Practice Management

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Health Advisory: Update on Influenza Prevention, Surveillance, and Control

This advisory contains updated information about influenza activity in New York with links and references to important influenza resources. You can read the entire Health Advisory Here.

What to Look For If the Diagnosis Isn’t Ebola

With the recent outbreaks in West Africa, Internists have a heightened sense of Ebola symptoms presenting during diagnosis. However, Ebola is not always the disease. From ACP Hospitalist is an article on what to look for when Ebola is ruled out.

An excerpt:
“If a patient comes to your hospital with a fever and history of travel to West Africa, there's no question what you'll be most worried about—Ebola.

But there are a number of other diseases that should be considered in differential diagnosis, even as you take precautions against the possibility of Ebola, because they will present with similar symptoms and are endemic to the same area. “

Read the full article here.

The Current and Future State of Stroke Treatment

Like any field of medicine, new technology and procedures are devised and implemented at a rapid pace; the process of stroke treatment is no different. This article from the ACP Hospitalist features insights from S. Andrew Josephson, MD, Medical Director of Inpatient Neurology and Chair of the Neurohospitalist Program at the University of California, San Francisco (UCSF) is essential for any physician that routinely encounters patients that require stroke treatment.

An excerpt from the article:
“Much research and discussion have focused on the right time window for giving thrombolysis to patients with acute ischemic stroke. Yet a day may come when the debate about a cutoff of 3 or 4.5 hours will seem rather quaint".

Read the full article here.

MLMIC Declares 7.5% Special Dividend

MLMIC Announces a 7.5% Special Dividend for our Policyholders!

MLMIC’s President, Dr. Robert Menotti, said that dividends “provide meaningful financial relief to our policyholders,” and that “they are an integral part of our mission to provide high-quality insurance at low long-term cost.” Since inception, MLMIC has returned over $300 million in dividends to our policyholder owners.

To qualify for this 7.5% Special Dividend, policyholders must be insured by MLMIC on February 1, 2015. The dividend will be applied to policyholder accounts on March 1.

Questions? Contact MLMIC today.

Experienced Nurse Practitioners New Collaborative Relationship Rules Effective 1/1/15

A new year means new regulations for experienced nurse practitioners with more than 3,600 hours of practice experience. In lieu of a written practice agreement and protocols with a designated collaborating physician, a nurse practitioner is now required to have and document a collaborative relationship with one or more physicians or a hospital.

You can read the full article by our Chapter here.

If You’re Unprepared for Implementation of E-Prescribing, Read this Blog Post

Within you'll find excellent and succinct tips to the questions you'll have about e-prescribing, courtesy of NYACP Member Ankita Sagar, MD, MPH! You can read the blog post here.

The Countdown to E-Prescribing

As the March 27, 2015 mandate draws near, there are several ways physicians can prepare themselves for implementation of eprescribing of all substances required by prescription. The New York Chapter ACP website has a wealth of resources on the subject including registration procedures, restrictions, and state regulations regarding controlled substances, all of which can be read here.

For physician practices who don't already have an electronic medical record system that can provide electronic prescriptions, see a list of "stand alone" e-prescribing software here. Watch soon for an announcement of a stand-alone product vendor discount for members.

In addition, the NYACP has hosted several webinars covering the e-prescribing mandate, the recorded versions can be viewed on our website

Coding for ICD-10-CM: More of the Basics MLN Connects™ Video

In a video on Coding for ICD-10-CM: More of the Basics, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) provide a basic introduction to ICD-10-CM coding. The objective of this video is to enhance viewers’ understanding of the characteristics and unique features of ICD-10-CM, as well as similarities and differences between ICD-9-CM and ICD-10-CM. The video covers:

  • How to assign a diagnosis code using ICD-10-CM
  • ICD-10-CM code structure
  • Coding process and examples: Combination codes, 7th character, placeholder “x,” excludes notes, unspecified codes, external cause codes
  • Resources for coders

Keep Up to Date on ICD-10, effective October 1, 2015
Visit the Medicare Fee-For-Service Provider Resources web page for a complete list of MLN Connects videos on ICD-10. To receive announcements for MLN Connects videos and the latest Medicare program information, subscribe to the weekly MLN Connects Provider eNews.
Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.

Guideline for Dietary and Pharmacologic Management of Recurrent Nephrolithiasis

The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the comparative effectiveness and safety of preventive dietary and pharmacologic management of recurrent nephrolithiasis in adults.

Virtual Patient Visits Becoming More Prominent

In a recent article published by the ACP Internist, Charlotte Huff investigates the impact of virtual consultations on the medical field. An excerpt:

"Unlike the e-mail consults that some doctors already provide their patients, these virtual consults essentially offer a way to bypass the family doctor or any in-person interaction entirely. For a fee, frequently out of pocket, patients with a "live" video connection can run their symptoms by a doctor without leaving their home or office. The service can be driven by patient demand for convenience, lack of access to in-person care, and sometimes both, experts said."

The full article can be accessed here.

Updated CDC Resource Available on Ebola

The Centers for Disease Control and Prevention (CDC) website has the latest information on Ebola Virus Disease (Ebola). New guidance has been added about the use of personal protective equipment in hospitals. Review and bookmark the CDC resources for health workers, and check back often for the latest updates.

New Resources Available on Ebola

NYSDOH: Revised NYS/NYC Laboratory Guidelines for Handling Specimens from Patients with Suspected or Confirmed Ebola Virus Disease


Guidance for Clinical Laboratories Using FDA Authorized Diagnostic Assays for Ebola Virus DetectionACP Smart Medicine

ACP Smart Medicine - How To Diagnose Ebola

CMS National Provider Call: Transitioning to ICD-10 Information

The Centers for Medicare and Medicaid Services (CMS) has sponsored a national provider call on Wednesday, November 5, from 1:30 - 3:30 PM EST to help providers transition to ICD-10.

October 1, 2015 is the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. During the MLN Connects National Provider Call, CMS subject matter experts will discuss ICD-10 implementation issues, opportunities for testing, and resources. A question and answer session will follow the presentations.

TO REGISTER: Visit MLN Connects Upcoming Calls at: Participation may be limited so early registration is encouraged.


  • Final rule and national implementation
  • Medicare Fee-For-Service testing
  • Medicare Severity Diagnosis Related Grouper (MS-DRG Conversion Project)
  • Partial code freeze and annual code updates
  • Plans for National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)
  • Home health conversions
  • Clams that span the implementation date

Countdown to ICD-10

Acknowledgement Testing Week: November 17 through 21, 2014

To help you prepare for the transition to ICD-10, CMS offers acknowledgement testing for current direct submitters (providers and clearinghouses) to test operability with the Medicare Administrative Contractors (MACs) and Common Electronic Data Interchange (CEDI) anytime up to the October 1, 2015 implementation date.

Acknowledgment testing gives submitters access to real-time help desk support and allows CMS to analyze testing data. Registration is not required for these virtual events. Mark your calendar:

  • November 17 through 21, 2014
  • March 2 through 6, 2015
  • June 1 through 5, 2015

How to participate:

Information is available on the website or through your clearinghouse (if you use a clearinghouse to submit claims to Medicare). Any provider who submits claims electronically can participate in acknowledgement testing.

What you can expect during testing:

  • Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2014 through November 17, 2014), since testing does not support future dated claims.
  • Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system.
  • Testing will not confirm claim payment or produce a remittance advice.
  • MACs and CEDI will be staffed to handle increased call volume during this week.

Information on acknowledgement testing and how to participate is available in MLN Matters® Article MM8858, "ICD-10 Testing - Acknowledgement Testing with Providers".

NYS Specific ICD-10 Readiness Survey

The New York State Department of Health would like to learn about our providers' readiness for the upcoming ICD-10 implementation and ask that you complete and submit the following brief, anonymous survey. This will help us to design and target our communication and implementation efforts as we approach 2015.

You can take the anonymous survey here.


ACP Toolkit Improves Care Coordination

ACP's High Value Care Coordination Toolkit features resources to improve referrals and care coordination between primary care physicians and specialists, eliminate waste and duplicative care, and create more efficiency in care delivery.

The toolkit was developed collaboratively through ACP's Council of Subspecialty Societies (CSS) and patient advocacy groups.

The High Value Care Coordination Toolkit includes 5 components:

  • a checklist of information to include in a generic referral to a subspecialist practice,
  • a checklist of information to include in a subspecialist's response to a referral request,
  • pertinent data sets reflecting specific information in addition to that found on a generic referral request to include in a referral for a number of specific common conditions to help ensure an effective and high-value engagement,
  • model care coordination agreement templates between primary care and subspecialty practices, and between a primary care practice and hospital care team, and
  • an outline of recommendations to physicians on preparing a patient for a referral in a patient- and family-centered manner.

These resources are part of ACP's High Value Care initiative, which is designed to help doctors and patients understand the benefits, harms, and costs of tests and treatment options for common clinical issues so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.

Previous Posts:

Ebola Update from NYSDOH 10.20.14

The CDC and the NYS Department of Health continue to issue guidance updates for diagnosis and handling of potential Ebola Virus Disease (EVD) cases.  NYS Acting Commissioner of Health Howard Zucker yesterday issued an “extraordinary order” setting forth actions to be taken by all general hospitals, diagnostic and treatment centers, off-campus emergency departments and ambulance services to manage and treat persons with confirmed cases of Ebola or with symptoms and risk factors indicative of Ebola.   Specific information is included in an FAQ document  for other settings such as private practices and pharmacies.   The following updates should be immediately reviewed by all physicians and other health care providers:

The NYSDOH is advising health care providers and facilities to review the new CDC health advisory regarding recommendations for evaluating patients for possible Ebola virus disease (EVD).  Main points from previous advisory are reminders to:

  • Increase vigilance in inquiring about a history of travel to West Africa in the 21 days before illness onset for any patient presenting with fever or other symptoms consistent with EVD
  • Isolate patients who report a travel history to an Ebola-affected country (currently Liberia, Sierra Leone, and Guinea) and who are exhibiting EVD  symptoms in a private room with a private bathroom and implement standard, contact, and droplet precautions (gowns, facemask, eye protection, and gloves); and
  • Immediately notify the local health department 

Travel history should be asked of all patients who present with symptoms such as fever (greater than 101.5°F or 38.6°C), severe headache, muscle pain, vomiting, diarrhea, abdominal (stomach) pain, or unexplained hemorrhage (bleeding or bruising) at initial presentation in EDs or reception in primary or urgent care settings. Signage asking patients to provide travel history should also be prominently posted. Rapid recognition of possible EVD cases is critical to protecting health and safety.
The NYSDOH is also advising health care providers and facilities to review previously released CDC and NYSDOH guidance on EVD. See the full PDF attached.
The NYSDOH is advising health care providers and facilities to utilize the algorithm/decision guide included in this advisory when evaluating patients for potential EVD.
Hospitals and other healthcare providers are strongly encouraged to perform drills in the early identification and isolation of suspected EVD patients to review plans for hospitalization of a suspect or confirmed EVD patient, and to identify and train staff who would provide care to a suspect or confirmed EVD patient. The drills should include staff and rehearse procedures for the use of personal protective equipment (PPE).
We have also received the following updated message from the CDC - Ebola Key Messages - please click here.

NY State Physician Organizations and Public Health Officials Launch "IMMUNIZE NY"

In an effort to address the rise of preventable diseases due to lack of immunization, New York State physician groups and public health officials have launched a program to encourage New Yorkers to be vigilant in keeping their immunizations up-to-date.

The New York Chapter of the American College of Physicians (NYACP), along with The Medical Society of the State of New York (MSSNY), the New York State Chapter of Academy of Family Physicians and the New York State Association of County Health Officials have launched "IMMUNIZE NY" to promote immunizations within the adult population. The campaign strongly encourages adults to discuss immunizations with their physicians and to ask specifically about pertussis, influenza, pneumococcal, HPV and shingles vaccinations. 

Preventing diseases through vaccine is one of the five public health priorities for the New York State Department of Health.  The Affordable Care Act's prevention provisions now cover vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) with no co-payments or other cost-sharing requirements when those services are delivered by an in-network provider.

For information on how to stay vaccinated this season, as well as more comprehensive background information, check out these websites:


New CDC Recommendations for 65+ for Pneumcoccal Vaccination

The Advisory Committee on Immunization Practices (ACIP) published its Morbidity and Mortality Weekly Report (MMWR) on 9/19/14. The report details new recommendations for pneumococcal vaccination in older adults. More details on the recommendations can be read here.

Free Smoking Cessation Learning Module Available Online!

Tobacco use is leading cause of preventable death in the U.S., and as health care professionals we are in a prime position to help our patients successfully quit tobacco, while simultaneously lowering their risk of heart disease, stroke, COPD and other diseases.

Recently, the NYC Health Department has developed an excellent and free online learning module to assist physicians by enhancing your knowledge on how to effectively assess, counsel, and treat tobacco use, greatly improving patients’ chances of successfully quitting. For medical residents, this module meets five of the six Accreditation Council for Graduate Medical Education core competencies and is able to be placed in your learning management system. For attending physicians, this module provides 1 CME credit.

Highlights of the module include:

  • The “5 A’s” model of treating tobacco use
  • Provider/Patient communication techniques
  • Treatment options and guidance, including combination therapy
  • New York State Medicaid Benefits
  • Billing information for smoking cessation counseling

Click here to access the online module and here to access additional provider resources.

NYSDOH Outreach To Physicians On Ebola Virus Disease:

Update On Management, Prevention, and Containment

In recent weeks, there has been a growing concern over the potential spread of Ebola Virus disease (EVD) from its native locus of Western Africa to the United States and other parts of North America. The Centers for Disease Control and New York State Department of Health have both released guidelines for proper care and handling of patients with potential cases of EVD along with any laboratory material with suspected EVD exposure.

Ebola Virus is transmitted via bodily fluids of those infected with Ebola and through the handling of rodents and primates infected with the virus; it is NOT transmitted through the air or respiratory droplets. Clinical criteria includes pyrexia along with severe headache and generalized muscle pain and malaise, GI upset including vomiting and diarrhea along with potential hemorrhage. It is important to note that while there have been a total of 1,323 cases of EVD as of July 27th, 2014; there have been no reported cases of the virus in North America. However, it is prudent to understand the guidelines and regulations in handling suspected cases of the virus as international spread is always a possibility.

For any patient with suspected features of EVD with recent travel to known areas of primary EVD disease, the attending physician should take extreme caution when examining patient, place patient in private room with a closed door, instruct patient on how to use rubber gloves and surgical mask and to abstain from touching items in the exam room. All medical staff should be alerted of the potential EVD case on premises, the amount of staff that come in contact with said case should be limited and those who do should use the proper personal protective equipment (gloves, fluid impermeable gown, eye protection, facemasks, leg and shoe coverings) in cases with open wounds or bodily fluid, clean room suits should be used.
Once patient is sequestered and safely kept, the attending physician should call the Local Health Department with the following information:

  • The patient's risk factors and travel history, including dates, destinations and other potential contact including contact with animals and other people.

  • The patient's current status including physical and mental along with pressing concerns for the patient's immediate health.

The Local Health Department will then confer with the attending physician regarding the testing procedures (as outlined below) and any further information regarding a potential transfer to another medical facility.

Laboratory guidelines are as follows:

  • When possible, tests should be done in patient's isolation room using Point-Of-Care (POC) instruments and testing methods. Transferring specimen from isolated room to other rooms should be done as minimally as possible and should be done with extreme caution using Clean Room Suits and hand carried in a container that has been thoroughly wiped down with 10% bleach. All specimen manipulation must be done in a Class 2 biosafety cabinet (BSC2)

  • Guidelines for specific laboratory procedures can be viewed in the attached NYSDOH Brief.

New York State Dept. of Health - Measels Advisory Alert

A total of 477 confirmed measles cases have been reported to the Centers for Disease Control and Prevention (CDC) nationwide as of 6/13/2014, surpassing the highest reported yearly total of measles cases since measles was eliminated in the U.S. Sixteen outbreaks throughout the U.S. have accounted for 84% of the cases reported. This includes an outbreak in Ohio with 316 cases to date, the largest single outbreak reported in the U.S. since 2000. The large number of cases this year emphasizes the need for health-care providers to have a heightened awareness of the potential for measles in their communities and the importance of vaccination to prevent measles.
Read Alert Here!


Prescribe Opioid's Safely
Access this FREE online educational program to help you safely prescribe opioids and manage patients with chronic pain.
Online CME is available.
Find out more.


Counsel's Forum
Laurie Cohen, Esq., Partner at Wilson, Elser, Moskowitz, Edelman, and Dicker LLP and the Chapter's attorney provides members with support and direction through articles and answering questions relevant to general practice.

Managing Your Patients With Diabetes - Tools & Resources
Useful Links:

Public Health
An overview of the Chapter's public health initiatives.

Health Information Technology
Learn about NY's information network, Meaningful Use, e-Prescribing, privacy and security and best practices.

Running a Practice
ACP has a broad array of products, services and expertise to help you run and grow your practice.

Patient Centered Medical Home - ACP has gathered a comprehensive collection of information, resources and demonstration projects to assist you in planning for a complete Patient-Centered Medical Home.

Physician Quality Reporting System - tools and resources to help guide you through collecting and reporting quality measure data.

Patient Care and Education
The following patient-related resources provide guidance in effectively maintaining and enhancing the doctor-patient relationship.

Last updated: 1.22.15

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