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NYSSOS Advocacy Day attendees took part in a direct briefing from top state officials concerning the status of the nascent State Master Plan for Aging. Governor Hochul signed an Executive Order in November of 2022 mandating the creation of the master plan, which is to include the development of strategies for government, the private sector, and the non-profit sector to support older New Yorkers.
The briefing to NYSSOS members was provided by NYS Office for Aging Chief of Staff John Cochran and NYSDOH Center for Aging and Long Term Care Bureau Director Karisa Capone.
The briefing and accompanying dialogue focused on strategies to address challenges related to communication, coordination and innovative care.
Engagement of the musculoskeletal community was emphasized by the presenters, who indicated that orthopaedic physicians“can play an important role in the care and identification of older patients, as well as their caregivers, that are in need of supports and services to help enable them to remain in their community of choice.”
According to the presenters, strategies than can be supported by the orthopaedic community include:
Addressing social determinants of health, and promoting healthy aging, including falls and fall injury prevention.
Employing alternatives to opioids for pain management to limit delirium and adverse medication interactions.
Developing partnerships with local Departments of Health, the aging services network and community based service providers to facilitate aging in place and successful post-acute care discharge outcomes.
Promoting social and recreational opportunities to increase mobility, including use of walkable, bikeable, transit-friendly communities.
Use of multi-disciplinary care models that foster aging in place.
NYSSOS will be represented on the Master Plan by its legislative and advocacy chairperson, John Reilly, MD, and will continue to work with state officials to monitor and assist in developing Master Plan orthopaedic elements that are effective, reasonable and sustainable.
To learn more about New York’s State Master Plan for Aging visit: https://www.ny.gov/programs/new-york-states-master-plan-aging
A team of NYSSOS leaders representing every corner of the state concluded a dynamic day of meetings on April18, converging in Albany for the NYSSOS 2023 Advocacy Day.
The team of orthopaedic surgeons collectively met with top several lawmakers, including those who chair the committees most important to advancing NYSSOS legislative agenda including:
Senate Insurance Committee Chair Neil Breslin - Senate sponsor of “Gold Card” legislation
Assembly Insurance Committee Chair David Weprin
Assembly Higher Education Chair Pat Fahy
Assemblymember John T. McDonald III - Assembly sponsor of “Gold Card” legislation
Senate Health Committee Director Tony Kergaravat
Assembly Health Senior Policy Adviser Mark Kissinger and Committee Coordinator Sherri Salvione
The topics addressed in the various discussions with the lawmakers and their staff focused on a number of NYSSOS’ legislative priorities, including:
Supporting legislation to reform insurance company prior authorization practices, including passage of the Breslin/McDonald sponsored “Gold Car” bill.
Supporting legislation to establish important qualifications for clinical peer reviewers by requiring them to be licensed in New York, and in the same or similar specialty as the treating physician.
Supporting legislation that would authorize licensure of athletic trainers, including provisions for athletic trainers to work under the supervision of a physician.
Opposing several separate proposals that would broaden the scope of practice for a number of non-physician professionals, including podiatrists, physician assistants, chiropractors and physical therapists. The general message relayed to lawmakers was that increasing scope of practice without commensurate education and training is unsafe.
Advocating for a thoughtful and comprehensive approach to reforming medical malpractice insurance practices.
NYSSOS is grateful to the members who traveled to Albany to advocate on behalf of the musculoskeletal community.
Access the NYSSOS 2023 legislative agenda, and tools you can use to contact your lawmakers, can be found at: https://nyssos.org/takeaction.
NYSSOS is pleased to report that the Workers Compensation Board (WCB)has revised a proposed rule on intraoperative neurophysiological monitoring to address numerous concerns raised by NYSSOS. As a result, the revised proposed rule now aligns with the current standard of practice and the standards of professional medical societies andpayers (including the Centers for Medicare and Medicaid Services), and assures that this critical service continues to be available for injured workers undergoing surgical procedures.
Based on concerns expressed by NYSSOS, the revised proposed rule includes important changes to several provisions. Among other provisions, the revised proposed rule:
Removed the requirement that the monitoring physician be in constant attendance and available for actual on-premises assistance.
Replaced the requirement for being on premises with a requirement that the Monitoring Physician be a WCB-authorized provider credentialed or with guest privileges where the procedure is being performed.
Removed reference to “available to provide actual on premises assistance.”
Deleted prohibition on using billing code 94941.
Added language clarifying that remote IOM billing shall not exceed the amount billed using code 95940
The revised rule is now subject to a 45-day public comment period.
To read the revised proposed rule CLICK HERE.
To read NYSSOS's letter to WCB supporting the revised proposed regulation and urging its final adoption CLICK HERE.
On February 28, 2023, the New York State Department of Health issued updated guidance regarding elective surgery pre-procedure testing for SARS-CoV-2. > Access the advisory: click here.
CDC guidance states that SARS-CoV-2 viral testing of asymptomatic patients before elective surgery or procedures by hospitals, ambulatory surgery centers, office-based surgery practices, and diagnostic and treatment centers, is at the discretion of the facility.
Pre-procedure testing to identify asymptomatic infection might continue to be useful in some situations, including when performing higher-risk procedures. Pre-procedure testing can also help inform the type of infection control precautions used (e.g., room assignment, cohorting, or personal protective equipment) to prevent unprotected exposures.
This advisory supersedes all previous guidance pertaining to elective surgery pre-procedure testing for SARS-CoV-2.
NYSDOH recommends that all healthcare settings continue to adhere to the infection prevention and control guidance issued by the Centers for Disease Control and Prevention (CDC).
See: Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease2019 (COVID-19)Pandemic).
General questions or comments about this advisory can be sent to:
covidhospitaldtcinfo@health.ny.gov, or icp@health.ny.gov
By NYSSOS President Samuel Flemister, MD
(Based on Written Testimony Submitted Earlier Today)
Governor Hochul ’s 2023-2024 Executive Budget proposal contains a number of elements that are of particular interest to orthopaedic care providers as they relate to our ability to sustain access to the best possible patient care.
We are grateful to see the proposed extension of the excess medical malpractice program through June of 2024. This program is essential to New York ’s ability to maintain a workforce of physicians that can meet current and future service demands. We would ask the Governor and Legislature to extend this program for more than just one year, however, since many physicians base their practice location decisions on multi-year environmental forecasts, including medical malpractice costs, which are already the highest in the nation in New York.
Additionally, NYSSOS supports the investments made by the Executive to aid in the recruitment and retention of skilled medical staff. We are indeed facing a staffing crisis that demands urgent government action, and we prevail upon the Legislature to make any additions possible to these efforts.
NYSSOS is also supportive of the Governor’s proposals to promote the avoidance of tobacco products. Tobacco has been shown to have detrimental musculoskeletal effects, both directly through smoking and passively through secondhand smoke inhalation.
There are other provisions in the Governor ’s proposal, however, that are of great concern relative to their likely impact on the quality and availability of care.
Chief among these concerns are plans to eliminate physician supervision requirements for Physician Assistants with 8,000 or more “primary care” practice hours. This action will significantly diminish the quality, safety and reliability associated physician-led care, especially for vulnerable populations. The promise of more effective and cost-efficient care rests not on the idea of physician extender independence, but rather on better practice integration of these skilled providers under the existing supervisory structures that are paramount to both care quality and patient safety. We therefore urge the Legislature to reject this proposal and to prioritize building healthcare teams with appropriate safeguards and increased transparency.
Similarly, NYSSOS is concerned with the potential unintended consequences of the Governor’s proposal regarding ‘Site of Service Reviews.’ This is a complicated proposal that deserves further study and scrutiny before any changes are enacted. NYSSOS believes the timeline for enacting the state budget stifles the opportunity for deliberative discussions and this proposal should be considered outside of the budget process.
Lastly, the Governor ’s proposal to submit certain private practice matters to state review and approval may pose a considerable threat to the organic evolution of medical services, especially in communities where the need for care is most acute. Minimally, we would ask the Legislature to remove this policy matter from the omnibus budget legislation and carefully consider its implications as a stand alone proposal. Within any context however, as written, we would urge the Legislature to reject it.
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About NYSSOS: Representing more than 800 orthopaedists across New York State, NYSSOS advocates for orthopaedic surgeons, patients and musculoskeletal health in New York State. NYSSOS is the orthopaedic community’s primary source of information and expertise concerning: legislative/regulatory advocacy (local, state and federal levels); practice trends and change; leadership training for national, state, and local issues and opportunities; assistance with establishing and maintaining a practice; and familiarity with state practice guidelines impacting the profession and patient care. Learn more at www.nyssos.org
The Governor’s address and accompanying book contained a number of measures that are of great interest to the orthopaedic community. Her initiative to focus on helping seniors live healthy and independent lives is an imperative. As NYSSOS members can attest, mobility is the greatest factor in maintaining independence, and helping seniors remain mobile and active is a singular focus of New York’s orthopaedic physicians as New York is home to the fourth largest population of older adults that continues to grow. We are eager to help the Governor succeed.
Other initiatives contained in the Governor’s message that are timely and necessary include proposals to address staff shortages, reform the certificate of need process, as well as proposals to expand insurance coverage.
Perhaps most notable is the Governor’s call to establish a Commission on the Future of Health Care. New York must adapt for the 21st century leveraging team-based care led by physicians, the power of technology and telehealth and lessons learned from the COVID-19 pandemic. We look forward to being part of these important discussions with other stakeholders, which must also address insurance and prior authorization reform and achieving comprehensive medical malpractice reform. These discussions are important as we seek to assure continued access to care for patients, reduce healthcare disparities and strengthen the healthcare workforce, systems and ecosystem.
NYSSOS recognizes the State of the State is the first step followed by the release of the Executive budget proposal and looks forward to discussing these important issues with the Governor and Legislature.
It’s no secret that New York’s medical liability system is broken, failing both practitioners and patients. It’s wasteful, costly, inefficient and inconsistent. Based on those concerns, the New York State Society of Orthopaedic Surgeons (NYSSOS) for years has joined a vast chorus of organizations in calling for the development of a comprehensive package of medical liability reforms that improve patient access to care, enhance patient-physician communication, facilitate improvement of patient safety and quality of care, reduce defensive medicine, decrease liability costs, and fairly compensate negligently injured patients.
S74A will do little to facilitate these goals. In fact, one recent actuarial study has estimated that this legislation could increase New York ’s already high medical liability premiums by as much as 40%. Moreover, Deiderich Healthcare ’s 2020 report identified New York as the national leader in malpractice payouts, which in 2019 exceeded $661 million dollars. The study further found New York second in the nation on a per capita basis in payouts. Advancing the legislation as written will only fuel more unpredictable and inequitable compensation amounts from case to case that are not necessarily related to medical negligence or adverse events.
But the most troubling issue with the legislation is not the dollars, it’s the impact that these already high costs have on patient care. More than 30 hospitals already receive extraordinary financial assistance from the state to sustain patient care services, and if this bill is signed in its current form, we risk hospital, emergency room, primary care and urgent care closures. These consequences will most severely impact safety net care providers in underserved communities, placing those with below average access to quality care at risk and compromising the social equity the bill’s proponents seek to achieve.
The Governor should use a veto as an important pause to reconsider a more balanced approach and bring New York into alignment with other states that have applied necessary and reasonable restrictions to similar legislation. Otherwise, the bill will reverse the state’s current investments in its health care workforce, threaten retention and growth in this sector of our economy and harm New Yorkers across the state by jeopardizing access to vital health care services. This would include orthopaedic high risk patients such as the elderly or persons with physical trauma.
For these reasons, NYSSOS has joined with numerous other organizations and industries to urge Governor Hochul to veto this bill. We also encourage policy makers to address liability reform with a more thoughtful and balanced approach to achieve comprehensive reform as other states have recently done, proving that consensus can be forged to protect patients as well as the health care system and physicians.
To provide a more meaningful context, consider that in her inaugural address Governor Hochul pledged to address what she termed “the affordability crisis in New York State.” This is a critical concern as a new census report found New York had the greatest population loss of any state between July 2021 and July 2022, with 180,000 New Yorkers leaving. Enacting S74a will only further incentivize an exodus the state can ill afford by driving insurance cost increases in nearly every sector, including health insurance, automobile insurance, and virtually every type of liability insurance.
A veto of S74A provides the Governor with a clear opportunity to address this crisis. We encourage her to do so, swiftly.
Samuel Flemister, MD, President of the New York State Society of Orthopaedic Surgeons, and Board Certified Orthopaedic Surgeon
Appeared in
The AAOS approved an update to the 2015 Clinical Practice Guideline (CPG) for the Surgical Management of Osteoarthritis of the Knee.
This CPG updated 18 of the 38 evidence-based recommendations included in the 2015 CPG.
This update resulted in 10 strong and six moderate recommendations for the surgical management of skeletally mature patients diagnosed with osteoarthritis of the knee.
View the new CPG
Amid a torrent of recent bill signings, Governor Hochul signed into law a measure (S4640/A273) mandating physicians treating painful neuromusculoskeletal conditions to consider, discuss, and, if appropriate, refer or prescribe non-opioid treatments before prescribing an opioid.
NYSSOS aggressively opposed this measure along with many other stakeholders due to its inherent interference with the physician-patient relationship and negation of the physician's expertise regarding treatment for neuromuscular problems. The enactment of this law was one of five bills signed by Governor Hochul to enhance access to care and treatment for substance use disorders. NYSSOS will continue to work with policymakers to mitigate the impact of the measure
In the meantime, NYSSOS is seeking clarity from state regulators concerning compliance and general implementation information. We will share any guidance provided by the state as soon as it becomes available.
In another action, Governor’s Hochul vetoed a bill (A879/S8113) that would have established important qualifications for clinical peer reviewers, who insurers and health plans use to make medical necessity determinations. The legislation would have required the reviewer to be a physician licensed in New York State and of the same or similar specialty as the physician who would typically manage the medical condition or disease or provide the treatment under review. Under current law, the reviewer does not have to be a physician licensed in New York State or have board certification and/or eligibility in the same or similar specialty.
NYSSOS joined with other organizations, including the Medical Society of the State of New York (MSSNY), to advocate in support of this measure. The governor’s veto message included a number of reasons for rejecting the measure, chief among them the concern that it would “pull specialists out of health care and into claims review, removing them from hospitals and specialty care offices” and thus exacerbating the current health care workforce crisis. The governor indicated that she planned to revisit the issue in the upcoming legislative session. NYSSOS will continue to partner with MSSNY and other organizations to address the inadequacies and inequities of current claims review processes and broader insurance and prior authorization reform.
The Department of Health and Human Services, Office of Civil Rights (“OCR”) has published a Bulletin which officially states that incorporating certain tracking technologies into websites and mobile applications may cause HIPAA violations that could result in breach notification obligations as well as penalties. This includes platforms and services provided by companies like Meta (formerly Facebook) and Google.
Covered Entities need to take immediate steps to identify their uses of tracking technologies and whether there are appropriate safeguards in place to prevent inappropriate use or disclosure of PHI.
Learn More
Advocating for the orthopaedic surgeon, patients and musculoskeletal health in New York.
info@nyssos.org 1-518-439-0000 Address: PO Box 38004, Albany, NY 12203
