July 2019 Issue
At the Society’s Annual Meeting on June 11, 2019, we welcomed new President Mimi Buchness, MD. Doctor Buchness is a graduate of the Columbia University College of Physicians and Surgeons. She is board certified in Dermatology and is an Attending Physician in Dermatology at the New York Presbyterian Hospital, Columbia University Medical Center. Doctor Buchness is Assistant Clinical Professor of Dermatology at the College of Physicians and Surgeons, Columbia University. Below are her remarks upon inauguration.
I am proud and honored to be up here tonight as the new president of NYCMS. This organization was started in 1806 and I am following in the August footsteps of approximately 172 distinguished men and 6 women. I also recognized 4 people from my own field (Dermatology) in the list.
How did I get here? Well, Cheryl Malone once sang the Oklahoma song, “I’m Just a Girl Who Can’t Say No” to me couple of years ago. I try to say no, but there is too much important work to be done.
Sometime in the late 80s or early 90s, I got a phone call from Doctor Dick Scher, who told me that they needed a woman from downstate on the Board of Directors of the New York State Society of Dermatology & Dermatologic Surgery (NYSSDDS). I did have those credentials. After about 15 years of being Vice President, I became President. During my tenure we eliminated the call for a tax on cosmetic botulinum toxin, we went to Albany to lobby against the insurance requirement for step therapy, which the governor signed into law, we had tanning bed use banned in New York for children under the age of 17, also signed into law, and we lobbied against the various groups trying to encroach on physician territory. Dermatology is a very small group, so as a multi–specialty organization imagine what we could accomplish.
I started attending the MSSNY House of Delegates as a representative for NYSSDDS, and was taken under the wing of Cheryl Malone and the NYCMS delegation. I became friendly with many of the people in this room and joined the Board of Directors of NYCMS. After a few years I was asked to be Vice President and the rest is history.
We are facing unprecedented times in medicine, and as doctors we have many concerns. The issues mentioned in a survey given to the Board of Directors were as follows: reduction of physician burden (e.g., regulation, government mandates), minimizing prior authorizations, eliminating RVU quotas for employed physicians, the right to collective negotiation, liability reform, truth in advertising, scope of practice, pharmaceutical issues, public health issues, EMR problems, etc. I would also add Medicare and/or single payer for all, abortion rights, and mass shootings. Unlike what the NRA says, we are the ones who put people back together, and it is most definitely in our lane.
I’ll tell you how easy it is to increase membership. I recently met a young dermatologist who was very upset about the restructuring of ZocDoc in a Face Book group. He was trying to mobilize people to action. I invited him to our most recent NYCMS meeting so that he could see what is already available to us re: advocacy. He joined and hopefully will convince some of the other young dermatologists that it’s worthwhile to join!
So, in summary, during the next year, NYCMS will prioritize and work on the two to three most important advocacy issues, increase membership, and hopefully convene a committee on gun violence. I have chosen members for this committee and I know who you are.
I’d like to thank you all for welcoming me into NYCMS. I’d like to thank Cheryl, Susan, Lisa, and Sony for their hard work with NYCMS. I’d like to thank my family and my wonderful staff. And finally, a shout out to Doctor Peter Lombardo, who has been my mentor for 40 years. Thank you, Peter.
At its Annual Meeting on June 11, 2019, New York County Medical Society President Naheed Van de Walle, MD, presented Stuart I. Orsher, MD, JD, with the 2019 Nicholas Romayne, MD Lifetime Achievement Award. It was said of Doctor Nicholas Romayne, the Society’s first president, that “He was unwearied in toil and of mighty energy, dexterous in legislative bodies, and at one period of his career was vested with almost all the honors the medical profession can bestow.” The Society chooses Romayne Award recipients accordingly.
Doctor Stuart Orsher, our 2019 Romayne Award recipient, is a graduate of Hahnemann Medical College in Philadelphia. After his medical training, he earned his JD degree from the Fordham University School of Law. Doctor Orsher is board certified in Internal Medicine. He is in private practice and is an attending physician in the Department of Medicine at Lenox Hill Hospital. In addition to long service to the New York County Medical Society, including his presidency in 1988, Doctor Orsher is past president of the Medical Society of the State of New York. He is a Fellow of the American College of Legal Medicine and a Board member of the Island Peer Review Organization (IPRO). He is an honorary police surgeon.
Doctor Orsher’s leadership years coincided with a renaissance as the Society re–examined its potential to affect policy and help doctors in practice in a rapidly changing health care environment. He still offers such inspiration and support to the Society today.
This feature of MM “NEWS” introduces you to Society leaders as they explain their vision of organized medicine’s activities. This month, read Society Immediate Past President Naheed Van de Walle’s speech at the Annual Meeting
As I stand here before you I feel humbled and privileged to have served you as your 179th President and sixth woman president of our esteemed Society since its inception in 1806.
I am profoundly grateful for the opportunity and the trust that you placed in me to allowing me to serve as your President over the past year .
When we chose medicine as our profession, we knew that medicine is both an Art and Science. It is our humanity and empathy, our caring, dedication and concern that is the ultimate measure of success and source of professional reward and fulfillment.
We all know that medicine and science thrive on change and innovation, but the changes in healthcare that we are witnessing today have taken us in a whole different direction, which those of us who are baby boomers would have never anticipated. We are all caught in this change whether we like it or not. We are all in a struggle to adhere to our principals even as we meet the requirements of those who employ us, whether it is the hospitals or insurance companies.
We are losing autonomy and control over the care we provide to our patients.
Some of you may have come across a timely article in the New York Times ( 6/8/19), “The Business of Health Care Depends on Exploiting Doctors and Nurses” by Doctor Danielle Ofri, Professor of Internal Medicine, Bellevue Hospital. If you have not read it, I urge you to read it. https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html?searchResultPosition=1
What Doctor Ofri notes in her article is what we experience on a daily basis. We as physicians are fully aware of it as we are faced with these challenges on a daily basis. But does the rest of the public know the extent of the burden carried by physicians and nurses? Do your patients know? Are they aware that you spend endless hours on needless regulatory requirements, time that could be better spent attending to patient’s needs.
Doctor Ofri emphasizes the fact that one resource seems infinite and free: The professionalism of care givers. She notes that the ethics physicians hold so dear is manipulated and exploited by the “corporatization” of medicine. It is because of that ethic and deep sense of professional obligation, physicians and nurses do not clock out at 5:00 p.m. like all the administrative and other staff do. Physicians stay behind to finish their notes, answer their emails, and empty their in baskets. Doctor Ofri goes on to say that hospital administrators are well aware of the fact that physicians will not abandon their patients.
The “corporatization” of medicine has not helped contain the costs of health care delivery. It is quite the opposite. Health care spending was 74.6 billion dollars in 1970 and increased to 3.5 trillion in 2017. Believe me, it is not the physician’s fault.
As per a report by economist Alan Sager, the mega mergers of hospitals and closure of beds in New York have not decreased the cost of care; instead we see an increase due to more costly elite hospitals. Clearly it is not the patients or the physicians who stand to benefit from this new business model of health care.
Regulatory changes have affected many physicians so profoundly that physician wellness and physician burnout are being seriously looked at by more progressive institutions. But we need to do more.
That is why we as physicians need to come together at state, specialty, and national society levels to stand against the bad outcomes of poor decisions made by corporations and other stakeholders. We must not allow the regulatory decisions to change the face of medicine to such a degree that it is unrecognizable. (and no amount of reconstruction will restore it to its original form).
Physicians can no longer afford to be silent bystanders and allow this wrecking ball known as corporate medicine to blind us to who we really are and what we stand for.
We need to proactively start discussions about decisions made for physicians that lead to bad outcomes for patients and physicians. These discussions need not be just among ourselves, but must include general public and the legislators.
We must pay attention to what Doctor Vivek Murthy, former Surgeon General, says: “We (physicians ) have been assigned a role as a moral leader in the society, and we need to embrace it. Being a moral leader means standing up to the truth, reason, and science. That also means that we hold our elected leaders accountable, and we use the media when possible to speak up against policies that would hurt our patients and fellow physicians.”
Mimi Buchness, MD, became president of the Society at its meeting on June 11, 2019. The following were also elected;
Arthur Cooper, MD, President–Elect
Keith La Scalea, MD, Vice President
Jessica J. Krant, MD, MPH, Secretary
Thomas Sterry, MD, Assistant Secretary
Jill Baron, MD, Treasurer
Erick Eiting, MD, Assistant Treasurer
Naheed Van de Walle, MD, Trustee
Board Members At Large
Ksenija Belsley, MD
Michael Borecky, MD
Stuart Gitlow, MD
Loren Wissner Greene, MD
Keyvan Jahanbakhsh, MD
Mark Milstein, MD
Linda Nicoll, MD
Richard Schutzer, MD
Ami Shah, MD
Gabrielle Shapiro, MD
Maria M. LoTempio, MD
Delegates to the Medical Society of the State of New York (MSSNY)
Mimi Buchness, MD
Arthur Cooper, MD
Stuart Gitlow, MD
Paul Orloff, MD
Naheed Van de Walle, MD
Alternate Delegates to MSSNY
Ksenija Belsley, MD
Dennis Gage, MD
Michael Borecky, MD
Loren Wissner Greene, MD
Heskel M. Haddad, MD
Keith LaScalea, MD
Richard Schutzer, MD
Thomas Sterry, MD
Maria M. LoTempio, MD
The Society congratulates two early career physicians on their victory at the 14th Annual MSSNY Resident/Fellow and Medical Student Poster Symposium in April during the 2019 meeting of the MSSNY House of Delegates.
First Place in Clinical Medicine went to Ian Bezahler, MD, Lenox Hill Hospital. Doctor Bezahler’s project was The Secondary Pulmonary Lobule, Not Secondary at All: Its Implications and Importance in Diagnostic Imaging and Patient Management.
Honorable Mention for Medical Students went to Munib Francis, Touro College of Osteopathic Medicine — New York for Enterobacter Cloacae — Associated Cotton Fever: An Atypical Presentation.
As a member, you are entitled to attend Society meetings and functions. Keep track of what is going on by checking this listing in every issue of MM “NEWS.” Members are invited to attend any of these sessions; however, we suggest that you call (212) 684–4670 to confirm meeting date and time.
— Thursday, October 3, 2019, 5:30 p.m. to 6:00 p.m. for light dinner and registration; and 6:00 p.m. to 9:30 p.m. for Surviving Litigation Seminar, a CME program (3.5 AMA PRA Category I Credits™) presented by The Doctors Company. Midpoint Bistro & Bar, 40 West 45 Street, New York, NY 10036. No charge. Registration to open soon.
— Thursday, December 19, 2019, 8:00 a.m. to 10:00 a.m., 2020 Medicare Update with James McNally, at MEETH’s Corwin Hall, 210 East 65 Street. No charge. Registration to open in fall.
Licensure and Regulation of Pharmacy Benefits Managers (PBMs)
S.6531/A.2836A, which will require licensure for pharmacy benefit managers (PBMs) and outline their duties and responsibilities, has passed both houses and awaits the Governor’s signature. This bill aims to provide clarity and oversight of PBMs, and requires PBMs to act in the best interest of covered individuals, health plans and providers.
A.3918/S.1813 would allow physicians to prescribe a controlled substance on a “partially filled” basis. This measure would align New York State’s law with federal law; partial fills were authorized on a federal level under the Comprehensive Addiction and Recovery Act (CARA).
Physicians/prescribers, in consultation with their patient, could prescribe up to a 30–day supply of a controlled substance, with a notation to the pharmacist that he/she should only dispense the agreed–upon amount. MSSNY believes this measure will let prescribers help patients balance the need to relieve pain with the need to limit medications to an appropriate but not excessive supply, by only filling part of the prescription.
Reduction of Certain Prior Authorization Requirements
A.2880–B/S.5328–B is designed to reduce insurer prior authorization (PA) requirements when a PA for a related procedure has already been received. If a physician providing a treatment for which a PA has been received determines that providing an additional or related service or procedure is “immediately necessary as part of such treatment,” and that it would not be “medically advisable to interrupt…care” in order to obtain a PA, then the insurer is not permitted to deny the claim, except under limited circumstances.
Mid–Year Formulary Changes
A.2969/S.2849 would substantially limit health insurers’ ability to change their prescription medication formularies during a policy year. During that year, the insurer could not add new or additional formulary restrictions, nor could it remove a prescription from the formulary.
If the formulary had two or more drug–benefit tiers with different deductibles, copayments or coinsurance, the plan could not move a drug to a tier that had higher patient cost–sharing. (Exception: The legislation does permit an insurer to move a prescription drug to a tier with a larger copayment, coinsurance and different deductible, but only if, at the same time, the insurer adds an AB–rated generic equivalent drug or interchangeable biological product to the formulary.)
Though the trial lawyers aggressively pushed the State Legislature on several adverse bills in the Session’s final days, the Legislature left Albany without taking action on many of the trial lawyers’ high–priority bills, which would have driven up liability costs and made it harder for physicians to defend themselves in medical liability actions. These bills would have exponentially expanded awardable damages in wrongful–death lawsuits (S.4006/A.5612); prohibited a defendant physician from interviewing a plaintiff’s treating physician (S.6194/A.2370); and permitted the admissibility of certain “hearsay” statements by employees (A.7599/S.6335).
The Legislature did pass two bills pertaining to certain multiple–defendant cases. These bills would have an inflationary impact on medical liability costs, and MSSNY and other groups will urge the Governor to veto them. A.2372/S.6081 would let a plaintiff collect directly against a third–party defendant whom the original defendant had sued for contribution and indemnification. (The concern here: “strapped” defendants might dodge their financial responsibility, and instead target some third party who had deep pockets.) A.2373/S.6552 would require defendants to choose award options prior to trial. If co-defendant A has settled but co-defendant B has not, B ought to wait for the jury verdict to see the amount of his/her liability exposure. This bill would require B to choose “blind,” before the trial, between the stated settlement amount or A’s equitable share. (B, having made that “blind” choice pre–trial, might end up owing the plaintiff more than the jury eventually awarded.)
Scope of Practice
Several scope–of–practice expansion bills moved forward in the Senate but failed to win approval in the Assembly. S.5395/A.6185 would have expanded podiatrists’ scope, (1) by reducing certification requirements for podiatrists seeking advanced surgical privileges, (2) by removing the requirement that a podiatrist seeking surgery privileges be directly supervised by a podiatrist with an advanced NYSED license (or by a physician), and (3) by letting podiatrists treat wounds that are not contiguous with structures of the foot or ankle. S.1193 would have let Optometrists prescribe oral antibiotic and other medications. S.5092/A.3867 would have added pharmacists to the list of licensed professionals authorized to perform non–invasive laboratory tests without a physician’s order. S.5227/A.6511A would have let pharmacists provide ALL of the adult–recommended immunizations on the ACIP (Advisory Committee on Immunizations Practices) list, more than doubling the number of immunizations they could provide. S.4975/A.6486 would have authorized a pharmacist to administer hepatitis A vaccines, hepatitis B vaccines, and human papillomavirus vaccines to adults via a script written for a particular patient, or a script that was not patient–specific.
Several opioid prescribing measures failed to win passage, that would have imposed even more requirements on physicians before they prescribed. 8256/S.5867A would have required practitioners, before prescribing an opioid medication, to consider alternative treatments such as chiropractic, massage therapy or behavioral therapy. The practitioners would have been required to discuss these treatments with the patient and perhaps prescribe the treatments or make referrals. 5603/S.5150 would have required a prescriber who was making a first–time opioid prescription to co-prescribe an opioid antagonist as well. 7285A/S.4277A would have required practitioners prescribing an opioid or other Schedule II Controlled Substance to discuss CSII risks with the patient, and also to co–prescribe an opioid antagonist.
Legislation to permit the legalization and commercial sales of recreational-use marijuana did not happen this year. However, A.8420A/S.6579A, decriminalizing possession of small amounts of marijuana and expunging records, was successful. Governor Cuomo has indicated that he will sign this decriminalization measure.
MSSNY worked with the New York State Association of County Health Officials (NYSCHO), the PTA, the NYS Sheriffs’ Association, and Smart Approaches to Marijuana (SAM) to give the legislature a unified message about marijuana’s potential impact on young people, as well as the adverse public–health impacts seen in other states. MSSNY also credits several members of the Legislature with bringing those concerns back to the Senate and Assembly.
The legislature also did not act on legislation that would have expanded the medical marijuana program. This bill, which MSSNY opposed, would have eliminated the “serious condition” threshold for certifying a patient for medical marijuana, and would have permitted smoked versions of medical marijuana. In addition, the bill would have allowed any “practitioner” who is NYS–authorized to prescribe controlled substances, to certify a patient for medical marijuana use.
Only Medical Exemptions for Immunization
In a significant move to change public health policy, the New York State Legislature has passed a measure (A.2371A and S.2994A) assuring that the only permitted exception to New York’s vaccination requirements will be when there are medical contraindications. Governor Andrew Cuomo has already signed this bill into law. The bill allows a school–age child who has begun the immunization process to attend school in Fall 2019. The law becomes fully effective in June, 2020. MSSNY led a group of 33 specialty societies, patient advocates and public health advocates in providing strong support for the bill and enlisting many physicians, nurses, parents, and other public–health organizations in support as well.
Medical Records Requirements When a Practice Closes
A.2349/S.5367 sets forth procedures for when a physician or practitioner stops providing patient care in New York State — for example, when he or she retires or moves to another state. At least 30 days before ending practice, the provider must make a good–faith effort to notify the practice’s “current patients” that the practice is closing, and that the patients have the right to request that their medical records be sent to the provider, facility, or practitioner of their choice (or returned to the patient). The bill does not define “current patient,” but it does state that its provisions do not apply where a practice is acquired or merged with another entity and the physician continues to deliver care to the same patients. MSSNY is reviewing this legislation with its General Counsel, and will submit comments to the Governor’s office when the bill is delivered to the Governor.
Cesarean Section Mandate
S.2888/A.318, requiring physicians and other providers to provide their C–section patients with specific written information about C–section risks, passed the Assembly but not the Senate. MSSNY and the American College of Obstetricians and Gynecologists (ACOG) opposed this bill. Its terminology was not consistent with accepted medical practice; and, the measure could interfere with the physician–patient relationship by requiring boilerplate, pre–determined written communication (rather than patient–centered, custom provision of care, varying from patient to patient). Physicians already seek informed consent. This legislation reflects a troubling statewide and nationwide trend in which legislatures mandate that physicians discuss certain things and/or take certain actions.
Thanks to all our members, especially the members of the Government Affairs Committee, for calling, emailing, and visiting legislators to express concerns about these issues.
The New York State Department of Health, the Office of Children and Family Services, and the State Education Department, has issued a joint statement on the law that removed non–medical exemption from school vaccination requirements. According to the statement, as of June 13, 2019, “there is no longer a religious exemption to the requirement that children be vaccinated against measles and other diseases to attend either a public, private or parochial school (for students in pre–kindergarten through 12th grade or child day care settings.” For those children that have had a religious exemption to required immunizations, they must receive their first age appropriate dose in each immunization series by June 28, 2019 to attend or remain in school or child care. A copy of the joint statement and Frequently Asked Questions about the legislation can be found at:
Physicians and other providers who provide immunizations to children are advised to be prepared to see an increase in children who need these vaccines and to try their best to accommodate them into their practice. As summer and travel begins, there will be an increased demand for immunizations for both children and adults. The measles outbreak continues to grow in New York State. There is continued ongoing transmission of measles in communities in NYS with the majority of cases in those who are unvaccinated or under vaccinated. The New York State Department of Health has issued a June 14, 2019 health advisory that says:
Since October 1, 2018, there have been 932 cases reported in NYS: including 267 in Rockland County, 49 in Orange County, 18 in Westchester County, 8 in Sullivan County, and 588 in New York City (NYC).
Providers should NOT rely upon self–report of vaccination as evidence of immunity. If there is no record of vaccination or evidence of immunity (and no contraindication), the patient should be vaccinated.
For adults in outbreak areas, the NYSDOH recommends administration of a second dose of a measles–containing vaccine (MMR) for adults with one documented dose of a measles–containing vaccine.
For adults in non–outbreak areas, recommendations have not changed. One dose of a measles containing vaccine (or other presumptive evidence of immunity) is sufficient for most adults.
Healthcare providers need to maintain vigilance for measles and immediately report any suspect cases by telephone to the local health department (LHD) where the patient reside
Reports from the membership have alerted the Society to letters being received by physician offices from insurance carriers, requesting that your office complete a lengthy Cybersecurity Attestation and Questionnaire with regard to the New York State Department of Financial Services (NYSDFS) cybersecurity regulation.
This regulation, put forth by the NYS Department of Financial Services (NYSDFS) back in 2017, does indeed address Cybersecurity concerns. However, it applies to financial services companies and the regulation defines persons that are subject to this regulation as follows.
Covered Entity means any Person operating under or required to operate under a license, registration, charter, certificate, permit, accreditation or similar authorization under the Banking Law, the Insurance Law or the Financial Services Law.
As mentioned, the Attestation Statement and Questionnaire referred to in their cover letter is a lengthy and general document and may be a pretext for them to contact you again to sign up for their Cyber Liability Insurance.
For guidance on this issue, contact us through the Third–Party Insurance Help Program, at (212) 684–4681.
The following is courtesy of James McNally, the Society’s Third–Party Insurance Help Program. If you have questions, call the Society at (212) 684–4681.
• United Healthcare and CIOX Stepping Up Risk Adjustment Data Validation Program Record Requests: In compliance with the Risk Adjustment Data Validation (RADV) audit program under the Affordable Care Act (ACA), United Healthcare (UHC) is stepping up their Risk Adjustment Data Validation Program record requests, now required by the Department of Health and Human Services (HHS) to provide supporting medical documentation for the annual medical claims review audit for United Healthcare commercial members in their Health Exchange plans.
The Centers for Medicare and Medicaid Services (CMS) is now reimbursing insurers for administering ACA Health Exchange plans. The plan’s reimbursement from CMS is based on risk–adjustments of a patient’s health status. CMS will reimburse a health plan at a higher rate for a patient with multiple chronic conditions compared to a healthy patient without any chronic conditions. As several physicians already know, UHC and CIOX had also been sending similar letters for Risk Adjustment record requests for their Medicare Advantage plans and other plans have done so as well.
In this initiative, UHC will be requesting medical records within a specific 2018 service date(s) starting in June 2019. Since only a few members will be randomly selected, not all physicians will receive this request.
If your claim is in the sample, you’ll be contacted to submit the medical records as outlined below. Please include only the minimum Health Insurance Portability and Accountability Act (HIPAA) necessary documentation:
• demographics sheet;
• progress notes/face–to–face office visits;
• consultation reports/notes;
• discharge summary;
• emergency room records;
• history and physical exam;
• medication list;
• operative/procedure notes;
• prescription for laboratory services;
• problem list;
• radiology and pathology services; and
• radiology reports.
UnitedHealthcare will use CIOX Health to conduct the request for medical records. CIOX Health can be reached at (877) 445–9293. CIOX has a new fast, easy and secure way to electronically submit medical records. See www.cioxlink.com for a short video tutorial.
• eMedNY Reminder: Changes to Claims Edit 02292 — Multiple Claim Submission for the Same Service: Effective May 1, 2019, edit 02292 (Claims limit exceeded) was changed from DENY to PAY/REPORT. Claims that fail the edit will be paid and tracked for NYSDOH informational purposes. HIPAA reason code 273 will still be reported on the 835 remittances so that providers can identify patterns and trends for multiple claims submissions. For questions or assistance, please contact the eMedNY call center at (800) 343–9000.
• Reminder on MBI Specifications: Under a 2015 law, Medicare must cease using patient Social Security numbers by 2019. To make the change, the Centers for Medicare and Medicaid Services had issued new beneficiary cards with an alphanumeric identifier in 2018. During the transition period noted below, you can submit claims with either patients’ Social Security number or their new Medicare beneficiary identifier.
Here’s what you need to know about the change.
All beneficiaries should now have new cards. Many Medicare Administrative Contractors are adding look up tools for easier verification. Be sure you are signed up with your MAC to access to their online portal and receive email updates. Your remittance advice should also provide the new number.
Transition period (SSN or new identifier accepted on claims): April 1, 2018, to Dec. 31, 2019.
What it means for you: You will need to update your practice management systems to accept the new patient identifier. Be sure to check with your vendor to see if they will provide an update or if you need to manually update your system.
Why the change: An effort to decrease identity fraud, included in the Medicare Access and CHIP Reauthorization Act of 2015.
A QR code, which is a type of bar code, may now be printed on the new Medicare cards issued to beneficiaries. This will not impact practices as its only use verifies the card is being sent to the correct beneficiary. Railroad Medicare cards will have the code on the front, however traditional Medicare cards will include it on the back. The notification is to alert practices that these cards are valid.
Assigned MBI may change. Beneficiaries or their representative may request a change to their new identifier. CMS will issue a new card upon that request. Remember always to ask for the most current payer information. This can also be verified with your MAC lookup tool, and on the remittance advice.
Beware of 0 versus O: Practices are reminded that certain characters are not be used in the Medicare Beneficiary Identifier (MBI) including S, L, O, I, B and Z. The number “0” will be included and should not be mistaken for the letter “O”.
What the New Medicare Card Format Looks Like
The new Medicare patient identifier follows the alphanumeric format below. Use the key to correctly update your practice management system.
POS 1 2 3 4 5 6 7 8 9 10 11
Type C A AN N A AN N A A N N
Each type may be a capital letter or number. The key below demonstrates each position of the 11-character ID:
C: Numeric 1–9
A: Alpha character (A–Z) except S, L, O, I, B and Z
N: Numeric 0–9
AN: A or N
Medicare vs. Railroad Medicare: Unlike the previous cards, Railroad Medicare beneficiaries will not have a unique identifier in their card number. Instead, their cards will include a separate logo that distinguishes their benefits.
• April 2018: CMS started mailing new cards. You should be ready to submit claims with the new beneficiary identifier. When verifying benefits, you will receive a message if the patient has received his or her new card and identifier.
• June 2018: Medicare Administrative Carriers will be able to give practices the new patient identifier through the secure portals.
• October 2018: Remittance advice statements will start to use the new identifier. You can still submit claims with the existing Social Security number, but the remittance advice will show the new identifier.
• January 2020: Dates of service submitted must provide the new identifier in order to be processed. Claims will be denied if the beneficiary is unable to be verified with the MBI.
Resources to Prepare Your Patients: Check to see if you have an unopened plain white envelope from the Department of Health and Human Services. Sign into MyMedicare.gov to get their new numbers or print official cards. An account will need to be created. Call (800) MEDICARE (800) 633–4227. CMS Fact Sheet Frequently Asked Questions
• Reminder on United Healthcare Consultation Policy Change: All physicians billing United Health Care (UHC), please take note: On June 1, UHC — following what CMS has already done — ended its policy of reimbursing services that are coded as Consults. UHC will reimburse these services if they are coded as E/M services. The New York County Medical Society suggests you use the E/M codes for New Patient since, more often than not, a Consult is referred from another physician and will be the first time you have seen the patient. If this is not the first time you have seen the patient, the Established patient code should be used.
We also suggest that you use the Comprehensive level (99215). More than likely, this code will be appropriate for the Consult, since it is the first encounter; the Comprehensive level of exam will be a logical choice and will require a comprehensive workup. If those circumstances apply, be sure to document the visit meticulously. Otherwise, if a Comprehensive level is not required/performed, use a lower level E/M code.
To level the reimbursement “playing field,” UHC has built additional RVUs (Relative Value Units) into the E/M codes that physicians are to use in coding, in place of the old consultation codes.
• United Healthcare Issues July 2019 Network Bulletin: United Healthcare has released their July 2019 Network Bulletin and it is available at the link below. This Bulletin also provides links to a number of Medical Policy Update Bulletins for July 2019 that impact their commercial and Medicare Advantage lines of business. Physicians are urged to review this monthly notification carefully to see if any of these policy changes or news impacts your practice directly.
The following is provided by Julie Brightwell, JD, RN, Director, Healthcare Systems Patient Safety, Department of Patient Safety and Risk Management, The Doctors Company, and Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company
Just as it is an acceptable and reasonable practice to screen incoming patients, it is acceptable and reasonable to know when to end patient relationships that are no longer therapeutic. It is critical, however, that the physician end the patient relationship in a manner that will not lead to claims of discrimination or abandonment.
The criteria for terminating a physician–patient relationship are numerous and varied. Although the list is not exhaustive, it is appropriate and acceptable to terminate a relationship under the following circumstances:
• Treatment nonadherence — The patient does not or will not follow the treatment plan.
• Follow–up nonadherence — The patient repeatedly cancels follow–up visits or is a no–show.
• Office policy nonadherence — The patient fails to follow office policies, such as those for payment, prescription refills, or appointments. For example, the patient uses weekend on–call physicians or multiple healthcare practitioners to obtain refill prescriptions when office policy specifies how to obtain refills between visits.
• Verbal abuse — The patient or a family member is rude and uses improper language with office personnel or other patients, visitors, or vendors; exhibits violent behavior; makes threats of physical harm; or uses anger to jeopardize the safety and well–being of anyone present in the office.
• Nonpayment — The patient owes a backlog of bills and has declined to work with the office to establish a payment plan.
Exceptions and Special Circumstances
A few situations, however, may require additional steps or a delay or even prohibit patient dismissal. Examples of these circumstances include the following:
- If the patient is in an acute phase of treatment, delay ending the relationship until the acute phase has passed. For example, if the patient is in the immediate postoperative stage or is in the process of a medical workup for a diagnosis, it is not advisable to end the relationship.
- If the practitioner is the only source of medical or dental care within a reasonable driving distance, he or she may need to continue care until other arrangements can be made
- When the practitioner is the only source of specialized medical or dental care, he or she is obliged to continue care until the patient can be safely transferred to another practitioner who is able to provide treatment and follow–up.
- If the patient is a member of a prepaid health plan, the patient cannot be discharged until the practitioner has communicated with the third–party payer to request that the patient be transferred to another practitioner or otherwise complies with the terms of the payer–provider agreement.
- A patient may not be dismissed or discriminated against based on limited English proficiency or because he or she falls within a protected category under federal or state legislation. Examples of civil rights laws include the Americans with Disabilities Act (ADA), the Civil Rights Act, and the Emergency Medical Treatment and Labor Act (EMTALA).
- If a patient is pregnant, the physician can safely end the relationship during the first trimester if the pregnancy is uncomplicated and there is adequate time for the patient to find another practitioner. During the second trimester, a relationship should be ended only when it is an uncomplicated pregnancy and the patient is transferred to another obstetrical practitioner prior to the cessation of services. During the third trimester, a relationship should end only under extreme circumstances (such as illness of the practitioner, etc.).
- Physician or dental groups with more than one practitioner may want to consider dismissing a patient from the entire practice. This will avoid the possibility that the patient might be treated during an on–call situation by the practitioner who ended the relationship.
- The presence of a patient’s disability cannot be the reason(s) for terminating the relationship unless the patient requires care or treatment for the particular disability that is outside the expertise of the practitioner. Transferring care to a specialist who provides the particular care is a better approach.
Steps for Withdrawing Care
When the situation with the patient is such that terminating the relationship is appropriate and acceptable and none of the restrictions mentioned above are present, termination of the patient relationship should be completed formally. Put the patient on written notice that he or she must find another healthcare practitioner. The written notice should be mailed to the patient by both regular mail and certified mail with a return receipt requested. (Both types of mailing are required in some states.) Keep copies of all the materials in the patient’s medical record: the letter, the original certified mail receipt (showing the letter was sent), and the original certified mail return receipt (even if the patient refuses to sign for the certified letter).
Elements of the Written Notice
The written notice terminating the relationship should include the following information:
- Reason for termination — Although a specific reason for termination is not required, it is acceptable to use the catchall phrase “inability to achieve or maintain rapport” or to state that “the therapeutic practitioner–patient relationship no longer exists.”
- Effective date — The effective date of termination should provide the patient with a reasonable amount of time to establish a relationship with another practitioner. Although 30 days from the date of the letter is usually considered adequate, follow your state regulations. The relationship may be terminated immediately under the following circumstances:
- — The patient has terminated the relationship. (Acknowledge this in writing with a letter from the practice.)
- — The patient or a family member has threatened the practitioner or staff with violence or has exhibited threatening behavior.
- Interim care provisions — Offer interim emergency care. Refer true emergency situations to an emergency department or instruct the patient to call 911 as necessary.
- Continued care provisions — Offer referral suggestions for continued care through medical or dental societies, nearby hospital medical staffs, or community resources. Do not recommend another healthcare practitioner by name.
- Request for medical or dental record copies — In your written notice, offer to provide a copy of the medical or dental record to the new practitioner by enclosing an authorization document (to be returned to the office with the patient’s signature). One exception is a psychiatric record, which may be offered as a summary in lieu of a full copy of the medical record.
- Patient responsibility — Include a reminder that the patient is responsible for all follow–up and continued medical or dental care.
- Medication refills — Explain that medications will be provided only up to the effective date of termination.
The following scenarios illustrate some of the issues involved in terminating a patient relationship.
A patient has been in your practice for about 10 years, has faithfully made regular visits, but has not been compliant with your medical regime for taking hypertension medications. You have repeatedly explained the risks of nonadherence, and you have rescued the patient on many occasions with emergent medications, usually in the local emergency department over a weekend. You are convinced that the patient understands but stubbornly refuses to comply.
Should This Patient Relationship Be Terminated?
With any nonadherent patient, it is essential to document your recommendations, the patient’s continued nonadherence, your efforts to help the patient understand the risks of nonadherence, and his or her failure to follow the treatment plan and advice. Terminate the relationship if the patient and physician agree that the patient would achieve better compliance with another practitioner. The written notice terminating this relationship should be explicit in stating the reason you are no longer willing to provide care — that the patient’s outcome is predestined to be unfavorable because of his or her nonadherence with recommended treatment plans. Suggest that the patient would benefit from a relationship with another physician, and state that continued medical care is an absolute requirement.
A new patient has made an appointment with your office for a full and complete physical examination. Before the appointment, the patient experienced an unusually long wait in your office as a result of your need to address an urgent situation with an infant. Your office personnel explained the delay to those in the waiting room, and this new patient reacted by becoming loud and abusive, insulting the registration person, and shouting that his time is as valuable as that of the doctor.
Options for the Practitioner
In the privacy of an office or an examination area, address your concerns about his behavior by indicating that the practice maintains a zero–tolerance policy for loud, threatening, or abusive behavior, and state that this type of reaction will not be tolerated in the future. After you have completed his physical examination, suggest that he seek medical care elsewhere if he is reluctant to observe office decorum. If the patient indicates a refusal to comply, consider preparing and sending a termination letter. If the patient fails to keep subsequent appointments or has notified your office that he will be seeking care with another physician, document the conversation and send the patient a letter reiterating his decision to seek care elsewhere.
NYCMS Educational Resources
Visit thedoctors.com/nycms for a collection of educational resources, including complimentary on-demand continuing medical education programs that have been selected expressly for NYCMS members.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
Find out how a large multi–physician group practice successfully improved their online presence across their multiple sites and increased referrals. Through implementation of a key practice management tool, they were able to in increase appointments, maximize community outreach and use their enhanced positive online presence to drive more referrals.
Developing an effective marketing strategy and having the right practice management marketing tools in place is key to ongoing practice success. Read this case study to learn how you can enhance and support your practice to engage with your existing or new patients at the right time, delivering an incredible experience and giving your practice the data it needs to continually improve and keep your patients loyal and referring you to others.
The following is a letter from Society member Connie DiMari, MD, who notes her concerns after participating in an education session on new practice models with EMRs. MM News thanks her for sharing with her Society colleagues.
I am very concerned with the practice model described in a recent webinar on EMR that I participated in. I was amazed that MAs (medical assistants) — high school grads with only six months of training — are now scribes and entrusted keepers of the all–important EMR. While this "team" model was well presented in the WebEx seminar, I can tell you from my experience, and that of numerous others, it does not work well in practice. I offer below several examples that clearly demonstrate that the model advocated in the seminar does not adequately capture what is happening in the real world.
First, I would like to describe a physician colleague’s recent experience at a retina specialist’s office. Initially she was interviewed by an MA who "did not know how to ask any questions relating to the eye." This MA was followed by a technician and retina specialist. None were introduced, and all three were dressed in scrubs, making it difficult for even a physician to distinguish who was who. My colleague then tried to report the details of her history to the physician, who cut her short and said her history had already been entered into the computer. Notably, he knew she was a physician. I can only wonder what happens to everyone else.
I personally accompanied a friend and her 91–year–old mother to an evaluation for a possible Transcatheter Aortic Valve Replacement. When a PA asked if the patient had worsening shortness of breath, the patient replied, "I've always been short of breath." The patient was then virtually coached to say "oh , yes, it's getting worse." I wasn't so sure this was the case.
The PA went on to review the details of the procedure. When the cardiac surgeon finally entered the room, I fully expected that he would review the patient’s history to explore the indications for surgery. Yet he only entered the room for a few minutes to introduce himself; the decision to go forward with the valve replacement had already been made.
A few weeks after the procedure, the patient’s daughter was disappointed that there was no improvement, and the patient’s niece, an RN, told me her aunt was significantly worse. I wonder if the cardiac surgeon will ever know the outcome of the surgery he performed, as post operatively the patient was seen only by NPs. Inserting a PA or an NP between the doctor and patient was a disservice, not only to this 91–year–old patient, but also to the field of cardiac surgery, as this cardiac surgeon's knowledge was not furthered.
In the webinar's chat room I was assured that only MAs personally trained and trusted would be assigned to the tasks you describe. Yet as physicians transition to large group practices or hospital practices, where attention to the bottom line dominates, they have less and less control over the MAs and technicians they work with. At a union health center, a very experienced ophthalmic assistant was pushed out, against the wishes of the ophthalmologists at the center, and replaced by someone who had no experience — but, tellingly, earned only half her salary.
Physicians also have much less control over the number of patients they see. When an ophthalmologist I worked with transitioned to a large group practice, he went from seeing 25 – 30 patients per day to 35 – 40. Then, when the practice was taken over by a private equity firm, he saw 50 – 60 patients. I recently attended a presentation concerning new specialty–specific EMR software. The retinal specialist giving the presentation boasted he could see 100 patients per day. Is this the future?
I was also surprised at the expectation in the WebEx that the physician will review the scribe’s entries and orders in between seeing patients. Could a physician really remember all the details for his first patient after seeing another three or four, or sometimes many more, in between? The more patients, the more decisions being made in less time, with less information and consideration, the more medical errors are likely. No wonder physicians are burning out.
The most concerning part of the webinar came when the physician left the exam room. An MA reviewed the physician's instructions. There are always patient questions at this point. Do we entrust an MA with this often complex task? I was then shocked when an MA was responsible for entering electronic prescription orders. Electronic prescriptions are often difficult because of the number of possible choices that come up on the screen. Serious mistakes are easy to make. I had two highly competent assistants — each worked with me for 25 years — and I would not trust them with this task.
I believe the "team" model will have the opposite of its intended effect: to increase the availability of care. It will only exacerbate the shortage of primary care physicians — 25 percent of whom are over 60. It is difficult for these physicians to speed–practice. Many colleagues have retired at 60. I know of wonderful senior physicians, unable to adapt to this model or forced out of practice by their employers. Even more concerning are the numbers of medical students, discouraged by what they are hearing — and also the least prepared for this model — not going on to residency programs and pursuing careers outside of patient care.
Will the team–based approach you describe be the new normal in medical care? I anticipate both a frightening decline in the standard of care and a decline in the availability of care as a smaller number of providers are kept on overload, racing from patient to patient. This step forward, in my opinion, is a major step backward in medical care.
Over the objections of many groups, two bills were passed at the end of the legislative session that could drive up medical liability costs and create an even more toxic malpractice adjudication system. Go to http://tiny.cc/VetoLiabilityBills to send the Governor an instant letter urging him to veto these two bills and instead, work for comprehensive reform.
S.6081/A.2372 will force certain defendants into a “blind gamble,” whereby the plaintiff’s total payout might actually exceed the jury’s award. Details are technical but the point is that this proposal has little justification other than increasing lawyers’ fees.
S.6552/A.2373 will let certain plaintiffs collect a judgment from a third party that isn’t even directly “in” the lawsuit. Again, it’s technical and unjustified. These bills, which the hospitals and insurers also oppose, would exacerbate an already onerous system. New York was recently granted the dubious distinction of having the highest cumulative medical liability payouts in the country. We urge the Governor to work towards comprehensive reform to enable an appropriate and needed supply of physicians across our state, rather than enabling cynical attempts to increase lawyers’ fees at the expense of patient care.
If you have questions, contact Susan Tucker, (212) 684–4681.
It’s no secret that regulatory compliance can be very time consuming and substantially increase costs. Confusing, obtuse regulations written in difficult to understand language can be bewildering for healthcare organizations, especially small to mid–size practices with limited management resources. HIPAA compliance is no exception. Small and mid–sized practices need to find a solution that makes HIPAA compliance as easy, efficient, and affordable as possible without cutting any corners.
Most regulations, including HIPAA, are created with good intentions. HIPAA was intended to protect the privacy and security of sensitive patient information, in response to many past privacy abuses. As an example, it was not unheard of for patient information to be sold to pharmaceutical companies so they could market new drugs and treatments to patients with specific conditions. The HIPAA privacy rule now effectively precludes this from happening.
The HIPAA Security Rule was enacted to prevent the unauthorized disclosure of patient information, and compliance became mandatory in 2006. Then, the Internet was relatively new, and SPAM, ransomware, and phishing emails were largely unheard of. Today, ransomware and phishing run rampant and represent a huge threat to your practice. In response, the Department of Health and Human Services issued an urgent advisory on this very subject late in 2018:
No organization is too small to be targeted and victimized, and many have been subject to cyber attacks. You just might not hear about it because it does not normally make national news. But sometimes small practices do make the news. As an example, here is a case of a small two–provider practice recently hit by ransomware, and they decided to close their doors:
Needless to say, this cyber attack will effect these physicians far into their retirement as all kinds of issues will arise that they have to deal with.
So, what can you do to minimize the real and tangible cybersecurity risks to your organization? Here is your prescription:
• Train your employees to understand and recognize threats.
• Send your employees fake ransomware / phishing emails to test them.
• Perform an annual security risk assessment.
And because you cannot reduce your risk to zero, you should have a comprehensive cyber insurance policy in place to mitigate against massive potential financial expenses.
To check your 2019 MIPS eligibility go to the Quality Payment Program (QPP) Participation Status Tool and enter your National Provider Identifier (NPI). CMS has eased the Low–Volume Threshold. You’re now exempt from MIPS if you:
• Bill $90,000 or less in Medicare Part B charges for services payable under the Physician Fee Schedule, or
• Furnish covered professional services to 200 or fewer Medicare Part B–enrolled beneficiaries, or
• Provide 200 or fewer covered professional services to Medicare Part B–enrolled beneficiaries.
If You’re Not Exempt from MIPS: If you don’t take action this year (2019), MIPS will penalize you by seven percent on your 2021 Medicare reimbursements. In order to avoid the 2021 penalty, you report six measures in the Quality area (similar to CMS’s old PQRS Quality Measures).Then, you have two choices. You can report Improvement Activities (IAs — under Care Coordination, Patient Safety, Emergency Preparedness and other common–sense categories), or you can report activities in the Promoting Interoperability (PI) area. These are computer–oriented, under four categories: Electronic Prescribing, Health Information Exchange, Provider to Patient Exchange, and Public Health and Clinical Data Exchange.
The Quality Measures: Just as you did for the old PQRS program, you can report the Quality Measures right on your Medicare claims or use other CMS–approved mechanisms. The reporting period is the full calendar year. To avoid the penalty, you only have to report six Quality Measures. For each Measure, you only have to report on one patient at one encounter (one point in time).
The Improvement Activities (Ias): Make an “attestation” (a legal statement) on the QPP Website. The performance period is 90 consecutive days. How many IAs to report: (Small practice: 15 or fewer providers under the same Tax ID Number) One “high–weighted” Improvement Activity or two “medium–weighted” activities.
The Promoting Interoperability (PI) measures: Make an “attestation” on the QPP Website and the performance period is 90 consecutive days. How many PI measures to report: Certain ones are required. In addition, you attest that your system has undergone a security risk analysis and doesn’t have features that could block information; also, that you’ll cooperate with any needed reviews or “spot checks” by the ONC (Office of the National Coordinator for Health Information).
The following 34 candidates for membership have been presented to the Board of Directors of the Society.
Sarp Orhan Aksel, MD
Abdullah Zoheb Azhar, MD
Puneet B. Belani, MD
Abigail Hannah Benudis, MD
Ian Joel Bezahler, MD
Morgan Busko, MD
Shirley Chan, MD
Peter C. Chien, Jr., MD
Heidi Choe, DO
Idoia Corcuera–Solano, MD
Miriam Defilipp, MD
Anna Bailey Egan, MD
Zaheer Faizi, MD
Neal E. Flomenbaum, MD
Flavia Alexandria Golden, MD
Cassandra E, Henderson, MD
Stefan G. Kantrowitz, MD
Adina Kern–Goldberger, MD
Simon J. Hong, MD
Brendon Clive Hopgood, MD
Nazia Khan, MD
Mary F. Lee–Wong, MD
Diana J. Lin, MD
Aleksey Maryanksy, DO
Amira Mohammed, MD
Tanmoy Mukherjee, MD
Michael Obedian, MD
Jean–Pierre P. Ouanes, MD
Ravi A. Patel, MD
Lucy Pereira–Argenziano, MD
Syed Rizvi, MD
Daniel Rothstein, MD
Zeeshan M. Sardar, MD
Ahmed Sawas, MD
Jeremy Slosberg, MD
Sophia Spadafore, MD
Madeline R. Sterling, MD
Joanne L. Stone, MD
Shashank Trivedi, MD
Rachna Valvani, MD
Congratulations to these members who celebrated their 50th anniversary of graduation from medical school in 2019.
David Harold Abramson, MD
Mahshid Arfania Assadi, MD
Cyrus A. Assadi, MD .
George J. Beraka, MD
Michael Borecky, MD
Graziano C. Carlon, MD
Richard M. Carlton, MD
Lucien Mayer Cesiano, MD
Jonathan Z. Charney, MD
Chin–Ting Chiu, MD
William Etra, MD
Frederic C. Fenig, MD
Herbert A. Fox, MD
Govindan Gopinathan, MD
Glenn S. Hammer, MD
Milton O. C. Haynes, MD
John William Jacobs, MD
Jonathan M. Kagan, MD
Carl H. Kleban, MD
Richard Steven Koplin, MD
Jerold D. Kurzban, MD
Peter James Linden, MD
Eric R. Marcus, MD
Sheila Margolis, MD
Charles Melone, Jr., MD
Christopher B. Michelsen, MD
Rebecca Faith Nachamie, MD
Nisar Ali Quraishi, MD
Kristjan Tomas Ragnarsson, MD
Amed A. Rawanduzy, MD
Lawrence S. Reed, MD .
Jonah Walter Schein, MD
Thomas Peter Sculco, MD
Gerald Jay Smallberg, MD
David J. Straus, MD
Elihu L. Sussman, MD
Anthony John Tortolani, MD
Zwi Weinberg, MD
The following article is provided by Amy Wasdin, RN, CPHRM, Patient Safety Risk Manager II, The Doctors Company, the Society’s endorsed medical liability insurance company.
Across the board, human trafficking is considered the fastest-growing organized crime activity in the country and, as of 2018, over 45,000 trafficking cases have been reported since 2007. According to the National Human Trafficking Hotline, New York has experienced 2,147 cases during that time span. In 2017—the latest year with complete data—New York was fifth in the nation for human trafficking, with sex trafficking making up the majority of that activity.
This crime occurs when a trafficker uses force, fraud, or coercion to make an individual perform labor or sexual acts against his or her will. Victims can be any age (adults or minors), any gender, and from any cultural or ethnic group. The trafficker—or abuser—might be a stranger, a family member, or a friend. This criminal industry is very profitable, generating billions of dollars worldwide. Lack of awareness and misconceptions can allow opportunities to identify victims to go unnoticed and unreported.
Although trafficking victims rarely find opportunities to interact with others without approval from the abuser, research shows that an overwhelming majority of victims see a medical or dental professional during captivity. A visit to a physician or dental practice provides a rare opportunity for an individual to receive help.
Human trafficking victims are commonly seen in medical and dental practices with the following conditions:
• trauma such as broken bones, bruises, scars, burn marks, or missing teeth;
• poor dental hygiene.
• gynecological trauma or multiple sexually–transmitted infections; and
• anxiety, depression, or insomnia.
Victims are usually afraid to seek help for reasons that stem from fear, shame, or language barriers. Medical and dental providers and their staff should be trained to recognize the signs of human trafficking and know what steps to take. Below are examples of red flags exhibited by human trafficking victims:
• depression or flat affect;
• submissive to his or her partner or relative;
• poor physical health;
• suspicious tattoos or branding;
• lack of control over personal identification or finances;
• not allowed to speak for himself or herself;
• reluctance or inability to verify address or contact information; and
• inconsistency with any information provided (medical, social, family, etc.).
Victims may be fearful and distrustful of their environment, so it is best not to ask individuals direct questions about being a victim of human trafficking. The following questions can help in identifying victims:
• Has anyone threatened you or your family?
• Can you leave your job or home if you want to?
• Are there locks on your doors and windows to keep you from leaving?
• Do you have to get permission to eat, sleep, or use the restroom?
• Has someone taken your personal documents or identification?
Human trafficking is a federal crime with severe penalties. The Trafficking Victims Protection Act, enacted in 2000, provides tools to address human trafficking on a national and worldwide level. Many states also have laws and penalties for human trafficking.
If you suspect that someone is in immediate danger, call 911. If you suspect that a patient is a victim of human trafficking, contact the National Human Trafficking Hotline:
Online Report: https://humantraffickinghotline.org/report-trafficking
Follow state laws regarding mandatory reporting to provide notification of patient abuse or neglect situations. All states require reporting of child trafficking but may not require reporting for adults. While the HIPAA Privacy Rule allows the disclosure of protected health information without authorization in some circumstances, such as imminent danger, contact your risk manager or legal counsel if you are in doubt. Unless calling the authorities is mandatory or impending danger is suspected, it is best not to do so without the patient’s permission.
Healthcare practices and facilities should have protocols in place that outline a process for recognizing the signs of human trafficking and taking action. Staff training opportunities should include role-playing scenarios for various human trafficking situations.
American Hospital Association, Protocols and Guidelines to Combat Human Trafficking
American Medical Association, How Physicians Can Identify, Assist Human Trafficking Victims
Centers for Disease Control and Prevention, Sex Trafficking
National Human Trafficking Hotline, Service Providers
The Joint Commission, Quick Safety 42: Identifying Human Trafficking Victims
U.S. Department of Health and Human Services, Adult Human Trafficking Screening Toolkit and Guide
Sexual Harassment Prevention: Easy Ways for You to Comply
No matter how small your office, all physicians are required to have a policy document, on Prevention of Sexual Harassment. You can get a model document free of charge at https://www.ny.gov/sites/ny.gov/files/atoms/files/SexualHarassmentPreventionModelPolicy.pdf. (You just fill in your practice name and address, etc.). If you haven’t taken this action yet, do so immediately.
If You Have One or More Employees, You're Required to:
Provide Your Employee(s) with a Complaint Form. Get this form free of charge at https://www.ny.gov/combating-sexual-harassment-workplace/employers.
Display a Poster in Your Office, and Give Your Employee(s) a Fact Sheet.
Get these materials free of charge at
Provide Your Employee(s) with a Training Program. Get a 45–minute training video free of charge at https://www1.nyc.gov/site/cchr/law/sexual-harassment-training.page. You must complete this action by October 1, 2019.
This video, on the Internet, is accessible via computer, tablet or smart phone. As an alternative to the video hold an in–person training meeting with your employees. (Deadline October 1, 2019.) Get a free script at https://www.ny.gov/sites/ny.gov/files/atoms/files/SexualHarassmentPreventionModelTraining.pdf. Since an interactive component is required with the script, you should have your employee(s) give you written feedback, and then hold a discussion about the feedback.
New employees should receive the training when they start, and receive training again within a year. After each employee has received training, have him or her sign and date a statement that he/she has received it. Keep records of all training sessions for three years.
You may have heard that the training video made by New York City is only required if the physician has 15 or more employees. That's true about New York City law, but the New York City video happens to be an easy way for you to meet the New York State requirement, which applies to all physicians, even those with just one employee.
For more information, go to https://www1.nyc.gov/site/cchr/law/sexual-harassment-training-main.page. on New York City, and
https://www.ny.gov/combating-sexual-harassment-workplace/employers. on New York State.
Flushing Bank is proud to be a sponsor of The New York County Medical Society. At Flushing Bank, we pride ourselves on providing our customers with customized solutions to meet the unique needs of each business segment. Over the years, we have established relationships with many small to mid–level medical and dental practices through our suite of products and services designed specifically to meet the needs of the medical and dental community.
To speak to the folks at Flushing about your practice’s banking needs, call George Bader at (646) 923–9524.
One of the most critical components of your business is your record keeping. You need to keep your documents in order and you need to be able to access them easily when they’re needed for tax or legal purposes. You also want to keep them secure. Your medical records are sensitive and you don’t want them falling into the wrong hands. You need to make certain that vital documents aren’t destroyed, while also recognizing that some documents may need to be destroyed eventually. For all of these reasons, you want a reputable document management company. Storage Quarters offers numerous document related services and we want to give you some information about document management and show you why these services might make sense for you.
Document Management Services
The use of a document scanner and using document scanning and imaging services is a great way to keep track of all of your records. It’s efficient, it can save you the cost and space of storing hard copies of your documents, and you can recover your documents even if the hard copy is lost or destroyed. You’ll want to look for a document management company that can allow you to retrieve your documents easily through the use of a bar code. If you’re storing records that involve the health of an employee or patients at a medical office, it’s critical that the document managers are trained to make sure the scanning and imaging is HIPAA compliant. It’s also a benefit to have the documents available for electronic medical records. Security is also very important in document management particularly when you’re destroying documents. If you do have to destroy documents, particularly potentially sensitive ones, you’re going to want to make certain that the document has been destroyed and your document management company should be able to certify that it happened. You may also want to ensure your documents are shredded in a secure atmosphere.
If you are looking for expert and efficient document management services or assistance when retiring your practice, Storage Quarters is here to help. We use bar coding technology, and our record specialists are available seven days a week. If you are looking for document shredding we offer several ways to do it. We can transport your documents to our HIPAA–compliant facility, you can drop your shredding at our facility and view the destruction or leave it with us. We also have a mobile shred truck that can come to your location and shred on site. For any questions or to book one of our services please call (516) 794–7300.
Citi Waste is now an exclusive provider of medical waste management services offering deep discounts to New York County Medical Society members. Whether sharps, red–bag, chemo, pathology, hazardous, or pharmaceutical waste, Citiwaste will work with you to classify and segregate waste streams for best pricing.
In addition, Citi Waste will determine the appropriate service frequency and deliver the supplies you need to package wastes. Guaranteed savings with no fuel, stop, energy, or environmental fees. Medical waste manifests available online 24/7 at no charge. One provider for all your medical, hazardous, and pharmaceutical waste.
Protection for your business with complete regulatory compliance. Call David at (718) 372-3887 to learn more about how Citi Waste can save you money.
Arthur Harold Aufses, Jr., MD died April 2019. Doctor Aufses received his MD degree from Columbia University College of Physicians and Surgeons in 1948.
Myles Michael Behrens, MD, died April 12, 2019. Doctor Behrens received his MD degree from Columbia University College of Physicians and Surgeons in 1962.
Murray John Berenson, MD. Doctor Berenson received his MD degree from New York University School of Medicine in 1961.
Elmer W. Davis, Jr., MD., died May 2019. Doctor Davis received his MD degree from Cornell University College of Medicine in 1951.
Kenneth A. Forde, MD, died June 2, 2019. Doctor Forde received his MD degree from Columbia University College of Physicians and Surgeons in 1959.
Janet O. Jeppson, MD, died February 25, 2019. Doctor Jeppson received her MD degree from New York University School Of Medicine in 1952.
Alfred J. Kaltman, MD, died March 10, 2019. Doctor Kaltman received his MD degree from New York University School of Medicine in 1946.
Daniel M. Maklansky, MD, died June 2019. Doctor Maklansky received his MD degree from State University of New York Downstate in 1956.
Theodore Rubin, MD, died February 16, 2019. Doctor Rubin received his MD degree from University of Lausanne College of Medicine in 1951.
Nicholas V. Steiner, MD, died January 25, 2019. Doctor Steiner received his MD degree from Wayne State University College of Medicine in 1962.
Ian Gerald L. Van Praagh, MD, died April 18, 2019. Doctor Van Praagh received his MD degree from University of Toronto School of Medicine in 1955.
Richard L. Friedman, MD, died December 4, 2018. Doctor Friedman received his MD degree from Chicago Medical School in 1991.
Sherwin Allen Kaufman, MD, died May 14, 2019. Doctor Kaufman received his MD degree from Cornell University College of Medicine in 1943.
Harry Weinrauch, MD, died April 23, 2019. Doctor Weinrauch received his MD degree from State university of New York Downstate in 1954.
Felix Wimpfheimer, MD died June 14, 2019. Doctor Wimpfheimer received his MD degree from New York Medical College in 1945.
Arthur Zitrin, MD, died May 11, 2019. Doctor Zitrin received his MD degree from New York University School of Medicine in 1945.