MEDICAL SOCIETY OF THE STATE OF NEW YORK

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

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Volume 74 • Number 4 www.mssny.org April - May 2018

CVS sued for revealing HIV status in Ohio ......................page 2

Where we need to go now and in the future ......................page 4

MSSNY’s statement re CVS-Aetna merger ......................page 4

Photos of the 212th House of Delegates....................page 10

State Legislature Completes Passage of Difficult Budget that Rejects Several Items Opposed

by MSSNYThe New York State Legislature recently com-

pleted passage of a $168 Billion State Budget that closed a $4.4 Billion Budget deficit. Importantly, the final adopted State Budget rejected numerous pro-posals of great concern that MSSNY together with specialty societies and other allies had been advo-cating against, including:

• Independent practice authority for CRNAs• Authorization for corporate-owned retail clinics• Steep Medicaid cuts to the Patient-Centered

Medical Home program• Elimination of “Prescriber prevails” protections

for prescriptions for patients covered by Medicaid• Overbroad state powers to penalize physicians

and other health care providers for Medicaid bill-ing errors

• Authorization for patient drug management protocols between Nurse Practitioners and phar-macists. Instead, there was a 2-year extension of the current Collaborative Drug Therapy pilot program (between physicians and pharmacists) that MSSNY supports

• Authorizations for EMTs to provide non-emer-gency care in patient homes without any express coordination requirement with that patient’s treating physician

• Provisions that would have reduced from 7 days to 3 days the length of an initial prescrip-tion for acute pain. The final bill did include a requirement, consistent with CDC Chronic pain guidelines, for a prescriber to have a written treatment plan that follows generally accepted professional or government guidelines for a patient on opioid medications longer than 90 days or past the time of normal tissue healing

• Significant expansion of the DOH Commissioner’s power to investigate physician misconduct, including provisions that would have a) greatly reduced the time to respond to document

2018 House of Delegates Resolution HighlightsPublic HealtH and education• MSSNY will support legislation to prohibit the sale of any device

– such as a bump stock – that functionally converts a firearm to fully-automatic operation.

• MSSNY will support legislation that would ban the sale and/or own-ership of high capacity magazines or clips and high speed high destruction rounds.

• MSSNY will support legislation that requires a waiting period and background checks prior to the purchase of all firearms.

• As gun violence in the United States is a public health crisis, MSSNY will support legislation that would reverse the ban that prohibits the Center for Disease Control from researching gun related injuries, deaths and suicides related to this violence.

• MSSNY will create a task force to study and make recommendations regarding how healthcare providers can play a role in safely sequester-ing a patient’s firearms to reduce the risk of suicide during a vulnerable time.

Governmental affairs and leGal matters a• MSSNY supports legislation to give discretion to the patient’s attend-

ing physician or the emergency physician to have such patient sent for skilled nursing care without having to first meet the current Medicare

(Continued on page 5)(Continued on page 7)

(left to right) EVP Phil Schuh; MSSNY President Thomas J. Madejski, MD; NYS Commissioner of Health Howard Zucker,

MD, JD; Immediate Past President Charles Rothberg, MD

2018 House of Delegates in Buffalo

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Page 2 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 3

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In March, New York Attorney General Eric Schneiderman led a coalition of 19 state Attorneys General, to oppose a proposed rule of the US Department of Health and Human Services’ Office of Civil Rights (OCR) that would significantly expand the ability of businesses and individuals to refuse to provide necessary health care on the basis of businesses’ or employees’ “religious, moral, ethical or other beliefs.”

The AG comments to OCR were submitted by the Attorneys General of New York, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington and the District of Columbia.

At MSSNY’s House of Delegates in March, the physician delegates also expressed strong concern with this HHS “con-science” proposal, passing a resolution that called for MSSNY to a) speak against policies that are discriminatory and create even greater health disparities in medicine; and b) be a voice

for New York’s most vulnerable populations, including sexual, gender, racial and ethnic minorities, who will suffer the most under such policies, further widening the gaps that exist in health and wellness in our nation.

The AMA also submitted a detailed letter to OCR express-ing its strong concerns, noting that “the Proposed Rule would undermine patients’ access to medical care and information, impose barriers to physicians’ and health care institutions’ ability to provide treatment, impede advances in biomedi-cal research and create confusion and uncertainty among physicians, other health care professionals and health care institutions about their legal and ethical obligations to treat patients. We are very concerned that the Proposed Rule would legitimize discrimination against vulnerable patients and in fact, create a right to refuse to provide certain treatments or services.”

NY AG, MSSNY AND AMA All Express Strong Concerns with Proposed OCR “Conscience” Rule

CVS Health Sued for Revealing HIV Status

of 6000 Patients in OhioCVS Health is being sued for alleg-

edly revealing the HIV status of 6,000 patients in Ohio.

A federal lawsuit claims CVS mailed letters last year that showed the sta-tus of participants in the state’s HIV drug assistance program through the envelopes’ glassine window.

The complaint, which was filed March 21 in federal court in Ohio, also names Fiserv, the company that CVS hired to mail the letters. On the envelopes used by Fiserv, the patients’ HIV status could be seen through the clear window, just above their name and address, the docu-ment states. The letters included the patients’ new benefits cards and information about a mail prescription program.

The attorneys claim that CVS failed to announce the breach of pri-vacy data and did not contact all the patients whose status was revealed. In a statement to CNN, CVS Health said the envelope window was intended to show a reference code for the assistance program and not the recipient’s health status. “CVS Health places the highest priority on protecting the privacy of those we serve, and we take our responsibility to safeguard confidential information very seriously,” the statement said. “As soon as we learned of this inci-dent, we immediately took steps to eliminate the reference code to the plan name in any future mailings.

Page 2 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 3

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MSSNY released the following statement after the House Judiciary Committee’s hearing regarding CVS’ acquisition of Aetna:

“It is incredibly important for federal and state oversight bodies to undertake a thorough review of the potential im-pact of the acquisition of Aetna by CVS. If approved, this transaction would pro-duce an enormous consolidation in the health care industry that will undoubt-edly have a profound impact on where patients received their needed care and medications.

We share the concerns expressed by the American Medical Association (AMA) regarding this potential enormous consolidation.

CVS already owns over 500 retail stores in New York State, while Caremark is the second largest PBM in the country. Meanwhile, according to the 2016 AMA Competition in Health Insurance report, Aetna is the fourth largest insurer in New York State, insuring a very significant portion of the commercial health insur-

ance market. Certainly, it is not hard to envision that, were this immense trans-action to be approved, other similar merger and acquisitions would follow.

We are very concerned that this pro-posed transaction could exacerbate the already fragile nature of New York’s healthcare delivery system. Our con-cerns are on a number of fronts. First, we are very concerned that the transac-tion will reduce choice of pharmacy for our patients, as it may become harder for non-CVS pharmacies to be incorpo-rated into the CVS-Aetna pharmaceutical network. Moreover, it could enable the Caremark PBM to impose even more burdensome prior authorization hassles for physicians and their staff as a pre-condition for patients receiving needed

My predecessors and good friends have set the bar high. I fully intend to keep it there.

Here’s the abridged ver-sion of how I got here, and where I think we need to go.

When I first joined MSSNY, I worked in Wayne County (part of the 7th dis-trict) and became friends with Dave Hannan. After 3 years as an employed physician, I established a practice in Orleans County. David and Donna Meza, and Art and Donna Mruczek welcomed Sandra and I to our new community. They helped us to get established in the community. Art, and especially David, became role models and sponsors for my activ-ity with MSSNY. I met Al and Barbara Ellman my first year as a delegate to MSSNY. The next year I was on the Public Health Reference Committee the year that HIV testing for new-

borns, a contentious issue at the time, became part of MSSNY policy. In retrospect this was obviously the right decision for patients, however, there was much controversy related to con-cerns about privacy and disclosure of information.

I saw physicians work-ing together to make the health and lives of their patients better. I saw phy-sicians applying the science

of medicine to the betterment of public health.

I was hooked. I have been fortunate to have had

many wonderful mentors over the last 25 years. This year, Dr. Rothberg has brought highly contentious issues to the fore that could change the course of MSSNY; he has had the courage to face those issues head on.

For his courage and his leadership, I salute him.

MEDICAL SOCIETY OF THE STATE OF NEW YORK

NEWS OF NEW YORK

Medical Societyof the State of New york

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

Philip A. Schuh, CPA, Executive Vice President

coMMUNicatioNS aNd PUBlicatioNS Maria Basile, MD, MBA, Commissioner

NewS of New yorkPublished by Medical Society

of the State of New York

Vice President, Communications and EditorChristina Cronin Southard

csouthard@mssny.org

News of New York StaffManager, Communications Division

Julie Vecchione DeSimonejvecchione@mssny.org

Roseann Raia, Communications Coordinatorrraia@mssny.org

Steven Sachs, Web Administratorssachs@mssny.org

Susan Herbst, Page Designer

NEWS of NEW YoRkADVERtiSiNg REPRESENtAtiVES

for general advertising information contactChristina Cronin Southard

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

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

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

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

President’s column

Thomas J. Madejski, MD

mssnY-Pac

Where We Need to Go for the Present and Future

Statement Of MssnY Immediate Past President Dr. Charles Rothberg Regarding U.S. House Judiciary

Committee Review of Cvs-aetna Merger

(Continued on page 8)

(Continued on page 13)

Page 4 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 5

requests and b) expanded the power to search and seize records and equipment. The final bill did include a provision to permit the Commissioner to summarily suspend a physician who is both been charged with a felony crime and believed to be an imminent danger to the public as determined by the Commissioner

At the same time, the final Budget included the following items supported by MSSNY:

• Continued funding for the Excess Medical Malpractice Insurance Program at the historical level

• A new $150,000 allocation for the MSSNY’s Veterans Mental Health Initiative

• Reducing some of the insurance barriers to substance abuse treatment

• Consistent with policy recently adopted at the MSSNY Council, prohibiting PBMs from disclosing to patients drug cost options that may be less than what is speci-fied in their insurance

• Continued historical funding and a 5-year extension of the MSSNY Committee for Physicians Health until 2023

Thank you to all the physicians who took the time to make phone calls, send letters, or meet with their local legislators over the last few months to advocate on all these issues. Certainly, our success on these fronts is in large part due to these extensive grassroots efforts.

However, we can’t exhale just yet – many of these pro-posals will continue to be raised during the remainder of the legislative session.

Dr. Kenneth Offit Makes Presentation to MSSNY Council on the

BRCA Founder Outreach StudyDr. Kenneth Offit, Chief of the Clinical Genetics Service at

Memorial Sloan Kettering Cancer Center, presented informa-tion on the BRCA Founder Outreach (BFOR) Study at last month’s MSSNY Council meeting.

The study is an innovative research initiative that will use an online platform and other novel approaches to health care delivery to address a longstanding, unmet need: access to screening for BRCA mutations. It has significant potential to save lives and advance progress in the emerging field of pre-cision medicine.

The BFOR study offers individuals no-cost BRCA testing for three mutations found in those of Ashkenazi ancestry. BRCA Mutations increase risk for breast, ovarian and prostate can-cer. Men and women at least 25 years old with at least 1 Ashkenazi Jewish grandparent are eligible. Participants regis-ter online and supply a DNA sample at a nearby lab.

The study seeks to learn how many participants will choose to receive their BRCA results through their primary care pro-vider (PCP) or from the study staff. If they choose their own provider, the PCP will have the option to disclose the genetic test results. If a PCP prefers not to disclose the results, the study staff will take this role. If a PCP chooses to disclose results, study staff will provide educational material to inform patient counseling and recommend additional testing if needed.

Physicians and patients can learn more about eligibility for the study through the attached information sheet please click here or at www.bforstudy.com or by calling 1-833-600-BFOR.

State Legislature Completes Passage of Difficult Budget

(Continued from page 1)

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Page 6 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 7

3-day hospital stay pre-condition.• MSSNY will advocate reducing the

administrative burdens of complying with value-based payment programs and advocate to assure that these pro-grams comply with evidence-based standards of care.

• MSSNY will work to assure strong enforcement of the NY and federal laws that require health insurance compa-nies to cover emergency room care when a patient reasonably believes they are in need of immediate medical attention, including the imposition of meaningful financial penalties on insur-ers who do not follow the law.

• MSSNY will advocate that all pharma-cies, prescription programs and EHR vendors adopt technologies for phy-sicians to easily cancel medications electronically.

Governmental affairs and leGal matters b• MSSNY will seek to have legislation

introduced and signed into law in• New York State stipulating that a patient

undergoing any medical treatment requiring anesthesia in a hospital or ambulatory surgical center, regardless of where the hospital or ambulatory surgical center is located and regard-less of the type of health insurance coverage, be guaranteed that a phy-sician-anesthesiologist will either personally administer or supervise a nurse anesthetist in the administration of anesthesia or the operative that a designated surgeon, who has agreed to medically supervise the nurse anesthetist.

• MSSNY will advocate for patients to have a choice to receive maintenance prescriptions from either a mail order pharmacy or a brick-and-mortar phar-macy without any financial penalty, and advocate for legislation that pro-hibits pharmacies from charging higher prices (from pharmacy benefit manag-ers or insurance plans) than the actual pharmacy price of the medication.

• MSSNY will support legislation to pro-hibit Medicare plans and HMO plans from changing covered drugs during the enrollment year.

• MSSNY will support the use of State funding to establish and to support addiction medicine fellowships in New York State.

socio-medical economics• MSSNY requests that the New York

State Department of Financial Services mandate that all insurance companies

print current copays and deductibles and date of issue on all subscribers’ health insurance cards.

• MSSNY will adopt the position that it is proper to remove the CLIA certification mandate requirement for physicians who only use CLIA-waived tests and physician-performed microscopy; and bring this proposal to the AMA.

• MSSNY should call on the AMA to reim-burse all AMA members for the fees they pay in relation to CPT coding; and that the New York delegation to the AMA bring this resolution to the Annual Meeting of the AMA in 2018.

rePorts of officers• Free county medical society and MSSNY

membership for medical students

(beginning in 2019)• Equity in Dues – HOD adopted policy

that the long-term goal of MSSNY is to achieve equity in dues for all members through growth in membership. The House of Delegates and the Council will monitor all programs created to achieve growth by enrolling members at special dues rates, to ensure that they are conducted in accordance with the MSSNY Bylaws.

• Life Member Administration Fee – The House approved a pilot project whereby Life Members would be sent an annual statement requesting payment of a recommended voluntary administra-tion fee of $100 to be shared equally by the county medical society and MSSNY.

2018 House of Delegates Resolution Highlights(Continued from page 1)

Page 8 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 9

Council Notes – March 6, 2018Kenneth Offit, MD, MPH presented an update on a NY cancer screening effort focused

on physician involvement. The BRCA Founder Outreach Study (BFOR) is a research initiative that will use an online platform to address a longstanding, unmet need: access to screening for BRCA mutations (see page 5). Dr. Offit is Chief of the Clinical Genetics Service and Vice Chairman, Academic Affairs, Department of Medicine at Memorial Sloan Kettering Cancer Center. Learn more at www.bforstudy.com

Donald Moore, MD, MPH, Chair, MSSNY’s HIT Committee, presented a proposal regarding a program that will focus on the legal pitfalls of EHR Technology and how to mitigate the liability risks to physicians. MSSNY pledged support, along with the Medical Society of the County of Kings, to sponsor, promote and implement a statewide, 5 credit CME/HIT Symposium and Expo at the Brooklyn Borough Hall on Saturday, April 28, 2018.

Council approved a new pilot project to facilitate recruitment of new members and former members who return after an absence of at least two years. The program will include a low introductory dues rate in participating counties and a schedule of gradually increasing dues over the course of four years.

Council passed the following resolutions:MSSNY will support the creation of a state-wide clinical preceptorship tax credit

for community and hospital based health care practitioners and that any necessary documentation for the tax credit be contained in a simplified form to encourage par-ticipation in the program. The resolution will be sent to the AMA for consideration.

MSSNY and the AMA and the American Osteopathic Association will communicate with US medical schools to study the inclusion of clinician-performed, point-of-care untrasound instruction and training. The resolution will be sent to the AMA for consideration.

prescription medications. Perhaps of greatest concern, we are concerned that this transaction will lead to an explosion of so-called “Minute Clinics”, to be owned by an insurance company that would have great incentive to steer patients to these sites instead of a com-munity based primary care practice that typically serves as a patient’s medical home.

These concerns have been magnified as a result of the recent investigation by several states, as reported by CNN, into whether Aetna may be inappropri-ately denying coverage for patient care.

Taking all these factors together, New York’s physicians have very strong concerns with this proposed enor-mous consolidation in our health care industry, which could have adverse con-sequences to our patients”.

mssnY-Pac(Continued from page 4)

In the current medical system, managing and prevent-ing chronic disease requires a strong partnership between patients and doctors. Consider the statistics around prediabe-tes: 84 million U.S. adults have prediabetes and 9 out of 10 don’t know it.

An effective and easy tool to help patients determine their risk of prediabetes and type 2 diabetes is the prediabetes online risk test. This one-minute screening tool quickly deter-mines if a patient needs further testing and encourages at-risk patients to join the National Diabetes Prevention Program (DPP). The DPP addresses lifestyle changes that can signifi-cantly empower patients to take control of their own health. In the case of prediabetes, it can be a reversible condition and the DPP helps prevent or delay type 2 diabetes through lifestyle modifications. Here are three ways to have productive conversations about prediabetes and help encourage patients to take an active role in managing their health.let tHe Patients tell You tHeir concerns

One tool that may help how you have these conversa-tions is offered on a new podcast from the American Medical Association (AMA) called AMA Doc Talk. Episode 3, “Coping with chronic disease,” dives into how care teams’ relationships with their patients play a role in management of chronic dis-ease such as type 2 diabetes.

Another useful tool to educate your patients about the impor-tance of diabetes prevention is the Prevent Diabetes STAT toolkit. This toolkit, developed by the AMA with the Centers for Disease Control and Prevention (CDC), provides resources to remind physicians to screen, test and refer patients with prediabetes to an in-person or online DPP. involve tHe entire care team

Developing a team-based approach allows everyone to become actively involved and share responsibility for improved patient care, and the entire practice becomes better equipped

to address patients’ questions and needs.Engaging the care team can help identify patients who may

need screening for diabetes, or referral to a diabetes preven-tion program. The AMA has developed a STEPS forward module for preventing type 2 diabetes, which includes resources to help you and your team determine roles and responsibilities regarding diabetes prevention and your practice workflow. consider usinG a HealtH coacH

A key part of patients taking an active role in their health is ensuring that they understand their care plans and how to achieve their health goals. It’s important for patients to understand that physicians and care teams are best suited to help them actively self-manage chronic disease, such as type 2 diabetes, or prevent it from developing.

Health coaches can be great support systems that help edu-cate patients and give them the skills and knowledge they need to participate in their own care.

As a part of its STEPS forward program, the AMA has devel-oped a module for health coaching that explains how it can be incorporated into a practice that includes case studies of how it’s been done successfully along with downloadable tools and implementation support.

The health coach may be even be part of your practice’s own diabetes prevention program or may help connect patients who have prediabetes to a National DPP in your nearby com-munity or online. However health coaches are integrated into a practice, they can help bridge a gap between you and your patients and help engage them in actively participating in their own health.

MSSNY is dedicated to educating the physician population on prediabetes and will be providing educational webinars and podcasts in the coming weeks. Physicians are encouraged to visit our Diabetes webpage to learn more about MSSNY’s collaboration with the AMA and the Prevent Diabetes STAT toolkit.

Three Strategies that Change the Conversation You Have with Patients on Type 2 Diabetes Prevention

Page 8 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 9

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Page 10 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 11

New York County1st row (left to right) Dr. Joshua M. Cohen; Dr. Naheed Van de Walle; Dr. Paul N. Orloff; Dr. Emerald lin. Second row

(left to right) Dr. Zebulon Taintor; Dr. Maria loTempio; Dr. Gabrielle Shapiro; Dr. Edward W. Powers, III; Dr. Michael T. Goldstein; Dr. Mimi Buchness; Dr. Marlin Mattson; Dr. Peter C. Lombardo; Susan Tucker, Esq.; Cheryl Malone, CAE. Third row (left to right) Dr. Scot B. Glasberg; Dr. Arthur Cooper; Dr. William B. Rosenblatt; Dr. Malcolm D. Reid; Dr. Anthony

A. Clemendor; Dr. Keith LaScalea; Dr. Erick Eiting; Dr. Milton O. Haynes

Queens CountyFront row (left to right) Vangie Rosado-Tripp, Executive

Director; Dr. Penny Stern; Dr. Lorraine Giordano; Dr. Catherine Steger; Dr. Arthur Fougner; Dr. Louis Auguste; Dr. Sandhya Malhotra; Dr. Leah McCormack. Back row (left to right) Dr. Michael Richter; Dr. David Vilabrera; Dr. Paul Aaronson; Dr. James Satterfield; Dr. Allen Small; Dr. Fred

Fensterer; Dr. Steven Schwalbe

Residents, fellows and medical students await the

start of the 12th annual 2018 Poster Symposium.

70 participants traveled to Buffalo to present their work.

Kings County and Richmond CountyFirst Row (left to right) Dr. Parag Mehta; Dr. Madhu

Gudavalli; Dr. Melissa Grageda; Dr. Monica Sweeney; Dr. Niraj Acharya; Dr. Pardha Valluru; Dr. Elizabeth Haines; Ms. Liz Harrison. Second Row (left to right) Dr. Ronald

Solomon; Dr. Simon Kokkanakis; Dr. John Maese; Dr. Marc Mendelsohn; Dr. Adolph Meyer; Dr. Jagdish Gupta; Dr. Lee

Loewinger; Dr. Prasad Gudavalli; Dr. Clarisse Clemons-Ferrara. Third Row (left to right) Dr. Jack D’Angelo; Dr. Sal

Volpe; Dr. Donald Moore; Dr. Steven Kaner; Dr. Gennidiy Grutman; Dr. Moustafa Elsheshtawy; Dr. Robert Frankel; Dr. Lance Austein; Missing from Photo: Dr. Sherman

Dunn, Dr. Larry Melniker, and Dr. Deeptha Nedunchezian

Nassau County(left to right) Dr. Paul Pipia; Dr. John Ostuni; Dr. Inderpal Chhabra; Dr. Paul Hamlin; Dr. Ronald Menzin; Dr. Vincent

Geraci; Dr. Carol Moodhe; Dr. Michael Ziegelbaum; Dr. David Podwall; Dr. Daniel Nicoll; Dr. Robert Schreiber

Photo Credit: Steve Sachs

2018 House of Delegates in Buffalo

Page 10 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 11(Continued on page 12)

Suffolk CountyFirst Row (left to right) Dr. Samara Churgin; Dr. Maria Basile; Dr. Frank Dowling; Dr. Aaron Kumar. Second Row (left to right) Dr. Ramin Rak; Dr. Princess Mark; Dr. Charles Rothberg; Dr. William R. Spencer. Third Row (left to right) Dr. Stephen F. Coccaro; Dr. Ani Bodoutchian; Dr. Kara Kvilekval; Dr. Daniel E. Choi

Fourth row (left to right) Dr. Nabil K. Kiridly; Dr. Hannah Ortiz; Dr. William Wertheim

Delegates not pictured: Dr. Richard A. Schoor and Dr. Diana Meyler

3rd & 4th DistrictFirst Row (left to right) Dr. Jose David; Dr. Gregory Threatte;

Dr. Gregory Pinto. Second Row (left to right) Dr. Sheila Bushkin; Dr. Jay Federman; Dr. Neha Gupta; Dr. Natalie

Adler; Dr. Myrna Sanchez; Dr. William Latreille; Dr. Robert Hughes. Third Row (left to right) Dr. Carolyn Jones-Assini; Dr. Margaret Woods; Dr. Malcom Roth; Dr. Joseph Sellers; Dr. Peter Sosnow; Dr. Roy Korn; Dr. Brian Murray; Dr. John

Kennedy; Executive Director, Jonathan Dougherty; Dr. Paul Salzberg

5th & 6th DistrictFirst Row (left to right) Dr. Howard Huang; County Executive Kathi Dyman; Dr. Marybeth McCall; Dr. Jennifer Congdon;

Dr. Cynthia Baltazar. Second Row (left to right) County Executive Shirley Cosgriff; Dr. Celeste Johns; Dr. Ashraf

Sabahat; Dr. Walid Hammoud; Dr. Duane Cady; Dr. Richard Semeran; Dr. Ken Visalli; Dr. Frank Dubeck; Dr. Barry Rabin;

Dr. Charles Aswad; Dr. Mohammad Aktaruzzaman. Third Row (left to right) Dr. MaryAnn Millar; Dr. Dan Young; Dr. Nancy Merrell; Dr. Kevin Hastings; Dr. Reginald Knight; Dr. Suresh Sharma; Dr. Brian White; Dr. Nameer Haider;

Dr. Sally White; Dr. Bipin Patel; Dr. Corliss Varnum; Dr. LouAnne Giangreco; Dr. Richard Silver;

Fourth Row (left to right) Dr. Robert Hesson; Dr. Richard Beers; County Executive Jim Coulthart; Dr. Joseph Mannino; Dr. Samuel Gooldy; Dr. Joseph Booth; Dr. Brian Johnson;

Dr. Geoffrey Moore; Dr. Jef Sneider

AMA DelegationFirst Row (left to right) Dr. Frank Dowling; Dr. Barry Rabin;

Dr. Thomas Madejski; Dr. Robert Goldberg; Dr. Jerome Cohen; Dr. Charles Rothberg; Dr. Kira Geraci; Dr. John Kennedy; Dr. Mark

Adams; Dr. Duane Cady; Dr. Parag Mehta; Dr. Howard Haung Second Row (left to right) Dr. Gregory Pinto; Dr. Bonnie Litvack; Dr. Malcolm Reid; Dr. Corliss Varnum; Dr. Rose Berkun; Dr. Dan

Young; Dr. Joseph Sellers Third Row (left to right) Dr. Robert Frankel; Dr. Joseph Maldonado; Dr. leah McCormack; Phil Schuh,

CPA; Dr. Robert Hughes; Dr. William Latreille; Dr. David Jakubowicz

Bronx CountyFirst row (left to right) Dr. Sarah Nosal; Pratistha Koirala, MS; Dr. Realba Rodriguez. Back row (left to right): County Executive, Ronald Blount; Dr. Alan Diaz; Dr. Nina Huberman; Dr. Anthony Pisacano; Dr. Michael A. Pisacano; Dr. Peter Wyer; Dr. Thakor Rana; Dr. David Jakubowicz; Dr. Peterson Maina

2018 House of Delegates in Buffalo

Page 12 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 13

William Latreille, MD (left) and Kira Geraci, MD (right) present outgoing MSSNY president Charles Rothberg, MD with an award for dedicated service

to the medical society.

Past mssnY presidents gather at the HOD: Front row (left to right) Duane M. Cady, MD; Charles N. Aswad, MD Back row(left to right) Malcolm Reid, MD, MPP; Michael Rosenberg, MD; John Ostuni, MD; Richard Peer, MD;

Robert Hughes, MD; Paul Hamlin, MD; Charles Rothberg, MD; Andrew Kleinman, MD; Joseph Maldonado, MD

thracian James-Goulbourne mbbs (1st Place – Vignettes), discusses her poster with Kira Geraci, MD at the Poster Symposium.

Right: Chairman of the Board Dr. Paul Hamlin

presents MSSNY’s highest honor, the Feinberg Award,

to Dr. Nancy Nielsen.

Medical student Pratistha Koirala with John

Kennedy, MD, AMA Delegate Chair

northwell physicians gather at the HOD: (left to right) Dr. Carlos Zapata, Dr. Louis Auguste, Dr. Art Fougner, Dr. Marie

Basile, Dr. Paul Hamlin, Dr. Penny Stern, Dr. Cara Kvilekval, Dr. Charles Rothberg, Dr. Ani Bodoutchian, Dr. Robert Schreiber,

Dr. Bonnie Litvack, Dr. Michael Ziegelbaum, Dr. David Podwall, Dr. Inderpal Chhabra, Dr. Carol Moodhe

Left: Thomas J. Madejski, MD, FACP speaks at the Theodore Roosevelt Inaugural Museum in Buffalo, hosted by the Erie County Medical Society

nYs commissioner of Health Howard Zucker, md, Jd receives Award of

Recognition from Charles Rothberg, MD and Thomas J. Madejski, MD.

Photo Credit: Steve Sachs2018 House of Delegates in Buffalo

Page 12 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 13

mY PrioritiesFor those who do not know me, I am an Internist who

specializes in geriatric medicine and palliative care. The practice of medicine has changed substantially over the last 25 years. Some of that change has been wonder-ful – many of my geriatric patients are living longer and healthier lives at the same time that a tsunami of obesity, diabetes, and disability arises in our younger population, disproportionately in people with social, eco-nomic and other challenges.

Changes in the healthcare system and health care financing have reduced the joy of practice and converted time that should be spent with patients to clerical activ-ity to arrange services for patients, play the incredibly popular online game – charting in the electronic medical record – or adding unnecessary documentation to stay out of trouble with sometimes overzealous regulators.

Dr. Rothberg’s Three Pillars for his presidency have been engagement, disparity, and wellness. During my presidency I would like MSSNY to build upon Dr. Rothberg’s themes and expand them further.

We are in the middle of a course correction, and have encountered some head winds, but I like our direction and my hope is that with constancy at the helm, and a great tactician like MSSNY’s Executive VP Phil Schuh and his capable staff to assist us – we will soon be on a broad reach, with the winds mostly at our back, and calm seas ahead. enGaGement

Dr. Rothberg rightly emphasized reaching out in new ways, to physicians, both members and non-members, and groups outside our usual friends. I would like to see us expand our reach to the colleagues that we work with every day. Membership in MSSNY should not be a ben-efit to just the physician member, but it should provide information and service to his or her team to enable them to do their best job, multiplying the value of mem-bership to our members. We serve our patients together as a team. We can also advocate more effectively as a team on behalf of our patients and for improvements in our practice environment.

We need to further engage our present members in the political process. Our team at governmental affairs has started what looks to be a very successful political outreach program. Our PAL program has already had great success. We have had additional activity at the HOD, and I would like to have a goal of a MSSNY physi-cian liaison for each member of the State and Federal legislative branches.

We had some disappointments with the legislature last year. If we want to modify that course, we must engage more fully with our legislators, and with our new allies, help improve the practice environment in New York State which is ranked last in desirability for practice amongst the 50 states.

We need to engage more members and raise more dollars for MSSNYPAC. I would respectfully request that you help us identify and recruit additional members and review your personal level of activity. Ask your friends

and fellow delegates “Are they in?” If not, respectfully, ask them to reexamine why one would spend three or more days out of their practice at the HOD to work on the issues critical to our profession, but not continue on implementation to make them successful. If everyone currently in the PAC moved up a level we would mark-edly improve our effectiveness in advocacy.PHYsician Wellness

It is not the practice of medicine that distresses us. It is non clinical distractions – burdens of paperwork, poorly functioning EMRs, meaningless data collection, prior authorization, and lack of adequate voice that afflict us. We will continue to work with our partners at the AMA and other organizations to improve the prac-tice environment and satisfaction of physicians and their patients with their practice.disParities

We will continue the work started to make sure that patients can find and engage with a physician who knows them and cares for and about them. MSSNY has been instrumental in the AMA reconvening a task force to continue to work on disparities and we will be well represented by Dr. Malcolm Reid and Dr. Erik Eiting in Chicago.

I would also like to expand some of our activity on socioeconomic disparities for patients and underserved groups within NY State. One of my other professional hats is that of medical director for Orleans Hospice. There are great disparities in access to and the quality of care at the end of life. It is a complex issue with large variations in the wishes of patients and the application of care when patients approach the end of their natural lifespan or are faced with a terminal illness. We need to create an environment that eliminates the desire for a patient to contemplate ending their life, due to fear of inadequate care at the end of life. I will ask a number of our committees to examine how MSSNY can help to improve the care of our patients at end of life.

I will continue to champion the Madejski rule – MSSNY will oppose any legislation, regulation or other activity that interferes with time spent with, or the quality of our relationship with our patients.Heroes

Teddy Roosevelt gave an address at the Sorbonne about Citizenship in the Republic. I’ve always felt it applied to the many colleagues and staff members that I admire in the Tri-counties, Eighth district, and MSSNY:

The credit belongs to the person who is actually in the arena; whose face is marred by the dust and sweat and blood; who strives valiantly ... who, at worst, if he fails, at least fails while daring greatly; so that his place shall never be with those cold and timid souls who know nei-ther victory or defeat.”

This House of Delegates is filled with men and women who are in the arena working tirelessly to improve the lives of their patients, colleagues, and all of the citizens of New York State. Together, we have shared victories, and some defeats, but return again to try and find and celebrate the truth.

Thanks to all of you for being my heroes.

(Continued from page 4)

President’s column

Page 14 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 15

Mobile Medication Management: Holding Your Practice’s Future in

Your Fingertips Think about the last time you logged into your computer

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

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

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

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

Congratulations and Best Wishes

Dr. Tom Madejski

You are our star!

We are so proud of you.

Love,

Aunt Marge, Cousin Marilyn, Joe and Otis Gibbon

Congratulations

Dr. Tom Madejski

and Best Wishes

for a Very Successful Year!

Love, Mom, Linda, Pantelis, Mary Ann and George

Physician Advocacy Institute Study: 42% of Physicians are Employed

by HospitalsOn March 14, the Physicians Advocacy Institute (PAI), of

which MSSNY is a charter member and a member of the Board of Directors, released a report that updates a pre-viously-released study conducted by Avalere Health that examined the continued growth in hospital acquisitions of physician practices and the trend toward physician employ-ment. The new study adds an additional year of data to the earlier study, which reviewed the period from mid-2012 to mid-2015.

Avalere researchers found that by mid-2016, hospitals acquired an additional 5,000 medical practices, and physi-cian employment grew 11% from a year prior. By 2016, 42% of physicians were employed, as compared to just one in four in 2012. In a regional analysis, researchers found growth in hospital acquisitions of medical practices in every region of the country, ranging from 83% to 205% over the four-year period.

PAI is studying these trends as part of an ongoing research collaboration with Avalere Health in order to better under-stand how physician employment and consolidation in the health care system affects the practice of medicine and impacts spending by payers and patients.

Page 14 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 15

Smoking Rates in New York Hit

new lowThe “number of smokers

in New York State is at the lowest level in recorded his-tory. 14.2 percent as of 2016, below the national average of 15.5 percent. According to the figures from the annual Behavioral Risk Factor Surveillance System, “smok-ing among 18-to-24-year-olds dropped from 21.6 percent to 11.7 percent; smoking among New Yorkers without a high-school diploma dropped from 25.7 percent to 19.2 percent; and smoking among people making less than $25,000 a year fell from 27.8 percent to 19.8 percent.”

The Drug Enforcement Administration is warning the public about criminals posing as DEA Special Agents or other law enforcement personnel as part of an international extor-tion scheme.

The criminals call the victims (who in most cases previously purchased drugs over the internet or by telephone) and identify them-selves as DEA agents or law enforcement officials from other agencies. The imperson-ators inform their victims that purchasing drugs over the internet or by telephone is illegal, and that enforcement action will be taken against them unless they pay a fine. In most cases, the impersonators instruct their victims to pay the “fine” via wire transfer to a designated location, usually overseas. If victims refuse to send money, the imperson-ators often threaten to arrest them or search their property. Some victims who purchased their drugs using a credit card also reported fraudulent use of their credit cards.

Impersonating a federal agent is a violation of federal law. The public should be aware that no DEA agent will ever contact members of the public by telephone to demand money or any other form of payment.

The DEA reminds the public to use cau-tion when purchasing controlled substance

pharmaceuticals by telephone or through the Internet. It is illegal to purchase con-trolled substance pharmaceuticals online or by telephone unless very stringent require-ments are met. And, all pharmacies that dispense controlled substance pharma-ceuticals by means of the internet must be registered with DEA. By ordering any pharmaceutical medications online or by telephone from unknown entities, members of the public risk receiving unsafe, counter-feit, and/or ineffective drugs from criminals who operate outside the law. In addition, personal and financial information could be compromised.

Anyone receiving a telephone call from a person purporting to be a DEA special agent or other law enforcement official seeking money should refuse the demand and report the threat using the online form below. Please include all fields, including, most importantly, a call back number so that a DEA investigator can contact you for additional information. Online reporting will greatly assist DEA in investigating and stopping this criminal activity.

To report an extortion scam incident, click here.

DEA Warns Public of Extortion Scam by DEA Special Agent Impersonators

Are you up to dAte on your dues?

www.mssny.org

Page 16 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 17

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Open Payments Program Year 2017 Review and Dispute Period Begins April 1st

Review and dispute for the Program Year 2017 Open Payments data begins on Sunday, April 1, 2018 and will last until May 15, 2018. During the review and dispute period physicians and teaching hospitals may review, affirm, and, if necessary, dis-pute their attributed records. Physicians and teaching hospitals must initiate their disputes during the 45-day review period in order for the disputes to be addressed before or reflected in the June data publication.

Note: Physicians and teaching hospitals must work directly with the reporting entity to reach a resolution. The Centers for Medicare & Medicaid Services (CMS) does not mediate or mod-erate disputes.

Physician and teaching hospital review of the data is vol-untary, but strongly encouraged. While the opportunity for physicians and teaching hospitals to dispute any data associ-ated with them expires at the end of the calendar year in which the record is published, the disputes must be initiated during the 45-day review and dispute period, ending on May 15, in order to be reflected in the June 30 publication. CMS will publish the Open Payments Program Year 2017 data and updates to previous program year’s data in June 2018.if You Have never registered in open Payments before:

• Before you begin, make sure you have your National Provider Identifier (NPI) number and State License Number (SLN). Initial registration is a two-step process and should take approximately 30 minutes:

• Register in the CMS Enterprise Identity Management System (EIDM);

• Register in the Open Payments systemfor users that registered last Year and Have used their accounts in the last 60 days:

Physicians and teaching hospitals who registered last year do not need to reregister in the EIDM or the Open Payments sys-tem. If the account has been accessed within the last 60 days, go to the CMS Enterprise Portal, log in using your user ID and password, and navigate to the Open Payments system home page.for users that registered last Year but Have been inactive for more than 60 days:

The EIDM locks accounts if there is no activity for 60 days or more. To unlock an account, go to the CMS Enterprise Portal, enter your user ID and correctly answer all challenge questions; you’ll then be prompted to enter a new password.

Page 16 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 17

mssnypAC Is for everyone!we urge you to support our efforts. you can do it right now by

clicking here and making a donation to mssnypAC. If you’re already a member, we urge you to contact 10 colleagues to be sure they are members.

For just $15/month, you can become a member of the pAC.

But why stop there?For $85/month, you can be a member of our prestigious Chairman’s Club. And for $210/month, you can join our elite president’s Circle.

How to Handle the Under-Performing Employee in Your Medical Practice:

Documentation, an Invaluable Cost-Containment Safeguard

By Andrew L. Zwerling, Esq. One of the greatest expenses for medical providers is labor

costs, which comprise, according to some estimates, almost 30% of costs. Employee discipline issues are a component of those costs and can become rather expensive if left unat-tended or handled poorly. Employee discipline issues can result in lower productivity, lower morale in the workplace, higher turnover and greater susceptibility to litigation and attendant legal costs. Furthermore, permitting adverse and disruptive employee behaviors may adversely impact patient safety and quality of care, because statistics confirm a correlation between disruptive behaviors and the quality of the delivery of patient care services. This topic is one that likely affects every medical practice and business on a daily basis, regardless of its size, with implications that can be far-reaching and costly. At some point, you will face an employee discipline issue and therefore need to know how to respond to it. ensure ProPer documentation

The most critical takeaway point concerning a problematic employee: ensure that you have proper documentation in place should you find the need to impose discipline, includ-ing termination of the employee. Documentation should take multiple forms. One type is having an employee policy manual that places employees on notice of your expectations as an employer and of behavioral standards. Employers can refer to provisions of an employee manual for purposes of estab-lishing legitimate and lawful reasons for taking an adverse employment action against an employee. Additionally, per-formance problems should be documented in both employee evaluation forms and in disciplinary memos. As to the latter, although not every incident will require a formal notice, it should still be documented.make documentation a PrioritY

Significantly, documenting employee matters is not simply a ministerial task of creating paperwork. A policy and practice of documenting such issues serves many purposes, including establishing a record of employment actions taken and the reason for the actions, enhancing employee morale, prevent-ing disruptions to the day-to-day operations of your medical practice, lessening the risks of lawsuit, and leading to greater success in litigation should your practice be sued by a dis-gruntled employee. Failure to document adequately can have serious implications, including a lack of formal evidence for defense in the event of legal claims, and also financial costs.Andrew L. Zwerling is a Partner-Director at Garfunkel Wild P.C. and a member of the firm’s Litigation and Arbitration, Employment Law and Compliance and White Collar Defense practice groups, and Co-Chair of the firm’s Appellate Practice Group. His direct line is 516-393-2581.

This organization receives financial support for offering this auto and home benefits program.1 Discounts and savings are available where state laws and regulations allow, and may vary by state. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify.Coverage provided and underwritten by Liberty Mutual Insurance and its affiliates, 175 Berkeley Street, Boston, MA 02116.©2015 Liberty Mutual InsuranceValid through February 24, 2016.

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Page 18 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 19

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Bolstering Small-Practice “Medical Home” Capabilities

Small independent primary care providers are a vital lifeline for New Yorkers, providing services to many diverse and often disadvantaged communities. While they make up approximately 40 percent of all primary care providers in New York City and State, these practices are at risk of falling behind in the race toward medical home recognition and value-based purchasing.

Understanding that challenge, United Hospital Fund (UHF) brought together more than 30 experts last year to discuss the potential for shared services among small practices-a way to pool resources for practice transfor-mation and eventual value-based purchasing (VBP). The results of that convening and subsequent efforts are now being finalized, with an anticipated release this spring.

Part of UHF’s partnership with the New York City Department of Health and Mental Hygiene and the New York City Population Health Improvement Program, the roundtable discussion solicited expert feedback on a white paper entitled New York City Population Health Improvement Program (PHIP) Small Primary Care Practice Project, Draft Interim Report, which was provided to par-ticipants in advance for their review and comment.tHat rePort revieWed:

Findings from a series of focus groups of small-practice providers in New York City, describing a specific set of capacities the practices felt they needed to operate as medical homes and participate in VBP contracts, but could not afford on their own. Providers reported willingness to consider sharing services with other small practices if those services were affordable and provided by a trusted organization with a track record of competence;

Findings from a series of interviews with organizations in New York State that are providing a range of services to small practices, describing the types of services offered and how they are organized, deployed, and supported.

The conversation reinforced the findings of this qualita-tive research, particularly related to the core competencies of medical homes and preparation for value based pay-ment. Of particular value were discussions on the scope of the shared service “bundle” that was envisioned, with discussants recommending that it include support in two priority areas with which many small practices often struggle:

• The adoption and best use of electronic medical records, and

• Practice management consultation and support on operational issues and on compliance with complex and changing requirements related to billing and coding.

The Draft Interim Report and roundtable findings served as the foundation for subsequent quantitative work describing the legal and regulatory issues involved in establishing a shared service program, and modeling the economics of such a venture.

The final report will bring together both the qualitative and quantitative reports findings of the project.

For more information, click here.

Page 18 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 19

New York State Attorney General Eric T. Schneiderman released a report detail-ing the work of his Health Care Bureau’s Helpline, a free service offered by the Office of the Attorney General that has investigated and resolved over 2,500 con-sumer complaints during the past year – saving or returning almost $2 million in health care expenses to consumers. The service has also helped countless New Yorkers access medically necessary care or prescription medication previously denied to them.

The Health Care Bureau’s 2017 Annual Report, Real Solutions for Real New Yorkers, details the work of Helpline advo-cates to resolve consumer complaints, and discusses some of the major cases handled by the bureau. The Attorney General’s toll-free HCB Helpline, 800-428-9071, is available for New Yorkers to report and resolve health care com-plaints and concerns ranging from simple payment processing errors to complex deceptive business practices. Consumers can also use the Attorney General’s online complaint form to lodge a complaint.

During 2017, Helpline staff handled 2,515 consumer complaints and provided another 3,050 consumers with informa-tion or referred them to an appropriate agency for assistance. These consumer complaints include issues such as incor-rect medical billing, wrongful health plan rejection, improper processing of health insurance claims and wrongful termination of health insurance.

• In one case, a consumer contacted the Helpline regarding her health plan’s denial of coverage for prescription medication for her son who was tak-ing a particular medication (Quillivant XR) that, after trying other medica-tions, was the only medication that successfully treated the son’s ADHD. The consumer’s request was particu-larly urgent because the health plan had denied continuation of the pre-scription as not medically necessary, leaving the child without medication for almost two weeks. Once a Helpline advocate intervened, the medication was approved.

• After receiving a complaint that Brooklyn Hospital Medical Center had illegally billed a sexual assault survi-vor seven separate times for a forensic rape exam (FRE) administered in the hospital’s emergency room, the HCB conducted an investigation that found that in 85 out of 86 cases between 2015 and 2017, the hospital either improperly billed the patient directly, or billed the patient’s insurance plan

without advising the patient of the choice of payment options as required by law. After these revelations, the Attorney General’s office secured a settlement requiring Brooklyn Hospital to pay restitution to improperly billed survivors, maintain and properly dis-seminate a Sexual Assault Victim Policy that prevents improper billing, and pay $15,000 to New York State. The investigation also led to HCB’s statewide investigation of improper hospital billing for FREs, which is cur-rently underway.

While not all complaints can be resolved favorably, the Helpline can often pro-vide reliable, objective information.

Additionally, Helpline advocates work to ensure that any negative effects from improper medical billing or insurance claims are removed from credit reports.

For more information about services provided by the Attorney General’s Health Care Bureau Helpline, click here. Consumers who believe that they may have been treated unfairly by an HMO or insurance plan, or health-related business should contact the Attorney General’s Health Care Helpline by either calling the Helpline at 1-800-428-9071, or by sub-mitting a complaint form online or by mail. Instructions for submitting a com-plaint form by mail are also provided on the website.

The BankAmericard Cash Rewards™ credit card

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

By opening and/or using these products from Bank of America, you’ll be providing valuable financial support to Medical Society of the State of New York.

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medICAL soCIety oF the stAte oF new yorK2017 ALBIon o. BernsteIn, md AwArd

the medical society of the state of new york is accepting nominations for the 2017 Albion o. Bernstein, md Award.

this prestigious award is given to:“…the physician, surgeon or scientist who shall have made the most widely

beneficial discovery or developed the most useful method in medicine, surgery or in the prevention of disease in the twelve months prior to December, 2017.”

This award was endowed by the late Morris J. Bernstein in memory of his son, a physician who died in an accident while answering a hospital call in November, 1940.

The $2,000 award will be presented to the recipient during a MSSNY Council Meeting.

Nominations must be submitted on an official application form and must include the nominator’s narrative description of the significance of the candidate’s achievements as well as the candidate’s curriculum vitae, including a list of publications or other contributions.

To request an application, please contact:Committee on Continuing medical education

Miriam Hardin, PhD, Manager, Continuing Medical EducationMedical Society of the State of New York

99 Washington Avenue, Suite 408Albany, NY 12210

518-465-8085mhardin@mssny.org

deAdLIne For nomInAtIons: may 31, 2018

8 Provisions That Can Make or Break Pay-For-Performance Contracts

By Andis Robeznieks, AMA Senior Staff WriterPay-for-performance agreements can either weigh physicians

down with a new load of administrative burdens or provide oppor-tunities to be rewarded for the high-quality affordable care they already deliver.

The direction these agreements take often depends on the details of a contract’s provisions related to patient assignment, claim submissions, access to data, quality measures, perfor-mance determination, payment and dispute resolutions.

An AMA resource, “Evaluating pay-for-performance contracts,” provides insights on key questions to ask regarding these issues and offers model contract language that can help physicians avoid pitfalls.

Government and private payers are increasingly turning to alternative payment models that seek to shift all, or a portion, of the risk of providing health care from the payer to physicians and others who provide health care services. Pay-for-performance is often the first step many payers and physicians take on their risk-based contracting journey.

Nearly 40 percent of physicians said in a 2016 AMA survey that they received some payment from participating in pay-for-perfor-mance programs.

In comparison, 34.8 percent participated in bundled payment, 25.1 percent in capitation and 16.7 percent in shared savings.

Meanwhile, a majority of practices operating as a medical home or participating in an accountable care organization (ACO) were involved in pay-for-performance agreements, the AMA survey found.

“Evaluating pay-for-performance contracts” provides guidance on choosing which payment model may be appropriate for your practice. It also suggests getting advice from peers on under-standing the underlying goals these models are designed to achieve.

There are eight common pay-for-performance contract provi-sions that should be identified and scrutinized, the AMA advises.

Patient assignment. Provisions on patient assignment consume a significant amount of time and attention during negotiations as the level of risk each party assumes depends on where lines are drawn on this subject. Physicians should push back if a plan attempts to assign patients retrospectively.

“The agreement should provide for most patients to be assigned prospectively, with the ability to reconcile the list at the end of the performance period to account for patients that have left or entered into the physician’s care during the performance period,” says the AMA resource.

It is also important to include how costs will be reconciled if a patient receives elective or emergency care from someone else.

Performance period phase-in. The “performance period” includes the starting and end dates between which a physician’s performance is measured. This differs from the “agreement term” that covers the length of the contract.

The agreement should acknowledge that, before the first performance period starts, physicians may need time to tailor administrative systems and clinical protocols to the specifications of the pay-for-performance agreement. Model contract language calls for the first 12-month performance period to begin 60 days after the start of the agreement term.

Claim submission. Physicians should watch for “potential nuances” in the contract that obligate them to submit claims dif-ferently for their pay-for-performance patients than they do for their fee-for-service patients – even though they are covered by the same payer. If payers request additional modifiers or docu-mentation, they need to give physicians sufficient time – 60 days is suggested – to incorporate these processes into their workflows.

(Continued on page 22)

Page 20 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 21

Brooklyn Borough Hall

APRIL 28, 2018 NEW YORK HIT SYMPOSIUM & EXPO The Legal Pitfalls of EHR Technology: Mitigating the Risks

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Page 22 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 23

Are You Part of the Solution?Join MSSNY’s Physician Advocacy

Liaison NetworkOne of the most frequent comments raised at MSSNY DGA staff’s

various meetings with legislators and their staff is the importance of hearing their physician constituents’ experiences, stories, knowledge and expertise. This is why participating in MSSNY’s PAL program is so important. Please see the information below on how to sign up to become a PAL.

With so many changes occurring in our health care system, and other opposing interests seeking to marginalize the physician’s role as leader of the health care team, we must make up for it with an overwhelming presence in grassroots activity that will make it impos-sible for legislators to ignore.

Physicians must mobilize and become more active in the legislative and budget process to better ensure the enactment of favorable legis-lation and the defeat of proposals that will adversely impact the care that you provide to your patients. Click here to sign up to be a PAL.

Physician Employment TrendsOn March 14, the Physicians Advocacy Institute (PAI), of which

MSSNY is a charter member, released a report that updates a previ-ously-released study conducted by Avalere Health that examined the continued growth in hospital acquisitions of physician practices and the trend toward physician employment. The new study adds an additional year of data to the earlier study, which reviewed the period from mid-2012 to mid-2015.

Avalere researchers found that by mid-2016, hospitals acquired an additional 5,000 medical practices, and physician employment grew 11% from a year prior. By 2016, 42% of physicians were employed, as compared to just one in four in 2012. In a regional analysis, research-ers found growth in hospital acquisitions of medical practices in every region of the country, ranging from 83% to 205% over the four-year period.

PAI is studying these trends as part of an ongoing research collabo-ration with Avalere Health in order to better understand how physician employment and consolidation in the health care system affects the practice of medicine and impacts spending by payers and patients.

ABBUHL, John W.; Albany NY. Died January 06, 2018, age 91. Medical Society County of AlbanyABELES, Ernest D.; New York NY. Died January 10, 2018, age 82. Medi-cal Society County of KingsANSON-FONTANA, Angelita G.; Penfield NY. Died January 28, 2018, age 97. Monroe County Medical SocietyBLAIS, Bernard R.; Clifton Park NY. Died December 23, 2017, age 86. Medical Society County of SchenectadyCHANG, Jacqueline; New York NY. Died March 20, 2018, age 98. Nas-sau County Medical Society CHIONG, Marcial M.; Dix Hills NY. Died December 20, 2017, age 89. Suffolk County Medical Society CINCOTTA, Onofrio; Bronxville NY. Died January 16, 2018, age 93. Medical Society County of WestchesterCLAPS, Albina A.; Saint Petersburg FL. Died January 05, 2018, age 95. Richmond County Medical Society COLGAN, John W.; Rochester NY. Died March 05, 2018, age 97. Mon-roe County Medical SocietyDOUCET, Roland Ernest; Schenectady NY. Died September 04, 2017, age 87. Medical Society County of SchenectadyFISHLER, James Stuart; Poughkeepsie NY. Died September 26, 2017, age 93. Dutchess County Medical SocietyHESS, Bennet John; Rockville Centre NY. Died March 08, 2018, age 84. Nassau County Medical Society HUMEREZ-ALCONCE, Roberto H.; Jersey City NJ. Died January 25, 2018, age 77. Medical Society County of Kings IMPARATO, Anthony M.; New York NY. Died February 12, 2018, age 95. New York County Medical Society HUMEREZ-ALCONCE, Roberto H.; Jersey City NJ. Died January 25, 2018, age 77. Medical Society County of Kings KLAVINS, Janis Viliberts; Scarsdale NY. Died February 11, 2018, age 96. Medical Society County of Queens MALONEY, Milford C.; Williamsburg VA. Died February 09, 2018, age 90. Erie County Medical SocietyPALERMO, Gioacchino; Long Island City NY. Died March 01, 2018, age 91. Medical Society County of Queens PINCHUCK, Arthur Leon; Brooklyn NY. Died December 30, 2017, age 88. Medical Society County of KingsPLETMAN, Robert Jonathan; Schenectady NY. Died January 06, 2018, age 88. Medical Society County of SchenectadyROSENFELD, Isadore; New York NY. Died January 30, 2018, age 91. New York County Medical Society SALWEN, Martin J.; Brooklyn NY. Died December 12, 2017, age 86. Medical Society County of Kings SONDERS, Lawrence Jay; White Plains NY. Died August 24, 2017, age 86. Medical Society County of WestchesterTEIN, Alfred Marvin; Williamsville NY. Died March 08, 2018, age 85. Erie County Medical SocietyWUNDERLICH, Howard O.; Lantana FL. Died February 11, 2018, age 98. Suffolk County Medical Society ZOBAL, Zdenek F.; Schenectady NY. Died March 05, 2018, age 83. Medical Society County of Schenectady

obituaries

“Physicians should be on the lookout for provisions that allow the payer to change the submission and reporting obligations of the physician without due notice, many of which can be ‘effec-tive immediately,’” the AMA resource says. This sentence should be included in the contract: “Payer shall make every effort to minimize the administrative burden associated with Physician’s participation in the Agreement.”

Data. Physicians must have timely access to data on patients for whose care they are being evaluated. Twenty-four hour access to patient data, quality metrics, itemized billing and patient-encounter information should be available via a secure online portal or dashboard. If this is not feasible, at a minimum weekly updates must be provided.

Ideally, payers should offer infrastructure or technical sup-port to facilitate fulfillment of the physician’s data-transfer obligations. The physician and payer may need to enter into a business associate agreement to ensure proper use and disclo-sure of patient health information and to be in compliance with Health Insurance Portability and Accountability Act standards.

Quality measures. Measures need to be relevant to the phy-

sician’s specialty and based on nationally accepted standards. Any additions, deletions or changes require mutual agreement.

Performance determination. The formula for calculating physician performance must be clearly spelled out in the agree-ment and payers must not be allowed to unilaterally change the terms. There should be a provision for appropriate risk adjustment. Physicians should be aware that payers often raise quality benchmarks from year to year reflecting the doctor’s increased ability to succeed. They also may lower benchmarks on decreasing costs as those often become more difficult to achieve over time.

Payment and reconciliation. The time frame for payment, reconciliation and any deductions for case management or administrative fees should be clearly defined. There must also be a defined appeals process for physicians to contest the payer’s decisions regarding performance, payment and reconciliation.

Dispute resolution. The agreement may include processes for mediation or arbitration. The resource, however, notes that physicians may not want to make these to be legally binding. Not doing so may give aggrieved physicians more leverage in the dispute.

8 Provisions That Can Make or Break Pay-For-Performance Contracts(Continued from page 20)

Page 22 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 23

By Michael M. Stone, Esq. Discontinuing a medical practice, whether due to retirement or

sale of the practice, requires careful planning. Although this arti-cle and the attached checklist attempt to be as comprehensive as possible, any plan to close should anticipate potential prob-lems and assume longer timelines as a result. In addition to the obligations to their patients, physicians who are closing or leav-ing a practice also have obligations to their employees, business partners, payors, contractors/landlord, and regulatory agencies. These obligations are the focus of this article and the checklist. The sale of a practice gives rise to additional issues, such as the proper valuation of the practice, confidentiality agreements with potential buyers, assignment of contracts, and the structuring of the payment of the purchase price in a manner that does not create potential anti-kickback or fee-splitting issues.i. Patients

Physicians have an ethical and legal obligation not to abandon their patients. Generally, physicians should inform their current patients that they are leaving or closing their practice 60 to 90 days before the date on which they intend to do so; a shorter or longer notice period may be appropriate for different spe-cialties. Payor contracts may have specific patient notification requirements. Generally, with respect to those patients who are not actively under the physician’s care (i.e., have not been seen by the physician within the past 2 years), a certified let-ter should be sent to each patient stating the date at which the physician’s practice will cease and instructing the patient to consult his or her insurance company’s provider directory or contact the local medical society for assistance with future care. If providing a certified letter to all such patients would not be feasible, the physician should consult an attorney for guidance. A HIPAA authorization form should be included with the letter to the patient to facilitate the transfer of medical records to the patient’s new provider. Note, however, that a patient’s failure to return the HIPAA authorization form cannot be grounds for denying the patient access to his or her medical records or for releasing the patient’s medical record to the patient’s new phy-sician. New York law requires only that a patient or qualified person submit a written request to review or to receive a copy of the medical records, or to release them, subject to certain

exceptions. In addition, the physician should be prepared to assist those patients who are actively under his or her care with arranging for the continuation of their care, particularly those patients who are hospitalized, in nursing homes, or other-wise unable to arrange for care on their own. Documentation of efforts to contact patients regarding the closing of the practice (e.g., copies of letters sent, returned letters, notes of telephone or in-person conversations) should be retained in patients’ records.retain records for 6 to 10 Years

The physician must retain each patient’s original medical record for at least 6 years after the last date of service, or, if the patient is a minor on the last date of service, until the patient turns 19 years old, whichever is later. Obstetrical records must be kept until the child is 19 years old. If possible, it is recom-mended that a patient’s original medical record be retained for at least 10 years. Records must be kept safe and secure and be made reasonably available to former patients or other qualified persons. The HIPAA Privacy Rule applies to storage, handling and disposal of the records and the protected health informa-tion they contain. Patients or other qualified persons may be charged for copies of their medical records at no more than 75 cents per page, but may not be denied a copy if they are unable to pay. If the patient’s original medical record has been trans-ferred to another provider, the physician should have a written agreement with that provider that specifies the length of time the record will be held, arrangements to transfer records at the patient’s request, a guarantee that the physician will have access to the record if necessary, and notification to the physi-cian before the record is destroyed or transferred.ii. employees

When a physician decides to close his or her practice, the practice’s employees should be the first to know. Any existing employment contracts need to be reviewed to ensure that notice to employees are consistent with applicable contract provisions concerning the timing and the form of the notice, as well as any additional obligations to the employee that arise as a result. The physician should consider offering incentives to retain nec-essary staff through the closure of the practice and whether

Valiere Alcena, MD – WestchesterDiego Alvarez, MD – Madison Bernard Asher, MD – Genesee Marshall Atwell, MD – Monroe George Baeumler, MD – Erie Kishan Rao Battu, MD – Rensselaer Bernard Berger, MD – Suffolk Rubin Berlinerblau, MD – Kings Kathy Birk, MD –Monroe Richard Blum, MD – Nassau Teresa Briggs, MD – Albany Damiano Buffa, MD – Suffolk Duane Cady, MD – Onondaga Michael Cesa, MD – Suffolk William Clack, MD – Chemung Joseph Cleary, MD – Suffolk Guido Di Benedetto, MD – Richmond Maria De Blasio, MD – Bronx Joseph Di Bianco, MD – Westchester Thomas Eagan, MD – Fulton Jacob Esses, MD – Queens

Gloria Faretra, MD – Queens Jay Federman, MD – Suffolk Stephen Friedland, MD – Dutchess Algirdas Gamziukas, MD – Erie Amado Gan, MD – Kings Nicholas Giampetruzzi, MD – Nassau Louis Giordano, MD – Broome Joseph Giovanniello, MD – Kings Ann Haag, MD –Monroe Edward Hanin, MD – Westchester Rita Harper, MD – Nassau Richard Henir, MD – Onondaga Ernest Horowitz, MD – Queens Tsung Che Huang, MD – Queens George Kaufman, MD – Bronx Barry Kent, MD – Bronx David Kluge, MD –Monroe Jehangir Kotwal, MD – Oneida Leon Krakower, MD – Dutchess Charles La Marca, MD – Queens Jose Andres La Paix, MD – Queens

Fidelina La Paix, MD – Queens Henry Lao, MD – Kings Khin Maung Latt, MD – Suffolk Rumoldo Layug, MD – Westchester Martin Lederman, MD –Westchester Amol S. Lele, MD - ErieMichael Madden, MD – Erie William Mc Intosh, MD – Erie Robert Michiel, MD – Onondaga Roger Moore, MD – Oneida Nicola Muia, MD – Suffolk Nagendra Nadaraja, MD – Monroe John Norlund, MD – ErieWilliam Nugent, MD – Onondaga Herman Oliver, MD – Nassau Manuel Palao, MD – St. LawrenceDominick Paonessa, MD – Albany Raymond Pastore, MD – Nassau Prakash Rao, MD – Queens Philip Reitz, MD – Oneida Jacob Rempel, MD – Niagara

Jeffrey Ribner, MD – Broome Patricia Romano, MD – Westchester Marlene Rosales, MD – OnondagaAustin Schlecker, MD – Kings Ralph Schlossman, MD – Queens Arthur Schore, MD - New York Joseph Sirna, MD – Kings Kenneth Steadman, MD – Ontario Robert Stookey, MD –Monroe Lucille Taverna, MD – Nassau Gregory Threatte, MD – Albany Miller Vaca, MD – Queens Juan Villarama, MD – Rensselaer Irma Waldo, MD – Columbia James Walker, MD – Nassau Leone Waltrous, MD – Kings Clifford Weingarten, MD – Suffolk Darius Winter, MD – Queens Joseph Yee, MD - New York

Closing Your Medical Practice? What You Need to Know

Life MembersThe Medical Society of the State of New York and the county societies are very grateful to the generous donations made by the following Life Members:

(Continued on page 25)

Page 24 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 25

Resident/Fellow Clinical Medicine First Place winner

Michael Kee-Ming Shu, MD

Medical Student Clinical Research First Place winner

Janki Shah

Medical Student Vignettes First Place winner Andrew Pasquale

Resident/Fellow Vignettes First Place winner

Tracian James-Goulbourne, MBBS

Rainbow Over Niagara FallsAMA Delegate Dr. Michael Richter took this spectacular photo while flying over Niagara Falls; Delegate Dr. Inderpal Chhabra was the pilot and Delegate Dr. Carlos Zapata was on board.

MSSNY’s 13th annual Resident, Fellow and Medical Student Symposium was held on March 23 at the House of Delegates in Buffalo. Seventy posters were accepted from a pool of 111 abstracts submitted statewide.

The presenters’ work was reviewed by vol-unteer judges drawn from the 2018 House of Delegates. The work was judged on origi-nality, significance, presentation, methods (where applicable), visual impact and inter-view, in four categories: Medical Student Clinical Research, Medical Student Vignettes, Resident/Fellow Clinical Medicine and Resident/Fellow Vignettes.Following are the winners in each category:Resident/Fellow, Clinical Medicine1st Place: Michael Kee-Ming Shu, MD2nd Place: Sarah Cairo, MDHonorable Mention: Asad Choudhry, MD and Halyna Chykyda, MBBSResident/Fellow, Vignettes1st Place: Tracian James-Goulbourne, MBBS2nd Place: Andrea Carr, MD3rd Place: Mihail Voica, MDHonorable Mention: Dalia Elias, MD and Jeffrey Rico, MDMedical Student, Clinical Research:1st Place: Janki Shah2nd Place: Benson KuHonorable Mention: Melanie HundtMedical Student, Vignettes:1st Place: Andrew Pasquale2nd Place: Fiorella CastilloHonorable Mention: Catherine Choi

2018 Poster Symposium WinnersPh

oto

Cred

it: S

teve

Sac

hs

do you have a great photograph that was shot in new york state?

send it to us atcsouthard@mssny.org

Page 24 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 25

it may be necessary to retain temporary personnel to replace those who decide to move on before the date of closure. While certain legal prior notification require-ments, such as the WARN Act, likely will not apply to a physician practice (the New York State WARN Act applies to employ-ers with 50 or more full-time employees), legal obligations with respect to termina-tion of individual employees still apply. Specifically, employees must receive notice in writing, within 5 days of termina-tion, of the exact date of their termination as well as the exact date of cancellation of employee benefits connected with their termination. The practice’s policies with respect to accrued vacation or sick time and with respect to severance pay must be followed as well.iii. business Partners

If a physician is leaving a practice he or she owns with other physicians, the co-owners should be the first to know. The practice’s organizational document, such as a partnership agreement, bylaws, or operating agreement, should be reviewed to determine the timing and the form of the notification to the co-owners. Depending on the physician’s role and ownership interest in the practice, the physician may be responsible for dissolving the pro-fessional services corporation (P.C.) or professional limited liability company or partnership (PLLC or LLP) that operates the practice and winding up the business. If the practice will continue without the physician, the physician should review the practice’s organizational document to determine whether a non-compete pro-vision restricts the physician’s activities after he or she leaves the practice. The physician should notify referring prac-titioners who may be affected by the closure of the practice and any hospitals and other facilities at which the physician has privileges of the physician’s intent to cease practicing. iv. Payors

If the practice is a Medicare provider, the date of the practice’s voluntary ter-mination is the date of closure. CMS requires Medicare providers to notify CMS’s regional office of their voluntary termination from Medicare and, upon receiving the regional office’s acknowl-edgement, to notify the public through a notice published in the local newspaper with the widest circulation as soon as pos-sible, and, if time permits, not less than 15 calendar days before the date of clo-sure. The regional office notifies the fiscal intermediary. State Medicaid regulations

require Medicaid providers to provide 30 days prior notice of termination to the Department of Health. Contracts with the third party payors with which the practice participates may have specific advance notice requirements and must be reviewed to determine the practice’s obligations with respect to termination and closure of the practice. When select-ing the date of closure, note that Medicare expects the first of the month, but gener-ally the physician should take into account issues that could arise from setting a clos-ing date that is mid-month or off-cycle.v. contractors/landlord

If discontinuing professional practice altogether, the physician should notify his or her malpractice insurance and general liability insurance carriers and arrange for tail coverage. If the physician intends to continue to provide medical advice or write prescriptions, malpractice insur-ance should be maintained. Suppliers (equipment lessors, office supplies, main-tenance and cleaning services, waste disposal, linen service, utilities, telephone, etc.) should be notified, and final state-ments should be requested. Depending on the provisions of the lease for the prac-tice’s office space, the physician may be able terminate upon notice to the land-lord. If not, and the term of the lease extends past the desired date of closure, the physician should attempt to negoti-ate favorable terms with the landlord for terminating the lease. If the physician is leaving a practice that will continue under the existing lease, the lease should be reviewed to determine whether the phy-sician is named personally as a tenant or otherwise obligated to guarantee the practice’s obligations under the lease. vi. regulatory agencies

With respect to the physician’s New York license, no action is required. The phy-sician’s registration may be permitted to lapse, and the physician can notify the NYS Education Department of his or her intent to cease practicing to avoid the potential imposition of late fees due to failure to reg-ister. Unused official NYS prescriptions/EMR paper must be returned to the atten-tion of the Official Prescription Program of the Bureau of Narcotic Enforcement for destruction, and instructions for the disposal of unused controlled substances should be sought. Instructions for retiring the physician’s DEA registration should be sought from the DEA.

Michael M. Stone is a partner at Garfunkel Wild, P.C. and can be contacted at mstone@garfunkel-wild.com and at 518.242.7582. Garfunkel Wild is General Counsel to MSSNY.

Checklist12 to 6 months prior to closing:• Decide on a specific date of closure or departure

from the practice at least 6 months in the future, if possible. Review lease and other contracts for notification requirements to ensure sufficient time for compliance with any such requirements. Consider setting the date of closure on the first of a month.

• Contact attorney and accountant for assistance.• Notify co-owners of the practice, if any. Review

the practice’s organizational document for obliga-tions related to departure from or dissolution of the practice.

• Meet with staff to notify them of the decision to leave or close the practice; plan to arrange for temporary staff, if necessary.

• Accelerate the processing of the practice’s accounts receivable to address outstanding accounts prior to closure as much as possible.

• Make arrangements for storage of patients’ med-ical records. If using a storage facility, make sure the facility has experience handling confidential medical records.

Three to two months prior to closing:• Notify patients of discontinuance of practice;

include instructions for access to medical records.• Notify payors, unless provider contract requires

earlier notification.• Notify landlord and contractors, including mal-

practice and general liability insurance carriers, unless lease or contract terms require earlier notification.

• Notify referring practitioners and facilities where the physician has privileges.

Two months to one month prior to closing:• Notify Medicare and Medicaid, as applicable.• Determine which medical records can legally be

destroyed and arrange for destruction.Within one month prior to closing:• Plan for possible outstanding receivables; con-

sider retaining assistance with collections.• Notify local medical society or other physicians

within the service area.• Publish notice of closure in local newspaper pur-

suant to Medicare requirements, if applicable.• Begin arrangements for disposal or sale of prac-

tice-owned assets, if applicable.• Prepare change of address forms.Upon closing:• Transfer remaining medical records to storage.• Notify NYS Education Department of cessation of

practice, if applicable.• Return unused official NYS prescriptions/EMR

paper to NYS Bureau of Narcotics Enforcement.• Dispose of unused controlled substances and

other medications as directed.• Maintain business records (personnel, tax returns,

invoices contracts etc.).• Maintain practice bank accounts for at least 90

days past closing to resolve outstanding payables.• Contact attorney to assist with dissolution of the

practice, if applicable.

Closing Your Medical Practice? What You Need to Know(Continued from page 23)

Page 26 • MSSNY’s News of New York • April - May 2018 April - May 2018 • MSSNY’s News of New York • Page 26

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No hospital rounding. Flexible and part-time schedules available. Sign-on bonus. For additional information please send inquiries or resumes to jobs@hhchc.

org. www.hometownhealthcenters.org

PatiENt NaVigatiON aNd PatiENt adVOCaCY SERViCES FOR YOuR PatiENtS

Barbara A. Brody & Associates, LTD., founded in 1992, is a private “Value–Added” resource for practices and patients. Barbara A. Brody, MPA

analyses medical insurance policies, long–term care policies, and insur-ance billing (physicians, healthcare facilities and pharmaceutical plans). We provide an understanding of the details of Medicare, Group and Individual policies to your patients and, in return, to you and your staff. We can help

your patients with long–term claim filing and medical financial management too. We help your patients figure out their insurance so you don’t have to.

Contact us at (212) 517–5100 or www.barbarabrody.com

–––––––––––––––––––––––aRE YOu tRYiNg tO lEaSE YOuR MEdiCal OFFiCE OR SEll YOuR

MEdiCal PRaCtiCE? tRYiNg tO SEll NEW OR uSEd MEdiCal EquiPMENt? Clineeds, the new online platform designed for medical providers.

With Clineeds you can lease your medical office, shared your office space, buy and sell used medical equipment, or post healthcare job opportunities. LIST-ING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up

Classified ads can be accessed at www.mssny.org. Click classifieds.JUNE 2018 ISSUE CLOSES MAY 15 $200 PER AD; $250 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 CHRISTINA SOUTHARD 516-488-6100 x355 • FAx 516-488-2188

classified advertisinG

OFFICE SPACE FOR LEASE/RENT

business sHoWcase

Over 35 years of experience representing physicians, nurses and other licensed health care providers in: •OPMCInvestigations,InterviewsandHearings; •OPDInvestigations,InterviewsandHearings; •SubstanceAbuseissues; •MedicalRecordKeeping; •SexualMisconductInvestigations; •ClaimsbyHMOsandMedicare/MedicaidforReim-

bursement; •ResolvingCriminalConvictionswithOPMCand

OPD.

Experienced, Reliable, Efficient and Discreet.

315 West 106th Street, Suite 1ANew York, New York 10025212-244-9090/ 646-678-0608pwalker@peltzwalker.com

PAUL E. WALKER, ESQ.ATTORNEY AT LAW

HELP WANTED

servICes