11.9.18: 2018 New York State Elections: How the Results May Impact Your Practice
For the first time in a decade and just the second time in more than 50 years, Democrats will control the New York State Senate as of January 1 with 40 of the 63 seats and a clear majority. While the Republicans have led the New York State Senate for decades, with a brief two year stint by Democrats in 2009-10, the balance of power will now shift to interesting and challenging times as the Governor, the Senate and the Assembly each offer their plans, priorities, and issues.
When Governor Cuomo proposes his 2019-2020 State Budget in early January, the Senate and the Assembly will be poised to ensure their own priorities are considered during review, amendment and negotiation procedures.The budget must be passed by April 1st. Before, during and after the budget negotiations, individual legislators and Departments from within the Administration will introduce and discuss their own "bills" of interest until session ends in mid-late June.
Important issues for physicians likely to be discussed during the upcoming legislative session include a single payer system, recreational use of marijuana, medical liability, physician assisted suicide, healthcare workforce and scope of practice issues, among many other public health related subjects. We will see a brand new, first-time Chair in the Senate Health Committee, Gustavo Rivera from the Bronx, and Assemblyman Gottfried of Manhattan will return as the Assembly Health Committee Chair.
Your Chapter, as always, will remain diligently involved in monitoring all of these proposals, and we ask you to continue to read our enews as it comes out bi-weekly in YCIA (Your Chapter in Action).
11.9.18: New White Papers from NYACP Committees Examine Geriatric Shortage, 2010 FHCDA
Two new white papers have been released by New York Chapter American College of Physicians (NYACP) Committees, one from the Geriatrics Task Force and one from the Ethics and Professionalism Committee. Details on the white papers can be read below.
The Ethics and Professionalism Committee - "New York State’s 2010 Family Healthcare Decisions Act (FHCDA): What NYACP Members Need to Know About Withholding and Withdrawing Life Sustaining Therapies for Adult Patients Without Capacity"
This white paper aims to educate practicing physicians on the New York’s 2010 FHCDA law, and clarify numerous questions surrounding the law, including: the role of guardianship, how to address conflict of interest and moral distress; when to enroll in hospice, how to implement a DNR, and when to invoke the Ethics review committee, and the process in New York State.
Read the white paper here.
The Geriatrics Task Force - "A Better Understanding of Geriatric Medicine"
This white paper outlines and advocates for geriatric-specific training in medical school and residency, as the geriatric-specific workforce capacity has decreased over the last decade. The white paper details why geriatric training is functionally different from general internal medicine training, and forecasts the need for an even greater geriatrician workforce in the near future. The paper also provides solutions to the problem, suggesting training programs for undergraduates, medical students and residents, and for higher reimbursement rates in the geriatric subspecialty. This paper is currently being used by the New York State Senate Health Committee to craft bill S.6257 (Hannon), which establishes a physician loan forgiveness program for geriatric medicine.
Read the white paper here.
The Chapter would like to thank members of both committees for their tireless work over the past two years in completing these white papers:
The Ethics and Professionalism Committee: Ellen C. Meltzer, MD, MSc, FACP, Chair, NYACP Ethics and Professionalism Committee; Jack P. Freer MD, FACP; Cynthia X. Pan, MD, FACP, AGSF; Daniel Pomerantz, MD, MPH, FACP; Timothy E. Quill, MD, MACP, FAAHPM; Elaine Schattner, MD, FACP.
The Geriatrics Task Force: Paula Lester, MD, FACP, Geriatrics Task Force Chair; Sharon Brangman, MD, FACP; TS Dharmarajan, MD, MACP; Tina Dobsevage, MD, FACP; Daniel King, MD; John Maese, MD, MACP; Ida Messana, MD, FACP: Donna Seminara, MD, FACP; Anita Szerszen, DO, FACP; Eleanor Weinstein, MD, FACP.
10.19.18: NYACP Council/Board Meeting Convenes to Discuss Priorities, Committee Work, and Other Issues
On October 19, the NYACP Council/Board met in Queens to discuss and vote on resolutions and priorities for the upcoming year. The Council/Board discussed and approved several important topics. The 2019 Legislative Priorities which includes championing Access to Care, advocating for Quality of Care and Patient Safety, and a focus on Public Health were approved. Eight committees, including Education, Geriatrics, Early Career Physicians, and others, reported on their activities since the last meeting.
Resolutions were approved, calling for revisions to EMTALA ( Emergency Medical Treatment and Labor Act ), expansion of Telehealth, and expanding access to HIT, including protecting physicians from the cost of Electronic Health Record (EHR) enhancements and improving interoperability. The C/B also agreed on formal policies defining existing communications and membership plans, strategic plans and leadership development as required for the Chapter Excellence Award.
Each year a full independent financial audit is conducted by the firm of Marvin & Company. The Council/Board reviewed the independent audit, as well as the current financial reports, and reviewed the 990 tax filings. Members should know the Chapter maintains an active Budget and Finance Committee that oversees the budget and financial report and meets three times during the year. The Executive Committee reviews all financial summaries every other month. If you would like a copy of the Chapter’s independent audit, or a copy of the 990 forms filed by NYACP, Inc and NYACP Services Inc, please contact Linda Lambert at firstname.lastname@example.org.
7.19.18: New York State Workers' Compensation Board to Reduce Paperwork and Lower Administrative Burdens for Physicians
The New York Chapter has been diligently advocating to reduce worker's compensation board administrative burdens for over a decade, and as announced on April 17, 2018, the New York State Workers' Compensation Board (Board) will replace the current Board treatment forms: Doctor's Initial Report (Form C-4), Doctor's Progress Report (Form C-4.2), Occupational/Physical Therapist's Report (Form OT/PT-4), Psychologist's Report (Form PS-4), and Ancillary Medical Report (Form C-AMR) with a singular form, the CMS-1500. This initiative will help reduce paperwork, lower provider administrative burdens, and will leverage physicians' current medical billing software and medical records while promoting a more efficient workers' compensation system.
It is expected that the initiative will roll out in three phases, see details here.
Visit the CMS-1500 Initiative section of the CMS website to access technical specifications for the CMS-1500 medical billing and associated acknowledgement data and to find periodic updates.
3.23.18: NYACP Holds Quarterly Council/Board and Health and Public Policy Committee Meetings
On March 1st, the Chapter convened for two meetings: the Council/Board Meeting and the Health and Public Policy (HPP) Committee meeting. These meetings were conducted via video conference across five sites including Long Island, Manhattan, Albany, Syracuse, and Rochester.
At the Council/Board meeting, current legislative activities and NYS budget items were discussed with significant detail following at the HPP meeting. Upcoming educational meetings were reported, and are posted in the Education section of the website
A large focus of discussion was a recent study from the New York Center for Health Workforce Studies showing that the gender pay gap in medicine is increasing in New York State. The full report can be read here. The Council/Board took a strong position opposing gender bias in the healthcare workplace and will advocate for equal pay and more awareness among members, leaders, academia, administration and teaching faculty.
A paper created through the Chapter’s Ethics Committee covering Life-Sustaining Therapies for patients who lack capacity was approved. The paper highlights components of the Family Healthcare Decisions Act and how it impacts providers.
During the Health and Public Policy meeting, current New York State budget issues were discussed in detail including the Comprehensive Medication Management (CMM) proposal, Community Para-medicine proposal (CPP) and authorization for corporate owned Retail Clinics, all of which are opposed by the Chapter in their current form.
CMM aims to build upon the success of the existing Collaborative Drug Therapy Management demonstrations by giving pharmacists the ability to manage patients’ medications after establishing a collaborative agreement with a physician or nurse practitioner. This proposal does not define the specific disease limitations, what this collaborative plan would look like, or mandatory requirements such as connected EMRS and adequate timelines for communication.
The CPP proposal would expand the scope of practice of EMTs and paramedics to allow them to provide primary care services in residential settings. The proposal is extremely broad in scope and not well defined, and although the intent to improve access to care is worthwhile, the potential of increased access will not result in improved quality without stricter definitions and/or limitations in the bill.
The creation of Retail Clinics owned and operated within corporate owned retail centers such as pharmacies, shopping centers, malls, etc. violates the current corporate practice of medicine restrictions in New York. These restrictions exist for a reason, prohibiting conflict of interest by corporate decisions makers based on profit versus clinical decision-making.
Legislation aimed at reducing paperwork for physicians would prohibit insurance companies from making mid-year formulary changes in a patient’s medications and is strongly supported by the Chapter.
More than 600 bills are monitored as priority for our Chapter within the current Legislative session. Chapter leaders and committee members set the policy for the Chapter, and the strong input of our members is clearly demonstrated at these meetings.
1.26.18: New York Chapter Advocacy in Action
Since the first of the year, the Chapter has handled a number of regulatory, legislative and administrative matters important to our members and their practices. Following is a bulleted list, in future issues we will go into more detail on some of the legislative and regulatory proposals.
- Reviewed State of the State and Budget released by Governor Cuomo
- Highlighted areas of interest and/or concern to our members including:
- additional accountability for opioid prescriptions
- taxation of vaping products
- surcharge on insurer profits to increase revenues for indigent care pools
- provisions for retail clinics within corporate entities such as pharmacies
- adequate funding for Doctors Across New York and other workforce programs
- provisions for telehealth/telemedicine enhancement and expansion
- continuation of excess (2nd layer) medical liability insurance coverage
- proposal to create protocols and collaborative agreements for pharmacists to perform comprehensive medication management of patients/establish community paramedicine – allowing additional services by EMS providers in residential settings under collaboration with a hospital, physician, EMS provider or home care in residential settings
- Drove out messaging on the cyber incident involving Allscripts with practical steps for members to take to handle prescriptions while the e-prescribing system was not functioning
- Continued to monitor impact of the e-prescribing failure with recommendations to the Department of Health to alleviate burden on practice
- Messaged Governor’s office again expressing our concern on the pending legislation to extend the statute of limitations in medical liability cases related to tumor care (to be signed or vetoed by Feb 1)
- Met with Senate staff to discuss additional legislation to create appropriation for medical liability discounts for risk management education provided by NYACP
- Met with DOH staff to articulate need for edits in pending legislation that changes new mandatory data fields in the physician profiles
- Represented our subspecialists who maintain office based surgery facilities to assure equity of new data reportingprocedures and communications
- Prepared to host four Advocacy interns (medical students and residents) serving a four week rotation to expand knowledge of public policy and how to be effective in impacting the legislative process
Any member who would like additional information on any of the above proposals should contact email@example.com.
11.22.17: CMS Joins ACP in Efforts to Put Patients Before Paperwork
Two newly announced programs from the Centers for Medicare and Medicaid Services aim to reduce the administrative burdens that government programs place on doctors, lining up with the American College of Physician's advocacy goals.
For one of the programs, CMS has indicated it would evaluate, and then amend, existing regulations so that doctors can spend more of their time treating patients. CMS officials are slated to travel the country to gather the information needed to do this. The program's name -- "Patients Over Paperwork" -- echoes ACP's existing initiative, called "Patients Before Paperwork." This initiative has been in place since 2015, and in May, its position paper on the topic, "Putting Patients First by Reducing Administrative Tasks in Health Care," was published in Annals of Internal Medicine. You can read more about ACP's initiative here.
The second CMS program, called "Meaningful Measures," aims to streamline various regulatory issues by eliminating those that are deemed overly burdensome or do not advance patient care.
To help make sure that internists are heard as CMS fleshes out the new initiatives, Shari Erickson, ACP's Vice President for Governmental Affairs and Medical Practice suggested that members "share with us what are they seeing and what are they doing, along with their practice characteristics, and we will use this information as feedback to the agencies."
Members can provide that information through a data collection tool on the College's website. ACP's data collection tool, "Administrative Tasks and Best Practices Survey", can be completed on the ACP website.
11.10.17: The Chapter's Fall Meeting with Legislative Leaders on Health Issues and Priorities for 2018
On October 31st, meetings were held in Albany with Assemblyman Richard Gottfried, Chair of the Assembly Health Committee, and Senator Hannon’s staff (Senator Hannon is Chair of the Senate Health Committee). These meetings were part of NYACP’s annual legislative planning process which allows for the Chapter to share healthcare priorities as well as determine the focus of the legislative health leaders for the 2018 session.
Linda Efferen, MD, FACP, Chair of NYACP’s Health and Public Policy Committee, Linda Lambert, NYACP Executive Director and Loretta Ponesse, NYACP Assistant Executive Director attended for the Chapter.
Existing legislation and areas for potential legislation development were discussed in detail. Copies of NYACP’s 2018 Legislative Priorities and draft Educational Paper on Geriatric Medicine (both approved on 10/27/17 and viewable here), were discussed. Serious concerns about the medical liability statute of limitations bill (S.6800/A.8516) which passed in June and will soon be sent to Governor Cuomo for his signature were reviewed, and its significant impact on internists and other primary care providers was outlined. Delays and challenges associated with the DANY application process, proposed changes to the NYS physician profile, and feedback pertaining to Alternative Payment Models (APMs) and Regulatory Modernization Initiative (RMI) workgroup meetings were other important topics covered. The Chapter will continue to provide legislative updates to members as we approach the end of the year and as the next session is convened in early January 2018.
6.29.17: End of Session Update
The 2017 State Legislative session ended with some wins and a loss. Final actions included expanding medical marijuana use for PTSD, curbing electronic cigarettes, and extending time limits for filing medical malpractice lawsuits.
There were also several noteworthy “victories”—bills that we opposed and were not passed. Our credible relationships with legislators and our office’s close proximity to the Capitol, as well as our strong coalition with other medical specialty societies and patient groups helped to stop these bills. We blocked several medical liability bills simultaneously introduced at the very end of the session, all of which threatened to increase attorney contingency fees beyond their current limit. Any increase in contingency fees would of course further increase premiums, which is why opposing such changes remains a top legislative priority for us. Other bills that we opposed and that were not passed related to opioids, including mandated provider counseling prior to prescription of a schedule II opioid and limitation of an initial opioid prescription to 3 days (reduced from the current 7-day limitation).
We also had some victories regarding bills that we supported. E-cigarettes are now regulated under the Clean Indoor Air Act, possession of e-cigarettes is now prohibited on school grounds, and e-cigarette retailers are now required to register with the department of taxation and finance.
Of most significance to our members was the change to medical malpractice cases that expands the statute of limitations for plaintiffs (injured patients) to bring lawsuits against a physician. Whereas previously patients had 2.5 years from the date of the alleged malpractice to file a lawsuit, now patients have 2.5 years from the date of discovery with a maximum time limit of 7 years from the date of the alleged malpractice for failure to diagnose cancer or malignant tumor. Since this bill’s passing, malpractice insurance premiums are expected to increase by a minimum of 15%.
Overall, this was a very busy legislative year and a particularly eventful end of session. We thank all of our members who responded to our calls for legislative action—your state representatives heard your voices, loud and clear! As always, we take our duty to advocate for our members’ interests very seriously, so we are already reflecting on this year’s outcomes to begin preparing for the legislative session in 2018!
5.1.17: 2017 ACP Leadership Day in Washington DC
ACP’s Leadership Day was held in Washington DC on May 23-24, 2017. The NY Chapter delegation consisting of 11 members, 4 residents, 1 medical student and staff visited with federal representatives and/or staff in the offices of: Senators Charles Schumer and Kirsten Gillibrand and 12 of our elected officials in the House of Representatives.
Discussion focused on:
- Reducing Unnecessary Administrative Tasks on Physicians and Patients
- Funding for Workforce, Medical and Health Services Research, Public Health Initiatives
- Graduate Medical Education (GME) Funding
- Medical Liability System Reform
- Protecting Affordable Health Care Coverage and Consumer Protections
1.18.17: What Advocacy Did for You in 2016
NYACP advocacy activity consists of monitoring legislative sessions and working with the legislators, the Administration, the State’s regulatory agencies, and industry stakeholders (such as other medical and specialty societies, insurers, hospitals, patients and other allied health professionals) to assure physician representation and input on all discussions related to patient care. Always putting patients first, by our actions we advance Internal Medicine and improve patient care.
Here are just a few
of the results of NYACP advocacy in 2016: Read the full report here.
Changes to E-Prescribing Laws
Passage of Prior Authorization Standards
- 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.
12.8.16: Chapter Approves 2017 Legislative Priorities
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.
12.8.16: NY Chapter Resolution Addressing "Cold Calling" Acted on by National ACP
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.
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
10.6.16: NYACP Members Act and Governor Signs E-Prescribing Amendment
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.
Last Updated 11.21.18
2019 New York Legislative Priorities
Grassroots Action Center