Governor Andrew Cuomo's Budget Proposals Related to Healthcare
Following are highlights of some key 2014-2015 proposed budget issues that the Chapter will actively follow.
Continuation of funds for Doctors Across New York (DANY)
DANY is a State funded program that supports physicians who choose to practice in underserved areas in New York. Loan repayment and/or funds to help establish a practice have been available. We strongly support initiatives to increase access to care for patients by expanding the physician workforce. The continuation and expansion of funding for this program is a top priority for the Chapter.
Out of Network Coverage
This budget provision seeks to enhance transparency of health coverage by including a proposal to regulate billing, reimbursement, physician and health care plan disclosures to consumers for health care services
provided to patients by “out-of-network” providers who do not participate in a patient’s health insurance plan.
Funding to promote Health Information Technology (HIT) connectivity through the State Health Information Network (SHINY)
The Department of Health is working to create a “pipeline” through which patient information can be safely transmitted from different regions across the state to improve patient care and allow providers access to important health information across all provider settings. $65 million in State funds is allocated for digitizing health records. By linking an All Payer Claims Database, which includes private payer and Medicare/Medicaid data, with EMR and public health records through a state supported infrastructure, NYS is working to improve clinical outcomes and overall health.
Establishment of Limited Service Clinics within Retail Spaces
This provision in the budget would allow for private businesses like CVS and Wal-Mart to establish for profit retail health clinics potentially staffed by Nurse Practitioners. The law includes no limitations on self-referrals (similar to requirements for private physician practices) meaning patients may use an onsite pharmacy in close proximity to other store products to increase profits. NYACP does not support this proposal that changes long standing “corporate practice of medicine” definitions and prohibitions.
Changes to Nurse Practitioner (NP) Collaboration
Alterations to the current regulations related to Nurse Practitioners could allow for NP’s with more than 36 months of practice and 3600 hours to work under a collaborative relationship with a hospital rather than in collaboration with a specific Physician. In addition, NP’s who have had their collaborative agreement with a physician terminated by physician relocation, retirement or death will be allowed to practice for up to 6 months under an NP of the same specialty who has over 3600 hours of experience until a new practice collaboration agreement with a physician can be achieved.
Excess Medical Malpractice Insurance
The second layer of medical liability coverage (accessed through hospital privileges) has been extended to 6/30/15.
Extension of HCRA which funds Hospitals and supports “public good programs” including GME
The Health Care Reform Act, which was set to terminate in March of this year, will be extended into 2017 in order to continue to provide services spanning many different areas of health care including workforce, hospital financing and GME training. HCRA also helps hospitals to negotiate rates with third party payers. A new addition has been proposed to the HCRA line and is mentioned in Health Information Technology section above.
This provision eliminates the separate written consent for HIV testing by a patient or health care proxy. The person ordering the test must advise the individual that an HIV related test is being performed and this notification shall be noted in the patient’s health record. New York and Nebraska are the only states who have continued to require written consent for HIV testing.
Certificate of Need Redesign
The process for undertaking limited construction projects for hospitals and diagnostic and treatment centers has been streamlined without regard to public need under certain circumstances. Also, the Commissioner of Health will issue new regulations to approve and issue operating certificates to open primary care facilities. In addition the “look back period” for approval has been reduced from ten to seven years. Also, there will be increased transparency with regards to transfer of ownership of these facilities. Disclosure of information will be required if over 10% of an operating facility’s worth is being transferred.
Elimination of IPRO resident work hour audits
The Accreditation Council for Graduate Medical Education has been tracking work hours of residents across the country, and the IPRO audits conducted by the State are now a duplication of this. Elimination of the regulation, which was made effective prior to ACGME tracking, will create savings to the State.
Definition of Urgent Care
The Executive Budget reflects recommendations of the Public Health and Health Planning Council and will restrict the use of the name “Urgent Care” to only those providers that meet specified criteria, including minimum scope of services requirements, as defined by the Department of Health.
Office Based Surgery
Office Based Surgery (OBS) and Office Based Anesthesia (OBA) will have more stringent accreditation processes and a more comprehensive reporting requirement for adverse events under the proposed budget provisions. The legislation suggests including podiatrists, monitoring of procedure and recovery times and requires registration and data submission of practices providing OBS and OBA.
Cancer Detection and Education Advisory Council
This provision consolidates funds for cancer research and advocacy groups to include additional cancer diagnoses. Also, the “Breast, Cervical and Ovarian Cancer Detection and Education Program Advisory Council” will be renamed to the “Cancer Detection and Education Advisory Council”. The provision adds colon, prostate and testicular to the list of cancer types on which the Board may advise.
Tax Requirements for Licensure Requests or Renewals
This provision would limit an individual who has an outstanding tax liability from obtaining an occupational, professional or business license and provide the State with means to enforce delinquent tax liabilities against an individual applying for or renewing such licenses.
Join the Effort to Halt Cuts to the SGR and Eliminate Medicaid Payment Incentives
Please take action today and urge your Representative of Congress as well as Senators Schumer and Gillibrand to stop the cuts now and provide stability for Medicare and Medicaid patients. 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 American College of Physicians strongly supports the "SGR Repeal and Medicare Provider Payment Modernization Act of 2014" (H.R. 4015). We are especially pleased that the agreement includes the following elements:
- Repeals the SGR and replaces it with a system focused on quality, value, and accountability.
- Removes the imminent threat of physician payment cuts and ensures a 5-year period of annual updates of 0.5 percent to transition to the new system.
- Improves the existing fee-for-service system by rewarding value over volume.
- Consolidates the three existing quality programs into a streamlined and improved program that rewards physicians who meet performance thresholds and improve care for seniors.
- Rewards physicians that engage in clinical practice improvement activities that will help facilitate their future participation in alternative payment models (APMs)
- Implements a process to improve payment accuracy.
- Creates incentives for care coordination efforts for patients with chronic care needs.
- Creates incentives for physicians to move into APMs, including a 5 percent bonus to physicians who receive a significant portion of their revenue from an APM, including patient centered medical homes (PCMH).
- Establishes a process to review and recommend physician-developed APMs based on criteria developed through an open comment process.
- Expands the use of Medicare data for transparency and quality improvement
ACP will continue to work with members of Congress to get this bill to the President for his signature no later than March 31, 2014, in time to prevent a scheduled 24 percent payment cut on April 1, 2014.
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"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.
NYACP Presents Testimony on New York's Healthcare Marketplace at NYS Senate Hearing on January 13, 2014
A Public Hearing was held on January 13th for Senators to hear from stakeholders on the implementation of the New York Health Insurance Exchange (New York State of Health). Chaired by Senator Kemp Hannon (Chairman of the Senate Health Committee) and Senator James Seward (Chair of the Senate Insurance Committee) a panel of legislators heard presentations from the Exchange staff, patients/consumers, physician groups, broker agents and insurers. Both the individual and small business options are currently open for enrollment: https://nystateofhealth.ny.gov/
To view the entire hearing click on the link below. Dr. Fitterman's testimony begins at 2 hours and 18 minutes into the hearing:
To read the final statement presented by the Chapter, click below:
Following the Chapter's Testimony, a brief survey was made available to our members to report physician understanding of the new Health Benefit Exchange. If you have not participated, please go to:
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