Suffolk County Medical Society Suffolk Academy of Medicine

BULLETIN

VOLUME 91 No.4 www.scms-sam.org October 2014

WE ALL KNEW THIS INDIVIDUAL

OBITUARY

S.O. Else

The Medical Society was saddened to learn this week of the death of one of our medical community’s most

valuable members, SomeOne Else. SomeOne’s passing creates a vacancy that will be difficult to fill. Else

has been with us for many years and for every one of those years, SomeOne did far more than a normal

person’s share of the work. Whenever leadership was mentioned, this wonderful person was looked to for

inspiration as well as results: “SomeOne Else can work with that group.” Whenever there was a job to do,

a resident to teach, a meeting to attend, one name was on everyone’s lists – “Let Someone Else do it.” It

was common knowledge that SomeOne Else was always the one who was happy to see the unfortunate

patient with no income or insurance. Whenever the society was called upon to support a charitable or

community project, everyone just assumed that SomeOne Else would provide what was needed. Some-

One Else was a wonderful person – sometimes appearing superhuman, but a person can only do so much.

Were the truth known, everybody expected too much of SomeOne Else. Now SomeOne Else is gone! We

wonder what we are going to do? SomeOne Else left a wonderful example to follow, but WHO is going to

follow it? Who is going to do the things SomeOne Else did? When you have a chance to participate in soci-

ety activities REMEMBER – we can’t depend on SomeOne Else anymore.

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Suffolk County Medical Society Officers July 1, 2014- June 30, 2015

PRESIDENT Maria A. Basile, MD

PRESIDENT-ELECT William R. Spencer Jr., MD

VICE PRESIDENT Alexios Apazidis, MD

SECRETARY Christine Doucet, MD

TREASURER Ramin Rak, MD

EXECUTIVE DIRECTOR Stuart S. Friedman, MPS

OFFICE MANAGER/EDITOR Barbara Baumgarten

MEMBERSHIP/WORKERS COMP Donna DelVecchio

EXECUTIVE SECRETARY/ Linda LoPorto

CME COORDINATOR

Suffolk Academy of Medicine Officers July 1, 2014 - June 30, 2015

PRESIDENT William R. Spencer Jr., MD

VICE PRESIDENT Alexios Apazidis, MD

SECRETARY Christine Doucet, MD

TREASURER Ramin Rak, MD

Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

Suffolk County Medical SocietySuffolk County Medical SocietySuffolk County Medical Society Suffolk Academy of MedicineSuffolk Academy of MedicineSuffolk Academy of Medicine

Upcoming Meeting Schedule

Executive Committee Board of Directors

November 4 (Tuesday) December 9 (Tuesday)

January 7 (Wednesday) February 11 (Wednesday)

March 11 (Wednesday) April 8 (Wednesday)

May 13 (Wednesday) May 29 (Friday)**

**Annual Meeting-Place TBD

All Meetings start at 6 PM and are held at the SCMS office.

IMPORTANT DATES TO REMEMBER:

Doctors of Tomorrow Symposium - Wednesday, Nov. 19th

MSSNY LEGISLATIVE DAY - Albany, Wednesday, March 4th

Review of Resolutions - Wednesday, April 29th

House of Delegates - Saratoga, Friday, May 1st - 3rd

Annual Meeting - Friday, May 29th

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

President’s Page President’s Page President’s Page --- Maria A. Basile, MDMaria A. Basile, MDMaria A. Basile, MD

PHYSICIAN LEADERSHIP – What We DID Learn In Medical School

Greetings from the House of Medicine! As President of our Suffolk County Medical Society, the premier professional organization for the physicians of Suffolk County, I am calling out to each of you to define your role as a physician leader.

I know you’re out there – nose to the grindstone, seeing patients, taking calls, operating, making rounds, at-tending meetings, writing papers, teaching. And above all that, you’re spending time with your family and friends, celebrating and mourning, worshipping and shopping, playing and relaxing, taking care of everyone close to you, and yourself – right? Doing your best to try to make it all work. It doesn’t seem like there is time to understand and develop your role as a leader.

The good news is you already ARE. Every day you are a leader. Whether you are solving a problem with the 40-page discharge summary that just jammed your fax machine, writing a letter to MSSNY or the NY Times about the real story behind the piece they just published, or guiding one of your patients and his family through a complicated plan of treatment, you are a physician leader.

Since 2009, the Gallup polls have identified physicians among the top most trusted advisors and leaders in people’s lives. They (with other healing professions, such as nurses and pharmacists) are identified as the leaders who are the most honest and trustworthy when people think about their own healthcare as well as when they form opinions about healthcare reforms.

Source: http://www.gallup.com/poll/120890/Healthcare-Americans-Trust-Physicians-Politicians.aspx

All around me I see examples of strong physician leaders, formal leaders who are Chief Medical Officers, Clini-cal Department Chairs, Section or Service Line Chiefs, elected officers of our medical staffs, heads of commit-tees. I also see physicians who are informal leaders, without hospital titles, who are by behavior and reputa-tion, respected leaders and influencers in our community, well positioned to champion clinical quality initia-tives, physician-hospital collaboratives, and effect true cultural change.

I’m trying not to sound like the little kid in the 1999 movie, Sixth Sense, when I say “I see Physician Leaders,” but I do. I see them everywhere; I see them leading hospitals and hospital systems, (Continued on page 4)

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medical staffs, departments, and committees. In our community, I see them leading businesses, parent-groups and school boards, coaching sports teams, leading choirs, and medical missions. Our President-elect at the Suffolk County Medical Society, William Spencer, was the first physician elected to the Suffolk County Legisla-ture, demonstrating his role as a physician leader and public health advocate.

And you – you are a leader, just as I am, because of the trusted role that we play in people’s lives. Another Gallup poll of 10,000 respondents asked what qualities people seek most from their leaders. They answered: Trust, Compassion, Stability, and Hope. That’s how I know that you and I are not just physician leaders, but can be great physician leaders. Because the things we learned in medical school and training – building trust, demonstrating compassion, fostering stability, and inspiring hope are the qualities that we offer our patients, bring to the board room, to the negotiating table, to Albany, and into our own neighborhoods and homes every encounter, every day.

President’s Page President’s Page President’s Page --- Maria A. Basile, MDMaria A. Basile, MDMaria A. Basile, MD (Continued from page 3)

Source: http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

Message From SCMS Councilor Message From SCMS Councilor Message From SCMS Councilor

Frank G. Dowling, MDFrank G. Dowling, MDFrank G. Dowling, MD

LLIKEIKE THETHE DDESIGNEEESIGNEE,, TTIMEIME TOTO CCONTRIBUTEONTRIBUTE TOTO MSSNYPAC!MSSNYPAC!

When the ISTOP Bill was first introduced, the bill required physicians to personally look up each patient and

enter each controlled prescription into the PMP Database before handing the prescription to each patient.

Your SCMS Leadership and MSSNY Physician and Staff Leadership were successful in removing the require-

ment to enter each prescription before giving the script to a patient. And we were successful in convincing

Albany leadership to amend the bill to allow a Designee to look up each patient and supply the PMP informa-

tion to each physician. In my practice, office staff looks up and prints the PMP information each evening for

the slate of patients scheduled the following day. The Designee saves each physician in our offices at least

30-60 minutes per day. The Designee saves each physician countless hours and thousands of dollars each

year, while the PMP information provided informs each physician when they prescribe. If you want SCMS

and MSSNY leadership to keep access to Albany leadership so we can continue to have an impact on legisla-

tion that impacts patients and physicians in NY State, then we need your support. If each physician contrib-

utes to MSSNYPAC at the Benefactor ($300) level, for less than a dollar per day we can work to achieve physi-

cians’ collective negotiations and more. To contribute to MSSNYPAC CLICK HERE or go to www.mssny.org

and click on MSSNYPAC link on the top of the page.

IMMUNIZE NY CAMPAIGN

In recent years we have seen a rise in preventable illnesses and deaths due to a rise in vaccine preventable

diseases. Measles, Mumps and Whooping Cough are making a comeback in NY at least in part due to missed

opportunities for immunizations. Healthcare disparities, lack of information, and well-intended but mis-

guided beliefs about dangers of vaccinations are some of the factors that contribute to the lack of immuniza-

tions of both children and adults in NY State and the United States. With the world becoming smaller and

smaller as a result of increased international travel including to and from impoverished regions where basic

healthcare and immunizations are not readily available to many people, the risks posed by vaccine prevent-

able diseases surely is increasing. Although Ebola makes the headlines (and is a real threat to the US and

other areas around the world outside West Africa), it’s likely that vaccine preventable diseases are more of a

threat to the health and well-being of the citizens of NY and the United States.

By the end of September 2014, the CDC reports that there were over 18 outbreaks of Measles with about

600 cases reported this year alone. This is very concerning, particularly when the CDC had documented the

elimination of Measles in the US as recently as the year 2000. Each year, anywhere from 5-20% of the US

population gets the flu, over 200,000 are admitted to the hospital due to severe cases or complications and

over 20,000 die.

MSSNY, the NY Chapter of the ACP (American College of Physicians), the NY State Chapter of the AFP

(Academy of Family Physicians), and the NY State Association of County Health Officials have partnered to

launch the Immunize NY Campaign. Through various strategies including public service announcements,

website information, flyers and physician and public health education initiatives, the Immunize NY Campaign

seeks to promote immunizations of adults by encouraging patients to ask about and discuss immunizations

with their personal physicians. The campaign will focus on pertussis, influenza, pneumococcal, HPV and shin-

gles vaccinations. (Continued on page 6)

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

Message From SCMS Councilor Message From SCMS Councilor Message From SCMS Councilor --- Frank G. Dowling, MDFrank G. Dowling, MDFrank G. Dowling, MD (Continued from page 5)

Prevention of diseases through increased vaccination rates is one of the top priorities of the NY State Depart-

ment of Health. In addition, the prevention provisions of the Affordable Care Act require insurance plans to

cover all vaccinations recommended by ACIP (Advisory Committee on Immunization Practices) with no co-

payments or other types of cost sharing for patients who seek these services from in-network physicians.

MANDATORY E-PRESCRIBING OF ALL MEDICATIONS DEADLINE IS APPROACHING

The ISTOP Law requires all physicians to E-Prescribe all prescriptions (not just controlled schedule II-IV prescrip-

tions) by March 27, 2015. If a physician does prescribe controlled medications, then the software used must be

1) Registered with the NY State Department of Health Bureau of Narcotic Enforcement and 2) must meet the

Federal DEA Requirements. Although vendors have been slow to adapt and upgrade e-prescribing programs to

meet these requirements, MSSNY has been advised that most will be able to do so by the end of 2014 or early

2015. To learn about these requirements and how to meet them, physicians and their office staff leadership

should attend one of the series of E-Prescribing Webinars that MSSNY has scheduled. The first webinar which

occurred on September 24th is available online through the MSSNY Website (WWW.MSSNY.ORG). Dates of ad-

ditional remaining webinars are:

Wednesday October 29, 2014 at 7:30-8:30 AM *** Wednesday November 5, 2014 at 6:00-7:00 PM

To register, physicians should visit https://mssny.webex.com and click on the “Upcoming” tab and then click on the “Register” link to the right of the appropriate date.

KEY MESSAGES – EBOLA VIRUS DISEASE UPDATE - WEST AFRICA PREPARED BY THE JOINT INFORMATION

CENTER, EMERGENCY OPERATIONS CENTER, CENTERS FOR DISEASE CONTROL AND PREVENTION Updated October 2, 2014

The Centers for Disease Control and Prevention (CDC) is working with other U.S. government agencies, the World Health Organization (WHO), and other domestic and international partners in an international response to the current Ebola outbreak in West Africa. This document summarizes key messages about the outbreak and the response. It will be updated as new information becomes available and will be distributed regularly. Please share this document with others as appropriate. CLICK HERE for Full Document. Additional Information can be found on the SCMS website , www.scms-sam.org.

NYS DOH ISSUES HEALTH ADVISORY ON ENTEROVIRUS

The Enterovirus D68 (EV-D68) is a type of non-polio enterovirus and there have been infections reported in pedi-atric patients to the Centers for Disease Control and Prevention (CDC) from twelve states, most of them located in the Midwest. While New York State providers are not required to report individual cases of suspected or con-firmed enterovirus infection, including EV-D68 infection, existing NYSDOH surveillance systems maintain the ca-pacity to identify unusual increases in the number of individuals seeking care in emergency departments for res-piratory illness and outbreaks, unusual presentations or severity of communicable diseases. For a copy of the DOH advisory CLICK HERE.

NYS DOH INFLUENZA VACCINE WEBINAR NOW AVAILABLE

The recorded version of the NYSDOH Bureau of Immunization's most recent webinar, Influenza Vaccine for the 2014-2015 Season: What You Need to Know, is now available for viewing. The link below will take you to the NYSDOH Immunization Update Webinar Series web page where you will find the program and how to access it. On this web page are past webinars that may also be of interest to you. http://www.health.ny.gov/prevention/immunization/providers/webinar_series.htm.

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It’s been a full year since open enrollment began for the Obamacare health plans. Much has

been said of the web glitches, the failure of many carriers to issue cards and documents, the nar-

row provider networks, and the higher co-pays and deductibles experienced under many of the plans. But not

much is mentioned about changes evident under the Medicare Advantage plans – changes occurring far

more quietly, but during this very same time period.

Medicare Advantage, also known as ‘Medicare Part C’ under the statute, is a relatively popular part of the

Medicare program. About 1/5 of beneficiaries elect Medicare Advantage instead of traditional Medicare.

Patients are attracted to the program chiefly because it provides limited out of pocket costs. In many in-

stances beneficiaries experience low or no premiums, the inclusion of a drug plan, and services such as office

visits that are often covered with a single low co-pay.

It works like this: a beneficiary elects to forgo traditional Part A and Part B benefits and instead to receive

coverage from a commercial insurer for a benefit package equivalent to Medicare. That insurer may offer

enhanced benefits (such as screening exams or a vision benefit) and can also impose certain restrictions un-

der the plan (including deductibles, co-pays, networks and rules about the use of the network such as refer-

rals). The insurer can collect additional premiums from the beneficiary to supplement what it gets from the

government.

Critics of Medicare Advantage point to its poor value, including less favorably rated ‘HMO doctors,’ despite

the additional cost to the government. Medicare Advantage typically costs the government 6% more per

beneficiary than traditional Medicare does.

Policymakers, historically troubled in justifying Medicare Advantage’s 6% cost premium over traditional

Medicare, may now assert that the ‘quality’ advantages are worth the extra cost.

For example, in Health Affairs, Harvard authors Ayanian, et al last year reported quality gains for Medicare

patients enrolled in Medicare Advantage plans. They found beneficiaries in Medicare HMOs were consistently

more likely to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardio-

vascular disease than those in traditional Medicare. They also found that Medicare HMO physicians, rated

less favorably by their patients in 2003, were rated more highly by 2009 than those in traditional Medicare.

So Medicare Advantage may appear to be, from a quality standpoint, a better deal than before.

But this year physicians have observed physician and provider networks that are far narrower. Co-pays and

premiums have been rising (increasing the out-of-pocket costs) and co-pays have been applied to more ser-

vices associated with an episode of care (dramatically raising the out-of-pocket cost). Because of costs now

shifted to the patient and because, unlike Obamacare plans, Medicare has no out-of-pocket maximum, bene-

ficiaries may this year want to revisit their Medicare options. Depending upon one’s health, Medicare Advan-

tage may be no advantage at all. This year, traditional Medicare, or Medicare coupled with a Medigap policy

may be the better deal for some.

There is a tool on CMS website to compare Medicare options (including the coverage for up to 25 drugs). It

can be found here: https://www.medicare.gov/find-a-plan/questions/home.aspx. This fall, I’m going to tell

my patients to check out their options.

Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

MSSNY Treasurer MSSNY Treasurer MSSNY Treasurer

Charles Rothberg, MDCharles Rothberg, MDCharles Rothberg, MD

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

A Message From Your Executive DirectorA Message From Your Executive DirectorA Message From Your Executive Director Stuart S. Friedman, MPSStuart S. Friedman, MPSStuart S. Friedman, MPS

“They Just Don’t Get It”

Very often physicians tell us that they do not see the value of medical society membership. The

often heard excuse from non-members is “I can’t afford to pay the dues,” and “after all, why should I join

when I still reap the benefits of organized medicine’s success?” These physicians “Just Don’t Get It.”

We all recognize that the cost of membership in the country and state medical societies is not inexpensive.

However, I would submit that the cost of not belonging could ultimately be detrimental to a physician’s prac-

tice and livelihood. Nonmembers need to understand just what organized medicine is able to accomplish on

behalf of the medical profession. Who else could claim victories such as:

Defeat of a proposed change in the medical liability statute of limitations from 2½ years from the

date of injury to 2½ years from the date the injury is discovered. If enacted, this bill would have

increased liability premiums by 15%;

Enactment of an out-of-network reform bill that assures greater transparency of a health insur-

ance OON coverage, assures that OON benefits are more comprehensive while also providing

greater negotiating leverage for participating physicians;

Defeated legislation which would have mandated all physicians to take a 3-hour CME course on

palliative and end-of-life care;

Additionally, intense lobbying helped to preserve the free, excess layer of liability coverage which

was secured for physicians many years ago.

I respectfully ask nonmembers “could you, as an individual, realistically have been able to have even a modi-

cum of success on these or any other issues?” What non-dues paying physicians also fail to realize is that as

organizations, like the county and state societies, lose members they gradually lose that political influence

and clout which they enjoy in Albany and Washington. Their (our) ability to effectuate meaningful change

will eventually diminish to the point where we become irrelevant. If you think things are bad now, imagine

how much worse they will be if the medical societies were not there to fight on your behalf and on behalf of

all of your patients.

Do nonmembers ever stop to think that the benefits they get “for nothing” would go away if their dues paying

colleagues en masse started thinking the same way?

Our membership numbers are declining. Physicians are getting older, looking for employment opportunities,

albeit short term, retiring and yes, dying. If new members do not join, or current members stop paying dues,

all of those successes cited above will quickly disappear. What will that mean for physicians in Suffolk

County? Will you be able to continue to stay in practice? While it is true that we have not yet succeeded in

obtaining true medical liability reform in New York State, we have been able to head off many bills that would

have definitely made things a whole lot worse for you, and ultimately your patients.

I implore every member to continue to pay dues and encourage your nonmember colleagues to join you. The

days of “free loading” must come to an end.

It’s a shame that nonmembers “Just Don’t Get It!”

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PUBLIC HEALTH PAGE From the Office of James L. Tomarken, MD, MPH, MBA, MSW, FRCPC, FACP

Commissioner of the Suffolk County Department of Health Services

Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

EBOLA VIRUS DISEASE Ebola Virus Disease (EVD) is currently experiencing its largest outbreak ever. The outbreak is centered in West Africa, specifically Sierra Leone, Guinea and Liberia. A small number of cases are reported in Lagos, Nigeria due to a sick indi-vidual in Liberia travelling to Nigeria as well as a case in Senegal due to a traveler from Guinea. A number of cases of Ebola due to a different strain are being reported in the Democratic Republic of the Congo. To date no confirmed cases are reported in the United States but 3 individuals who contracted the disease in Africa have been brought here for treatment, 2 of whom have recovered and have been discharged from hospital.

The international community is involved in attempting to mount a response to contain the disease. Partners include the CDC and other US agencies, the World Health Organization (WHO) along with additional international partners and which has activated its Emergency Operations Center.

EVD is a virus with 5 subspecies of which 4 are known to cause human disease. Where the virus originated, its natural reservoir, is not known for sure, but it is likely from bats based on similar viruses. EVD is one of the viral hemorrhagic fevers and it can be severe, resulting in death. It has an abrupt onset with an incubation period of 2-21 days, with the usual range of 8-10 days. The diagnosis is based on the following criteria:

1-Clinical criteria, including:

-Fever >38.6 degrees C or 101.5 degrees F AND

-Additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unex-plained hemorrhage, AND

2-Epidemiologic risk factors within the past 3 weeks before the onset of symptoms, such as:

-contact with blood or other body fluids of a patient known to have or suspected to have EVD.

-residence in-or travel to-an area where EVD transmission is active.

-direct handling of bats, rodents, or primates from disease-endemic areas.

Once symptoms develop the patients is contagious through their bodily fluids and after death. Currently in West Africa the mortality rate is ~50% with those recovering having immunity to the specific subspecies contracted.

WHAT TO DO IF YOU HAVE A PATIENT WITH SUSPECTED EVD (NYS DOH Health Advisory Aug 8, 2014)

1) For any ill patient who presents with fever and additional symptoms and who reports recent travel (3 weeks prior to onset of symptoms) to an area with ongoing EVD transmission as mentioned above:

Screen upon presentation and immediately place patient in a private room with a closed door.

Provide the patient with a surgical mask and demonstrate its proper use.

Minimize the number of staff who interact with the patient and keep a list of these staff.

Staff who interact with the patient should follow standard, droplet, and contact infection control precautions. EVD is NOT transmitted through the airborne route.

Appropriate personal protective equipment (PPE) should be worn upon entry to the patient’s room to in-clude gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and a face-mask.

Additional protective equipment might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.

More detailed information on these and other infection control issues including environmental cleaning and disinfection, applicable to both the inpatient and outpatient settings, is available at http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html (Continued on page 10)

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PUBLIC HEALTH PAGE From the Office of James L. Tomarken, MD, MPH, MBA, MSW, FRCPC, FACP

Commissioner of the Suffolk County Department of Health Services

EBOLA VIRUS DISEASE (Continued from page 9)

Call the Local Health Department in which your facility is located for consultation to determine if fur-ther evaluation is needed

2) When you call the LHD, be prepared to:

Describe the patient’s risk factors and travel history, including dates and locations of travel and any con-tact with sick patients, healthcare facilities, or animals in areas with ongoing EVD transmission.

Describe the patient’s presenting symptoms, signs, and duration of illness.

3) When you call the LHD, you can expect to:

Discuss the case and possible recommendations for testing.

Be provided consultation on the need to refer the patient to a hospital for further workup and testing.

Receive assistance to arrange transport to another medical facility if needed.

4) Do NOT refer the patient to an Emergency Department, hospital, or other facility without consulting with the LHD.

This includes situations in which you speak to the patient on the phone, but do not see him/her in person.

If the patient must be immediately referred to an Emergency Department, at a minimum please alert the ED and the LHD.

5) Providers who are unable to reach their LHD can contact the NYSDOH Bureau of Communicable Disease Control at 518-473-4439 during business hours or 1-866-881-2809 evenings, weekends and holidays.

Additional Information

The CDC’s Ebola Website contains the most up-to-date information about the outbreak and has specific materials for healthcare workers, airline personnel, travelers, and the general public. It can be accessed at http://www.cdc.gov/vhf/ebola/.

Treatment

At this time supportive treatment is the mainstay of therapy by:

Providing fluids and electrolytes.

Maintaining oxygen status and blood pressure.

Treating other infections if they occur.

Due to the highly contagious nature of the patient’s body fluids, healthcare workers should follow standard, droplet and contact infection control precautions.

There is no specific treatment that is known to cure EVD. A few patients have received antibody injections (ZMapp) from recovered patients with mixed results. The US Health and Human Services (HHS) organization has contracted with Mapp Biopharmaceutical to produce more ZMapp. The National Institutes of Health (NIH) will begin testing a vac-cine this month and is working with a company to develop an antiviral drug. The US Department of Defense is funding two . companies to develop therapies and a vaccine.

This is a changing environment so for updates and specific guidelines please go to the CDC website noted above or:

http://www.cdc.gov/vhf/ebola/index.html?s_cid=cdc_homepage_whatsnew_002

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

WHAT IS STAGE 2 OF THE EHR INCENTIVE PROGRAMS? WHAT IS MEANINGFUL USE ?

It’s not enough just to own a certified EHR. Providers have to demonstrate to CMS that they are using their EHRs in ways that can positively impact the care of their patients. To do this, providers must meet all of the objectives established by CMS for these programs. Then they will be able to demonstrate MEANINGFUL USE of their EHRs and receive an incentive payment. CLICK HERE For Infor-mation Guide.

HARDSHIP EXCEPTION APPLICATIONS TO AVOID THE 2015 MEDICARE PAYMENT

ADJUSTMENT DUE NOVEMBER 30, 2014 CMS is announcing its intent to reopen the submission period for hardship exception applications for eligible professionals and eligible hospitals to avoid the 2015 Medicare payment adjustments for not demonstrating meaningful use of Certified Electronic Health Record Technology (CEHRT). The new deadline will be November 30, 2014. Previously, the hardship exception application deadline was April 1, 2014 for eligible hospitals and July

1, 2014 for eligible professionals.

As part of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Congress mandated payment adjustments under Medicare for eligible hospitals, critical access hospitals, and eligible professionals that are not meaningful users of CEHRT. The Recovery Act allows the Secretary to consider, on a case-by-case basis, hardship exceptions for eligible hospitals, critical access hospitals, and eligible professionals to avoid the pay-ment adjustments.

This reopened hardship exception application submission period is for eligible professionals and eligible hospi-tals that:

Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availabil-ity; AND

Eligible professionals who were unable to attest by October 1, 2014 and eligible hospitals that were un-able to attest by July 1, 2014 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.

These are the only circumstances that will be considered for this reopened hardship exception application sub-mission period. Applications must be submitted by 11:59 PM EST November 30, 2014.

More Information More information about the application process will be shared soon. We intend to address this issue in upcom-ing rulemaking. Visit the Payment Adjustments and Hardship Exceptions webpage for more information about Medicare EHR Incentive Program payment adjustments.

MAP OF 2015 HEALTH PLANS OFFERED IN NY STATE OF HEALTH

Health plans offered in the Marketplace fall into categories called metal tiers. The metal tiers are bronze, silver, gold and platinum, and are associated with an actuarial value. Actuarial value is the percentage of total aver-age costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, the consumer would be responsible for, on average, 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy. Platinum provides the highest level of cov-erage, followed by gold, silver and bronze.

The full lists of certified plans are available below. The 2014 health plans map for Suffolk CLICK HERE

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

Endorsed by

The Suffolk County

Medical Society

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Alan Kahn, CPA, MBA, CLU, ChFC The AJK Financial Group

20 Crossways Park Drive North, Suite 410 Woodbury, NY 11797

Tel: 516-677-0270 Fax: 516-677-0273

Working Social Security into your Retirement Plan

One of the most important decisions you will have to make in formulating a retirement plan is when to begin receiving your Social Security benefits.

Deciding when to file for Social Security benefits is a personal decision and everyone’s situation is unique. Personal factors you should consider are your health (and that of your spouse if you are married), life expec-tancy, financial and income tax situation as well as other sources of income.

Other Important facts to consider when making this decision are:

Full retirement age is gradually increasing; age 67 for people born after 1959

The age you choose to start receiving your benefits (between ages 62 and 70), can have a sig-nificant impact on your future benefits.

Reduced Social Security benefits are allowed at age 62. Keep in mind that if you collect reduced benefits and continue to work between age 62 and full retirement age, any income above the social se-curity earnings threshold, will be subject to the “earnings Penalty” rules. At full retirement age there is no earnings limit.

Currently for 2014, the earnings threshold is $15,480. One-half of your

earnings over this threshold will be deducted from your social security

benefit.

Delaying benefits past full retirement age can increase your monthly benefit by approximately 8% a year.

At full retirement age, strategies such as “File and Suspend” and “Restricted Application” rules can maximize your Social Security benefits

Conclusion

Based upon the above facts, it is apparent that Social Security benefit options are way too important to leave to chance! Understanding and educating oneself regarding Social Security rules and strategies will as-sist in maximizing your benefits and enhance your retirement plan.

AND REMEMBER, PEOPLE DON'T PLAN TO FAIL, THEY JUST FAIL TO PLAN………

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

MSSNY SURVEY SHOWS PHYSICIANS UNABLE TO COMPLY WITH E-PRESCRIBING MANDATE

Over 800 physicians have responded to MSSNY’s survey on the state of physician readiness for the e-prescribing mandate. While 85% of physician respondents indicated that they were aware of the March 27, 2015 e-prescribing mandate, 58% indicated that they were not currently e-prescribing. Of those who stated that they were e-prescribing, 91% were e-prescribing only non-controlled substances. Less than 9% of survey respondents stated that they were e-prescribing both controlled and non-controlled substances. The results further showed that the difficulties with compliance go well beyond the control of the physician.

Of the 42% of physicians who indicated that they were e-prescribing, 65% stated that their vendor’s software for e-prescribing of controlled substances (EPCS) is not yet certified for EPCS. This is a problem of significant magnitude. Many of the vendors with the largest market share in New York State remain in the queue for certi-fication. Only 31% of the physician survey responded that their vendor has stated that they will be certified and the physician’s software upgraded by the March 27th deadline. Also of concern, is the 50% of physician respon-dents who are e-prescribing non-controlled substances but who haven’t yet contacted their e-prescribing ven-dor to update their software to be compliant with EPCS standards. While admittedly, a segment of that cohort (16%) will not be e-prescribing controlled substances, many physicians will need to e-prescribe narcotics and should promptly get in touch with their e-prescribing vendors since the certification and installation processes take months to complete, depending upon the software used and the size of the practice involved. Also con-cerning were the 6% of currently e-prescribing respondents who said that their vendor would not be able to complete installation and testing of the certified software by March 27th and the 5% of respondents who stated that their vendor has informed them that its software will not be certified by March 27, 2015.

The survey showed that many of the 9% physicians who are e-prescribing controlled substances have not regis-tered their EPCS software with the Bureau of Narcotics Enforcement (EPCS) as is required. 60% of those who responded to this question stated that they have not registered their software.

For more information on the e-prescribing mandate, click on the following link to the Bureau of Narcotics En-forcement: or go to https://www.health.ny.gov/professionals/narcotic/electronic_prescribing/

MSSNY is currently conducting a vetting initiative of e-prescribing vendors. Through this initiative, physician experts will review the functionality of integrated and stand-alone e-prescribing software. In exchange for spe-cial MSSNY recognition, MSSNY members will receive discounts on the e-prescribing software chosen by the MSSNY HIT experts. It is anticipated that MSSNY will announce the results of this initiative in the Fall of 2014.

GOVERNOR SIGNS MSSNY-SUPPORTED “POTTED PLANT” LEGISLATION

TO EXPAND PHYSICIAN RIGHTS TO DEFEND THEMSELVES

Governor Cuomo signed into law legislation supported by MSSNY and MLMIC that would reduce the risk of a

non-party physician called to participate in a deposition from being subsequently sued. The new law

(A.9077/S.5077) would enable a non-party physician called to testify in a deposition to have an attorney pre-

sent and make objections on behalf of such non-party physician. While this sounds like a basic right, the law

was necessary to overturn an aberrant decision by the Appellate Division, 4th Department, in Thompson v.

Mather (2010) which interpreted CPLR Section 3113 to rule that counsel for a non-party witness does not have

a right to object during or otherwise to participate in a pretrial deposition. In the words of one New York court,

this ruling reduced the non-party witness's attorney to nothing more than a "potted plant." The remediating

legislation, developed by the NYS Office of Court Administration, would better assure that plaintiff attorneys do

not use the deposition process to cause physicians to make damaging admissions against their interest that

could result in additional liability.

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

URGENT CARE CENTERS POPPING UP ALL OVER LONG ISLAND. Newsday (9/29/14) reports that urgent care centers “are popping up all over Long Island,” New York. Long Is-land is currently home to about 140 to 150 urgent care centers. Dr. Jeffrey Schor, a founder of PM Pediatrics said his centers, staffed by pediatricians, operate hours that other pediatricians are not likely to be open and send any records to a child’s regular doctor. In response to Dr. Schor’s office practices, Dr. Andrew Kleinman, President of the Medical Society of the State of New York and a plastic surgeon in Westchester, praised Schor’s PM Pediatrics for providing good care and making sure pediatricians were aware of visits to his centers. “An urgent care center can see people in a hurry after-hours and provides an alternative to the emergency room,” he said. But, Dr. Kleinman added that “the real danger is in terms of follow-up, in an urgent care center you don’t always have continuity of care.” CLICK HERE For Full Article

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

LONG ISLAND W ILL DETERMINE BALANCE OF POWER IN SENATE

Arthur "Jerry" Kremer

No one has ever declared that “as Long Island goes so goes New York State,” but that just may be the case this year.

The outcome of three State Senate contests on Long Island may very well determine whether Republicans maintain their power-sharing arrangement with the Independent Democratic Conference or are relegated to minority status. If the results go the way Democrats hope they will, their party would control the governor’s office and both cham-bers of the Legislature, a prospect that has the state and national Republican Party more than a little nervous.

For the past 10-plus years, the nine-member Republican Senate delegation from Long Island has been their party’s power broker and wielded enormous influence on the state as a whole. But growing Democratic registration and the increase in the number of independent voters in Nassau and Suffolk Counties have dramatically altered the electoral landscape. A victory by the Democratic nominee in any of the three key contests may have serious ramifications in Albany.

The two open-seat races on the Island present Democrats the greatest possibility to break the Republicans’ monopoly. Last December, popular South Shore Republican Senator Charles “Chuck” Fuschillo resigned to accept a job with the Alzheimer’s Foundation. His departure gives Democrats one of their best chances to pick up a seat.

They went with Nassau County Legislator Dave Denenberg as their candidate. Denenberg represents a portion of the Senate district in the county legislature and enjoys solid name recognition.

Not to be outdone, Republicans selected Michael Venditto, also a county legislator. Venditto benefits from even stronger name recognition, as his father, John, is the long-time supervisor of the Town of Oyster Bay. This contest will attract substantial sums of money from the Senate Republi-can Campaign Committee and a somewhat lesser amount from the Democratic Senate Campaign Committee, which has a smaller war chest.

The second race in Nassau County pits Roslyn school board member Adam Haber against incumbent Republican Sena-tor Jack Martins. Haber lost the Democratic primary for county executive last year to Tom Suozzi, who held that of-fice from 2002 until 2009, when he was defeated by the current incumbent, Republican incumbent Ed Mangano, who again bested him in their rematch this past November.

Though Haber lost the primary, he gained substantial expo-sure. In the Senate race, he has picked-up the endorsement of the Retail, Wholesale and Department Store Union, which represents 100,000 members in Nassau County. Moreover, his considerable personal wealth will enable him

to self-finance most of his campaign.

Martins is a strong campaigner with a long history in the district, having served as mayor of the Village of Mineola. The state Republican Party will no doubt contribute heavily to keep the seat in its column.

The key Suffolk contest pits Republican Tom Croci, the Town of Islip’s supervisor, versus Democrat Adrienne Esposito. They will battle for the 3rd district seat, which is being va-cated by the GOP’s Lee Zeldin, who is challenging six-term incumbent Democrat Rep. Tim Bishop in a rematch of their 2008 contest, which Bishop won handily (58% to 42%).

During the early stages of this State Senate campaign, Re-publicans anointed Islip Town Board member Anthony Senft, Jr. as their candidate, however, an investigation into illegal dumping in town parks hurt Senft and tilted the race towards Esposito, an environmental activist. Republicans then shifted their support to Croci, a U.S. Naval Reserve offi-cer who served in Afghanistan and is untainted by the dumping scandal. That substitution evens up the race.

At this stage it is hard to predict who will emerge victorious in any of these races. While the State Senate contests are local affairs, all have a national overlay.

The national Republican Party has a strong vested interest in the outcome of these races. If New York Republicans lose control of the State Senate, the party’s influence in Albany will be practically nonexistent. The national GOP risks losing the prestige of holding power in at least one chamber of government in one of the biggest states in the country.

It is a risk Republicans will not take lightly. The national GOP and the New York Republican Senate Campaign Com-mittee will spend heavily to keep those seats. Look for a lot of political action committee money to come in from out of state.

Democrats likely will not be able to match Republican spending. That imbalance will make Election Day turnout critical to the Democrats’ hopes of taking control of the State Senate. If rank-and-file Democrats on Long Island opt to stay home in November either because of apathy or dis-satisfaction with the party, the consequence could very well be a Republican sweep on the Island, a critical outcome for the GOP to achieve if the party is to have any hope of ac-complishing its goal of maintaining a hand on the levers of power in Albany.

Arthur "Jerry" Kremer served as a Democratic member of the New York State Assembly from 1967 to 1989, including 12 years as chairman of the Ways & Means Committee. He is Chairman of Empire Government Strategies and author of Winning Albany - Untold Stories About the Famous and Not So Famous.

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

Every year, Americans are more likely to send e-mail mes-sages, bank online, archive family photos and participate in social media. Many people even decide to "go paper-less," paying bills and accessing all account information online. It's a sign of the times that states are passing leg-islation to grant family members, executors and other fi-duciaries the right to access a decedent's "digital assets," including e-mail, social media, photos and financial ac-counts that are contained on personal computer files and cloud networks.

But access to a deceased person's digital assets can be a touchy subject, because individuals have privacy rights, too.

For example, maybe a grandmother doesn't want her family to read personal e-mails she sent to an old flame after her husband's death ten years earlier. Perhaps she doesn't want her squabbling adult children to read confi-dential e-mails they sent her, bashing one another. It's also possible that she doesn't want her children and grandchildren to access her medical records.

Digital Assets Aren't Like Other Assets

Digital assets don't disappear when a person dies. They sit in cyberspace or are locked inside a computer unless a spouse, an executor or some other fiduciary receives the passwords and authorization to access them. Digital as-sets also continue to pose cyber-security risks. For exam-ple, hackers could gain access to the records -- and heirs, executors and other fiduciaries might lack the ability to change passwords.

Digital assets face obstacles that don't apply to tradi-tional types of property, including passwords and encryp-tion. In addition, unsuspecting executors and family mem-bers who access digital assets may inadvertently trip criminal laws regarding unauthorized access to com-puters, such as the Computer Fraud and Abuse Act, or data privacy laws, such as the Stored Communications Act.

States Join the Digital-Asset Bandwagon

Courts are just beginning to see disputes over digital as-sets. So far, no decisive rulings have determined who owns a deceased person's "digital access" and who gets to see digital records. To complicate matters, there's little uniformity in current state laws.

Currently, at least eight states -- Connecticut, Idaho, Indi-

ana, Louisiana, Nevada, Oklahoma, Rhode Island and Vir-ginia -- have enacted laws that grant executors and other fiduciaries access to a dead person's digital information. Executors or trustees are generally given the same control over those assets as they have with physical assets, such as safety deposit boxes and stock certificates.

Delaware may soon be the next state to move into this cyber zone if its governor signs pending legislation that would make digital assets part of a person's estate upon death. At least ten other states are expected to consider similar legislation this year.

Call for Nationwide Protection

To head off confusion and help establish a nationwide standard, the Uniform Law Commission (ULC) recently passed a model digital assets law called the Uniform Fi-duciary Access to Digital Assets Act (UFADAA) for states to follow. The ULC is a nonprofit organization of lawyers, legislators and judges appointed by every state to draft and standardize laws.

"In the modern world, digital assets have largely replaced tangible ones," the ULC says. "Documents are stored in electronic files rather than in file cabinets. Photographs are uploaded to websites rather than printed on paper. However, the laws governing fiduciary access to these digital assets are in need of an update."

The question about what to do about a deceased person's digital assets is a topic that's highly debated in the world of cyberspace and emerging law. The UFADAA attempts to solve the problem. Essentially, if a fiduciary would have access to a tangible asset, that fiduciary will also have access to a similar type of digital asset under the UFADAA.

The UFADAA governs four common types of fiduciaries:

1. Personal representatives of a deceased person's estate;

2. Guardians or conservators of a protected person's es-tate;

3. Agents under a power of attorney; and

4. Trustees.

The purpose of the UFADAA is to give these fiduciaries the authority to access, control or copy digital assets, while respecting the privacy and intent of the account holder. Sometimes fiduciaries might need to access digital assets while an account holder is still alive but otherwise inca-pacitated.

Who Will Have Access to Your 'Digital Assets' When You Die?

By Thomas J. Novak, CPA, Partner at Sheehan & Company

22

WELCOMEWELCOMEWELCOME NEWNEWNEW MEMBERSMEMBERSMEMBERS ACTIVE MEMBERSHIP

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

Christopher R. Adam, MD

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Megan Haberlein, MD

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MLMIC RESIDENTS

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

AMA RELEASES FACT SHEET TO HELP PHYSICIANS COMPLY WITH NEW HYDROCODONE REGULATIONS.

The American Medical Association (AMA) released a new fact sheet on September 18th to assist physicians in complying with new federal regulations on prescribing hydrocodone and help avoid disruptions in patient care. The rule, effective October 6, 2014, reschedules hydrocodone combination products (HCPs) into Controlled Sub-stance Schedule II. Millions of patients will be impacted by this new rule from the Drug Enforcement Administra-tion (DEA), and the new resource will help physicians understand the rule and avoid interruptions in access to medically necessary HCPs for their patients.

“The AMA is strongly committed to combating prescription drug abuse and diversion while at the same time pre-serving patient access to medically necessary treatments for pain,” said Dr. Robert M. Wah, President of the AMA. “This new fact sheet explains how new regulatory changes impact both physicians and pharmacists, which will help ensure patients continue having access to the care they need under the new federal rule.”

Prescriptions for HCPs issued before October 6 that have authorized refills can be dispensed in accordance with current DEA rules for refilling, partial filling, transferring, and central filling of Schedule III-V controlled sub-stances until April 8, 2015. However, due to state laws and limitations on some pharmacy and insurance proc-esses - some health insurers and pharmacies may deny requests for refills on or after October 6th . To help ensure continuity of care for patients and reduce confusion, the AMA is encouraging prescribers to act now to provide new hard copy or electronic prescriptions for patients, rather than depending on existing refills. CLICK HERE for Full Article

It is with deep regret we announce the passing of the following members:

Dr. Donald Pevney of Riverhead passed away July 20, 2014, at his home after a long illness. He was 80.

Born and raised in Brooklyn, he was a graduate of Columbia College and New York University School of Medicine. He served in the U.S. Navy from 1960 to 1963 before settling in Riverhead, where he was the town pediatrician for many years before retiring from clinical practice in the late 1990s.

Dr. Peveny was a member of Suffolk County Medical Society, the Medical Society of the State of New York, and the Suffolk Pediatric Society, of which he was a past president. In later years, he served as a consultant for Medi-cal Liability Mutual Insurance Company of New York and was a frequent lecturer on the standards of care in pe-diatrics. Dr. Pevney found great joy and pride in his family, his work and his many intellectual pursuits, and will be remembered as a uniquely capable physician and a generous and caring person, always willing to provide help and advice to friends and family.

Dr. Roy Hershel Brown of Huntington, NY passed away on January 30, 2014 at the age of 89, after a four-month struggle with lymphoma.

Dr. Brown was born in Cayo Mambi, Cuba on August 2, 1924, and was raised in Jamaica, West Indies. Dr. Brown came to the United States to attend Fordham University, majoring in pre-med. He at-tended medical school in Zurich, Switzerland, where he met his wife Lilly. Dr. and Mrs. Brown cele-

brated 61 years of marriage on January 29, 2014.

In 1961, Dr. Brown moved his young family to Huntington, Long Island, after taking a position as an emergency room physician at Huntington Hospital. Dr. Brown is fondly remembered for delivering countless babies and car-ingly treating numerous patients for a wide range of ailments. Dr. Brown also established a family practice on Depot Road in Huntington, where he generously treated members of the community without regard to their abil-ity to pay. Dr. Brown completed a fellowship in Physical Medicine and Rehabilitation at New York University's Rusk Institute of Rehabilitation Medicine in 1968, and was one of the first board certified physiatrists.

Dr. Brown went on to become the first Director of Rehabilitation Medicine at the Trump Pavilion for Nursing and Rehabilitation at the Jamaica Hospital Medical Center. Dr. Brown touched the lives of tens of thousands of pa-tients during his 58-year medical career.

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Suffolk County Medical Society Bulletin October 2014 www.scms-sam.org

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