Update on E-Prescribing
As the March 27th effective date for New York’s mandate on physicians to electronically prescribe medications approaches, there are extensive activities underway to urge the Legislature to enact a one year extension of the deadline. Significant challenges with EMR readiness, nursing home, long term care and home care readiness, and residency training program procedures have been identified that will impact care delivery if the deadline remains in effect.
All of these issues, in addition to the challenges private practices face with the transformation to e-prescribing from paper based systems or from EMR systems that are not compatible with the new rules, have been the focus of much public discussion during the Legislature’s budget hearings and in one on one meetings with legislative leaders. This week the Senate passed a one year extension of the deadline, and a companion bill in the Assembly was reported out of the Health Committee and will go to the Assembly floor for a vote when they return to session after the President’s Week break.
NYACP Meets with NYS DOH Patient Safety Center
On January 26th, the Chapter met with key representatives from the New York State Department of Health’s Patient Safety Center to (1) share the Chapter’s mission of quality and patient safety, education and advocacy and (2) share NYACP’s interest in exploring collaborative opportunities in the area of patient engagement and quality improvement. Tobacco cessation, shared decision making, and pre-surgical clearance were a few of the topics discussed. The Chapter’s Near Miss Registry under the ACP PSO was also of great interest, since it has evolved significantly from its initial demonstration under the confidentiality protections of the Department several years ago.
NYS Meningococcal Vaccine Bill
On January 30th the Chapter met with other interested stakeholders to review a legislative proposal that would add meningococcal immunizations to the list of other required immunizations a child would receive before entering the 6th grade and a booster dose before entering 11th grade in New York State. The legislation has been introduced by Assemblywoman Aileen Gunther and a Senate bill is expected soon. Planned activities include two advocacy days on February 25 and on April 21 to raise awareness and promote support for the legislation, timed to align with recognition of World Meningitis Day on April 24, 2015.
Governor Cuomo Presents State of the State and New York State Budget
On January 21st, Governor Andrew Cuomo presented his $141.6 Billion proposed state budget. In the health area, the Governor proposed to continue and advance new approaches to healthcare delivery to control spending growth and improve health results. Of interest to our members, healthcare transformation utilizing federal waiver monies, awarded through DSRIP grants, seeks to reduce avoidable hospital use by 25% over the next five years. In addition, the CMS $100 million grant to implement the State Health Innovation Plan over a four year period builds upon Medicaid reform efforts and extends them to achieve similar outcomes across the entire health care system, both public and private. The Chapter will be reviewing the entire 548 page budget booklet, looking for more specific detail on “increased payments to essential community providers”, “leveraging health homes”; some changes to “health insurance premiums for coverage both inside and outside of the Health Benefit exchange”; investments in caregiver supports, New York Connects, a statewide one stop access to free and objective assistance on accessing long term care services; discontinuing resident work hour audits (noting duplication of effort with federal oversight), discontinuation of the physician profile website and “ending the Aids Epidemic by 2020”.
Public hearings on the budget will be announced shortly, in anticipation of final budget action by March 31, 2015.
E-Prescribing Deadline – March 27, 2015
The Chapter’s e-prescribing advocacy activities are a high priority in anticipation of the upcoming March 27th implementation deadline for electronic prescribing for all prescription medications including electronic prescribing of controlled substance (EPCS). Following many meetings in the late fall and early winter, we have met with the Bureau of Narcotic Enforcement, worked with key legislators in the Senate and Assembly and the Administration, including the Governor and the Dept. of Health, to communicate our ongoing concerns with challenges faced by our members. Many of the EMR software vendors are not ready to launch or test their systems prior to the mandatory date, the waiver process has not yet been released, there are multiple challenges with nursing home and home care, and responsibilities/procedures for residents in training are not clearly defined by the regulations. We have advocated directly on behalf of our members and joined with many others in medicine in a joint statement calling for the State to delay implementation or ease enforcement timelines.
Nurse Practitioner (NP) Attestation Form
The Chapter submitted formal comments on the new nurse practitioner attestation form for those nps with more than 3600 hours of experience resulting from last year’s change in the nurse practice act. The Chapter also signed onto a joint letter submitted on behalf of NYACP, MSSNY, NYSSA, NYSAFP, ACOG District II, NYSSOS, AAP District II, NYSPA and the NYSRS We will continue to report on your role as a “collaborating physician” with both experienced nurse practitioners with more than 3600 hours and those with less than 3600 hours. Watch our website and upcoming issues of YCIA.
Collective Negotiations Legislation
The Chapter is monitoring (through a statewide collaboration with many other stakeholders) Collective Negotiation legislation (A.355(Gottfried)/S.1157(Hannon) that would enable independently practicing physicians to jointly negotiate patient care payment terms with health insurance companies under close supervision by the State.
NYS Abuse Deterrent Formulation Legislation
The Chapter's Health and Public Policy committee continues to monitor and participate in discussions related to legislation focusing on abuse deterrent formulation (ADF) to reduce abuse and diversion of opioid drugs.
Current legislation has two components which deal with pharmacy switching: (1) the bill prohibits the substitution of an ADF with a non-ADF without the MD’s written consent and (2) the bill prohibits non ADF opioid prescriptions to be filled unless an ADF is not available. The Chapter continues to solicit input from members on how these concepts impact practice, following last year’s focus group that yielded interesting results. The Chapter remains interested, active and committed to the goal of reducing drug abuse in NYS.
Hudson Valley Chapter Governor-Elect Designee
Congratulations to Louis S. Snitkoff, MD, FACP; our new Governor-elect Designee to ACP National! He will serve a year of orientation as a Governor-elect and then will start his four-year term as Governor in the Spring of 2016. As Governor, Dr. Snitkoff is the official representative of the College for the New York Hudson Valley Region, providing a link between members at the local level and leadership at the national level.
The Countdown to E-Prescribing (eRx)
As many of you are aware, the e-prescription mandate under the I-STOP Act will go into effect on March 27, 2015. Educational webinars are being held to better prepare physicians and their practices for the transition. Your Chapter has diligently participated in activities with the NYS Department of Health, Board of Regents, Bureau of Narcotic Enforcement and others to represent challenges to physicians as the new rules go into effect.
In the meantime, if you are a physician that is unsure of how to proceed in the coming months, here are some things you can do to prepare:
- For physician practices who don't already have an electronic medical records system that can provide electronic prescriptions, see a list of "stand alone" e-prescribing software here.
- For practices that have an EMR, immediately contact your IT administrator or your vendor to obtain further info about your system readiness for eRx and for documentation required for your Registration.
- If you haven't registered already, you must file the EPCS registration form, which can be e-mailed to firstname.lastname@example.org.
- New York State also has specific regulations pertaining to issuing electronic prescriptions for controlled substances. (here)
Join the Effort to Ensure Medicaid Fee Parity for Primary Care Physician Visits
Please take action today and urge Senators Schumer and Gillibrand to support the "Ensuring Access to Primary Care for Women & Children Act" (S. 2694). To ensure parity for Medicaid patients, this bill would continue payment of Medicaid fees at Medicare levels beyond 12/31/14.
It takes less than a minute! A sample message is provided for you to personalize. Be sure to add an opening and closing and we urge you to edit the suggested text to reflect your own practice situation.
The two-year Medicaid Primary Care Pay Parity program was enacted as part of the Affordable Care Act (ACA), and was effective Jan. 1, 2013 through Dec. 31, 2014.
Before this program went into effect, many New York State Primary Care Physician practices were unable to accept more Medicaid patients because Medicaid reimbursement rates in New York were much lower than Medicare and other payers, an astonishing 42% of Medicare, well below the actual cost of care. Please show your support of S. 2694 and tell your senators that Medicaid fee parity is important to the overall health of New York State!
Click the link below to log in and send your message:
CMS Launches Road to 10 Webcast Series
The Centers for Medicare & Medicaid Services (CMS) has released a new webcast introducing the "Road to 10" tool. Accessible through the "Road to 10" link on the CMS website, the webcast covers the history of the International Classification of Diseases (ICD) and the benefits of ICD-10. This is the first in the new "Road to 10" webcast series. Five more webcasts will follow-all aimed at helping small practices get ready for ICD-10 by the October 1, 2015, compliance date.
Also available now is a brief video introduction to the "Road to 10" tool. Developed in collaboration with physicians, the "Road to 10" tool offers:
- Clinical documentation tips
- Coding concepts
- Clinical scenarios
- Training calendar
Go to the CMS ICD-10 website to get started on the "Road to 10" today.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare.
Chapter Leaders Meet With Acting NYS Health Commissioner Zucker
On Monday, July 14th, Chapter Leaders met with New York State Acting Health Commissioner Howard A. Zucker, MD, JD in his Manhattan offices. Those attending presented a brief overview of the Chapter's mission and focus on physician education, advocacy and quality improvement/patient safety. Dr. Zucker briefly addressed his vision for the future of healthcare in New York and discussed at length his concerns over physician workforce capacity in the area of primary care and general internal medicine. The Chapter was asked to prepare a list of options that could assist the Commissioner as he seeks ways to build and maintain physician capacity, with some emphasis on ways to support small practices.
Mandatory Electronic Prescribing Effective March 27, 2015
Amendments to Title 10 NYCRR Part 80 Rules and Regulations on Controlled Substances have been adopted and became effective as final regulations on March 27, 2013. The amendments authorize a practitioner to issue an electronic prescription for controlled substances in Schedules II through V and allow a pharmacist to accept, annotate, dispense and electronically archive such prescriptions.
The amendments require the following;
- Computer applications utilized must meet federal security requirements.The federal requirements are included in the Drug Enforcement Administration Interim Final Rule regarding Electronic Prescriptions for Controlled Substances. The rule may be accessed via the U.S Department of Justice DEA Office of Diversion Control website. Contact your software vendor to determine if your application meets the above mentioned requirements.
- Computer applications meeting federal security requirements must be registered with the Department of Health, Bureau of Narcotic Enforcement.
- To meet the New York State Public Health Law data submission requirements for electronic prescribing of controlled substances, the pharmacy must submit controlled substance dispensing data to the Department of Health, Bureau of Narcotic Enforcement, using the American Society for Automation in Pharmacy (ASAP) format Version 4.2 or greater.
- Pursuant to Public Health Law section 3302(37), an electronic prescription for controlled substances may only be issued in accordance with Department of Health regulations, as well as NYS Education Department regulations and federal requirements. NYS Education Department regulations may be accessed electronically.
New York State Regulations related to Electronic Prescribing of Controlled Substances may also be accessed electronically. Specific regulations pertaining to issuing electronic prescriptions for controlled substances may be accessed in 10 NYCRR 80.64
By March 27, 2015, all prescriptions (including prescriptions for non-controlled substances) issued in New York State must be electronically transmitted, with certain limited exceptions. Please continue to visit this webpage for information pertaining to electronic prescribing of controlled substances.
If you have met all federal security requirements and would like to register the application with the Bureau of Narcotic Enforcement, send an email to email@example.com. Include "Electronic Prescribing" in the subject.
- Letter to Pharmacies Regarding Electronic Prescribing Registration
- Letter to Practitioner Regarding Electronic Prescribing Registration
"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 WAG (Physician Workforce Advisory Group) 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.
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