Reform Needed Before Date of Discovery Change – June 12, 2015
This week, the NYS Assembly passed “Lavern’s Law,” legislation that extends the statute of limitations (SOL) on medical malpractice cases. If passed, the SOL begins to run from the date of discovery of the alleged harm rather than from the date of “injury” as is currently the law. It remains to be seen if next week, the Senate takes up the bill in the remaining days of the current legislative session. On the surface, it seems impossible to raise any valid ethical arguments against the right of an injured patient to be legitimately compensated for harm caused. It seems logical that a wronged patient should be able to file a lawsuit within a period of time that commences the running of the statute of limitation from the time they became aware of the injury. Is it really fair that the timeline for seeking redress begins from the time of injury when one is not aware that injury has occurred? This is the argument raised by those advancing Lavern’s Law. Raising any objection or any argument against this framing or analysis seems repugnant and places those advancing a different view in a seemingly untenable position. And yet, I argue that we must advance a different view to afford ALL New Yorkers the justice they deserve.
Consequences of Lavern’s Law
The framing of justice for injured parties must be placed in a wider framework that includes consideration for all parties in a claim concerning injury as well as the consequences to society at large in regards to access to healthcare. First, one needs to ask the question why are there two time standards concerning the SOL for the Lavern case? The time frame for filing a lawsuit alleging harm in the case of municipal hospitals such as in the Lavern case is 15 months. However, in most other cases, the SOL runs 2 ½ years. Shouldn’t the standards be the same? Second, should any consideration be given to the consequences on premium rates and ability to retain physicians in NYS if the SOL is amended? Are the residents of the State of New York benefitted by a law that may drive physicians to insurance companies in precarious financial positions or may not even be chartered in New York, thus making recovery for damages more difficult for legitimately injured parties? Will New Yorkers benefit from a seemingly just law that drives more Obstetricians and Neurosurgeons out of this state? Third, Lavern’s Law fails to grant justice to defendants where a statute of limitations is drawn out longer possibly blurring the memories of both the plaintiff and defendant. What can an injured party recall about a conversation with a physician nine years after a patient-doctor encounter? What can a physician recall about his/her cognitive thinking on a finding in question where the standard of care has changed over that period of time?
Big Picture Required for Real Solutions
On the surface, Lavern’s Law seems just. And yet, on further analysis, one realizes it is a disservice to ALL New Yorkers. Concerns for injured parties who are unaware of injury and later cannot obtain justice within the current legal framework deserve justice. However, solutions for how justice should prevail MUST be carried out within a more comprehensive discussion on tort reform. Other states that have addressed justice for the concerns in Lavern’s Law have done addressed other “big picture” concerns such as caps on non-economic damages. It’s time New York did the same: REFORM OUR TORT SYSTEM!
Please have your medical staff and family weigh in on this issue affecting ALL NEW YORKERS by using our grassroots advocacy website.
Joseph Maldonado, M.D, MSc, MBA, DipEBHC
Please send your comments to email@example.com
All physicians must continue to contact their senators immediately to urge that they oppose legislation (S.911, Libous) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule. The letter can be sent here. This week the bill was passed by the New York State Assembly by a 120-25 vote (roll call here).
MLMIC’s estimate based upon similar legislation is that this could single bill could increase physician liability premiums by an untenable 15%! As New York physicians continue to pay liability premiums that are among the very highest in the country and face reduced payments from Medicare and commercial insurers, as well as rapidly increasing overhead costs to remain in practice, no liability increases can be tolerated.
MSSNY is working with many other provider associations also impacted by this legislation, including HANYS, GNYHA, nursing homes associations, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation. As reported in today’s Crains’ Health Pulse, ads will be running in several newspapers across New York State urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care. For example, the ad notes that while many other states have adopted “date of discovery” exceptions to their statutes of limitations, the vast majority of these states have also enacted limitations on non-economic damages. To view the ad, click here. (DIVISION OF GOVERNMENTAL AFFAIRS)
The New York State Senate on Tuesday, June 9, 2015 passed Senate Bill 4348 (Hannon), which would require physicians to take three hours of continuing education on pain management, palliative care, and addiction. Its companion measure, Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal, is on the Assembly Debate list and can be voted at any time. While several legislators have urged that this bill be defeated, we need more given the significant recent media attention to this issue. Physicians are urged to send a letter urging defeat of this measure.
Additionally, the Governor has submitted to the NYS Legislature, language in his heroin legislative package that would require a four hour course work in pain management and addiction as part of registration renewal for all prescribers in New York State. This language also provides an exemption from the requirement to anyone who requests the exemption and can clearly demonstrate that there would be no need for him/her to complete such course work because of the nature of his/her practice or can demonstrate that he/she has completed course work deemed by the department or the professional’s certifying or accrediting body to be equivalent to the course work approved by the department.
Assembly Bill 355/Senate Bill 4348 would require three hours of course work every two years for physicians and other healthcare workers. Under the bill’s provisions, the course work would include each of the following topics: I-STOP and drug enforcement administration requirements for prescribing controlled substances; pain management; appropriate prescribing; managing acute pain; palliative medicine; prevention, screening, and signs of addiction; responses to abuse and addiction; and end-of-life care.
New York legislators have already taken aggressive and far-reaching actions to reduce the inappropriate prescribing of diverting of pain medications and the action taken has worked. In particular, New York State now ranks 50th in overall utilization of opioids and has shown a -12.4% reduction in the filling of hydrocodone prescriptions between 2013 when the ISTOP law was first implemented and 2014. This comparison data is from IMS, Inc. Plymouth Meeting PA, — a company that provides information, services and technology for the healthcare industry. It is the largest vendor of U.S. physician prescribing data in the nation. It was provided to MSSNY from the American Medical Association. Nationwide, there are 13 states that require physicians and other prescribers to complete either a one-time course or a course every two to four years in pain management and opioid prescribing. All of these states ranked higher than New York State (50th) in overall utilization of opioids (annual prescriptions per capita 2014 Opioid Products). New York State was 46th in the growth in opioid utilization by state (per change in filled prescription 2014 vs 2013)—only two states with CME had a greater reduction in the growth of opioid utilization. New York State also ranked 45th in growth on hydrocodone utilization by state (NY saw a reduction of -12.4% in filled prescriptions between 2014 vs. 2013)—again only two states that require CME had greater reduction—Rhode Island ( a state that requires CME) had a -12.9% reduction in filled prescriptions. According to IMS Health, Inc., NY is ranked 49 in overall utilization of Controlled Substances II and 41 in growth in Controlled Substance II utilization. Overall utilization of Controlled Substance III, New York State is ranked 27th, however, growth in Controlled Substance III was reduced by -5.8% and the state is ranked 50th in growth of utilization with all CME states above New York.
This data shows strong evidence that prescribing practices by physicians have changed within the last two years due to the implementation of ISTOP in August 2013 that required physicians to check the Prescription Monitoring Program (PMP) prior to issuing a prescription for any controlled substances. There has been strong physician compliance with the law and in many respect; it has been successful in achieving its goals to significantly reduce doctor shopping and reduce drug diversion. According to the New York State Department of Health and the policy paper by Brandeis University: Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States— since the implementation of ISTOP drug diversion in New York State has been reduced by 75%. MSSNY believes that the implementation of the I-STOP law and the statutory requirement for all prescribers to check the PMP prior to issuing a Controlled Substances II, III, IV prescription has already changed prescribing practices within New York State in a relatively short period of time. It would appear from the data noted above the PMP has changed behavior more significantly than would continuing medical education coursework and training in the area of pain management and opioid use as noted by the data by the IMS Health, Inc. MSSNY also believes that the implementation of the E-prescribing requirement for controlled substances and non-controlled substances in New York State, will also significantly impact prescriber’s behavior and the exercise of their clinical judgment in the use of controlled substances. (CLANCY, DEARS)
MSSNY, working closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, is aggressively pursuing legislation (S.4651-C, Griffo/A.7129-C, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public. Importantly, this bill will require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional. In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information. Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty. Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship. Importantly, this measure would also require health care practitioners to wear an identification name tag during patient encounters that includes the type of license held by the practitioner. The bill would also require the health care practitioner outside of a general hospital to display a document in his or her office that clearly identifies the type of license that the practitioner holds.
Physicians are encouraged to contact their elected representatives in both houses of the Legislature to ask that the bill be passed this year.
Legislation that would expand the list of immunizations that pharmacists can provide to adults appears headed for passage in the New York State Legislature. A. 123B/S. 4739A, sponsored by Assemblywoman Amy Paulin and Senator Kemp Hannon, would add Diphtheria, Tetanus and Pertussis to the list of vaccines that can be administered by pharmacists. The bill also allows physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines. The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script. The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis. Importantly, the bill requires the pharmacist to report the administration of the vaccine to the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry. Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner. The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide. The bill also contains a three year sunset. The New York City Department of Health has made passage of this bill a priority; pharmacists and the pharmaceutical industry is also lobbying in support of the bill’s passage. The Medical Society of the State of New York remains opposed as it believes that this policy would further fracture the concept of the “medical home”. The bill is pending in the Higher Education Committee of both houses, but it is expected to be placed on the agenda and moved to the floor for passage next week.
(CLANCY, DEARS, ELLMAN)
Senate Bill 2202B/A. 5595B, sponsored by Senator Kemp Hannon and Assemblywoman Linda Rosenthal, is pending in the New York State Legislature. The bill would prohibit e-cigarette use in all public places in accordance to the NYS Clean Indoor Air Act. The bill is on Senate floor and is in the Assembly Codes Committee. Physicians are urged to contact their legislators in support of this measure. In 2003, New York updated its Clean Indoor Air Act by prohibiting the use of tobacco products in all workplaces. The purpose was to protect workers from the dangers of secondhand smoke and to provide clean indoor air for the overwhelming majority of New Yorkers who do not smoke. Due to this law and other important steps that New York has taken, the state have seen major reductions in smoking rates. However in recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit. Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions. Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law. The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure. The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute. MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air Act. (CLANCY, ELLMAN)
Assembly Bill 791C, sponsored by Assemblywoman Aileen Gunther, is pending in the Assembly Codes Committee and its companion measure, Senate Bill 4324A, sponsored by and Senator Kemp Hannon, is on the floor of the Senate for a vote. This bill would require school-based immunizations against the meningococcal disease for every person entering seventh grade and 12th grade. The Medical Society of the State of New York has been part of a coalition of organizations supporting this legislation and is urging physicians and their patients to advocate in legislation. Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill. MSSNY has also developed a patient-support letter that patients can use to urge support of this legislation.
This bill is consistent with the Advisory Committee on Immunization Practices. Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis. The bacteria are spread through the exchange of nose and throat droplets, coughing, sneezing or kissing. Young people, between the ages of 10-25 years of age, are most at risk for this disease. If not treated quickly, it can lead to death within hours or lead to permanent damage to the brain and other parts of the body. Organizations in support of this measure include GMHC, the American Academy of Pediatrics NYS Chapter, District II, Latino Commission on AIDS, Kimberly Coffey Foundation, March of Dimes, Meningitis Angels, National Meningitis Association, the Nurse Practitioner Association New York State, New York State Academy of Family Physicians, and the New York Chapter of the American College of Physicians. (CLANCY)
The Centers for Disease Control and Prevention (CDC) continues to work with the World Health Organization (WHO) and other partners to closely monitor Middle East Respiratory Syndrome Coronavirus (MERS-CoV) globally, including the cases of MERS-CoV infection recently reported by China and the Republic of Korea. The CDC has issued an advisory to provide updated guidance to state health departments and healthcare providers in the evaluation of patients for MERS-CoV infection, which have been revised in light of the current situation in the Republic of Korea.
The Medical Society of the State of New York has a free online program on “Coronavirus” on its website http://cme.mssny.org/. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page. Click on the menu on “My training page” to view and take the various courses. The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Healthcare providers and public health officials should maintain awareness of the need to consider MERS-CoV infection in ill persons who have recently traveled from countries in or near the Arabian Peninsula or in the Republic of Korea as outlined in the guidance. Since May 2015, the Republic of Korea has been investigating an outbreak of MERS. It is the largest known outbreak of MERS outside the Arabian Peninsula. Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS affects the respiratory system (lungs and breathing tubes). Most MERS patients developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died. The CDC is “sounding the alarm for American doctors now,” as more than 1,200 people have been infected around the world and the death toll is “approaching 500.” Further information on MSSNY CME online programs may be obtained by contacting Pat Clancy at firstname.lastname@example.org.
The following are among many scope-of-practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:
- 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians. This bill remains in the Higher Education Committee in both the Senate and Assembly.
- 5805 (McDonald)/ S.4857 (LaValle) – a bill that would expand the definition of “collaborative drug therapy management” to include patients being treated by PAs and NPs, not just physicians, and extend collaboration to unspecified disease states. It allows a pharmacist to prescribe in order to adjust or manage a drug regimen, and adds a non-patient specific protocol. The bill includes nursing homes in the definition of facility. This bill is in the Higher Education Committee in the Senate and Assembly.
- 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand on a bill enacted in 2012, and would allow podiatrists to care for up to the knee. This would include diagnosing, treating, operating or prescribing for cutaneous conditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds. It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle. It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves. This bill is in the Higher Education Committee in the Senate and Assembly.
- 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers, and call themselves naturopathic doctors. While they claim the bill would not permit them to perform invasive procedures, it would allow them to immunize and perform cryotherapy. This bill remains in the Higher Education Committee in the Senate and Assembly.
- 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use. This bill is in the Higher Education Committee in the Senate and Assembly.
- 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct. This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.
- 5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill is in the Senate Higher Education Committee. There is no same-as bill in the Assembly. (ELLMAN)
The New York Workers Compensation Board (WCB) will be hosting regional programs across New York State to update physicians, their staff and other WC stakeholders regarding the status of its Business Process Re-Engineering (BPR) to improve the WC program in New York State. The programs will be held in each District Office beginning next Tuesday in Albany and running through the first week of July. The discussion will include updates on the Board’s proposal to establish a Medical Authorization Portal and assure greater payor compliance. The release by the WCB also notes that the program will discussing upcoming initiatives. The schedule is listed below. Physicians and/or their staff are encouraged to attend.
|Menands/Albany||100 BroadwayCR 518A & 518BMenands, NY 12241||6/16/15||12:00 pm4:00 pm|
|Syracuse||935 James StreetSyracuse, NY 13203||6/17/15||12:00 pm4:00 pm|
|Binghamton||State Office Building44 Hawley Street, 18th FloorWarren Anderson Community RoomBinghamton, NY 13901||6/18/15||12:00 pm4:00 pm|
|Brooklyn||111 Livingston Street19th Floor, Room 1917Brooklyn, NY 11201||6/23/15||12:00 pm4:00 pm|
|Manhattan||215 West 125th StreetRoom 509-511New York, NY 10027||6/24/15||12:00 pm4:00 pm|
|White Plains||75 South BroadwayWhite Plains, NY 10601||6/30/15||12:00 pm|
|Queens||168-46 91st Avenue3rd Floor, Room 325Jamaica, NY 11432||7/1/15||12:00 pm4:00 pm|
|Hauppauge||220 East Rabro DriveBoard Room 116-HHauppauge, NY 11788||7/2/15||12:00 pm4:00 pm|
|Buffalo||Ellicott Square Building295 Main StreetSuite 400, Room 438Buffalo, NY 14203||7/7/15||12:00 pm4:00 pm|
|Rochester||130 Main Street WestBasement Conference RoomRochester, NY 14614||7/8/15||12:00 pm4:00 pm|
MSSNY joined with the Healthcare Association of New York State (HANYS), the Greater New York Hospital Association (GNYHA) and other provider associations in urging the New York House Congressional delegation to reject a Medicare sequestration cut extension (in 2024) included in the Trade Act of 2015 that was passed by the US Senate. To read the letter, click here. As of this writing, it appeared as if the US House of Representatives would remove the sequestration extension provision in a separate piece of legislation also to be passed by both Houses. The letter notes that: “Extending Medicare sequestration reductions to pay for non-Medicare programs reinforces a dangerous precedent set last year of syphoning funds from the Medicare Trust Fund for non-Medicare purposes. Such action will most certainly undermine the strength of the Trust Fund and the ability of hospitals, health systems, physicians, home care providers, nursing homes, and other providers to deliver the care our communities need and deserve.” Earlier this year, the American Medical Association joined the American Hospital Association in a similar letter to Congress expressing concern with extending Medicare sequestration to pay for non-health care programs.
The June 9, 2015 “Advocacy Matters” CME webinar was on the topic “SHIN-NY Statewide Patient Record Look-Up.” There will be three more sessions offered on the same topic, co-sponsored by MSSNY in conjunction with the New York Chapter of the American College of Physicians (NYACP) and the New York eHealth Collaborative (NYeC). The faculty will include David Whitlinger, CEO of NYeC, Inez Sieben, NYeC COO, Lisa Halperin Fleischer, NYeC CMO, and Paul Wilder, NYeC CIO.
- Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
- Give Healthcare Providers information on how they will be able to access and share patient records through the SHIN-NY
- Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access.
Dates, times, and registration links are as follows:
June 16, 2015 (8-9 AM): Register Here
June 18, 2015 (6-7 PM): Register Here
June 24, 2015 (6-7 PM): Register Here
For more information on the June 16 or June 18 program, contact Karen Tucker at email@example.com or (518) 427-0366. For more information on the June 24 program, contact Miriam Hardin at firstname.lastname@example.org or (518) 465-8085.
Program flyer is available here.
New York County Medical Society Honors Anthony A. Clemendor, MD
At its annual meeting on June 2, New York County Medical Society President Joshua M. Cohen, MD, MPH presented the Society’s Nicholas Romayne, MD Lifetime Achievement Award to Anthony A. Clemendor, MD.
“Dr. Clemendor has worked tirelessly on behalf of physicians and patients throughout his career,” said Dr. Cohen. “He embodies the finest attributes represented by this award and its namesake, Dr. Romayne.”
The award is named for Dr. Nicholas Romayne, who in addition to serving as the Society’s first president in 1806, was also a founder of the New York College of Physicians and Surgeons. It was said of Dr. Romayne that “he was unwearied in toil and of mighty energy, dexterous in legislative bodies, and at one period of his career was vested with almost all the honors the medical profession can bestow.” In recognition of the caliber of physician this award honors, this year the Society presents it to a physician of equally impressive stature.
A graduate of the Howard University College of Medicine, Dr. Clemendor is board certified in obstetrics and gynecology. He is Clinical Professor of Obstetrics and Gynecology at New York Medical College, where he served as a dean for 23 years.
As a member of both New York County Medical Society and the Medical Society of the State of New York, Dr. Clemendor has served in a number of capacities: he chaired the MSSNY Task Force to Eliminate Ethnic and Racial Disparities in Health Care, and served on the AMA Commission to End Disparities in Health Care. He served on the New York State Board for Professional Medical Conduct; as treasurer of the Empire State Medical Scientific and Educational Foundation; and on the New York State Council on Graduate Medical Education. In addition, he served on the Executive Committee of the Medical Society of the State for New York as Treasurer and as Councilor representing Manhattan and the Bronx.
Dr. Clemendor is a fellow of the New York Academy of Medicine. He continues to serve as vice chair of the Society’s delegation to the Medical Society of the State of New York.
Smoking levels in New York State have reached a “historic low.” According to data released Monday by the state, smoking among high school students has dropped 42% over the past four years, with the rate now at 7.2%. Similarly, the adult smoking rate of 14.5% is below the national average of 17.8%. The statewide drop comes “even as smoking has been on the rise in the city after years of decline,” reaching 16% in 2013 after achieving a low of 14% in 2010. Experts cited New York’s “nation-high tobacco taxes as a reason,” alongside anti-smoking ads, laws and programs. Gov. Cuomo said, “With the lowest smoking rate in recorded history, it’s clear that New York State is becoming healthier than ever.”
Harlan Juster, director of the state’s Bureau of Tobacco Control, stated that the data is part of an annual survey that will be released in a full report later this year. He said the state has been collecting data on smoking since 1985, “when smoking rates were 31 percent among adults.” The data shows that 17.1% of men versus 12.1% of women smoke. Furthermore, “blacks have the highest percentage of smokers: 16.1 percent, compared with 15.1 percent of whites and 14.1 percent of Hispanics.”
A study conducted by researchers at the University of Michigan and published in Stroke, based on data from over “4,900 black and white Americans aged 65 and older who underwent tests of memory and thinking speed between 1998 and 2012,” found that a stroke had the effect on the test results equivalent to aging 7.9 years. The effect of the stroke was “similar” for black and white patients.
Physicians at the 2015 AMA Annual Meeting passed policy requesting that CMS wave penalties for errors, mistakes or malfunctions in the system for two years directly following implementation. The policy stipulates that CMS should not withhold physician payments based on coding mistakes, “providing for a true transition, where physicians and their offices can work with ICD-10.” With less than four months to go before the deadline for implementing the ICD-10 code set, physicians agreed to seek a two-year grace period for physicians to avoid financial penalties to facilitate a smoother transition that would allow physicians to continue providing quality care to their patients without undue disruption.
Related policy pushes the AMA to advocate for physician voices to be part of the group that manages the International Classification of Diseases (ICD). Currently, the four cooperating parties that manage ICD code sets are the Centers for Disease Control National Centers for Health Statistics, CMS, the American Hospital Association and the American Health Information Management Association. A physician group is necessary in these conversations because none of the current groups “represent providers who have licensed authority to define, diagnose, describe and document patient conditions and treatments.”
The new policy also directs the AMA to seek data on how ICD-10 implementation has affected patients and changed physician practice patterns, such as physician retirement or moving to all-cash practices.
CMS has acknowledged that the transition to ICD-10 will have an impact on physician payment processes. The agency estimates that “in the early stages of implementation, denial rates will rise by 100-200 percent,” according to a 2013 report from the Healthcare Financial Management Association.
A 2014 AMA study (log in) conducted by Nachisom Advisors on the cost of implementing ICD-10 estimated that a small practice could see payment disruptions ranging from $22,579 to $100,349 during the first year of ICD-10 implementation. The study also estimates that a small practice could incur a 5 percent drop in revenue because of productivity loss during and after the change.
While the AMA continues to urge regulators to ease the burden of ICD-10 implementation on physicians, physicians should act now to make sure your practice is prepared.
Parents’ Age May Play Role in Children’s Autism Risk
A study found increased autism rates among children born to teen moms and among kids whose parents have large gaps between their ages. The research, published in Molecular Psychiatry, indicated that “autism rates were 66 percent higher among children born to dads over 50 years old, as compared to dads in their 20s.” Meanwhile, “autism rates were 15 percent higher when moms had children in their 40s and 18 percent higher for children of teen moms, when compared to those born to women in their 20s.”
The risk also went up even more if the parents’ ages differed by at least 10 years. The researchers found that “the age gap risk showed up especially among fathers between 35 and 44 with a partner more than 10 years younger, and among mothers in their 30s with a partner at least 10 years younger.” The investigators came to these conclusions after looking at nearly “31,000 children with autism to nearly 6 million without autism in five countries.” These findings were reported online June 9 in the journal Molecular Psychiatry. The study authors compared almost 31,000 children with autism to nearly 6 million without autism in five countries. Those countries included Australia, Denmark, Israel, Norway and Sweden.
The CDC estimates that one in 68 children has an autism spectrum disorder.
Physician burnout is largely attributed to the increasing administrative burden of modern medicine, according to a study from the AMA and RAND Corporation, a nonprofit, nonpartisan research organization that helps improve policy and decision-making.
The initiative, called AMA STEPS Forward, is comprised of interactive, online “physician-developed strategies for confronting common challenges in busy medical practices and devoting more time to caring for patients.”
“Research shows that rates of overall burnout among U.S. physicians approach 40 percent, more than 10 percentage points higher than the general population, which is why the AMA is taking a hands-on approach to meeting their day-to-day concerns through a new online practice transformation series called AMA STEPS Forward,” said James L. Madara, MD, AMA Executive Vice President and CEO, in a press release.
Many physicians say factors such as bureaucratic obstacles, administrative rules and paperwork have negatively impacted their job satisfaction—taking time away from patients and affecting their ability to provide high-quality, the report found. The initiative provides strategies to help physicians refocus their practices so they and their staff can “thrive in the evolving health care environment by working smarter, not harder.”
There are currently 16 modules available at www.STEPSforward.org. They focus on practice efficiency and patient care, patient health, physician health and technology and innovation. More than 25 modules are expected to be available by the end of the year, according the AMA. The modules can be used to earn continuing medical education credit.—
With growing concerns about the negative health effects of sports-related concussions in recent years, the American Medical Association (AMA) voted today to adopt policies aimed at reducing the risk of concussions in young athletes.
The AMA’s newly adopted policy supports requiring youth athletes who are suspected of having sustained a concussion to be removed immediately from the activity and allowed only to return with a physician’s written consent. The new policy also encourages the adoption of evidence-based, age-specific guidelines for physicians, other health care professionals and athletic organizations to use in evaluating and managing concussion in all athletes as well as the development and evaluation of effective risk reduction measures to prevent or reduce sports-related injuries and concussions.
According to the Centers for Disease Control and Prevention, between 1.6 million and 3.8 million sports- and recreation-related traumatic brain injuries, including concussions and other head injuries, occur in the U.S. every year. A recent study shows that 59 percent of middle school female soccer players reported playing with concussion symptoms, with less than half having been evaluated by a physician or other qualified health professional. A study of high school athletes with concussions also found that 15 percent returned to play prematurely, and nearly 16 percent of football players who sustained a concussion that resulted in loss-of-consciousness returned to play in less than one day.
Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.
The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.
To file a hardship exception, you must:
- Show proof of a circumstance beyond your control.
- Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.
Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.
You do not need to submit a hardship application if you:
- are a newly practicing eligible professional
- are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22 ; or
- Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)
CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.
Apply by July 1
As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered.
If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.
In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:
- Medicaid only
- No claims to Medicare
Transitioning to ICD-10-CM
This webinar will provide Part B providers with an overview of ICD-10-CM and will assist you with planning for the mandated ICD-10-CM transition. This session will include testing opportunities and transition stages that will help you prepare your office for the upcoming implementation.
As per the CMS IOM Publication 100-09, Chapter 6, Section 30.1.1, National Government Services cannot make determinations about the proper use of codes for the provider. Questions related to ICD-9-CM and ICD-10-CM are handled by the American Hospital Association’s Coding Clinic. Details about this resource are available at http://www.ahacentraloffice.org.
Date: Tuesday, 6/16/2015
Time: 12:00-1:30 p.m.
Register for session
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