Governor Cuomo announced on December 1st a series of new initiatives in the fight against AIDS – building on the state’s blueprint to end the epidemic by 2020. Earlier in the week, the Governor signed comprehensive legislation to eliminate barriers to HIV testing and other sexually transmitted infections, increase access to prevention and treatment, and expand research capabilities. Governor Cuomo also called on the federal government to authorize $45 million in Medicaid matching funds for critical programs supporting the battle against AIDS.
How to Contact Your Legislator
Here are just a few of the results of NYACP advocacy in 2016: Read the full report here.
Changes to E-Prescribing Laws
- Pharmacy to pharmacy transfer allows, upon request of the patient, a pharmacy to transfer an e-prescription to another pharmacy. This addresses many issues raised by ACP with regard to patient choice based upon pricing, convenience and pharmacy supply.
- Elimination of the need for prescribers to notify DOH each and every time an exception to the e-prescription mandate is utilized.
- 7-day limit on initial prescription of any Schedule II, III or IV opioid for acute pain, described as pain, whether resulting from disease, accidental or intentional trauma, or other cause, expected to last a short period of time.
The Chapter worked directly with sponsors on a bill that directs the Commissioner of Financial Services to develop a standard prescription drug approval form in an electronic version for all payers in the healthcare system. This will reduce burden on our members by requiring greater standardization among insurers for making prior authorization requests.
Passage of Step Therapy (Fail First) Drug Protocols for All Insurers
This bill was recently signed by the Governor to address Step Therapy protocols used in Utilization Reviews (UR) of prescriptions drugs. Insurers and UR agents must use evidence-based and peer reviewed clinical criteria appropriate for the patient’s clinical condition.
Adequate Workforce Capacity Advocacy
- Support for Doctors Across New York (DANY) - Funding was continued and increased by an additional $1 million, the application process was streamlined and total funding options merged. To date a total of $57.4 million has been awarded to 445 physician recipients to practice in New York State.
- The Chapter continues to support legislative and regulatory efforts related to increasing workforce capacity, especially in primary care and specialty shortage areas.
On November 28th, Governor Cuomo signed S7537/A1044 which amends the Public Health Law to allow a pharmacy, upon the patient’s request, to transfer an e-prescription to another pharmacy effective March 1, 2017. This was a legislative priority for NYACP having heard from many members of the challenges faced as e-prescribing has been implemented – and this bill resolves many of those concerns. Support from other professional medical societies helped to emphasize the concerns across all medical specialties.
This new law eliminates much waste on both patients and our members’ time when they had to re-issue scripts for reasons such as lack of supply in stock at time of fill, the patient for convenience stops at a different pharmacy or the patient has found another pharmacy to issue the drug at a cheaper price.
At the Board Meeting on December 7 in Queens, New York, the Chapter approved its 2017 State Legislative Priorities. These priorities are revised each year by the Health and Public Policy Committee and reflect the Chapter’s strong advocacy focus on Access to Care, Quality of Care and Patient Safety, and Public Health and Health Care Delivery.
To see the NYACP 2017 Legislative Priorities, please click here.
At its recent Board of Regents meeting, the American College of Physicians (ACP) adopted the following statement on Unsolicited Communications (also known as “cold calling”):
ACP opposes unsolicited communications (“cold calling”) of pharmaceuticals, durable medical equipment, supplies, and healthcare services that target patients and/or physicians and/or other prescribing clinicians including via direct mail, telecommunications, or facsimile. ACP believes this practice can lead to inappropriate treatment, interferes with the patient-clinician relationship, adds unnecessary costs to the health care system, and raises legal issues.
This statement began as a resolution from the NY Chapter and has been adoped by ACP as a formal policy stance, demonstrating that a member's idea for action can be turned into formal ACP policy.
11.17.16 : Govenor Cuomo Signs Prior Authorization Bill
On November 14, Governor Andrew Cuomo signed into law S.4721A/A.6983A , which directs the Commissioner of Health and Superintendent of Financial Services to establish a standard prior authorization request for utilization review of prescription drug coverage. The law does not impose additional burdens on the Department of Health to create new standards but instead utilizes existing standards created by the National Council for Prescription Drug Programs (NCPDP). This expands the use of standardized prior authorization processes across all payers, having clear implications for improved efficiency and enhanced patient outcomes. The law takes effect immediately.
This was a legislative priority for NYACP. The Chapter, working with the Medical Society of the State of New York (MSSNY), drafted this legislation with the Senate and Assembly Legislative sponsors, and continued advocacy until it was signed into law.
10.20.16: Activities Within This Past Week: Your Chapter Acting on Your Behalf
- Conducted a webinar on Preparing for Alternative Payment Models:
Help for Small Practices – a demonstration of “sharing allied health professionals,data, analytics, and other services”
- Held a post site analysis, with Iroquois Hospital Association, of the Take A Look Tour for Residents held in Upstate New York September 28-30 and planning for the Spring 2017 event
- Held two Chapter Committees via Conference Call:
- Member Engagement Committee
- Geriatrics Task Force
- Presented at a live conference with the Home Care Association of New York State, discussing the alliance of primary care physicians with home care providers – opportunities, barriers and challenges
- Continued planning for the State’s mandate of a three hour CME course on pain management
- Met with New York eHealth Collaborative (NYeC) officials on the status of EHR adoption by physicians, and ways to address interoperability, access and support for practice transformation
- Held two district meetings – one in Syracuse on Hormonal Replacement Therapy and Physician Burnout, and one in Buffalo on Changing ABIM's Maintenance of Certification and Changes in the Management of Atrial Fibrillation in 2016
- Conducted a webinar on Preparing for Value Based Purchasing/An Introduction to MACRA
- Participated in the Annual Conference of County Health Officials discussing communication with physicians on adult immunization
On Friday, September 30, Governor Cuomo signed as Chapter 350 of the Laws of 2016 legislation (A.9335/S.6778) changing e-prescribing exception regulations. Instead of sending an e-mail to the Department of Health containing an onerous amount of information about the issuance of the paper prescription every time an exception is invoked, as the regulations originally required, a prescriber can now make a notation in the patient's medical record indicating that they have issued a paper prescription and noting one of the three statutory exceptions as the reason why an e-prescription was not possible. This bill reduces an unnecessary administrative burden that was placed on physicians while preserving those measures within I-STOP that have been successful in reducing diversion and misuse of controlled substances.
Following a significant amount of effort by leaders and staff on this legislative priority, the bill was signed in part because of the large number of Chapter members that sent letters to Governor Cuomo through NYACP's Legislative Action Center, urging him to sign the bill.
As the Legislature comes to its final three weeks of session, your Chapter continues to monitor, meet with regulatory and legislative leaders and represent members on important pending issues that impact your practice and patient care.
A sample of some of the many topics covered by our advocacy efforts includes:
- Several bills to mandate continuing medical education on opioid prescribing, pain management, addiction response and treatment, end of life care, and palliative care
- The State’s administrative requirements of I-STOP and e-prescribing
- Proposals to adjust the current system related to medical liability that would create costly premium increases
- A resurgence of previously enacted legislation relating to tanning and dense breast notifications
- Aid in Dying proposals
- Adjustments in the medical marijuana laws
- Physician collective negotiations, expansion of peer review protections for physicians who participate in meaningful review processes
These are just a sampling of the more than 18,000 bills introduced in the current NYS legislative session. More than 500 of these are health bills targeted by our Chapter for active monitoring.
A Specialty Care Coalition lobby day was held on May 17, 2016, where NYACP joined with the New York Coalition of Specialty Care Physicians to lobby in Albany. NYACP representatives met with Assembly Majority leader Joseph Morelle and Senator Joseph Robach, among others. Key issues discussed during the day included support of e-prescribing changes which would remove the requirement to e-mail the Department of Health each time a physicians invokes an exception. The NY Chapter also spoke in opposition to current legislation that would extend the statute of limitations for malpractice cases to 30 months after the date of discovery.
New York State Fail First/Step Therapy Lobby Day
On Monday, May 23, 2016, NYACP joined together with other coalition members to urge support of passage of legislation [S.3419-B (Young) /A.2834-B (Titone)] that would regulate the use of “fail first” or “step therapy” policies by commercial health insurance companies in New York State. The Fail First/Step Therapy Coalition is comprised of over 60 organizations from across the state, and met with more than 70 legislators and/or key office staff.
A fail first or step therapy policy/protocol used by an insurer requires a patient to try and fail on other, generally less expensive drugs before coverage is granted for the drug initially prescribed by the patient’s physician. The bill includes two basic patient protections to improve the safety and efficacy of such policies:
It requires clinical review criteria used by an insurer to establish fail first/step therapy policies based on science and evidence-based clinical practice guidelines.
It requires a clear and expedient appeals process that can be used by physicians and other prescribers to request an override of a fail first/step therapy requirement.Under the bill, an override would only be granted if the patient’s physician can demonstrate that the drug(s) being required by the insurer will likely cause patient harm, is expected to be ineffective, has been tried by the patient and was proven ineffective, the patient is stable on the drug being recommended by the physician, or the drug is otherwise not in the best interest of the patient, as demonstrated by the physician.
2016 ACP Leadership Day – Washington DC
ACP’s Leadership Day was held in Washington DC on May 3-4, 2016 in conjunction with ACP’s Annual Internal Medical Meeting. The NY Chapter delegation consisting of members, residents, medical students and staff visited with staff in the offices of: Senators Charles Schumer and Kirsten Gillibrand, and 20 of our elected officials in the House of Representatives.
Discussion focused on:
- Improving the Care of Patients with Chronic Disease
- Making Graduate Education (GME) Funding More Effective
- Improving Health Information Technology challenges
- Enhancing Telemedicine opportunities
- The Current Opioid Abuse crisis
- Rising Prescription Drug Costs
- Integrating Behavioral Health into Primary Care.
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.
NYACP Recognizes Falls Prevention Awareness Day
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
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.
President Signs SGR Repeal Into Law!
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, 2015. President Obama signed the bill into law on April 16, 2015, 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.
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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