How to Contact Your Legislator
On Monday, April 11, 2016, the New York Chapter ACP held its Annual Legislative Day in Albany with physician members who participated in briefings and legislator appointments throughout the day.
Group visits were held with high ranking staff from the Governor’s office and the Department of Health as well as with Senator Kemp Hannon (R), Chair of the Senate Health Committee, and Monica Miller, Senior Legislative Associate, from Assemblyman Richard Gottfried’s (D) office (Mr. Gottfried is Chair of the Assembly Health Committee). Individual legislator appointments during the afternoon allowed physician attendees an opportunity to meet with their own elected NYS representatives.
The day was filled with discussion about practice and patient care issues and experiences, covering the adequacy of the physician workforce, public health and insurance issues, and the many alternative payment models under development. Attendees felt the time spent in Albany was rewarding and beneficial.
We urge all members to become familiar with the legislators in their district and to meet with them in their local offices. Chapter staff are prepared to brief any member who would like to connect with their Legislator in their community.
- The minimum wage will be raised over a phased in period to $15 an hour in every region of the state and a paid family leave policy funded through employee contributions was enacted (see detail below)
- Growth in state spending was held to 2% for the sixth consecutive year
- Personal income tax cuts were enacted, saving middle class New Yorkers nearly $6.6 billion in the first four years, with annual savings reaching $4.2 billion by 2025 (see detail below)
- $24.8 billion was appropriated in school aid – the highest in state history – and ending the Gap Elimination Adjustment. The school aid budget reflected a 6.5% increase in spending over last year
- $55 billion will be invested in New York’s roads, bridges, airports and transportation enhancements, the largest state transportation plan ever approved, including $27 billion for the Department of Transportation and NYS Thruway Authority and $27 billion for the MTA
The budget agreement includes spending in the following categories:
- Total State Operating Funds: $96.2 billion; 2.0 percent growth
- School Aid: $24.8 billion; 6.5 percent growth
- Medicaid: $18.5 billion; 3.4 percent growth under the cap
- Higher Education: $7.2 billion; 2.0 percent growth
- Excess Liability coverage was maintained. The proposed cut to the “2nd layer of coverage,” also known as excess medical liability coverage provided through hospitals, was not adopted and funding was maintained at its current level
- An additional $1 million was added to Doctors Across New York (DANY), and the funds were streamlined to combine loan forgiveness and practice start up opportunities. Funding was adjusted to $40,000 per year with a maximum of $120,000 for either program for a 3 year commitment to practice in New York State
- E-prescribing – a new process for physicians who prescribe under 25 scripts per year (including oral and written) to apply for an exemption each year was approved. This action supplemented the Commissioner of Health’s additional exception blanket waiver of one year for clearly defined situations
- Changes proposed by the Governor to existing “Prescriber Prevails” rules in Medicaid Fee for Service and Medicaid Managed Care were rejected
- Support for expanding the Chapter's Take A Look Tours, in partnership with Iroquois Hospital Assocation, was included under an individual member line item. These tours are designed for residents to be introduced to the value and benefit of practice in Upstate New York
- Prior authorization of Opioids in the Medicaid program was modified and approved in the final budget, and will include exceptions for persons in hospice care, sickle cell patients, cancer patients and other diagnoses approved by the Commissioner of Health
Details on the Minimum Wage Hike - This Will Affect ALL Employers Including Physician Practices:
- For workers in New York City employed by large businesses (those with at least 11 employees), the minimum wage would rise to $11 at the end of 2016, then another $2 each year after, reaching $15 on 12/31/2018.
- For workers in New York City employed by small businesses (those with 10 employees or fewer), the minimum wage would rise to $10.50 at the end of 2016, then another $1.50 each year after, reaching $15 on 12/31/2019.
- For workers in Nassau, Suffolk and Westchester Counties, the minimum wage would increase to $10 at the end of 2016, then $1 each year after, reaching $15 on 12/31/2021.
- For workers in the rest of the state, the minimum wage would increase to $9.70 at the end of 2016, then another .70 each year after until reaching $12.50 on 12/31/2020 – after which will continue to increase potentially to $15 on an indexed schedule to be set by the Director of the Division of Budget in consultation with the Department of Labor.
The final budget bill provides a safety net to the increases. Beginning in 2019, the State Budget Director will conduct an analysis of the economy in each region and the effect of the minimum wage increases statewide on a yearly basis to determine whether a temporary suspension of the scheduled increases is necessary. It is estimated that more than 2.3 million people will be affected by the increases in the minimum wage if fully implemented.
Details on Paid Family Leave - This It Will Affect ALL Employers Including Physician Practices:
The budget agreement includes the longest and most comprehensive paid family leave program in the nation. When fully phased-in, employees will be eligible for 12 weeks of paid family leave when caring for an infant, a family member with a serious health condition or to relieve family pressures when someone is called to active military service. Benefits will be phased-in beginning in 2018 at 50 percent of an employee’s average weekly wage, capped to 50 percent of the statewide average weekly wage, and fully implemented in 2021 at 67 percent of their average weekly wage, capped to 67 percent of the statewide average weekly wage. This program will be funded entirely through a nominal payroll deduction on all employees so it costs businesses – both big and small – nothing. Employees are eligible to participate after having worked for their employer for six months.
Details on the Middle Class Tax Cut
The budget lowers Personal Income Tax rates for middle class New Yorkers. With the middle class tax cuts of 2012, rates were lowered from 6.85 percent to 6.45 percent for taxpayers in the $40,000-$150,000 income bracket, and to 6.65 percent in the $150,000-$300,000 income bracket. Under these new reforms, the rate will drop even further beginning in 2018 and will continue to drop all the way to 5.5 percent when the cuts are fully phased in.
These new lower tax rates will save middle class New Yorkers nearly $6.6 billion in the first four years, with annual savings reaching $4.2 billion by 2025. As the new rates phase in, they will be the state’s lowest middle class tax rates in more than 70 years.
On Thursday, March 3, the NYACP Health and Public Policy Committee convened at the Desmond Hotel in Albany. The meeting was well attended, with over 40 members in attendance.
An overview by Chairman Louis Snitkoff, MD, FACP, covered legislative bills that the Committee is monitoring in 2016, including a new proposal for a CME mandate for education related to controlled substances. Among the 46 other Bills covered, tobacco restrictions, STEP therapy, and an extension of the standardized prior authorization form used in Medicaid to all commercial payers were highlighted.
There were also more than three dozen bills pertinent to health care monitored by the Chapter and signed over the course of 2015, including the extension of the I-STOP implementation deadline and mandatory vaccinations for meningococcal virus – bills that NYACP was instrumental in getting passed through its strong advocacy efforts. The Committee also held a lively discussion centered on issues involving the NYS Physician Profile, medical marijuana, and aid in dying proposals.
Concerns over the implementation of e-prescribing were raised, as medical centers and private practices alike face issues with implementation. NYACP will continue to monitor and document these issues as they are reported to us.
The next Health and Public Policy meeting will be in the fall on September 16, 2016, and the Chapter's Legislative visitation day will be held on April 11, 2016.
ACP Offers a 'Voter's Guide' to Health Care Issues
With the upcoming presidential election, the American College of Physicians is taking steps to keep members informed about health care issues that could come up during the campaign.
ACP staff members have created a new section on the College's website that's intended to give internists information to weigh when comparing candidates' positions on various health care topics as well as questions to consider when evaluating the candidates' positions. The College does not endorse candidates for elected public office nor take partisan stances. The information on the new web page is solely educational, ACP officials noted.
The "Election 2016" web page highlights nine issues:
- Access to care
- Bending the cost curve
- Firearm violence
- Graduate medical education and workforce support
- Health insurance consolidation
- Medicaid and Medicare benefit reform
- Medical liability reform
- Affordable prescription drugs
- Payment and delivery system reform
To read more, click here.
Highlights of Health-Related Issues
Governor Cuomo released his proposed $143.6 billion budget for the upcoming State fiscal year beginning April 1, 2016 through March 31, 2017. While there were significant proposals to stimulate the economy and strengthen the State’s infrastructure, there were several proposals that will have an impact on healthcare and physician practices if enacted. The Legislature will now hold public hearings on the various elements of the budget, and will then negotiate with the Governor in the hopes of passing a final budget before April 1. The Governor proposed a $15 minimum wage for all workers, and an expansion of vital infrastructures to include both new building of mass transit capacity and re-building of roads and bridges. In healthcare, the following proposals will be closely monitored as the hearings and negotiations get underway:
- Reductions in the medical liability excess pool that provides the “second layer” of coverage. The proposed changes would favor high risk specialties and territories which may leave many physicians without this needed coverage
- Limited Service (or Retail) Health Clinics would be allowed to provide a list of limited services and be responsible for adhering to new accountability requirements similar to those of Diagnostic and Treatment and Community Health Centers.
- Changes to the Workers’ Compensation Law to expand eligible providers, change certification procedures and make improvements to the hearing process for these cases
- Eliminates existing prescriber prevails rules under the Medicaid program except for certain psychiatric drugs
- Continues funding for Doctors Across New York and proposes a separate category of funding for mental health providers which would supplement the spots for other shortage specialties.
The extensive budget documents have many other provisions, and we will continue to highlight these in upcoming issues of Your Chapter in Action as discussions and the Legislative sessions continue.
Early last week, stakeholders who worked toward the passage in 2015 of the mandatory meningitis vaccination legislation came together to meet with Senate and Assembly sponsors of the legislation, Senator Kemp Hannon (R-6) and Assemblywoman Aileen Gunther (D-100), in celebration of the public health success. (pictured on right)
Stories of lost loved ones and survivors were shared amongst all who worked so hard to get the legislation passed and ultimately signed by the Governor. Personal tragedy was turned into hope for the future as speaker after speaker expressed gratitude for the strength of the coalition against significant odds. The Chapter had been active in this campaign, and was represented in Albany by Brianne Navetta, MD and Chapter Executive Director Linda Lambert. The passage of this bill serves as a model for advocacy action by physicians, as again and again the power of having Brianne (“the Doctor”) at the Capital speaking at meetings on the clinical issues related to caring for patients and the value of the vaccine was emphasized.
One-third of people 65 and older fall each year, and 20% of those falls cause a serious injury such as head trauma or a fracture. With proper precautions, these falls and accidents are preventable. To heighten awareness of these issues, the NYSDOH organized the 8th annual Falls Prevention Awareness Day on September 23, 2015. This year’s theme was Take a Stand to Prevent Falls.
Below are several resources to further your knowledge and practices to assist patients in falls prevention, including opportunities to earn free CME Credits! Also be sure to take advantage of the free patient/caregiver resources, distributed with permission by the New York State Department of Health, to help your older patients stay independent as long as possible.
CDC Online STEADI Training:
You can take the CDC’s new STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Online Training for Providers at: www.cdc.gov/steadi. All you need to do is create a free account on CDC TRAIN, Log in, and search “STEADI”.
The content is based on established clinical guidelines. You will learn:
- Two easy screening methods to determine a patient’s fall risk
- Three rapid standardized gait, strength and balance assessment tests
- To apply the STEADI algorithm to determine a patient's fall risk level
- To select appropriate evidence-based interventions based on risk level
- To engage your older patients in interventions to reduce their fall risk
CDC developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Initiative to help providers incorporate fall prevention into clinical practice. CDC created this training to give you the tools you need to make fall risk screening, risk factor assessment, and falls interventions part of your clinical practice.
- What You Can Do to Prevent Falls Pamphlet
- Check for Safety Checklist
- Be Car Ready Feet Steady Pamphlet
- Debunking the Myths of Older Adult Falls
Print and share this article with older adults and caregivers
- 6 Steps to Protect Your Older Loved One from a Fall
Print and share this tip sheet at your falls prevention event
- Osteoporosis and Fall Prevention
Share this one-page handout on the link between fall-related injuries and osteoporosis.
Please Note: Some resources are large files that may take a long time to download
The NYS Legislature did not adjourn last week as scheduled, and they were back in Albany this week to address unfinished business including New York City rent control, education reform, a tax rebate program, funding support for non-public schools, and new support to address sexual assault on campuses.
Here are sample of some important legislative items that have passed both houses in the final two weeks of session, all of which are important to healthcare and for which the Chapter was extremely active.
- A bill requiring school-based immunizations against meningococcal disease for every person entering 7th and 12th grade.
- A bill to extend and expand the authorization of pharmacists to perform collaborative drug therapy management (CDTM) with physicians, nurse practitioners and PA's in certain settings.
- Legislation extending authority of pharmacists to administer additional immunizations to adults including Diphtheria, Tetanus and Pertussis (DPT).
Note: Bills are sent to the Governor in stages over the next several months for his signature, so not all are signed into law within ten days of the session end!
The following issues were not enacted in the final days, but saw significant progress and can be revisited by the Legislature in 2016:
- Adding E-Cigarettes to New York’s Clean Indoor Air Act, which would then prohibit their use in all public places in New York.
- A bill to require physicians to take three hours of continuing medical education every two years on the following topics: I-STOP and drug enforcement administration requirements for prescribing controlled substances; pain management; appropriate prescribing; managing acute pain; palliative medicine; prevention, screening, and signs of addiction; responses to abuse and addiction; and end-of-life care.
- A proposal to address burdensome Step Therapy or “Fail First” policies by insurers was amended but remained in the Insurance Committee in both the Senate and Assembly.
It is important to note that the Chapter follows almost 600 health bills each year, so this brief report just highlights recent actions. A report summarizing more of the New York State health legislation important to physicians from this session will be included in a future YCIA. We will also publish this information on the Advocacy Page of the Chapter website.
Chapter advocacy activities are much broader than monitoring legislative sessions and engaging legislative leaders in discussions about important health topics. Advocacy activity includes work with the Administration and the State’s regulatory agencies, industry stakeholders such as insurers, hospitals and other allied health professions to assure physician representation and input on all discussions and proposals related to patient care.
On Thursday, June 4, NYACP Manhattan-Bronx Governor Lawrence Phillips, MD, FACP led the American Heart Association attempt to achieve a Guinness World Record for the most people participating in a hands-only CPR Relay in New York City. Over 700 celebrities, athletes, media representatives, high profile corporate executives, hospital leaders, survivors and political figures including NYS Assembly Health Committee Chair, Richard Gottfried, all gathered in Times Square to participate in the World Record attempt. They succeeded! The previous record of 240 was passed for a new record of 700!
This event was held in conjunction with National CPR & AED Awareness Week. CPR, especially if performed immediately by someone nearby, can double or triple a cardiac arrest victim’s chance of survival. Most Americans (70 percent) feel helpless to act during a cardiac emergency because they don’t know how to administer CPR or they’re afraid of hurting the victim.
You can watch Dr. Phillips being interviewed by the local CBS affiliate Here.
In addition, the American Heart Association has prepared a video containing the proper steps to administering hands-only CPR for you to share with your patients.
With control over e-cigarettes being hotly debated over recent months at both our State and National level, the American College of Physicians has just released a policy paper, "Electronic Nicotine Delivery Systems: Executive Summary of a Policy Position Paper From the American College of Physicians."
The ACP last issued a position on electronic nicotine delivery systems in 2010. With more products on the market and more research data, the College was encouraged to update their existing position statement. The ACP believes flavored e-cigarettes should be banned and governments at all levels should extend no-smoking rules to include all electronic nicotine delivery devices. The College also supports education efforts to explain the risks of e-cigarettes and believes the products should face the same advertising restrictions as traditional cigarettes.
Two New York Chapter leaders, Susan Stewart MD, FACP, Chair of Tobacco Prevention Task Force, and Roy Korn Jr., MD, FACP, were instrumental in creating a Chapter resolution that led to this policy paper update.
E-cigarettes have become more popular than ever, especially among young people, according to a report issued on April 16 by the FDA and the Centers for Disease Control and Prevention. The number of middle- and high-school students using the products tripled from 2013 to 2014, the CDC reported -- from about 4 percent to more than 13 percent of high school students and from 1 percent to nearly 4 percent of middle school students. Sales have been estimated to be nearly $2 billion in 2014.
To read the American College of Physicians full policy paper, please click here.
On April 21, 2015, advocacy intern Harshitha Kota met with a passionate group of stakeholders representing patients, physician leaders and other industry groups at Albany’s Capital Building to urge passage of the Meningococcal Immunization Bill (A.791/S4324). Sponsored by Senator Hannon and Assemblywoman Gunther, it would add meningococcal immunizations to the list of immunizations a child would receive before entering the 6th grade and a booster before entering 11th grade to align with CDC recommendations.
Patient advocates shared personal stories on how meningitis, a preventable disease, cost the lives of their loved ones.
While CDC recommendations are trusted and followed by the medical community, there is no current requirement enforcing meningitis vaccines in New York State. Passing the bill would help protect young children and adolescents, and potentially prevent outbreaks similar to the ones that have been publicized in recent months. Our advocacy interns continue their service during legislative session from January - June each year.
NYACP leader Bradley Flansbaum, DO, FACP, Chair of the Chapter's Health Benefit Exchange Task Force, traveled to Washington, DC to represent hospital medicine and celebrate President Obama’s signing of this historic repeal. The President spoke at a reception and mingled with the crowd, giving Dr. Flansbaum the opportunity to meet the President. NYACP’s Advocacy activity helped lead to the invitation and is something that all of medicine can be proud of.
The Senate followed the House of Representatives in passing comprehensive legislation to repeal Medicare’s Sustainable Growth Rate (SGR) formula and transition physicians to a new value-based payment system. This action comes on the heels of an overwhelming show of support in the House, where both Republicans and Democrats voted in favor of H.R. 2 on March 26. President Obama signed the bill into law on April 16, which averted a 21 percent Medicare payment cut from taking effect.
Highlights of the H.R. 2 legislation include:
- The SGR is permanently repealed, effective immediately; reversing the 21 percent SGR cut that went into effect on April 1.
- Positive payment updates of 0.5 percent are provided for four-and-a-half years, through 2019.
- Current quality incentive and payment programs are consolidated and streamlined into a new Merit-based Incentive Payment Program (MIPS), and the aggregate level of financial risk to practices from penalties has been mitigated in comparison to current law.
- Physicians in alternative payment models (APMs) receive a 5 percent bonus from 2019-2024.
- Strong incentives are created for physicians to participate in qualified Patient Centered Medical Homes (PCMHs), an innovative model of care that has been shown to improve outcomes, patient experience, and reduced costs. Physicians in qualified PCMHs will get the highest possible score for the practice improvement category in the new MIPS program. PCMHs that have demonstrated to HHS the capability to improve quality without increasing costs, or lower costs without harming quality, can also qualify as an APM without having to accept direct financial risk.
- Technical support is provided for smaller practices, funded at $20 million per year from 2016 to 2020, to help them participate in APMs or the new MIPS program.
- Funding is provided for quality measure development, at $15 million per year from 2015 to 2019. Physicians retain their preeminent role in developing quality standards.
In addition, H.R. 2 provides continued funding of the National Health Services Corps, Community Health Centers, Teaching Health Centers, and the Children’s Health Insurance Program, programs that are especially important to ensuring patient access to primary care.
In order to allow providers additional time to achieve Patient Centered Medical Home (PCMH) recognition from the National Committee for Quality Assurance (NCQA) under the 2014 standards, New York State Medicaid is extending the implementation date of the Statewide PCMH Incentive Payment Program changes affecting payments to providers recognized under 2011 or 2014 standards to January 1, 2016.
This was originally announced in the February 2015 Medicaid Update. This extension only applies to providers recognized under the 2011 standards and all incentive payments for PCMH-recognized providers under NCQA’s 2008 standards will still be discontinued as of April 1, 2015.
This revised policy is applicable to both Medicaid Managed Care (MMC) and Medicaid fee-for-service (FFS). The January 1, 2016 implementation date for these changes give primary care practices and providers a financial incentive to achieve level 2 or 3 NCQA PCMH recognition under the 2014 standards by the end of 2015.
You can read the rest of the article here. (Article is on Page 23)
On March 13, Governor Cuomo signed legislation S.2486(Hannon)/A.4274 (McDonald) into law to delay by one year the implementation of New York's e-prescribing requirements. While the mandate to electronically transmit all prescriptions, including controlled substances is delayed until March 27, 2016, we urge all members to continue to work with their vendors to get their e-prescribing software up and running as soon as possible. Those who have already begun e-prescribing, including controlled substances, have reported great satisfaction and success. There are extensive resources for finding certified vendors and preparing your practice for implementing e-prescriptions available on the NYACP website.
The e-prescribing requirements were a part of the State's Internet System for Tracking Over Prescribing (I-STOP) laws, enacted in 2012. I-STOP requires all prescribers to 1) consult the Prescription Monitoring Program (PMP) prior to prescribing Schedule II, III and IV controlled substances and 2) electronically transmit all prescriptions. To do so, each prescriber must have an individual Health Commerce System Account (HCS) to gain access to the PMP registry at https://commerce.health.state.ny.us
In addition, I-STOP also made changes to some controlled substance schedules, created a Prescription Pain Medication Awareness program, and a method for safe disposal of unused prescription medications. For more details on all I-STOP related updates, continue to monitor the NYACP Resource Page.
On Monday March 2, 2015 the Chapter’s Health and Public Policy Committee met to discuss multiple issues impacting the practice of internal medicine and patient care including: Tobacco Control, Collaborative Drug Therapy, Death with Dignity and Immunizations, as well as to discuss reports on Geriatrics, Obesity, GME, Hospital Medicine, and other committee reports. Staff Members of Assemblyman Richard Gottfried, Chair of the Assembly Health Committee, were present for a portion of the meeting to discuss Medicaid Parity, Doctors Across New York (DANY), ACO Regulations, Single Payer Legislation, and Convenient Care and Retail Clinics.
On Tuesday March 3, 2015 eleven members of the Committee participated in the Chapter’s Annual Legislative Day. The aim of Legislative Day is to allow physicians to discuss medical issues impacting patient care with their own elected officials. The main topics discussed throughout the day included Medicaid Parity, DANY, ACO Regulations, and Tobacco Control. The group also met with Senator Kemp Hannon, Chair of the Senate Health Committee, and several high ranking officials from the Governor’s Office and the NYS Department of Health. Legislators acknowledged the importance of physicians visiting with them as a valued resource on healthcare issues.
As evidenced by our physician representatives' experiences and feedback on the value of spending their time Albany...You can make a difference!
"Doctors Across New York" - Vital Program for our Future
NYACP sponsored visits at the State Capital along with representatives from several other state healthcare organizations as part of the Physician Workforce Advisory Group (WAG) to inspire support for continued and expanded funding of DANY (Doctors Across New York). DANY award recipients were present to tell their real life story of how they settled into a community and began their medical career with the assistance with this vital state funded program. DANY was established to promote recruitment and retention of physicians providing care to underserved populations in New York. We met with State Senators and Assemblymen to discuss the benefits of a strong primary care foundation in the State and the dialogue was very productive. Legislators were actively engaged about the looming physician shortage, especially in primary care, the increase in insured patients due to the New York's Health Benefit Exchange and the need for a solid primary care workforce to keep New Yorkers healthy. In addition to DANY, the WAG also promoted the continued funding of the PCSC (Primary Care Service Corps) to support the growth of allied health providers to increase effective care teams.
The DANY program has allocated more than 34.2 million dollars to more than 100 award recipients. Continuation and expansion of this program is a priority legislative goal.
Our online grassroots legislative action center provides quick and easy access to your local and federal representatives. All you need to identify your legislative representative is your 9 digit zip code.
NYACP advocates to increase access and quality of care, promote patient safety, and improve the public's overall health.
The NYACP Medical Student Advocacy Internship is a four week internship designed to give fourth-year Medical Students and Residents hands-on experience in advocacy activities with a medical professional organization. Learn how to monitor legislation, analyze governmental policy relevant to public health as well as communicate with elected State appointed leaders. The elective is offered from January through June. Interested in public policy? Email us today.
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