY shall submit the above resolution to the American Medical Association (AMA) at its annual meeting. Collapse Of Workers’ Compensation And No Fault Benefits Into Regular Insurance Under the Affordable Care Act (ACA) most individuals are required to be covered by health insurance. Workers Compensation Insurance and Motor Vehicle No-Fault insurance should be collapsed and combined into an individual’s health insurance to prevent a redundancy of coverage. MSSNY should seek legislation and regulation to collapse or combine Workers’ Compensation health benefits into an individual’s ordinary coverage, without cost share to the injured worker; and to collapse or combine Motor Vehicle No-Fault health benefits into an individuals ordinary coverage without cost share to the individual and that MSSNY bring a resolution to the annual meeting of the American Medical Association to seek federal legislation and regulation on the above resolution. Physician Liability And Patient Protection Under The False Claims Act MSSNY should support legislation and regulation to limit physician liability under the False Claims Act specifically to those instances where the practitioner presented or caused another person to have presented a claim for payment to the federal government; the claim must have been proven to be false or fraudulent and the practitioner knew of the claim and that the claim was false or fraudulent. MSSNY should also support legislation and/or regulation that would compensate patients, utilizing the proceeds of False Claims Act settlements, for the adverse economic and/or health impact of any unnecessary, and/or inappropriate treatment that may have resulted in the settlement. MSSNY should submit a resolution to the AMA to support legislation and regulation on the above resolution. Affordable Care The ACA has ushered in an era of health plans with narrow networks and high deductibles that may need to be met before benefit dollars apply. MSSNY should advocate for regulation and legislation to provide that insurers give reasonable credit for out of network expenses toward a participants annual deductibles and out of pocket maximums and that MSSNY submit a resolution to the annual meeting of the American Medical Association on the above resolution. Increasing Medical Student And Physician Interactions MSSNY has previously worked with medical schools to promote community physicians as mentors. The participation of medical students in county medical societies would expose them to more specialties. MSSNY encourages all county medical societies with medical students training in that county to have a medical student representative on their boards of directors and that they work with their medical student members to create outreach programs. Availability Of Treatment Slots For Substance Abusers Since the Rockefeller Laws have been repealed, the influx of drug crime courts mandates to overflow available substance abuse treatment slots. Because of this, MSSNY should urge the NYS DOH to commission a study analyzing the projected slots needed from drug crime sentencing to ensure the system will be equipped to handle the increased volume. If there is a shortage of treatment slots projected, MSSNY will lobby to increase the number of slots available to meet the need. Support Of The MSSNY/ Dr. Duane And Joyce Cady Honor Fund The MSSNY/ Dr. Duane and Joyce Cady Honor Fund has been established to benefit medical students in NY State and to educate future physicians. Because of this, a voluntary donation of ten dollars will be added to the MSSNY/Dr. Duane and Joyce Cady Honor Fund in 2015 and future MSSNY dues bills. Proposal And Plan For Developing And Maintaining High Quality Healthcare For Our Older Patients In The New Millennium Because older Americans are now living longer, they are accumulating more diseases and disabilities. At the same time, the number of geriatricians in the United States is anticipated to drop to one geriatrician for every 3,798 Americans over the age of 75 by 2030. Due to this phenomenon, MSSNY will work with the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine to petition the American Board of Medical Specialties, to definitely re-open the boards for physicians with high quality training experience and additional education without fellowship to sit for the boards in geriatrics. Maintaining And Developing High Quality Hospice And Palliative Care Physician Workforce In The New Millennium The Palliative care and Hospice service has improved for patients with issues such as pain and depression. It has also improved patient and family satisfaction while reducing costs in Medicare and hospitals and prolonging life. There is still a need for an estimated 4,487 hospice and 10,810 palliative care physicians to staff the current number of Hospice and hospital-based palliative care programs at appropriate levels. MSSNY has worked with the American Medical Association, along with many other agencies to re-open the boards for physicians with high quality training experience and additional education without fellow to sit for the boards in hospice and palliative care. Raising The Purchase Age Of All Tobacco Products In New York State Ninety percent of chronic smokers began their addiction to nicotine as a teenager or younger and the e-cigarette can also initiate or perpetuate that addiction. Since these companies are marketing their products to youth, MSSNY should seek legislation to raise the purchase age in New York State to 21 years for all tobacco products as well as e-cigarettes and other unregulated nicotine delivery devices. Driving While Intoxicated, Impaired Or Distracted By All Substances The NY Public Health Law 3306 has created a loophole that allows drivers who are stopped under the influence of drugs or intoxicants not listed under a select list of substances to be charged with a lesser crime then legal punishments that are given out for driving while intoxicated or impaired. Since persons impaired or intoxicated by any drug should not drive a motor vehicle and such drivers pose a risk to the public health, MSSNY should work to clarify the legal definition of driving while intoxicated or impaired and supports programs that educate the public on the dangers of driving while intoxicated, impaired or distracted. Exclusion Of Physicians From The New York State Health Benefit Exchanges Many sick and infirm patients are losing long-standing relationships with their physicians in situations where the physician is needed for their case. The Patient Protection and Affordable Care Act of 2010 provides for state-based Health Benefit Exchanges designed to help residents purchase affordable health insurance coverage, but has been limited by certain New York health insurers whose provider networks exclude a large number of physicians. This jeopardizes patients’ ongoing needed treatment and places these patients in dire straits. Because of this situation MSSNY has petitioned the Governor’s Office to monitor all termination or exclusion actions that New York insurers take in with Health Benefit Exchange plans set up under the Patient Protection and Affordable Health Care Act. MSSNY has also started a public relations campaign to highlight these exclusionary activities. Medicare Advantage Terminations Due To The Affordable Healthcare Act (ACA) Many private/managed care insurers who administer Medicare Advantage plans for the federal government have terminated large numbers of physicians who have been participating in their Medicare Advantage plans under the Patient Protection and Affordable Health Care Act of 2010. Due to ongoing deficits in the federal budget, insurers are likely to continue to terminate more physicians, which may cause elderly, frail and sick patients to lose long-standing relations with their physicians. While patients have had the option of switching back to traditional fee-for-service Medicare, that option would require them to pay for drug coverage and a secondary plan. These exclusionary actions and resulting matters have led MSSNY to urge the Centers for Medicare and Medicaid Services (CMS) to prevent the insurers with which CMS has contracted for Medicare Advantage plans from terminating physicians from those plans. MSSNY has also urged CMS to set up a system to monitor determination of the adequacy of individual Medicare Advantage Plan networks and for them to complete any significant narrowing of their Medicare Advantage networks by at least six months before any open enrollment period begins. Easy Choice Health Plans Payment Issues Easy Choice Health Plans is a Medicare Advantage insurer that also is a purveyor of commercial HMO products that operate in New York State. It was placed in a form of “receivership” under the New York State Department of Financial Services (NYSDFS) for an interim period, in which the task of administering unpaid claims and their subsequent payments. Some physicians have been forced to write off substantial sums even though those sums were legally and properly owed to them under the terms of their contracts and interaction between the medical societies and those federal and state agencies have been successful in inducing the insurer to pay individual physician’s claims. No global solution has been found for the insurer’s continuing failure to pay claims on a timely basis. Because of this matter MSSNY petitioned for CMS and NYSDFS to launce an investigation into Easy Choice. If the payment situation with Easy Choice continues, MSSNY should ask CMS to cancel Easy Choice Health Plan’s contract. Patient Fact Sheet On Insurer Abuses Third-party insurers have intruded in the physician-patient relationship and have adjusted their policies and procedures regarding coverage and reimbursement for cost containment. These policy adjustments have had negative effects on patients, physicians and the delivery of healthcare. Patients are sometimes not even aware of these negative changes. MSSNY has developed a series of template-type, patient-centered “Fact Sheets” for members to give to their patients informing them of these negative chances. MSSNY has also made patients aware of when the insurer is responsible for a delay, denial or constraint of care. Protection Of Private Practice Some companies have taken steps to discourage or exclude private physicians from participating in networks for insurance plans. A range of physicians in a community means a wider range of patient choice for treatment options. Private physicians account for 330,000 jobs statewide and are known for outstanding patient care and choice to thousands of New Yorkers. The MSSNY has supported legislation that prohibits insurance plans from designing networks which exclude access to private primary-care physicians and private specialists in a patient’s community. The MSSNY has also supported legislation that prohibits hospitals from directing their physicians to stop referring patients to private practice physicians and from attempting to remove private practice physicians from insurance company panels. Access To Timely Care An adequate health insurance provider network provides reasonable access to both primary care physicians and specialists, but if the patient waits a long time to see the appropriate physician as their condition grows worse, then that is not reasonable. MSSNY supports legislation that requires insurance networks either to provide members with access to an in-network physician who can see the member within 30 days of the member’s request or to provide out-of-network benefits with fees based on the FAIRHEALTH data base, when such timely access cannot be provided. Dangers Of Youth Football The National Academy of Sciences released a report noting concerns about sports-related concussions for youth which found that high school football players suffer concussions at a higher rate then college football players. The Pop Warner Youth Football program has reported a decline in participation and the effect of safety for children who play contact football is still not fully researched. MSSNY has adopted a policy that supports the American Academy of Neurology’s extensive research on youth football including its Sports Concussion Tool Kit and encourages parental awareness of football’s dangers and careful deliberation in their permission for children to play the sport. Thoroughly Informing Patients And Physicians About Out-Of-Network Benefit Reduction And Cancellation Insurers are declining to offer health plans that include outof-network benefits. Patients believe they continue to have the out-of-network coverage that they always have had. Patients have a right to freedom of choices and the freedom to be fully and effectively informed. The reduction and cancellation of out-of-network benefits threatens the future existence and availability of a two-tier medical delivery system that exists in most western industrialized countries. MSSNY should take all appropriate steps to fully educate patients about the emerging realities of out-of-network benefits. Exemption Criteria For Electronic Health Record Adoption And Cloud-Based Electronic Health Record Packages The Centers for Medicare and Medicaid Services have pushed for the adoption of Electronic Health Records by physicians. Physicians are now becoming more aware of this requirement and are urged to obtain EHRs, but are deterred because of the cost and inconvenience of the system. Some physicians are in good faith with the new procedure but the American Medical Association has urged CMS to grant an exemption to physicians who are in solo practice and those who are 64 or (Continued on page 6) April 2014 • MSSNY’s News of New York • Page 5 2014 Medical Society of the State of New York Annual House of Delegates Resolution (Continued from page 5) older by the end of 2014 or who would reach age 62 by 2020. The CMS has declined to include such an exemption in the Final Rule. MSSNY has asked that the American Medical Association not give up the fight for EHRs exemption and continue to petition for CMS. The MSSNY has also urged the AMA to require that the CMS grant a “temporary waiver” for physician practice that are in the process of attempting to implement the new system but due to technical issues outside of their control will be unable to meet the October 2014 attestation deadline. Unintended Consequences Of An OPMC Determination A physician through settlement or hearing determination can be disciplined by the New York State Office of Professional Medical Conduct (OPMC) for professional misconduct and still be allowed to practice medicine in New York. The Office of Medicaid Inspector General can independently suspend the physician from the Medicaid program thus rendering the doctor unemployable. This inconsistency is not commonly known by the medical community such that physicians can enter into OPMC settlements without realizing that the Medical Inspector General can still terminate them from the Medicaid program and render them unemployable. MSSNY has worked to pass legislation that bars the Office of Medicaid Inspector General from removing a physician from New York State’s Medicaid program in reliance solely on a consent order between the physician and the Board for Professional Medical Conduct. Preserving Independent PracticePhysician Cooperatives New healthcare models are too complex and require too elaborate of an infrastructure for independent physicians to participate in them. New York is launching a new Fully Integrated Duals Advantage Program pilot project to provide comprehensive care on a captivated basis for a subgroup of Medicare/Medicaid dualeligible patients. If this model is successful, it could expand to over 150,000 dual-eligible New Yorkers. Because the model is untested for health care, there is a need for a pilot project to test the concept. MSSNY is in position to play a proactive role in restructuring healthcare. MSSNY should use its resources to help create, on pilot project basis, physician provider cooperative with a centralized infrastructure and a wide range of physician members. Medical Cannabis for Seriously Ill Patients A growing body of scientific literature supports the use of cannabis in treating certain conditions and symptoms such as nausea, spasticity, seizures and pain relief. MSSNY should adopt as policy that the use of medical marijuana may be appropriate when certified by a licensed physician to treat certain conditions and symptoms. Physicians that prescribe cannabis for certain conditions and symptoms shall not be held criminally, civilly or professionally liable and that the New York State Department of Health determine what diseases and medical conditions can be treated with cannabis. MSSNY should also support continued clinical trials on the use of marijuana for medical purposes. Protecting Public Health from Elevated Radon Exposure Radon originates naturally in bedrock and shale and is therefore extracted with natural gas during the “fracking” process. Marcellus Shale gas is higher in radium and therefore produces more radon. There is no current technology available to remove or separate radon and its decay products from natural gas or to inactivate it following emission. Radon and its decay products (progeny) are known to be the number one cause of primary lung cancer in non-smokers, and exposure to radon increases the likelihood that smokers will develop lung cancer. MSSNY should support policy that limits exposure to radon and its decay products. MSSNY should also support legislation that protects the public health by ensuring that New York State is committed to reducing sources of excess radon emissions, and monitoring radon gas exposure levels to confirm that these radon gas lev- els do not exceed the recommended levels set by the Environmental Protection Agency. Hospital Closings Due to economic difficulties, some community hospitals have become part of large hospital networks, have closed or have had clinical services severely curtailed. MSSNY should ask the New York State Legislature to enact laws that require hospitals that are going to close, or have the level of clinical services significantly change, to develop a clinical impact statement and that the statement be presented at a public hearing run by the Health Department. The clinical statement should document the diminution in services and outline ways that the community can be compensated or continue to receive these services in other venues. The public should have a chance to comment on this document with the Health Department as the final arbitrator if the removal of the services creates a danger to the community. CMS “Two Midnight” Policy Medicare’s new policy of reimbursing hospitals for providing in-person services at out-patients rates, if the person does not remain in the hospital for more than two nights is having negative financial consequences for the patient when they need to be placed in a rehabilitation or nursing facility. MSSNY should ask the AMA to demand that the Centers for Medicare and Medicaid educate the public and produce documents that outline the potential in negative financial consequences of the “two midnight” policy. Use Of Guidelines As Absolute Clinical Judgment By The Provider Third party payers are using clinical guidelines based on evidence based medicine in a strict manner and not allowing for individual clinical guidelines. MSSNY should resolve that guidelines are not to be used in an absolute fashion by insurers or providers when a clinical situation does not fit the guideline precisely and that peer to peer reviews allow for judicious alteration of guideline driven care when appropriate. Changes In Pre-certification For Medications To Reduce Delays To facilitate expedient delivery of medications to patients and control cost and quality of care, insurance companies have developed mail order pharmacies to diminish cost and improve patient access to medications. Insurers should educate providers with cost comparisons for like products and urge rewriting of prescriptions as long as quality and intent of treatment is not compromised-as many patients on a given therapy remain so for years. MSSNY should resolve that there be a minimum delay for patients to obtain medication and that pre-certification for medications are kept at an absolute minimum and that pre-certifications need not be repeated on an annual basis. Use Of Patient Satisfaction Surveys To Determine Payment For Medical Services Federal payers have decided that patient satisfaction surveys be used to adjust payments to hospitals and physicians. Such surveys are not statically valid and quality health care is different from other consumer services by the nature of health care. MSSNY should resolve that customer satisfaction surveys, such as Press-Ganey are not to be used to determine payment for medical services rendered and that said surveys can be used to educate providers in an attempt to upgrade services. Physicians And Health Care Institutions As Providers Of Health Insurance Healthcare providers and their institutions should be in the business of providing quality care; not insurance. MSSNY should resolve that providers and their institutions should not be providers of health insurance nor promote any specific insurance product. If a healthcare institution does provide insurance, they should be held to the highest standards and oversight to prevent conflicts of interest that would impair quality of care. Any institution in the business of health care insurance should not have on its governance board employees of the institution providing such insurance. Page 6 • MSSNY’s News of New York • April 2014 Physician Control Of Treatment Administration Physicians are trained in the judicious use of pharmaceuticals. Certain pharmaceuticals are approved by third party payers. Dosing of these drugs require the judgment of trained medical professionals, especially when the dosing goes beyond the original FDA trials. Due to the expense of testing pharmaceuticals for dosing or alternate indications, MSSNY should resolve that once a treatment or medication is approved by a third party payer, it is within the purview of the trained health care professional to administer that treatment as he/she sees fit so long as quality of care measures are met regardless of cost. Cost Concerns Used To Downgrade Physician Designation And Listing On Insurance Panels Physicians and other health care providers cannot know the cost of services beyond their practices, especially with regard to medication and designated health services. Third party payers have used cost as well as quality of care as determinants to downgrade provider status or to dismiss them from insurance panels. MSSNY should resolve that cost concerns not be used to reflexively downgrade a physician’s designation or listing on insurance panels and that said cost analysis should be used only as an education tool for providers and patients and should not to be used in a punitive fashion. Workers Compensation And No-Fault Carriers To Use ICD-10 Currently, ICD-10 coding will be required as of October 1, 2014 for Medicare, Medicaid and all commercial payors. Workers Compensation and No-Fault carriers are currently not required to convert to ICD-10 and may remain with ICD-9 due to increased costs. There will be significant costs and inefficiencies borne by medical practices to maintain the ability to code with two systems. MSSNY should seek legislation at the state level to require all insurance carriers operating in New York State to utilize a consistent ICD system. A Resolution On Gun Violence Gun violence has become commonplace in the United States. MSSNY should advocate for tighter regulations on gun sales, increasing background checks that would screen for mental illness, include verifiable character references, and require permit holders to be educated and required to safely and securely store their guns. MSSNY should also encourage physicians to add “gun ownership/possession” to the social history in order to intervene and counsel gun owners on proper safety, security, and prevention of theft. Point Of Care Dispensing More and more states are passing laws that will permit physicians to dispense prescription drug medication at the point of care. Current law in New York State prohibits physicians from dispensing prescription drug medication. MSSNY should seek legislation that will permit physician point of care dispensing or prescription medication to their patients. Bylaws Amendment To Permit MSSNY Committee Members To Submit Resolutions To Annual House Of Delegates MSSNY should allow the MSSNY Bylaws to be amended to permit the submission of resolutions by committees who are duly appointed by the MSSNY President. MSSNY should amend Article III, Section 3, Paragraph 3 of the MSSNY Bylaws to read: Resolutions may be submitted to the House of Delegates only by members of the House of Delegates as individuals or by component county medical societies, district branches, specialty society delegates, the organized medical staff delegate, the resident and fellow section delegate, medical student section delegates and medical school delegates and MSSNY committees. Application Of Debt Collection Improvement Act Of 1996 The Debt Collection Improvement Act of 1996 (DCIA) may require Federal Agencies to refer delinquent debts to the Department of Treasury and/or the Treasury Offset Program even if the affected ns physician was not involved in the calculation resulting in such debt. Medicare will begin collection proceedings for a refund of an overpayment amount; even if due to CMS error, for as low as $.01 with penalties and interest amounting to as much as 6,740 times the original debt. A ten dollar overpayment could become $67,400.00. MSSNY should resolve that CMS’ use of the DCIA of 1996 be applicable from overpayments exceeding $10.00. MSSNY’s House of Delegates should forward this resolution to the AMA HOD for its consideration and redirection to the appropriate federal agency for implementation on a national level. Protecting Public Health From Natural Gas Infrastructure Due to the dangerous nature of high volume hydraulic fracturing (HVCF) and the potential for numerous health disorders resulting from HVCF and its accompanying infrastructure, MSSNY should support a policy to delay activities concerning the expansion of natural gas infrastructure components until valid information is available to evaluate the process for its potential impact on human health and the environment. MSSNY Support Of The Single Payer Health Care Legislation America spends more per capita on health care than any other country in the world. The current healthcare financing system is burdensome, inefficient and promotes over-utilization of medical services. MSSNY should support the single-payer health reform bill (New York State Health bill A. 5389 Gottfried/S. 2078 Perkins). MSSNY should introduce a resolution at the AMA House of Delegates to support the Expanded and Improved Medicare for All Bill (National Single Payer Health Care Legislation) in Congress HR 676 (Conyers). members in the news MSSNY Member Leonard Gelman, MD, New President of AMDA During remarks at the conference, Dr. Gelman urged his colleagues to make the Leonard Gelman, MD, was named 2014most of their knowledge and expertise to pro15 President of The Society for Post-Acute mote quality, compassionate post-acute and and Long-Term Care Medicine (AMDA) long-term care. “There is a lot of experience during the organization’s recent annual conin long-term care but few experts,” said Dr. ference in Nashville, TN. Gelman. “We are the experts.” Dr. Gelman A member of MSSNY since 1992, encouraged them to work with AMDA to Dr. Gelman is medical director of both extend their expertise into areas such as Maplewood Manor, a 237-bed nursing home value-based purchasing, accountable care in Ballston Spa, and Indian River Nursing organizations, service bundling, health inforHome in Granville. Additionally, he mainmation technology (including but not limited tains a private family practice in Saratoga to electronic health records) and developing County, where he has practiced for nearly and implementing quality measures. 30 years. Dr. Gelman received his Medical Degree Dr. Leonard Gelman “No one has done more to ensure that every from the University of Brussels in Belgium medical director has access to every tool they and completed his residency at St. Clare’s need and [the support of colleagues] to be effective leaders in Hospital in Schenectady, NY. He is board certified in family their communities,” said 2013-14 AMDA President Jonathan medicine, geriatric medicine, and hospice care and palliative Evans, MD, CMD, MPH, of Dr. Gelman. medicine. Mssny members in the news wanted! Have you – or a colleague – recently won an award or been recognized by your hospital, community or other organization? We want to hear about your accomplishments for possible inclusion in our Members In The News feature in News of New York. Please contact Julie Vecchione DeSimone: jvecchione@mssny.org or 516.488.6100 x340. Development Of A Transparent And Fair Payment Process For ERISA Plans Some union benefit plans often exploit their ERISA preemptions to delay or avoid payment to providers and deny needed healthcare to their beneficiaries for the sole purpose of cost savings. These plans are not regulated by the states or CMS but by the Department of Labor (Employment Benefits Security Administration) and have ERISA preemptions. MSSNY should introduce a resolution at the AMA House of Delegates to seek legislation through Congress or through regulation by the Department of Labor which would require ERISA Plans to develop and administer a transparent and fair process for the payment of claims to providers, similar to States prompt payment laws and CMS regulation. Point Of Care Availability For Blood Glucose Testing Due to a recent ruling by CMS, finger stick monitors to test blood glucose for patients other than those who have had a prior diagnosis of diabetes is an off label use and will no longer be a covered CLIA exempt test. MSSNY should call on the AMA to work with CMS to seek the maintenance of the CLIA exempt status of point of care glucose testing. Maintaining Tax Exempt Status For Youth Service Organizations In an effort to combat childhood obesity and to provide New York State youths with outdoor activities, non-profit organizations maintain wilderness camps throughout New York State. These camps provide much needed outdoor experiences to our youth. There have been proposals in Albany to remove land tax exemptions from youth service organizations. MSSNY should oppose any attempt to remove the tax exempt status of these non-profit youth service organizations that are so important to the health of our youth and the health of our environment. Medical Board Recertification Medical Board recertification is becoming more and more of a burden for physicians. MSSNY should support recertification limited only to new knowledge acquired in the preceding periods of ten to fifteen years. Recertification should be constructed to limit maximally the financial and bureaucratic burden on physicians. MSSNY should present this resolution to the next meeting of the House of Delegates of the American Medical Association. Requirement For Pharmacist To Label Expiration Date On Dispensed Medication It is the practice of many pharmacists to tell patients to discard medications one year from the date dispensed, although the shelf life of the stock bottle may be longer. MSSNY should seek legislation that all prescription medications dispensed in the State of New York be labeled with the expiration date on the stock bottle from which it is dispensed. MSSNY should bring a similar resolution to the AMA. Gun Violence In an effort to compensate victims of gun violence, MSSNY should work with the legislature to establish mandatory liability insurance for owners of all types of guns, just as there is mandatory insurance for automobile owners, with minimum coverage of $1 million/$3 million to compensate the victims. April 2014 • MSSNY’s News of New York • Page 7 2014 Physicians Advocacy Days in Albany Legislative Panel engages with physicians at MSSNY’s Capitol Forum MSSNY’s President Elect Andrew Kleinman, MD, speaks to Lobby Day participants about out of network insurance issues. Donna Frescatore, Executive Director of the New York Health Benefit Exchange, addresses physicians at MSSNY’s Capitol Forum. Participants listen to health policy officials at MSSNY’s Capitol Forum at the Albany Hilton on March 10 NYS’s Deputy Superintendent for Health Troy Oechsner addresses physicians at MSSNY’s Capitol Forum. Also pictured are MSSNY’s Speaker Jerome Cohen, MD, and Vice Speaker Kira Geraci-Cohen, MD. Westchester County Medical Society members meet with Dean Skelos, Senate Majority Leader. (left to right): Gino Bottino, MD, WCMS Board; Kira Geraci-Ciardullo, MD, MSSNY Vice Speaker; Senator Dean Skelos; Thomas Lester, MD, WCMS Vice President; Robert Lerner, MD, WCMS President; and Brian Foy, WCMS Executive Director. (Left to right) Barbara Ellman, MSSNY’s Associate Director for Policy; Senator Joseph Griffo, sponsor of the Healthcare Professional Transparency Act; Dr. Robert Walther, President of the NYS Society of Dermatology and Dermatologic Surgery ; Lisle Soukup, American Society for Dermatologic Surgery Association; Mary Ruth Buchness, MD, Immediate Past President of the NYS Society of Dermatology and Dermatologic Surgery. High School seniors who are interested in careers in the medical profession listen to presentation at MSSNY’s Lobby Day on March 11. AMA National Advocacy Conference MSSNY’s Moe Auster, Vice President, Legislative & Regulatory Affairs, details key managed care and medical liability reform issues. Page 8 • MSSNY’s News of New York • April 2014 MSSNY was well represented at National Advocacy Conference March 4-6 in Washington DC. (standing, left to right) Moe Auster, MSSNY VP, Legislative and Regulatory Affairs; Jim Coulthart, Onondaga County EVP; Dr. David Halleran, President of the Onondaga County Medical Society; Phil Schuh, MSSNY EVP; Dr. John Kennedy, Vice Chair AMA Delegation; Dr. Jerry Cohen, AMA Council on Constitution and Bylaws; (seated, left to right) Senator Charles Schumer; Dr. Robert Goldberg, Chair AMA Delegation. Council Notes: March 10th, 2014 • Dr. Frank Dowling presented a memorandum to Council regarding legislation on non-patient specific scripts for administration of Narcan for use in opiod overdoses. In explaining the issue, Dr. Dowling noted the considerable increase in heroin use and overdose deaths in the last several years. He explained that both the Senate and the Assembly bills would expand the emergency use of Narcan and would allow a prescriber to prescribe, dispense, or distribute an opioid antagonist directly to a person at risk of experiencing an opiod-related overdose. The legislation also allows the prescriber to issue a non-patient specific script to a family member, or friend of an individual who may be at risk of an overdose. The bills provide protection from criminal, civil and professional disciplinary action that could result in prescribing, dispensing or administering an opioid antagonist. Currently, MSSNY does not have policy on this issue. Council discussed the issue and passed a resolution to support the emergency use of Narcan. • Hope Plavin, Director of Policy and Planning, Office of Quality and Patient Safety, New York State Department of Health, delivered an informational presentation on SHIP, the State Health Innovation Plan. SHIP is a program that promotes primary care delivery reform, coupled with payment reform, to improve health, improve care and reduce costs. The program encourages hospitals, nursing homes, clinics and other key stakeholders to form local partnerships to transform the delivery system. These partnerships will seek to transfer the healthcare delivery system, according to Plavin, by working together to improve quality and health outcomes while lowering costs. To date, 800,333 have completed applications and 501,205 have enrolled. For more information on the SHIP program, visit www. health.ny.gov/technology/innovation_plan_initiative/ • Ed Amsler, Medical Liability Mutual Insurance Company (MLMIC), announced another policyholder dividend for 2014. The dividend is 5% this year, and will be applied on July 1 to all physicians who are policyholders on May 1 and maintain continuous coverage through July 1. • Dr. Frank Dowling submitted the Science & Public Health committee’s report. The Addiction & Psychiatric Medicine Committee approved a statement from MSSNY Executive Committee following the Governor’s State of the State address on the subject of Medical Marijuana: “MSSNY appreciates and shares the Governor’s concern regarding the need for further research to determine the potential effectiveness of marijuana in treating certain medical conditions. While there is some research to support the use of marijuana for medical reasons, good controlled research regarding the poten- tial medical indications and benefits and risks of marijuana and its key metabolites is needed. Research on medical marijuana use should use a tightly controlled process through a hospital patient qualification review committee or human research review committee using sound research principles to develop and approve study protocols, to select appropriate candidates and to accrue and review scientific data to see if there is any truly beneficial effect of medical marijuana on patient care. If well designed protocols are conducted, then patients may benefit from the development of good quality research initiatives in this area. MSSNY will proactively engage with the Governor and his staff to provide its clinical knowledge and expertise in the area of psychiatric and addiction disorders and scientific research to advise on the essential components that will assist in ensuring the development of good controlled research protocols and equitable patient access to scientifically diverse research designs.” • The Medical, Educational, and Scientific Foundation of New York, Inc. reported that the foundation has submitted an application to the Physicians Foundation for a $75,000 grant to extend the Leadership training program to locations across New York State. This program would be an abbreviated version of the Syracuse program and would be offered through county and specialty societies. Legislature Developing One-House Budgets (Continued from page 1) 5. Oppose Proposal Which Would Allow NPs to Practice Independently From Physicians The proposed budget would allow nurse practitioners to practice for six months in collaboration with an NP who has been in practice for more than three thousand six hundred hours if (a) the collaborating physician retires, moves, dies or becomes unqualified to practice and (b) the NP has demonstrated to the Department of Health that she has made a good faith effort to find another collaborating physician but cannot. In addition, the proposal would allow NPs with more than 3600 hours of practice to collaborate with either a physician or a hospital. We can fathom no instance where the quality of patient care can reasonably require the elimination of the written practice agreement and protocols. Such an expansion of scope of practice for NPs will inevitably increase health care costs – not decrease them. Nor will such proposals address our physician workforce shortage. Non-physician practitioners wish to practice in the very same regions of the state in which physicians now practice. Studies show clearly that they do not choose to practice in rural or urban underserved communities. Urge your legislators to reject the proposal to allow NPs to practice independently from a physician. 6. Support the Elimination of the Requirement for Written Consent When Offering an HIV Test The proposed budget includes a provision to remove the requirement for a separate, written consent when offering an HIV test. MSSNY has long advocated that an HIV test be part of routine medical care and believes that the separate written informed consent has been the most often cited barrier to patients getting tested for HIV. Urge your legislators to support the elimination of the written consent requirement for an HIV test. 7. Oppose One-Sided No-Fault Reform The proposed budget would confer upon the Superintendent of Financial Services an unfettered right to investigate a health care provider’s office when the “Superintendent deems it expedient for the protection of the interests of this State.” This may create an unlimited right of DFS to investigate a doctor’s office for reasons that may go far beyond reasonable suspicion of fraud. This proposal will undoubtedly have a huge chilling effect on physicians treating injured auto accident victims. Urge your legislators to reject this proposal. April 2014 • MSSNY’s News of New York • Page 9 Page 10 • MSSNY’s News of New York • April 2014 (Continued from page 1) Government Affairs SCHIMMINGER INTRODUCES BILL TO LIMIT REQUIREMENTS OF BOARD CERTIFICATION Assemblyman Robin Schimminger (D-Kenmore) has introduced legislation (A.8979) that would prohibit a hospital from requiring board certification as a condition of having staff privileges, and prohibit a health insurance company from requiring board certification as a condition of being a participating physician in such plan. The cost of obtaining and updating board certification status is increasingly becoming prohibitively expensive for many physicians at a time when they are already being squeezed between rapidly increasing office overhead costs and cuts in insurer payment. This legislation would help to assure that board certification remains aspirational for physicians, but not mandatory, by assuring that hospitals and health insurance companies cannot impose such requirements as a condition of participation, and reduce one barrier to delivering medical care in New York State WORKING WITH PHYSICIANS WHO OPERATE URGENT-CARE PRACTICES TO OPPOSE PROPOSED REGULATION OF THEIR PRACTICES The proposed State Budget includes provisions which may adversely impact the ability of physicians to remain in practice as “urgent care” practices. Physicians should send a letter to their elected representatives in opposition to this proposal from MSSNY’s Grassroots Action Center by visiting mssny.org. Specifically, the budget would define “urgent care” to mean “the provision of treatment on an unscheduled basis to patients for acute episodic illness or minor traumas that are not life threatening or potentially disabling for monitoring or treatment over prolonged periods.” The proposal prohibits anyone from operating as an urgent-care practice unless they are accredited pursuant to regulations to be promulgated. The Public Health and Health Planning Council (PHHPC) would be specifically authorized to adopt and amend rules and regulations, subject to the approval of the commissioner which would establish standards for referral and continuity of care, staffing, equipment and maintenance, and transmission of patient records. Advocacy against this proposal includes three main points: (1) an urgent-care practice is a medical site that is essentially indistinguishable from any other office-based medical practice, staffed by appropriately licensed and credentialed physicians; (2) physicians operating urgent-care practices do so in a safe and effective manner and there have been no demonstrated examples of public-safety risk that justify a need for new mechanisms of oversight; and (3) physicians operating urgent-care practices provide their communities with highquality, timely, cost-efficient, and effective care, which is highly valued by patients seeking access to acute unscheduled care, in lieu of that which would only be available otherwise from the hospital emergency room. ASSEMBLY PASSES BILL TO ENHANCE DUE PROCESS PROTECTIONS FOR PHYSICIANS Legislation (A.6498, Lavine) recently passed the Assembly that would provide physicians with necessary due process protections where health insurers seek to terminate a physician (or other health care practitioners) from its network by failing to renew the physician’s contract. Current law prohibits a health insurance company from terminating a physician’s contract without a written explanation of the reasons for the proposed contract termination and an opportunity for a hearing on the proposed action by a panel comprised by three persons including a clinical peer in the same or similar specialty. These provisions, however, do not apply to situations involving the non-renewal of physician contracts. There have been some instances when it could be reasonably inferred that an insurer sought to remove a physician from its network for reasons that may be related to these physicians challenging the insurer’s payment practices or the physician’s referral of patients to certain needed specialists, but avoided triggering these important due process protections by simply non-renewing the physician’s contract. This bill would address this discrepancy. Identical legislation (S.5762, Hannon) has been introduced in the Senate and referred to the Senate Health Committee. ELIMINATION OF CITIZENSHIP REQUIREMENT BILL PASSES ASSEMBLY Legislation (A.1160 (Cahill)/ S.981 (Libous), has passed the Assembly that would remove the citizenship or permanent residency requirement for all professions that still have it. It was forwarded to the Senate, where it is in the Senate Higher Education Committee. Of the 50 licensed professions, only 13 currently require citizenship or permanent residency for licensure, including medicine. MSSNY supports this bill. CLASSIFIED ADVERTISING MSSNY’S CLASSIFIED HAS GONE GLOBAL Now can be accessed on MSSNY’s website at www.mssny.org. Click classifieds. MAY 2014 ISSUE CLOSES APRIL 16 $100 per ad; $150 with Photo PHYSICIANS’ SEARCH SERVICES • ALLIED MEDICAL PLACEMENTS LOCUM TENENS • practice valuation • practice brokerage practice consulting • Real estate for help, information or to place your ad, call 516-488-6100 x355 • Fax 516-488-2188 PHYSICIAN EMPLOYMENT OPPORTUNITIES Faculty Internist – General Medicine Unit Unity Health System in Rochester, NY is seeking BC internists to join the core faculty teaching unit of its outstanding 41 resident Internal Medicine Program. Leadership opportunities possible. General Medicine Unit (GMU) Faculty physician positions include a mixture of clinical, academic/ educational, administrative, and hospital citizenship responsibilities including: • Participating in unique ambulatory teaching environment which includes a “4+1” block curriculum. (Educational opportunities include a dedicated ambulatory curriculum with didactic and clinical teaching sessions, ambulatory morning report, 1:1 faculty to resident teaching and mentoring.) • Participating in annual resident recruitment process • Participating in Morning Report; Attending Rounds; Grand Rounds presentations; and other teaching activities • Precepting residents for 6 sessions per week in our ambulatory clinic • Effectively serving as attending physician for inpatient care of admitted clinic patients • Participating equitably in after-hours call rotation in support of Unity Faculty Partners (call is 1:6) • Seeking opportunities to involve residents and other faculty in scholarly work • Actively participating in staff meetings, and on assigned hospital committees • Faculty appointment at University of Rochester School of Medicine and Dentistry Unity Hospital is a suburban, 208-bed community hospital with excellent facilities, quality care, and a collegial atmosphere. Excellent compensation package including 6 weeks time off, 5 days CME, and malpractice with “tail” coverage. Unity is a major teaching affiliate of the University of Rochester School of Medicine and Dentistry. Send CV to: Becky Jones, Physician Recruiter, Unity Health System, 1555 Long Pond Rd., Rochester, NY 14626; fax: 585-723-7180 e-mail: bjones@unityhealth.org OFFICE SPACE RENT/LEASE/SHARE FULL TIME RENTAL Elegant ground floor corner Park Ave office (mid 70’s). Large consult room with windows on Park Ave, treatment room, dedicated secretarial space. Lots of storage space. Shared reception. Available accredited OR on premises. Ideal for surgical specialty. Lobby entrance with doorman 24/7. Available July 1, 2014. Call: (212) 570-6080 OFFICE/MEDICAL SPACE FOR LEASE – PRIME LOCATION IN NASSAU COUNTY OBITUARIES BRODSKY, Linda; Buffalo NY. Died February 13, 2014, age 61. Erie County Medical Society. CHAUDHURI, Bijon Kumar; Atlantic Beach FL. Died February 10, 2014, age 89. Steuben County Medical Society. COST, Stephen S.; Syracuse NY. Died February 20, 2014, age 90. Onondaga County Medical Society. COTRONEO, Vincent S.; Buffalo NY. Died February 07, 2014, age 97. Erie County Medical Society. GORVOY, John D.; New Hyde Park NY. Died February 12, 2014, age 95. Medical Society County of Queens. KEEGAN, Albert F.; Bryn Mawr PA. Died February 23, 2014, age 87. New York County Medical Society. KORNBLAU, Gertrude K.; Roslyn NY. Died February 12, 2014, age 99. Medical Society County of Queens. KOZINN, Harold A.; Rockville Centre NY. Died November 23, 2013, age 85. Nassau County Medical Society. MAHLAB, Edward D.; Forest Hills NY. Died February 12, 2014, age 102. Medical Society County of Queens. MCCONNELL, Michael Martin; Buffalo NY. Died February 07, 2014, age 70. Erie County Medical Society. MOSBY, George Saml; Hornell NY. Died February 10, 2014, age 62. Steuben County Medical Society. SHAHEEN, David John; Titusville FL. Died January 20, 2014, age 93. Medical Society County of Oneida. SLIMBAUGH, William Paul; Johnson City NY. Died February 11, 2014, age 75. Broome County Medical Society. SPATOLIATORE, Vincenzo; Brooklyn NY. Died February 28, 2014, age 84. Medical Society County of Kings. SVERDLIK, Samuel Simon; Fort Myers FL. Died February 02, 2014, age 97. Nassau County Medical Society. WEIL, Inga Frenkel; Whitestone NY. Died February 12, 2014, age 99. Medical Society County of Queens. WEISS, Leonard S.; Wellington FL. Died February 21, 2014, age 79. Nassau County Medical Society. 1 ARLINGTON AVENUE MALVERNE, NEW YORK +/-4,100 SF Property Features: Total Building Size 8,188 SF New fire alarm system • Multiple entrance/exits • Elevator Excellent parking: Rear lot plus municipal parking 0.2 miles from Long Island Railroad- Malverne • Close proximity to Southern State Parkway Nearby major hospitals including: Mercy Medical Center, Franklin Hospital, NSH/LIJ, South Nassau Communities Hospital Sublease opportunities available for 1st floor offices Contact Hillary at: hillary-aig@optonline.net Place Your Classified Ad In News Of New York! Leasing or Selling Space? Selling your practice or equipment? All Ads $100; $150 with Photo • Call 516-488-6100, ext 355 business showcase April 2014 • MSSNY’s News of New York • Page 11
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