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December 22, 2022840 people answered this week -see how you rated!President's Message: Dr. Jitendra BarmechaProgress Note:This is my final progress note of 2022!I am pleased to announce that our own S

 

January 19, 2023


911  people answered this week -see how you rated!

President's Message: Dr. Jitendra Barmecha
Progress Note:

Last week, Governor Hochul gave her State of the State address setting the framework for her legislative agenda for 2023, indicating items that may be included in the Executive Budget for FY 2023-24 (likely to be released later this month). There are few that physicians are likely to support.  However, there are a handful of items which are concerning, particularly as it relates to scope of practice.  Below is a general list of noteworthy items – which the Chapter will continue to monitor:

  • A new $1 billion investment in New York’s mental health care infrastructure.
  • Improvement to the New York Essential Plan through increasing health care provider reimbursements, reducing enrollee cost-sharing and requiring health insurers to spend more on care delivery.
  • Increasing Medicaid reimbursement for Primary Care and reproductive health care providers.
  • Creation of a Medical Guaranty Fund to cover claims in the event of a health insurer default.
  • Permit disabled New Yorkers to buy into the Medicaid program.
  • Create a Commission on the Future of Healthcare.
  • Permitting New York to join the Interstate Medical and Nursing Licensure Compacts.

NYACP has submitted a Chapter Advocacy Internship Program poster for ACP’s Mary Bieter Evergreen All-Stars Award on “A LEGISLATIVE AND HEALTH POLICY EDUCATIONAL OPPORTUNITY FOR INTERNAL MEDICINE RESIDENTS AND MEDICAL STUDENTS” that was developed in memory of Steven Walerstein, MD, MACP. The Mary Bieter Evergreen All-Stars Award recognizes exceptional and sustained chapter-initiated programs that support and adapt to the Internal Medicine landscape in the United States and around the world. Voting is now open and will close on January 31. VOTE NOW!

New York hospitals received approximately 38 new GME residency positions effective July 1. By 2034, the US is projected to have a shortage of 124,000 physicians. The recently passed federal omnibus-spending bill will add another 200 residency positions in 2026, with 100 slots dedicated specifically to psychiatry and psychiatry subspecialties. Direct Graduate Medical Education (DGME) | CMS

Another positive report shows continued decreases in overall cancer mortality, approximately 33% since 1991, and an estimated 3.8 million lives saved from cancer. On the contrary, the annual Cancer Statistics are being projected to be over 1.95 million people diagnosed with cancer and nearly 610,000 will die of cancer in 2023, an uptick from 2022 projections. Among the major findings: lung and colorectal cancers cause the most deaths, prostate cancer is rising among men, and cervical cancer rates have seen an ‘astounding’ drop among young women, possibly due to early prevention and HPV vaccines.

Lastly, Generative Pre-trained Transformer (ChatGPT), which is a type of machine-learning or next gen AI model, is trained on large amounts of data to produce human-like text. These models use technologies like Natural Language Processing (NLP) and Natural Language Generation (NLG) to better understand and reproduce human language. The latest version, ChatGPT v4.0, will be able to translate into other languages, summarize and generate text and answer questions, and include a chatbot.

(Note: this progress has been drafted without using ChatGPT tool).

Stay safe and warm,

 

 


Jitendra Barmecha, MD, MPH, FACP, SFHM
President


NYACP Advocacy Intern Corner
Summaries from NYACP Advocacy Interns
*Disclosure:  The articles written below are based upon individual reflections to the Governor’s January 10th State of the State.  

Governor Hochul's State of the State - January 10, 2023: 
Winnie Chu, DO - Northwell Health

The theme of Governor Hochul’s State of the State address was “Achieving the New York Dream” - a dream that she hopes to realize through keeping New York safe, more affordable, and allowing New Yorkers more opportunities. This includes New Yorkers that have historically been marginalized, such as those struggling with mental health concerns. Her pledge to commit one billion dollars to critical policy changes to meet the mental health needs of the people was met with roaring applause and a standing ovation. The aim is to reduce the number of those with unmet mental health needs by half over the next five years. Critical changes proposed included:

  • Expanding the total number of inpatient psychiatric beds available by 1000;
  • Investing in services to reintegrate patients into society, such as supportive housing;
  • Building 3500 residential units supported by intensive mental health services;
  • Requiring facilities to discharge high risk patients to wraparound services;
  • Prohibiting insurance companies from denying coverage of mental health services; and
  • Increasing mental health support and preventative services in the school environment.

In addition, she touched upon efforts to staunch the addiction and opioid crisis and the growing threat of additives such as Xylazine and Fentanyl through local and federal partners. Other prominent topics in the address included gun and bail reform, affordable housing, investment in infrastructure, combating inflation, decreasing carbon emissions. 

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State of the State Address: A Win for New Yorkers and Scope of Practice Creep
Shane Solger, MD - SUNY Downstate University

Governor Kathy Hochul's State of the State Address has laudable goals for the healthcare of New Yorkers. She highlighted segments of her written strategy in her speech, and the most emphasized part of her plan was the pivot toward addressing the mental health crisis that is going on in our State. However, hidden within her written plan was concerning language surrounding a permanent expansion of Advanced Practice Providers' (AAP) scope of practice. Below, we will summarize and address those aspects of her blueprint that are important to us as internists. 

Money for Mental Health:

            To address the growing number of untreated and decompensated mental health problems among New Yorkers, Governor Hochul outlined a $1 billion investment plan that will go towards:

  1. Increasing the number of inpatient psychiatric beds by 1,000;
  2. Creating 3,500 new housing units for those with mental illness;
  3. Expanding outpatient mental health services;
  4. Expanding insurance coverage for mental health services;
  5. Expand mental health services for school-aged children; and
  6. Improving admission and discharge planning from inpatient units and emergency departments to outpatient facilities and providers

Even as many of us may not treat behavioral health issues, the focus and investment in treating mental health problems will undoubtedly benefit all within the internal medicine community.

Many of us have seen the clinic patient with poorly controlled mental illness, an A1C >10, and a systolic blood pressure >160. It's not that they do not want to exercise or check their blood sugar; it is that they cannot. We have seen our fair share of hospital ward patients with a poorly controlled mental health disorder that has led to decompensation of their physical illnesses, who then fall under our care for their infected diabetic foot ulcer. 

This investment in stabilizing New Yorkers' mental health issues will make us more effective internists as New York State moves towards addressing social determinants of health that make psychiatric diseases hard to control. Managing the medications for a chronic illness is much easier with safe housing and a stable place to store medicines. Investing in wrap-around services will provide these patients with the support structure they need to make their "q3month" appointments for diabetes management. Ultimately, if we can find, maintain, and fund the staff required to support the plan, I am hopeful for this policy pivot as it relates to our specialty.

Healthcare Reform: The Good and the Ugly.

While she did not discuss it in her address, Governor Hochul outlines a three-part plan to address healthcare reform in New York. For the most part, the plan is sensible. To describe it very broadly, it acknowledges that New York spends a lot of money and does not get much return. She describes her efforts to lean into the recent shift in medicine that embraces a change in the delivery of care to telehealth, home-based care, and outpatient services, and that New York will invest in those technologies that will make our system safer and more efficient. The Governor acknowledges that there is a healthcare worker crisis, and the cost of the Agency Nurses has become untenable for our healthcare system. She wants to prepare for future emergencies, make Medicaid more accessible, place a stronger emphasis on preventative care, end tobacco and drug use, make primary care more accessible, and reinvigorate our Emergency Medical Services. Many of us would agree that these are essential issues to invest in and address.

The sheep in wolf's clothing within her plan is that the Governor has doubled down on her Executive Order from September 2021, which allows AAPs to work without the supervision of a physician. What is more concerning is that her State of the State address would like to expand their scope further. The ACP has previously released a statement and toolkit regarding "Scope of Practice" issues. 

As internists, this is a disconcerting decision, as it is transforming what was a desperate contingency plan for a deadly global pandemic into a permanent policy solution that equates the care of a physician with that of an AAP. Governor Hochul purports that this will help alleviate our shortage and allow our healthcare system to provide more care, but the expansion does not equate to more care of the same quality. On the contrary, this shift will enable those practitioners with less education and significantly fewer clinical hours to make more decisions autonomously. The net effect of this will be a healthcare system that will see more inappropriate antibiotic use, higher opioid prescription rates, and more radiology ordering, as seen in the AAP community compared to physicians.

Ultimately, I am hopeful that our State has begun to invest in a fundamental concept taught in medical school: the biopsychosocial model of care. It is an acknowledgment that we cannot treat a patient's hypertension unless we help them treat their depression and address their unstable housing. I am concerned, however, that there is an a priori belief that a Nurse Practitioner or a Physician Associate can autonomously deliver the same degree of care without physician oversight. As we enter the new year, we need to advocate for ourselves and our patients by discussing with our elected officials that AAPs enrich a physician-led team, however, they should not supplant it. 


A Summary of the Recent ACP/Annals Firearm Injury Forum 
By Winnie Chu, DO  

The ACP/Annals Firearm Injury Forum, held on January 11th, 2023, presented a multi-disciplinary and holistic approach to firearm safety. The message was clear -  firearm injury is a public health issue with a vital role for physicians. Dr. Sue Bornstein was the moderator. Panelists, Marian (Emmy) Betz, MD, MPH; Scott P. Charles, MAPP; and Thea L. James, MD, MPH, MBA, discussed three clinical cases. The main takeaways included:

  • As with all topics, conversations regarding firearms should be nonjudgmental and patient-centered.
  • Consider framing it as a component of the home safety elements (e.g. removing household hazards and locking doors for patients with dementia prone to wandering).
  • There is a strong link between firearm and suicide risk. Half of suicide deaths are by firearm and approximately half of firearm deaths are suicide. In high risk patients, it is critical to address access to firearms due to impulsivity during high risk crisis periods.
  • Engage patients in their own care, including making decisions about voluntarily relinquishing access to firearms during periods of high risk (e.g. storage of guns with trusted individuals outside of the home).
  • Extreme Risk Protection Orders may be invoked by family members or law enforcement and would direct the person to surrender their firearm(s) as well as prevent purchase of new ones.
  • Victims of firearm injuries, as well as their family members, caregivers, and others, may seek counseling and social services through the Health Alliance for Violence Intervention.
  • Healthcare providers may be hesitant to broach the topic of firearm safety for a variety of reasons. For those concerned about alienating the patient, remember that obtaining a history of sensitive topics (e.g. sexual history) may require practice. Consider normalizing the topic (e.g. “One of the things I always want to talk about is how to keep the home safe…”).
  • Be intentional -“Do you have access to any guns where you are living?” Ownership does not matter as much as access to firearms.
  • Patients may also be worried about documentation in the medical record – physicians can provide and document counseling of firearm safety and storage.

I Raise the Rates Adult Immunization Program

The New York Chapter is proud to once again partner with the American College of Physicians' Center for Quality in supporting the “I Raise the Rates Adult Immunization Program.”  The program's monthly newsletter, I Raise the Rates (IRtR), will  include a variety of resources from various public health partners, unique educational opportunities, and media articles related to immunization. The monthly IRtR Newsletter can be found under the “What’s New” section on the homepage of the Chapter Website.  ACP's I Raise the Rates program is currently supported through funding from CDC and Sanofi Pasteur, Inc. 


New NYACP Staff Member

NYACP would like to welcome Izaiah Wright as a new member of the Chapter staff.  Izaiah’s title is NYACP Districts Liaison and Meetings Specialist. Izaiah will be working directly with NYACP’s District President's, Councilors, Councilors-at-Large and other Chapter leaders.  He looks forward to revitalizing educational programs and events at the local level, as well as staffing committee and task force meetings, and fulfilling other programs and projects as needed. Welcome aboard!


Members in the News!

Congratulations to Parag Mehta, MD, MACP for being named on the 2023 City & State Health Care Power 100 List! 

City & State’s Health Care Power 100 sheds light on these decision-makers in the medical world in New York, including prominent public officials, influential hospital and health care executives, heads of other nonprofit providers, union leaders, academics and an array of advocates and activists who take their case to Albany and City Hall.


 

ACP's Advanced Quality Coach Program
Congratulations to the following Chapter members who have been selected by ACP to participate in ACP's Advanced Quality Coach Program: Cori Salvit, MD, FACP, Christopher Migliore, MD, FACP, Vasundhara Singh, MD, FACP, Harvir Singh Gambhir, MD, FACP, Marc Braunstein, MD, FACP and Camile Gooden, MD, FACP.

ACP Quality Coaches work with physician-led teams to co-create and implement initiatives designed to achieve their quality goals. Coaches are practicing physicians who receive specialized training on validated coaching techniques to engage clinical teams to build their QI expertise and capacity.


Doctors Across New York (DANY) Cycle IX is now open!

New York State Home

Doctors Across New York is a state-funded initiative enacted in 2008 to help train and place physicians in underserved communities in a variety of settings and specialties to care for New York´s diverse population. 

The grant is being offered as a Solicitation of Interest (SOI), and it is posted on both of the following websites:

Doctors Across New York (DANY)

New York State Contract Reporter

This is an important reminder: A Grants Gateway account is no longer necessary to apply. 

There is also an important change: Applicants no longer have to be “new” to an underserved area.  Any doctor that will be working in an identified underserved area during the DANY obligation period of July 1, 2023 to June 30, 2026 is eligible to apply.


NYACP Leadership Academy

Applications are now being accepted for the NYACP Leadership Academy. This course is a six-part CME accredited certificate program beginning in May 2023, ending with an in-person final session at the NYACP Annual Meeting on Saturday, Oct. 28, 2023 in Rochester, NY. 

Course schedule: 6:30 - 8:00 pm 
Thursday, May 4 - Leadership in Medicine
Thursday, June 1  -  Opportunities in Medicine
Thursday, July 6 - Strategies & Skills
Thursday, August 3 - Identifying & Mentoring
Thursday, September 7 - Leadership and Underrepresented Minorities

Final session in-person at NYACP Annual Meeting
Saturday, October 28, 2023 - NYACP Annual Meeting

Apply Here


NYSDOH Announces:

The Health Equity Leadership Institute 

The Health Equity Clinical Leadership Institute is a 12-month virtual learning collaborative for physicians, advanced practice nurses and health facility administrators.

The Institute will focus on evaluating the real-world application of NYSDOH Health Equity
Competencies and Health Care Organization Considerations in Support of Health Equity.
Through monthly, 90-minute meetings, health equity leaders will learn from nationally
recognized health equity experts and begin the process of transforming their practices and
organizations by implementing and evaluating the impact of one or more elements from the
Health Equity Competencies or Health Care Organization Considerations in Support of
Health Equity. 

More Details

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