June 2013 News Archive

MLMIC Update
New York State Concussion Guidelines: What You Need to Know
Q&A: Tenancy and Security
Renew Your "Doctor On Call" Card
Special Deal at the Vanderbilt YMCA
Discounts on Movie Tickets, Theater, and Other Attractions
Talk to the President
The Keys to Selecting a Collection Agency
Health Care Reform: 2014 Marks a New Era*
Free Book Offer for Members
Help for Your Addicted Patients
Fifty Years On
Spingarn Fund Says Thanks to Our Members
Board Mourns Aaron G. Meislin, MD
In Memoriam
McNally's Corner
Like Us On Facebook
Medelita® Offers Member Discounts
Prepare NOW for I-Stop
Dateline: NYCMS
From the Board Room
From the Front
Be A Hero to Your Patients
Wave of New Members
Hats Off
Discount on Wild Medicine Tickets
Legal Briefs



MLMIC Update
The following is provided by the Society’s endorsed medical liability insurer, the physician–owned Medical Liability Mutual Insurance Company.

A lot of change is occurring in healthcare today, which can increase costs and/or lower reimbursements. As the leading professional liability insurer of physicians, hospitals and dentists in New York State, we know that this can put pressure on our insureds to manage the cost of their professional liability insurance. There are several things you can do to prudently manage the cost of your professional liability insurance:
  • See if you qualify for our claims–free discount. MLMIC offers a 7.5 per cent discount for physicians that have continuously been in practice for a minimum of five years and have no open or closed claims within the past five years. About half of our insured physicians currently receive this discount. Some that haven’t received it may soon qualify. Others that meet the criteria and are currently not insured by us could qualify for the discount if they became insured by MLMIC. For more information, please visit the Underwriting section of MLMIC.com.
  • Take full advantage of MLMIC’s online risk management course. We offer an online risk management course that can be completed in just a few hours from a home or office computer. It offers CME credits and a five percent premium discount upon successful completion. Many physicians take advantage of this course, but some do not. For more information, please visit the Risk Management section of MLMIC.com.
  • Request a risk management survey for your group. MLMIC has a team of risk management professionals that works with its insureds to identify causes of loss and ways to mitigate them. This can help lower professional liability insurance costs over time. For more information, please visit the Risk Management section ofMLMIC.com.
  • Be wary of professional liability insurance quotes that are materially lower than your current premium. This can occur when the proposed coverage is not as comprehensive as your existing coverage. For example, switching coverage from occurrence to claims made initially triggers a substantial reduction in premium, but it may also create the need for tail coverage when the policy is cancelled. If you are comfortable with this, we can make this switch for you at MLMIC. We stand ready to help you compare quotes, explain the key differences, and discuss coverage options, if desired. For more information, please visit the Underwriting section of MLMIC.com.
  • Monitor the financial condition of your insurer. If the insurer is weak, they may have difficulty honoring their policyholder obligations. Some insurers may not be protected by the New York State guaranty fund, which protects insureds in the event of an insurer’s insolvency. Also, strong insurers are better able to reduce rates or declare dividends when actuarially indicated. Financial statement information is often available on insurer websites (please visit the About Us section of MLMIC.com). It also may be obtained independently from the National Association of Insurance Commissioners at www.naic.org.

MLMIC recognizes that change can present challenges and opportunities. As a mutual insurer, we are committed to meeting the professional liability insurance needs of our policyholder owners, as we have since our founding in 1975. If you have specific questions, please contact Gary Andelora at (716) 648–5923.


New York State Concussion Guidelines: What You Need to Know
The Concussion Act of New York State took effect July 1, 2012, and requires schools to:
  • Educate parents, athletes, coaches, athletic trainers, physical education teachers, and school nurses on concussion.
  • Remove observed or suspected concussed students from play based on signs and symptoms.
  • Withhold further participation until evaluated by, and received written and signed authorization to return to activities from a licensed physician.
  • Obtain physician clearance, and when the athlete has been symptom free off pain–killing medicines for a minimum of 24 hours, allow them to begin a monitored progressive six– phase return to play.

Current thinking is that optimal recovery of concussed students occurs when there is cognitive, physical, and emotional rest following injury. Additionally, research has shown that 92 percent of second injuries occur in the first week following the initial injury, and the goal is to allow adequate recovery time before allowing a student to risk re–injury.

Pressure to return an athlete before it is safe can be intense from parents and athletes. Primary care physicians are being asked to assist in the process of keeping injured children safe by remaining objective and withholding participating until it is deemed safe with a reasonable degree of medical certainty.

Making a Clinical Determination

Information on clinical diagnosis and management is provided by the CDC.
  • Symptoms: somatic (e.g., headache, nausea, dizziness), cognitive (e.g., feeling in a fog), and/or emotional (e.g., lability);
  • Physical signs: history of loss of consciousness, amnesia, poor coordination or imbalance, vomiting, sensitivity to bright light and loud noise;
  • Behavioral changes: irritability, personality changes;
  • Cognitive impairment: Hard time concentrating, trouble remembering, not feeling themselves, being confused, thinking speed slowed down, taking a longer time to react; and
  • Sleep disturbance: drowsiness, insomnia.

Graduated Return to Physical Exertion and Activity or Return to Play (RTP)
This is a six–step gradual return to activity. The RTP protocol may not start until an athlete is completely symptom free for a full 24 hours off pain–killing medicines, and must remain symptom free for 24 hours following each stage before progressing further.

Recovery
Average recovery following concussion is about a week to ten days; protracted recovery with post–concussion syndrome is after 21 days. Young teenage girls often have protracted recovery more than any other group.

Return to Learn (RTL)
More information will be forthcoming about RTL (cognitive return to school), but we anticipate a similar slow exertional challenge as we see in RTP. The graduated steps begin after the student has a medical clearance to return to academics, and is symptom free off pain–killing medicines for a full 24 hours. RTL should be an individualized steady progression with the parents checking the child daily for a return of symptoms and alerting the physician if the student is struggling so the doctor can provide appropriate requests for medical accommodations to the school as needed.

Unlike a RTP, the RTL might start at any level and progress at a rate individualized to the student’s needs and tolerance. Steps might be skipped as tolerated, and might look something like this: Students with reasonable recovery times typically will get accommodations within the school by the principal. Students with protracted recovery beyond about 10 weeks, a school quarter, are likely eligible for a 504 plan or an IEP, and a physician might be asked to write a request to support the family at that time.

Resources

  1. http://www.cdc.gov/concussion/headsup/physicians_tool_kit.html
  2. http://www.healio.com/pediatrics/journals/PedAnn/%7BAA104351-036F-4CECA871-13925D21CD31%7D/Pediatric-Assessment-and-Management-of-Concussions
  3. http://bjsm.bmj.com/content/43/Suppl_1/i76.full.pdf
  4. http://impacttest.com/doctors/id/4
  5. Guidelines for Concussion Management have been published by the NYS Education Department -
    http://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/
    ConcussionManageGuidelines.pdf

This article is provide by the New York State Department of Health’s Bureau of Occupational Health and Injury Prevention.


Q&A: Tenancy and Security
Q: Patients have started to complain because the security staff in our lobby are slow in allowing people access to the elevators. Sometimes they seem rude or just complacent. Some patients report waiting at the front desk more than five minutes. This could cause us to lose revenue. What can we do?

A: From Marisa Manley, President, Commercial Tenant Real Estate Representation, LTD, and the Society’s Commercial Tenant Concierge Program: Security is a challenging issue. The best approach may be to identify times when this issue is particularly problematic and to then negotiate a special procedure with your landlord. Commercial Tenant Concierge can help you develop a plan and negotiate for landlord approval.

Commercial Tenant Concierge can help you analyze your needs, develop a plan and negotiate with your landlord for reasonable pricing. Call the Society for member access at (212) 684–4670, ext. 214.


Renew Your "Doctor On Call" Card
If you have a “Doctor–On–Call” card for your automobile windshield, the current card expires June 30, 2013, and must be renewed. Renew your card by sending in a check for $25.00 payable to New York County Medical Society, “Doctor –On–Call,” 12 East 41 Street, 15th Floor, New York, NY 10017. You will receive a new validated card for 2013–2015. The agents of The Parking Violations Bureau look for required updated validation cards after June 30th, so renew your card today. For more information call Valerie Davis, Parking Supervisor, at (212) 684–4670, ext. 220.


Special Deal at the Vanderbilt YMCA
You can join the Vanderbilt YMCA at a special rate through Labor Day (September 2, 2013). Pay just $200 for an adult or $275 for the whole family, at the Vanderbilt YMCA, 224 East 47th Street. Included in membership:
  • 130+ FREE weekly Group Exercise classes like Zumba, Spinning, and Yoga;
  • Cardio Fitness Center, Strength Training, and Free Weight Rooms;
  • Two Swimming Pools, Sauna, Steam Room, and Free Towel Service;
  • Basketball Court;
  • Free Y Personal Fitness start–up coaching program; and
  • Free Child Watch.

You will also have the opportunity to continue your membership into the fall and waive the joiner’s fee (a savings of $125). Call (212) 912–2508 or e–mail vanderbilt@ymcanyc.org


Discounts on Movie Tickets, Theater, and Other Attractions
The Society is pleased to offer to the membership a unique entertainment internet discount program, Working Advantage. Discounts are offered in the following areas:

Entertainment: Savings up to 40 percent on movie tickets, museums, attractions across the country.

Theater & Events: A huge selection of theatrical productions, family events and sporting events nationwide is offered at a discount.

Shopping: Respected online vendors offer excellent discounts on apparel, accessories, books and music, electronics, flowers, gourmet food, office supplies and much more.

Gifts: Purchase discounted gift certificates in the areas above.

Advantage Points: Earn rewards while you save. Members can redeem points on selected items for a variety of products, including movie tickets and gift cards.

Postings will be sent to our members via e–mail. Members call the Society to receive a member ID number. You then can log on to www.workingadvantage.com to create a password.

To get your Society ID for savings, call Natalie Ruoff at (212) 684–4670, ext. 214.


Talk to the President
Do you have issues to bring to Society leadership? Society president Paul Orloff, MD, invites you to call him at the Society and he will get back to you to discuss your concerns about aspects of practice in New York City. Call Doctor Orloff’s voice mail box at the Society, (212) 684–4670, ext. 213, and leave your name, phone number, the best time to reach you, and the issue about which you are calling. Remember extension 213 to speak to the president.


The Keys to Selecting a Collection Agency
It can be difficult to select a collection agency when most claim to offer the “Lowest Rates” with the “Highest Recoveries.” Try shifting your focus to the following:
  1. Experience: How long has the agency been in business? Does it specifically collect for physicians?

  2. Compliance: Every agency should be a member of ACA International, the Association of Credit and Collection Professionals; members are required to comply with all federal/state laws. Beyond membership, consider if the agency truly invests in compliance by:
    — certifying its collectors through ACA International; and
    — adhering to best practices as an ACA PPMS–CERTIFIED agency; approximately 70 agencies worldwide are certified.

  3. Quality Assurance: Be sure the agency is a Better Business Bureau (www.bbb.org) “Accredited Business” so it’s committed to resolving consumer complaints. Ask for a Liability Insurance Certificate and confirm coverage extends to you. Make sure the agency is licensed/bonded in ALL requiring states. Verify its DATA SECURITY; ask for documentation of a SOC 2 TYPE 2 attestation and a PCI audit. How many societies recommend the agency’s services?

Additional key factors to consider include the agency’s product offerings and its accessibility.

To learn more , download I.C. System’s 12–page booklet titled THE IN$IDE FACT$: Things Most Collection Agencies Won’t Tell You. You’ll learn the most costly collection mistake you can make, how to avoid making it, and much more. Download your FREE booklet at www.icmemberbenefits.com or call (800) 279–3511.

I.C. System has been the New York County Medical Society’s preferred collection agency since 2005. Society members receive a 20 percent discount.


Health Care Reform: 2014 Marks a New Era*
Health care reform is in full swing with the heftiest legislation set for 2014 — when health insurance will become available to millions of Americans who were previously uninsured. Starting January 1, 2014, most Americans will be required to have health insurance and many businesses will be required to offer coverage to their employees. In addition, health insurance exchanges will be available to facilitate access to coverage.

Starting in 2014, Americans must have minimum essential coverage or pay a tax penalty. Options for coverage include insurance purchased through the individual market, a public exchange, a government program or an employer–sponsored program. Minimum essential coverage includes ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health/substance abuse treatments, prescription drugs, rehabilitative services, laboratory services, preventive/wellness services and pediatric services.

Changes Coming in 2014
  • Individual Mandate — Everyone (with few exceptions) will be required to have health insurance or pay a penalty. Penalties start at $95 per individual, $285 per family, or one percent of income (whichever is greater), and increase in subsequent years.
  • Employer Mandate — Employers with 50 or more full–time equivalent employees must offer minimum essential coverage that is affordable (where employee only contributions do not exceed 9.5 percent of household income) for at least 95 percent of its full–time employees or pay a penalty (i.e. play or pay) if one full–time employee goes to an Exchange and receives a premium tax credit.
    — If coverage is not offered, penalty is $2,000 multiplied by the number of full–time employees (minus the first 30 employees).

    — If coverage is offered but not affordable or does not cover at least 60 percent of essential benefits, the employer will be assessed $3,000 for each employee receiving a tax credit or $2,000 per full–time employee (the lesser will apply) (excluding the first 30 employees).

    — All states must have a health insurance exchange available for individuals and small business owners to view, compare, and purchase health plans offering minimum essential coverage.
  • Subsidies — Through the exchange, individuals may qualify for a subsidy in the form of a tax credit if household income is between 100 – 400 percent of the federal poverty level.
  • Guaranteed Issue — Health insurers must sell coverage to everyone, regardless of pre–existing conditions, and can't charge more based on health or gender.
  • No Annual or Lifetime Limits — Individual and group health plans may not impose annual or lifetime limits.
  • Free Preventive Care — Plans offering minimum essential coverage must provide several preventive services and screenings at no charge.

Options for Employers with Less Than 50 Employees
  • Purchase coverage via the SHOP exchange (Small Business Health Option Program) or traditional market.
  • Stop offering coverage and let employees buy an individual plan from the exchange.
  • Provide a defined contribution to assist employees with purchasing coverage.
  • Apply for tax credits to help cover the cost of premiums if the employer:
    — Employs 25 or fewer employees.
    — Pays annual wages averaging less than $50,000 per full–time equivalent employee.
    — Provides at least 50 percent of the cost of health care coverage for their employees.

Impact on Individuals and Employers

Individuals, their families, and their employees will have access to health insurance on a broad basis. Employers must assess their options carefully to determine the pros and cons of continuing to provide coverage or allowing employees to access the exchanges. Although long–term implications are unknown, a number of experts agree reform regulations (i.e., guaranteed issue and mandated level of benefits) may result in increased premiums that will ultimately be passed to employees.

Learn More

Stay tuned for more health care reform communications, including information on Marsh’s private health care exchange for members. In the meantime, please call Marsh at (800) 888–6926 for more information.

*Marsh and the Society do not provide tax or legal advice. Please consult with your own advisors to determine how the law’s changes and your decisions impact your personal situation.

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800-888-6926 • NYCMS.Insurance@marsh.comwww.NYCMSMemberInsurance.com
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d/b/a in CA Seabury & Smith Insurance Program Management



Free Book Offer for Members
In an environment of decreasing reimbursements, increasing compliance and practice overhead costs, physicians need to employ best practices to protect their business. The Society is dedicated to this proposition, which is also the premise behind the new book, For New York Doctors: A Guide to Asset Protection, Tax Reduction, Practice & Wealth Management , co–authored by Society special counsel Scott Einiger, Esq. As a Society member, you have access to a free copy of For New York Doctors , the only book of its kind written specifically for New York physicians. Please visit nycmsbookoffer.com to learn more about the book and download your free electronic version, or request a free hard copy by contacting the Society at (212) 684–4670. (Hard copies are limited.)


Help for Your Addicted Patients
If your patient was abusing prescription or illicit drugs, would you know?

In 2011, 3.1 million persons aged 12 or older reported using an illicit drug for the first time within the past 12 months. This averages to approximately 8,500 initiates per day1. Additionally, 6.1 million persons aged 12 or older reported the nonmedical use of prescription psychotherapeutic drugs in the past month.2

The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, is interested in improving clinical outcomes by providing science–based resources to clinicians about drug abuse and addiction. To help achieve that goal, NIDA has developed NIDAMED, a portfolio of resources to help clinicians better address drug abuse in their patients. Visit the NIDAMED website now to view the portfolio of free resources.

Available materials include:

The NIDA Drug Use Screening Tool This interactive Web tool, easily accessible from mobile devices, offers a single question Quick Screen to identify patients with recent substance use. If a patient is found to be at risk using the Quick Screen, the NM ASSISTprovides more in–depth questions about patient drug use. A substance involvement score, generated from patient responses, suggests the level of intervention needed.

Screening for Drug Use in General Medical Settings: Resource Guide . This guide supplements the NIDA Drug Use Screening Tool by providing more detailed instructions to clinicians about how to use the tool, discuss screening results, offer brief interventions, make necessary referrals, conduct biological specimen screening, and locate substance abuse treatment facilities.

Screening Tool Quick Reference Guide This pocket guide provides an abbreviated version of the NIDA Drug Use Screening Tool and instructions on its use.

Patient Resources These materials were developed to help clinicians provide patients with information about drug use, addiction, and treatment. Resources include 1) one–page fact sheets about prescription drug abuse, marijuana, and substance abuse treatment options; 2) booklets about the science of addiction, facts about drugs, and tips for finding treatment; 3) posters to help start conversations with at–risk patients about their drug use; 4) an online tool that highlights parenting skills to prevent the initiation and progression of drug use among youth; and 5) a web site written in simple, direct language to help readers understand drug abuse, addiction, and treatment.

Substance Abuse–Related Continuing Education Courses (CME/CEs) These two new MedScape CMEs/CEs, which offer up to three CME/CE credits, include video vignettes modeling clinician–patient conversations about the safe and effective use of opioid pain medications. The courses were created to help clinicians understand and address the complex problem of prescription drug abuse. More than 30,000 clinicians have completed the course for credit, and an additional 50,000 have viewed it.

Curriculum Resources This series includes ten innovative drug abuse and addiction curricula, which were designed to help teach students to identify and treat patients struggling with drug abuse and addiction. The resources were created to help fill gaps in current medical education related to both illicit and prescription drug abuse.

If you have questions about any of the NIDAMED resources, contact nidacoeteam@jbsinternational.com.

1 Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H–44, HHS Publication No. (SMA) 12–4713. Rockville, MD: Substance Abuse and Mental Health Services Administration.

2 Ibid.


Fifty Years On
Congratulations to New York County Medical Society members celebrating 50 years as physicians in 2013:

Martin Barandes, MD
Norma Mai Tsen Braun, MD
Neville Wayne Carmical, MD
Anthony Arnold Clemendor, MD
Morton Coleman, MD
Jack Murray Dodick, MD
Benjamin Feldshuh, MD
Anthony John Grieco, MD
Laurence S. Harris, MD
Yashar Hirshaut, MD
Joel S. Hoffman, MD
Martin Avi Hurwitz, MD
William L. Jaffe, MD
Martin L. Kahn, MD
Monroe Stuart Karetzky, MD
Alvin Katz, MD P.C.
Harvey Klein, MD
Raymond Donald La Raja, MD
Donald Joel Mayerson, MD
James Thomas Mazzara, MD
Michael Frank Michelis, MD
J. P. Mohr, MD
Philip K. Moskowitz, MD
Sophie Helen Pierog, MD
Michael Ruoff, MD
David B. Sachar, MD
Nathan Emile Saint–Amand, MD
Eduardo Agustin Salvati, MD
William J. Schneider, MD
Kent Shinbach, MD
Jerome Leonard Shupack, MD
Don Sloan, MD P.C.
Ian Albert Spira, MD
Paul Sherman Striker, MD
Jacquelyn C. Trent, MD
Malcolm Howard Weinsaft, MD
Bruce Kenneth Young, MD
Stuart Harris Young, MD


Spingarn Fund Says Thanks to Our Members
The Society’s thanks go to the following members who made generous contributions to the Clifford L. Spingarn, MD Memorial Education Fund (aka, MEDCOFUND) in 2012.

Special Benefactors (Over $300)
Janet O. Jeppson, MD
Robert Emmet Martin, MD
George Schwarz, MD
Marie Gloria Sortino, MD
Wolfgang Tretter, MD

Benefactors ($300)
Kenneth Haskell Brookler, MD
Lucien Mayer Cesiano, MD
Robert Charles Eberle, MD
Carla Anna F. Job, MD
Ludwig Gerald Laufer, MD
Peter C. Lombardo, MD
Henry J. Magliato, MD
Jack Richard, MD
Jayaraja Yogaratnam, MD

Patrons ($200 and up)
S. Raymond Gambino, MD
Antoine C. Harovas, MD
Gideon G. Panter, MD
Peter Boutros Saadeh, MD
Elliot Wilson Strong, MD
Apostolos P. Tambakis, MD
Ana Angela Villanueva, MD

Friends ($100 and up)
Herbert I. Cohen, MD
Nicolas H. Del Valle, MD
Magdalena Fuchs, MD
Emanuel Goldberg, MD
Heskel Marshall Haddad, MD
Elias R. Halac, MD
Julian B. Hyman, MD
Jacob S. Israel, MD
Judith J. Levine, MD
Jerome M. Levine, MD
Hamid Mouallem, MD
Francis S. Perrone, MD P.C.
Marinos Anthony Petratos, MD
Raymond Adrian Raskin, MD
Herbert S. Rubinowitz, MD
William J. Schneider, MD
Gerald Weintraub, MD
Miltiades Zaphiropoulos, MD

Supporters (up to $100)
John Cohn, MD
Felix De Pinies, MD
Elaine Virginia Digrande, MD
Elliott J. Howard, MD
Russel H. Patterson, MD
David B. Sachar, MD
Harry Weinrauch, MD


Board Mourns Aaron G. Meislin, MD
The Board of Directors of the New York County Medical Society mourns one of its own, as Aaron G. Meislin, MD, member of the Board of Medical Ethics and Delegate to the Medical Society of the State of New York, passed away on June 19, 2013.

Doctor Meislin was a 1954 graduate of the New York University School of Medicine. He was board certified in pediatrics, and affiliated with Bellevue Hospital and NYU Hospital. Doctor Meislin served as a delegate to the Medical Society of the State of New York since 1981. Throughout the 1980s, he chaired the Society’s Child Welfare Committee. He was a member of the Board of Censors (now Board of Medical Ethics) and Board of Directors since 1999. Doctor Meislin served on the Society’s Grievance Committee for 25 years. He was the first to volunteer for any Society program helping children and was one of the stalwarts who gave camp physicals for the Single Parent Resource Center as part of the Society’s volunteer projects.

He was always kind, thoughtful, and measured in his response to issues. His example prompted a son and granddaughter to follow him into the medical profession.

The Society sends its condolences to his wife Monica and his children and grandchildren.


In Memoriam
John W. Angers, MD , died December 7, 2012. Doctor Angers received his MD degree from McGill University School of Medicine in 1953.
Richard Arthur Bader, MD. Doctor Bader received his MD degree from Columbia University College of Physicians and Surgeons in 1946.
Robert E. Barrett, MD. Doctor Barrett received his MD degree from VA Commonwealth University School of Medicine in 1957.
William A. Bauman, MD , died November 28, 2012. Doctor Bauman received his MD degree from Columbia University College of Physicians and Surgeons in 1947.
Elliot D. Blumenthal, MD. Doctor Blumenthal received his MD degree from Columbia University College of Physicians and Surgeons in 1943.
Eugene A. Brody, MD , died June 27, 2012. Doctor Brody received his MD degree from State University of New York Downstate Medical Center in 1952.
Bernard Burack, MD , died September 30, 2012. Doctor Burack received his MD degree from Creighton University School of Medicine in 1949.
Chu Huai Chang, MD. Doctor Chang received his MD degree from St. John’s University School of Medicine, China in 1944.
Mansoor B. Day, MD , died April 6, 2013. Doctor Day received his MD degree from Tehran University of Medical Science and Health Services in 1947.
John Eschwege, MD , died July 23, 2012. Doctor Eschwege received his MD degree from University of Zurich Faculty of Medicine in 1956.
John Wilson Espy, MD , died December 22, 2012. Doctor Espy received his MD degree from Cornell University Medical College in 1956.
David B. Friedman, MD , died September, 2012. Doctor Friedman received his MD degree from New York University College of Medicine in 1945.
Harold Grushkin, MD. Doctor Grushkin received his MD degree from Chicago Medical School in 1949.
Frederick M. Lane, MD , died June 12, 2012. Doctor Lane received his MD degree from Yale University School of Medicine in 1953.
Bao–Cheng Lee, MD , died April 23, 2013. Doctor Lee received his MD degree from West–China–Union University Medical College in 1945.
Aaron G. Meislin, MD , died June 19, 2013. Doctor Meislin received his MD degree from New York University School of Medicine in 1954. Doctor Meislin was a long–time member of the Board of Directors of the New York County Medical Society and its delegation to MSSNY.
Gordon R. Meyerhoff, MD , died May 9, 2012. Doctor Meyerhoff received his MD degree from Columbia University College of Physicians and Surgeons in 1950.
David S. Mintz, MD , died November 8, 2012. Doctor Mintz received his MD degree from Royal College of Edinburgh, Scotland in 1944.
Marvin S. Mordkoff, MD , died January, 2013. Doctor Mordkoff received his MD degree from State University of New York at Buffalo in 1971.
James C. Newton, MD. Doctor Newton received his MD degree from Jefferson Medical College in 1957.
Luigia Norsa, MD. Doctor Norsa received her MD degree from Washington University School of Medicine in 1949.
Lazare Novack, MD , died February 7, 2012. Doctor Novack received his MD degree from University of New York Downstate Medical Center in 1952.
William H. Panke, MD , died December 16, 2012. Doctor Panke received his MD degree from New York University School of Medicine in 1951.
Robert F. Porges, MD , died November 1, 2012. Doctor Porges received his MD degree from SUNY College of Medicine at New York in 1955.
Leonard H. Schuyler, MD , died May 10, 2013. Doctor Schuyler received his MD degree from Duke University College of Medicine in 1950.
Daniel Shapiro, MD. Doctor Shapiro received his MD degree from University of Illinois College of Medicine in 1945.
Walter Wainer Tuchman, MD , died September 12, 2012. Doctor Tuchman rceived his MD degree from Columbia University College of Physicians and Surgeons in 1954.
Robert J. Walsh, MD , died July 14, 2012. Doctor Walsh received his MD degree from New York University School of Medicine in 1950.
Joseph Noel Ward, MD , died July 3, 2012. Doctor Ward received his MD degree from University College of Cork, National University of Ireland in 1949.
Robert D. Wickham, MD , died February 22, 2013. Doctor Wickham received his MD degree from Albany Medical College Union University in 1952.
Joseph Howard Zuch, MD. Doctor Zuch received his MD degree from State University of New York Downstate Medical Center in 1960.


McNally's Corner
The following is courtesy of James McNally, the Society’s Third–Party Payer Coding Assistance Program.

Aetna Revises Clinical Policy Bulletins (CPBs): Aetna Health Plans has updated or otherwise revised a number of Clinical Policy Bulletins that impact the practice of medicine across all specialties. Read more.

Reminder on Revalidation Request Letters from Medicare: Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011.

Between now and March 23, 2015M, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier.

DO NOT do anything until and if you receive a Revalidation Request!

However, to check to see if you were sent a revalidation request and if you are concerned that you might not have received it, please do the following.

Go to the link below and in the “Downloads” section is a listing of all providers and suppliers who have been mailed a revalidation notice. The files are broken down by the month in which the revalidation request was mailed. If you are listed, and have not received the request, please contact your Medicare contractor.
http://www.cms.gov/MedicareProviderSupEnroll/11_Revalidations.asp#TopOfPage

Clarification Received on Dates of Service — ICD–9 versus ICD–10: With the October 1, 2014, ICD–10 deadline approaching, the Centers for Medicare and Medicaid Services (CMS) has released information on how to code a claim that you are submitting in October 2014 for a service that your practice provided in September 2014. Even if you submit your claim on or after the ICD–10 deadline, if the date of service was before the October 1, 2014, deadline, you will use ICD–9 to code the diagnosis. For dates of service on or after the October 1, 2014, deadline, you will use ICD–10. You may not be able to use ICD–9 and ICD–10 codes on the same claim based on your payers’ instructions.

This may mean splitting services that would typically be captured on one claim into two claims: one claim with ICD–9 diagnosis codes for services provided before October 1, 2014, and another claim with ICD–10 diagnosis codes for services provided on or after October 1, 2014. Some trading partners may request that ICD–9 and ICD–10 codes be submitted on the same claim when dates of service span the compliance date. Trading partner agreements will determine the need for split claims.

For example: A patient has an appointment on September 27, 2014, and is diagnosed with bronchitis. He returns for a follow–up appointment on October 3, 2014. In this case, a practice will submit a claim with an ICD–9 diagnosis code for the first visit and another claim with an ICD–10 diagnosis code for the follow–up visit.

Make sure that your systems, third–party vendors, billing services, and clearinghouses can handle both ICD–9 and ICD–10 codes depending on the dates of service in the months following October 1, 2014.

Please note that future updates will explore how Medicare will handle dates of service for inpatient settings (e.g., a hospital inpatient stay that begins before the transition date and ends after the transition date will be coded on a single claim with ICD–10).

CMS Clarifies Two Percent Sequestration Cuts Imposed by Medicare Advantage Plans: Reports from the membership indicate that many Medicare Advantage Plans (MA Plans) are imposing the two percent Sequestration payment reduction for their Medicare Advantage products. However, CMS issued a memorandum clarifying that sequestration does not necessarily mandate a two percent reduction of reimbursement to MA Plan contracted providers and Part D (PD) Plan network pharmacy providers. The memorandum states:

[W]hether and how sequestration might affect an [MA Plan’s] payments to its contracted providers are governed by the terms of the contract between the [MA Plan] and the provider . . .

AND

Similarly, the question of whether and how sequestration might affect a Part D plan sponsor’s payment to its contracted providers is governed by the payment terms of the contract between the plan sponsor and its network pharmacy providers.

MA Plans and PD Plans can only impose these cuts to their physicians if their contracts with the physician permit it.

It is recommended that you check your insurer Remittances for the MA Plans you participate with and see if the payments are being impacted by the two percent sequestration cuts.

If they are, review your contract and, if applicable, you should consider challenging the reductions as a breach of your participation and network agreement.

CMS Pulls Surprise Move with Regard to Payment for Copying of Records Requested by the RAC: The Centers for Medicare and Medicaid Services (CMS), in what has been described by some as a “clandestine move,” has instituted a reimbursement cap of $25 per medical record when charts are requested by a Recovery Audit Contractor (RAC) vendor. This surprising change went into effect in 2012, but this information is just now being released by CMS. Any medical record submitted to a Recovery Auditor after April 1, 2012 will receive a maximum of $25 per medical record. This includes both the $0.12 per–page cost for photocopying, as well as first class postage. If you receive a RAC request, ask for their reimbursement cap of $25 per medical record. The official notice from CMS is located at the following link if supporting documentation is needed in the event that the RAC balks at allowing the capped amount: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Recovery-Audit-Program/Recent_Updates.html

If you have questions about these issues or others, contact the Society’s Third–Party Coding Assistance Program, at (212) 684–4670, ext. 212.


Like Us On Facebook
Check out the Society’s Facebook page. Please be sure to "like" the page and share it with your friends and colleagues and encourage them to like it as well. Let’s keep a “buzz” going about our members’ issues and activities. This month, see pictures from the 2013 Annual Meeting.


Medelita® Offers Member Discounts
New York County Medical Society is proud to announce a new member benefit — a discount on all non–sale Medelita brand items purchased from the company’s online store at medelita.com. This new member benefit is another example of the value of membership. NYCMS members can save on premium Medelita lab coats and scrubs for themselves and their staff at a special NYCMS rate. Further, NYCMS members may choose to embroider the NYCMS logo without incurring any artwork digitization costs.

Medelita designs with a focus on fit and functionality. Medelita lab coats are treated with Advanced Dual Action Teflon® fabric protector, which allows the fabric to repel and release stains and liquids. Medelita scrub tops are tailored to fit the human body while its scrub pants feature combined drawstring and elastic waistband for added comfort and security. Drirelease® with FreshGuard® fabric in Medelita scrubs resists pilling and fading while the moisture wicking and bacteriostatic fabric lends odor–free comfort.

Medelita scrubs and lab coats represent a paradigm shift from traditional lab coats, offering sophisticated style, performance fabric and gender specific sizing and styling. For more information, visit http://www.medelita.com or call (877) 987–7979 and mention the Society. To get your Society discount, go to the Society’s website and click on the Medelita icon.


Prepare NOW for I-Stop
The new I–STOP prescription tracking system will soon be up and running. Here’s what you need to know right now:

I–STOP will let prescribers and pharmacists know in real time about controlled–substance prescriptions that patients have received. As of August 27, 2013, physicians will have a duty to consult I–STOP before prescribing Schedule II, III, and IV Medicines.

You need to prepare now by setting up your Health Commerce System (HCS) account. The New York State Department of Health’s (NYSDOH’s) electronic HCS network is how you will access the I–STOP system, and you need to act now to be ready in August.

Go to https://hcsteamwork1.health.state.ny.us/pub/top.html and click “Request an HCS Medical Professions account application.” Enter your license type, name, and license number as they appear in the State Education Department’s database, plus your address and other key data. Just a few more clicks and your request will go to the Health Department’s Bureau of Narcotics Enforcement; you’ll get a form by e–mail. You will also need to complete the Official New York State Prescription Form, DOH–4329 (7/12), have it notarized and forward it to the NYSDOH Bureau. The form is located on the MSSNY website.

If you have questions, call Susan Tucker at (212) 684–4670, ext. 212.


Dateline: NYCMS
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.

— August 6, 2013, ICD–10 Coding: Introduction for the Ophthalmology Practice, Corwin Hall, North Shore LIJ–Lenox Hill’s Manhattan Eye Ear and Hospital site, 210 East 64 Street, 8:00 a.m. to 10:00 a.m.
— August 22, 2013, ICD–10 Coding: Introduction for the Otolaryngology Practice, Corwin Hall, North Shore LIJ–Lenox Hill’s Manhattan Eye Ear and Hospital site, 210 East 64 Street, 8:00 a.m. to 10:00 a.m.
— September 11, 2013, ICD–10 Coding: ICD for Internists, and General Introduction to ICD–10, Corwin Hall, North Shore LIJ–Lenox Hill’s Manhattan Eye Ear and Hospital site, 210 East 64 Street, 8:00 a.m. to 10:00 a.m.
— September 9, 2013, Board of Directors, at the offices of MLMIC, 5:30 p.m.
— September 10, 2013, CME Committee, at Lenox Hill Hospital, Weisner Conference Center, 5:30 p.m.
— September 11, 2013, ICD–10, Manhattan Eye Ear and Throat Hospital, Corwin
Auditorium, 7:00 a.m. to 11:00 a.m.
— September 25, 2013, Political Forum on Hispanic Health, Einhorn Auditorium, Lenox Hill Hospital, 6:00 p.m.
— October 8, 2013, CME Committee, at Lenox Hill Hospital, Weisner Conference Center, 5:30 p.m.
— October 21, 2013, Board of Directors, at the offices of MLMIC, 5:30 p.m.
— November 14, 2013, Medicare Rules, Manhattan Eye Ear and Throat Hospital, Corwin Auditorium, 7:00 a.m. to 11:00 a.m.


From the Board Room
At its meeting on May 13, 2013, the Board of Directors of the Society did the following:
  • heard a report on activities at the Medical Liability Mutual Insurance Company;
  • reviewed planned programs to assist members with medical economic issues, such as ICD–10; and
  • congratulated Doctor Peter Lombardo on his presidency at his final meeting.
The next meeting of the Board will be held on September 9, 2013.


From the Front
This feature of MM “NEWS” introduces you to Society leaders as they explain their vision of organized medicine’s activities. This month, read the remarks of Peter C. Lombardo, MD, FAAD, at the Annual Meeting.

The Future
I’ve been President of the New York County Medical Society for one year, which is not long in view that our Society goes back to the early days of the republic. So what have we accomplished in one year? Along with our excellent officers, Board members, and staff we have continued the work of my predecessors to position the Society for our tasks in the 21st century. We have:
  1. Rejuvenated our officer group and Board members with younger members whose ideas will be important to the new issues that will confront their practice of medicine. I turn my office over to our outstanding new president Doctor Paul Orloff, who is arguably the most knowledgeable member about our Society, and I look forward to his tenure. And we welcome our younger officers, Doctor Josh Cohen, our new president–elect; Doctor Matt Bonanno, our new vice president; Doctor Michael Goldstein, our new secretary, as well as our good friend and financial watchdog and treasurer, Doctor Scot B. Glasberg.
  2. We have offered new programs to our membership including the DocBook program, discount prescription program with Good Rx, a new and energetic financial advisor, OJM Group, while continuing our time honored programs of professional assistance with coding and insurance problem and health insurance for our members.
  3. We have reviewed all facets of our organization through our Future Committee and especially have concentrated on cost–cutting issues to ensure the financial health of the Society for years to come. One of these measures will soon result, hopefully, in moving our offices to new and more efficient quarters.
  4. We continue our lobbying activities with our local senators and assemblymen, establishing friendly relationships with them and having our voices heard.
  5. We have started an outreach program to the Hispanic community and our many Hispanic members, which will continue with our seminar dealing with the medical problems of that community in September.

Why do we prepare for the future?
Our problems are many, e.g., the implementation of the Affordable Care Act and new programs such as ACOs, medical homes, relationships with hospitals and hospital–owned medical practices, EHRs, the ongoing burden of medical liability injustice and of course the fate of “fee for service.” Will it survive and in what form? Will it still be a major player or must we adjust further to alternate forms of reimbursement probably tied to measures of quality? We must face these difficult problems head on and be open to change if it is for the good, always having our voice heard in every decision–making forum that deals with our future. We must be open to discussion, but always watchful of our unalterable principles, namely:
  • Do no harm.
  • The physician/patient relationship is sacred and must not be intruded upon by any financial, social, or governmental considerations.
  • The patient’s record remains private especially as the EHR systems come into play.

Finally we must never forget that our greatest advocates are our patients. They listen to us about medical issues and will do so on these issues if only we ask them.

I close by thanking our wonderful staff including Cheryl Malone, Susan Tucker, and Natalie Ruoff, without whose efforts we would have accomplished nothing.

Thank you.
Peter C. Lombardo, MD, FAAD
President


Be A Hero to Your Patients
The New York County Medical Society is pleased to introduce its members to GoodRx. GoodRx is a portal that: shows your patient the closest pharmacies with the cheapest price; provides lowest discount coupons; shows manufacturer coupons; and provides average savings of 58 percent. When you direct your patients to GoodRx, they will be grateful at the possibility of getting the same medication at the lowest price. You will be more confident that your patients will actually get the drugs prescribed because the costs won’t be prohibitive. Although best for underinsured/uninsured patients, people have been able to get drugs for less than their co–pays. It has already been used by over 900,000 customers each month to look up over 6 million prices. Get your Free GoodRx Office Kit at this link through the Society at GoodRx for Physicians or through www.nycms.org


Wave of New Members
The following 38 candidates for membership are presented to the Board of Directors of the Society. Anyone with information reflecting against election of a new member is requested to notify the secretary of the Society as soon as possible.

Rebecca Ashkenazy, MD
Allan J. Blaivas, DO
Alexandrina Chetreanu, MD
Jean DelBrune, MD
Amish Harish Doshi, MD
Lincoln Hernandez Feliz, MD
Maria T. Filopoulos, MD
Darren Fitzpatrick, MD
Zhanna Fridel, MD
Eduardo J. Garrido, MD
Cosmin Gauran, MD
Shweta Gera, MD
Sheldon Gorbacz, MD
Sanjeev Gupta, MD
Brian Hurley, MD
Han Jo Kim, MD
Michael S. Leapman, MD
Rita Hsiao–Hui Lin, MD
Brian Keith McNeil, MD
Anjali D. Manavalan, MD
Szilvia Nagy, MD
Anne Nolte, MD
Ikechi John Nwankwo, MD
Vanessa Valerie Pena, MD
Ravindra C. Rajmane, MD
Alain Ramirez, MD
Ethan Rand, MD
Michael Evan Rettig, MD
Janet Marie Rivera, MD
Huaibao Sheng, MD
Allyson Shrikhande, MD
Ryan Sobel, MD
Jaime Javier Tavarez, MD
Diana M. Tran–Kim, DO
Nirit Weiss, MD
Kirk Zachary, MD
Yinggang Zheng, MD
Wendi Zhou, MD


Hats Off
Hats off to Society past president Kenneth H. Brookler, who was presented the Arnold D. Tuttle Award by the Aerospace Medical Association. Doctor Brookler was recognized as a co–author of the winning scientific paper, “Oculo–Vestibular Recoupling Using Galvanic Vestibular Stimulation to Mitigate Simulator Sickness,” which was published in Aviation, Space, and Environmental Medicine. Doctor Brookler, a board–certified otolaryngologist practicing neurotology, is a graduate of the Faculty of Medicine of the University of Manitoba, in Winnipeg, Canada, and affiliated with Lenox Hill Hospital.

If you or someone you know deserves a salute, contact MM “NEWS” at 12 East 41 Street, 15th Floor, New York, NY 10017, fax: (212) 684–4741, or e–mail to cmalone@nycms.org


Discount on Wild Medicine Tickets
The New York Botanical Garden is featuring a special exhibit called Wild Medicine: Healing Plants Around the World, Featuring the Italian Renaissance Garden . The exhibit runs until September 8, and highlights the connection between biodiversity and human health, and explores how cultures have relied on plants for essential needs including medicine. Learn more, and receive 20 percent discount on tickets and use code 9944 to purchase your New York Botanical Garden tickets to Wild Medicine.


Legal Briefs
The following article is provided by Scott Einiger, Esq., and Adam Heckler, Esq., from the firm of the Society’s special counsel, Abrams Fensterman.

The 2013 HIPAA Amendments

I. Introduction

Key Dates:
  • March 26, 2013: the Final Rule became effective
  • September 23, 2013: Covered Entities, including group health plans and their “Business Associates,” must generally comply with the Final Rule’s provisions
  • September 25, 2013: disclosures of PHI will become subject to the new restrictions on their sale
  • September 22, 2014: Covered Entities (and their covered subcontractors) must bring all of their Business Associate Agreements (“BAAs”) into compliance with Final Rule
____________________
1 Jenner & Block, Health Insurance Portability & Accountability Act (HIPAA), http://www.mssny.org/mssnyip.cfm?c=s&nm=HIPAA/NPI, last visited June 5, 2013.
2 Kevin Eldridge, Jennifer Hennessy, Jennifer Rathburn, HIPAA Final Rule Analysis: Will the New Breach Rule Result in More Notifications?, Quarles & Brady LLP, http://www.quarles.com/hipaa-final-breach-rule-2013/, last visited June 5, 2013.
3 Id.
4 Boris Segalis, New HIPAA/HITECH Rules Implementation Roadmap: Countdown Begins to September 23, 2013 Compliance Deadline, available at http://www.infolawgroup.com/2013/03/articles/hipaa/hipaahitechrules/ , March 31, 2013.


II. Greater Breach Notification Requirements
Covered Entities and Business Associates have to notify individuals of any breach of unsecured PHI. The relevant inquiry, then, is one into the definition of a breach. Under the current law, a Covered Entity or Business Associate must conduct a risk assessment to determine whether the impermissible acquisition, access, use or disclosure of PHI in question “poses a significant risk of financial, reputational, or other harm to the individual.”

The Final Rule, however, imposes the presumption that an impermissible acquisition, access, use or disclosure of PHI constitutes a breach unless the Covered Entity or Business Associate “demonstrates that there is a low probability… protected health information has been compromised” through a risk assessment of four enumerated factors:
  • The nature and extent of the PHI involved, including the types of identifiers and the likelihood of re–identification;
  • The identify of the unauthorized person who used the PHI or to whom the disclosure was made;
  • Whether the PHI was actually acquired or viewed; and
  • The extent to which the risk to the PHI has been mitigated.

In addition to thoroughly documenting the risk assessment from a risk management perspective, Covered Entities and Business Associates must demonstrate either the absence of a breach or the presence of all required notifications. Ultimately, since the new standard is much easier to satisfy, the Final Rule will require many more breach notifications and expose Covered Entities and their Business Associates to a greater potential for liability.

In order to avoid breaches of unsecured PHI, employers should review and enhance their privacy and security practices. Most importantly, organizations should implement security protections for PHI such as encryption technology, password protection mechanisms, data destruction schedules, and data transmission safeguards.
______________
5 Elizabeth A. Diller & James P. McElligott, Jr., Navigating the HITECH “Omnibus Final Rule,” MCGUIREWOODS, http://www.mcguirewoods.com/Client-Resources/Alerts/2013/3/Navigating-the-HITECH-Omnibus-Final- Rule.aspx , last visited March 1, 2013.
6 Id.
7 Id.
Id.
9 See Christie Burbank, Jade Dodds & Susan Steelman, Significant Changes to HIPAA Effective March 26, 2013, MILLER &MARTIN PLLC, http://www.jdsupra.com/legalnews/significant-changes-to-hipaa-effective-m-51197/ , last visited June 5, 2013.
10 Diller, supra n5.
11 Eldridge, supra n2.


III. Changes to Notice of Privacy Practices
The Final Rule requires group health plans to make several revisions to their notice of privacy practices, including:
  • Notifications for affected participants of a breach of unsecured PHI that include:
    • A description of the types of uses and disclosures that require authorization under HIPAA,
    • A warning that individuals have the right to opt out of receiving fundraising communications, and
    • A warning that individuals have a right to pay out–of–pocket for a service;
  • A prohibition on the use or disclose of genetic PHI for underwriting purposes; and
  • A required authorization from individuals before plans use PHI for marketing or sales purposes.

Practitioners should review and update their HIPAA policies, procedures and documents to reflect these changes, lest they be subject to increasing penalties set forth by the new law.

IV. Heightened Enforcement and Penalties
In accordance with the tiered system set forth under HITECH, the new civil monetary penalties will begin to apply to the Covered Entities as well as Business Associates and their subcontractors — not just to Covered Entities as before. Civil penalty amounts will range from $100 per violation up to a maximum of $1.5 million for violations of the same HIPAA provision in a calendar year. An entity’s level of culpability will determine its required payment; low penalties ($100 – $50,000) are levied when entities are unaware of a negligent violation, while high penalties (above $50,000) are levied when entities demonstrate “willful neglect” in violating HIPAA. Moreover, the Final Rule institutes criminal penalties of up to ten years imprisonment. All employers should review vendor contracts to ensure they provide adequate protection of their information. Additionally, it is important to make certain some recourse is in place in the event information is not protected, especially since liability may be imputed to an organization for the actions of vendors that are agents.
___________________
12 Burbank, supra n9.
13 Diller, supra n5.
14 Id.
15 Burbank, supra n9.
16 Id.
17 Id.
18 Diller, supra n5.
19 Eldridge, supra n2.


V. Genetic Information Nondiscrimination Act
The Genetic Information Nondiscrimination Act of 2008 (“GINA”) prohibits employers and health insurance plans from discriminating on the basis of genetic information. To implement GINA’s protections, the new Rule has added “genetic information” to the definition of “health information” and prohibits its use or disclosure for underwriting purposes. Though, a health plan may still use genetic information in a medical appropriateness determination when a participant or dependent seeks a benefit under the plan.

VI. Expansion of “Business Associate” Scope and Liability
The HHS previously defined a Business Associate as including “a person who performs or assists… a function or activity involving the use or disclosure of… PHI for a Covered Entity.” The Final Rule expands this definition to include persons who “create, receive, maintain or transmit PHI in connection with performing a function or service for a Covered Entity,” regardless of whether they actually view the PHI. Further, it also includes subcontractors who create, receive, maintain or transmit PHI on behalf of a Business Associate.

In addition to this expanded scope, the larger pool of Business Associates will also be required to directly comply with HIPAA or be subject to all available criminal and civil penalties. As previously noted, those penalties were increased significantly under HITECH. Business Associates will now be directly liable for:
  • Impermissible uses or disclosures of PHI;
  • Failure to provide proper breach notifications to a Covered Entity;
  • Failure to provide appropriate access to an electronic copy of PHI to a Covered Entity, individual, or individual’s representative;
  • Failure to disclose PHI when required by HHS to investigate the Business Associate’s compliance with HIPAA;
  • Failure to provide an accounting of disclosures; and
  • Failure to comply with the applicable requirements of the Security Rule.

One of the most noteworthy changes is the transformation of a Business Associate’s violation of a BAA provision from a contractual violation into a HIPAA violation. The Final Rule also states that Business Associates may only use, disclose, or request PHI from another entity if they limit PHI to the “minimum amount necessary” to accomplish the intended purpose of the use, disclosure, or request.
_______________
20 Diller, supra n5.
21 Id.
22 Id.
23 Id.
24 Id.
25 Id.
26 Burbank, supra n9.
27 Id.
28 Id.
29 Id.


To limit potential liability, practitioners should review the vendors with whom they contract for group health plan services and ascertain which of their vendors fit in the expanded definition. Employers should also practicably limit, to the minimum amount necessary, the information their organizations receive, use, disclose and retain.

VII. Business Associate Agreement Revisions
The Final Rule includes several new provisions that must be included in BAAs in order to disclose PHI to Business Associates. In particular, such an agreement must require the Business Associate to:
  • Comply with the applicable provisions of the Privacy Rule;
  • Comply with the applicable provisions of the Security Rule;
  • Report breaches of unsecured PHI to the Covered Entity as required under the breach notification rules; and
  • Ensure that any subcontractors that create or receive PHI on behalf of the Business Associate agree to the same restrictions and conditions that apply to the Business Associate (in these circumstances, there must now be a BAA in place between a Business Associate and its subcontractors).

Further, all medical practices must update their BAAs by the effective date of September 22, 2013. A sample BAA is attached below.

If you have any questions, please contact Scott Einiger, Esq., at Abrams, Fensterman, Fensterman, Eisman, Formato, Ferrara & Einiger, LLP, through the Society at (212) 684–4670. Adam Heckler, Esq. earned his J.D. from St. John’s University School of Law in 2012. He is a member of both the New York and New Jersey Bar and can be reached at ahecklerjd@gmail.com.
_________________
30 Diller, supra n5.
31 Eldridge, supra n2.
32 Diller, supra n5.
33 Burbank, supra n9.
SAMPLE BUSINESS ASSOCIATE AGREEMENT