Articles
Midterm election could shift balance of power in state legislature. On the eve of the midterm elections, much of the political focus in New York is on the race for governor and some key Congressional races…(nystateofpolitics)
For Election Day, here's what to know and what to watch. A primer on everything from absentee ballot-counting to the races that matter..(timesunion)
Board of Elections: NY poll workers prepped with de-escalation training. Threats to democracy have remained a top issue for voters this year as a Russian businessman Monday admitted to interfering in U.S. elections and says he'll continue to do so…(spectrumlocalnews)
Ballot questions New York voters will be asked on Election Day. New Yorkers filling out their ballots on Election Day will find more than just candidates…(pix11)
Voting law changes allow formerly incarcerated New Yorkers to vote. This midterm election could be the first year that formerly incarcerated New Yorkers have their voice heard since their convictions due to a 2021 law that reformed voting laws in the state…(nystateofpolitics)
Capital Health Consulting LLC 136 State Street, Suite 501 | Albany | NY | 12207 www.capitalhealthconsulting.com
Biden visit highlights dueling Hochul, Zeldin plans for New York's economy. The race for governor of New York this years been dominated by a debate over public safety, crime and how to fairly treat people accused of breaking the law…(nystateofpolitics)
Oregon could be 1st state to make health care a human right. Oregon voters are being asked to decide whether the state should be the first in the nation to amend its constitution to explicitly declare that affordable health care is a fundamental human right…(apnews)
Hospitals test the goodwill of Congress on Medicare cuts. Hospitals are pleading with Congress to postpone looming Medicare pay cuts, citing what they say has been an extraordinarily difficult year…(axios)
YouTube Health expands validation process for health information. As it attempts to combat health disinformation, YouTube is allowing certain healthcare professionals to apply for verification…(modernhealthcare)
WHO: Tuberculosis cases rise for the first time in years. The number of people infected with tuberculosis, including the kind resistant to drugs, rose globally for the first time in years, according to a report Thursday by the World Health Organization…(apnews)
The New York State Department of Health has extended its completion deadline for the cultural competency CME requirements to November 1, 2022 for physicians and other network providers of Medicaid Managed Care plans.
The requirement stems from the Mainstream Medicaid Managed Care, HIV Special Needs Plans, and Health and Recovery Plans Model Contract Section 15.10(c) requires that the MMCP “...ensure the cultural competence of its provider network by requiring Participating Providers to certify, on an annual basis, completion of State-approved cultural competence training curriculum, including training on the use of interpreters, for all Participating Providers’ staff who have regular and substantial contact with Enrollees.”
DOH’s notification indicates the requirement can be fulfilled through courses offered by US Department of Health and Human Services (HHS), Office of Minority Health, Think Cultural Health. Only 1 of the 3 courses is necessary to fulfil the requirement.
Access a previously published DOH letter to Health Plan Administrators with more details about the requirements.
Fact Check: Gubernatorial debate between Zeldin and Hochul. The first and only gubernatorial debate is in the books…(cnycentral)
Governor Hochul Announces Steps to Protect New Yorkers from Respiratory Illnesses This Fall and Winter. Governor Kathy Hochul today announced steps the New York State Department of Health is taking to raise awareness of and protect New Yorkers against respiratory virus infections that are spreading this fall and expected to continue through the winter…(governor.ny)
Can independent voters make the difference in New York governor's race? For Tim Dunn, neither Democratic Gov. Kathy Hochul nor her Republican opponent, Lee Zeldin, offer much for independent voters like him…(nystateofpolitics)
Concussion protocols are based on research of mostly men. What about women? Lindsay Simpson still has questions about her concussions…(npr)
(Albany, New York) The New York State Society of Orthopaedic Surgeons (NYSSOS) today announced that it has selected Assemblymember John T. McDonald III, RPh, as the 2022 NYSSOS “Legislator of the Year.”
The award was presented to Assemblymember McDonald at the NYSSOS 2022 Annual Meeting and Symposium, entitled “50 Years of Service and Innovation,” which marks NYSSOS’ 50th anniversary.
Assemblymember McDonald was selected for the award based on his strong commitment to developing balanced and thoughtful solutions to the complex issues that abound in the arena of health care policy.
In particular, he has been a strong supporter of reducing administrative and regulatory burdens to better ensure patients everywhere have access to quality, comprehensive musculoskeletal care in New York State. His sponsorship this year of much needed prior authorization reforms (A.9908A) is just the most recent example of his leadership in crafting sound health care policy.
In presenting the award, NYSSOS President John DiPreta, MD, said of Assemblymember McDonald: “His is a voice of reason, compassion and firsthand knowledge that has been an indispensable element of New York’s efforts to meet the challenges of our healthcare system. On behalf of the New York State Society of Orthopaedic Surgeons, it is with great pleasure that we recognize Assemblymember John T. McDonald III as the 2022 NYSSOS Legislator of the Year.”
Assemblymember John T. McDonald III, RPh, said: "Thank you to the New York State Society of Orthopaedic Surgeons (NYSSOS) for the honor of being named as your ‘Legislator of the Year.’ As a health care professional and legislator, I believe that my experience as a pharmacist is an asset when considering and shaping legislation. Congratulations to NYSSOS on your 50th anniversary and I hope you have productive meeting and symposium.”
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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
This is a reminder that mandatory use of the CMS-1500 form went into effect on July 1, 2022, for professional services and durable medical equipment bills/reports. Facility-based services may continue to be billed on a UB-04 or CMS-1450.
You can read more about the requirements and form changes in the GovDelivery dated June 27, 2022.
Important: In the medical narrative attachment that accompanies the CMS-1500 form, health care providers must indicate (either at the top of the narrative, or otherwise prominently displayed) the injured worker’s temporary impairment percentage, current work status, and the causal relationship of the injury or illness.
If any of these elements are missing, the medical narrative report may be found legally defective, which means the injured worker may not receive benefits and you may not be paid for rendered services. You can use the Board’s medical narrative template to ensure you capture these elements.
Visit the Workers' Compensation Board’s (Board's) website for CMS-1500 news, FAQs, and more. The Board has also created a special webpage dedicated to sharing timely updates on various Board initiatives with a health care provider focus. Visit What Providers Need to Know to view the latest!
For CMS-1500 feedback and questions, email CMS1500@wcb.ny.gov. For clinical feedback and questions, email provider@wcb.ny.gov.
AAOS leadership, in conjunction with the Office of Government Relations, is hosting a second annual Orthopaedic Advocacy Week from August 1-5. Similar to the inagugural event in 2021 (see recap infographic), this completely virtual opportunity is designed to offer members simple, minute-long ways advocate for priority healthcare policy issues. All AAOS members in the U.S. are invited and encouraged to particiate. We need the engagement of members nationwide to amplify the orthopaedic voice! This year, we will focus our advocacy efforts on the following issues:
Below is a preview of the daily themes and related calls-to-action, which will be emailed to those who sign up and also available from this webpage during Orthopaedic Advocacy Week:
Sign up by July 29 to participate, encourage your colleagues to do the same, and let's get ready for #OrthoAdvocacyinAction!
In order to increase health care provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) made a strategic decision to transition toward making the CMS-1500 a required form.
Providers have indicated that the unique paperwork requirements currently in the workers' compensation system are time consuming to complete. To reduce the administrative burden and increase provider participation, the Board will consolidate and eliminate certain medical billing forms and convert to the CMS-1500, the universal claim form used by medical providers to bill the Centers for Medicare and Medicaid Services (CMS) as well as health insurers.
The initiative will leverage providers' current medical billing software and medical records while promoting a more efficient workers' compensation system.
The Board replaced the following forms with the CMS-1500:
The CMS-1500 must be submitted with a detailed narrative report to be considered a valid submission The Board has developed a template that providers can use to create the medical narrative report that accompanies provider submissions of the CMS-1500. A sample of the template can be found on the CMS-1500 Requirements page.
STATEWIDE SURVEY OF ORTHOPAEDIC SURGEONS FINDS INEFFICIENCY, CARE DELAYS AND PATIENT HARM CAUSED BY “PRIOR AUTHORIZATION” REQUIREMENTS
Findings Align With Recent AMA Survey; Provide Powerful Evidence Supporting Reform Proposal Introduced by Senator Breslin and Assemblymember McDonald
Albany, New York — The New York State Society of Orthopaedic Surgeons (NYSSOS) today released the findings of a statewide survey of NYSSOS member orthopaedic surgery practices concerning their experiences in complying with “prior authorization” requirements implemented by insurance companies.
The survey results were consistent, with nearly every respondent reporting that the requirements delayed needed care and often caused preventable harm, debilitation and pain for patients.
As healthcare utilization has increased, programs such as prior authorization have been implemented with the intention of ensuring more cost effective care. However, as these programs have proliferated, patients often experience unnecessary delays and denials for care deemed necessary by their treating physician. In addition, the indiscriminate growth of these practices has created enormous administrative burdens for orthopedic surgeons, limiting the time they have available to provide direct patient care.
Specifically, the survey found:
- 97% of respondents reported that prior authorization fails to achieve its intended purpose of reducing healthcare costs.
- 88% reported having patients abandon care due to delays associated with prior authorization.
- 94% had patients experience a deterioration of prognosis or quality of life due to prior authorization delays.
- 96% had patients experience sustained or increased pain and/or symptoms due to prior authorization delays.
- 89% had patients experience a delayed return to employment due to prior authorization delays.
- 97% say that removing prior authorization would result in more expedient care for their patients.
- 94% say that removing prior authorization would improve the quality of care their patients receive.
- 94% say the administrative burden prior authorization places on their practice has gotten worse in recent years.
The complete NYSSOS survey findings, which can be found at: https://nyssos.org/News/12777960, are very similar to the findings of a recent nationwide American Medical Association (AMA) survey concerning the same issue https://www.ama-assn.org/system/files/prior-authorization-survey.pdf.
A proposal has been introduced recently in the state Legislature to address this issue. The bill, S.8299/A.9908-A, introduced by Senator Neil Breslin (D-Albany) and Assemblymember John T. McDonald III, RPh (D-Cohoes), would create what is known as a “Gold Card” program that would provide an exemption from prior authorization for health care professionals who receive at least 90 percent approval for a particular health care service over a six-month period. NYSSOS strongly supports this legislation.
Senator Neil D. Breslin, Chair of Senate Committee on Insurance, said: “Current prior authorization requirements result in notable delays in medical care, interfere with continuity of care, while at the same time, impose unnecessary administrative work on health care professionals. The Gold Card bill that I am sponsoring will make sure patients receive the treatment they need in a more timely fashion, resulting in a higher quality of care.”
Assemblymember John T. McDonald III, RPh said, "I sponsor the Gold Card bill to help streamline the prior authorization process and ease the burdens that patients face when accessing care. When someone is facing a medical issue, we want to make it easier for the patients to receive necessary treatment and for providers to provide the care needed. I believe this is a commonsense measure that would address some of the challenges that too many face, and builds toward a better healthcare system."
A similar proposal was recently enacted into law in Texas. https://www.ama-assn.org/practice-management/sustainability/new-physician-gold-card-law-will-cut-prior-authorization-delays
NYSSOS President Dr. John DiPreta said: “It ’s time that we confront a growing problem that is present in virtually every treatment room in our state. The proliferation of prior authorization activities is causing unnecessary delays in care, harming patients and driving avoidable administrative burdens for practitioners. We are calling on state leaders to end the unnecessary patient suffering and debilitation that is directly caused by current prior authorization practices, and we are hopeful that the solution proposed by Senator Breslin and Assemblymember McDonald quickly makes its way through the Legislature and is delivered to the Governor ’s desk.”
Delayed musculoskeletal care comes at a tremendous cost not only to the patient in terms of quality of life and productivity but to the overall health care system. According to the American Public Health Association, musculoskeletal conditions are a leading cause of disability in the U.S. accounting for more than 130 million patient visits to health care providers annually and the number one reason individuals to see their physician.[1]
Despite relatively low peer-to-peer denial rates, insurer’s prior authorization and utilization reviews continue to focus on micromanagement aspects of care, typically driven by financial factors. These techniques are in direct conflict with the patients interests since the results pose unnecessary delays in routine musculoskeletal care and treatment.
In April 2022, NYSSOS conducted a statewide survey of its membership concerning their experiences in complying with “prior authorization” requirements implemented by insurance companies.
The survey results were consistent, with nearly every respondent reporting that the requirements delayed needed care and often caused preventable harm, debilitation, and pain for patients. Specifically, the survey found:
- 97% of respondents reported that prior authorization fails to achieve its intended purpose of reducing healthcare costs by denying truly ineffective or unnecessary care.
> See the complete results
"Gold Card Legislation" A proposal has been introduced recently in the state Legislature to address this issue. The bill, S.8299/A.9908-A, introduced by Senator Neil Breslin (D-Albany) and Assemblymember John T. McDonald III, RPh (D-Cohoes), would create what is known as a “Gold Card” program that would provide an exemption from prior authorization for health care professionals who receive at least 90% percent approval for a particular health care service over a six-month period. NYSSOS strongly supports this legislation.
“It ’s time that we confront a growing problem that is present in virtually every treatment room in our state. The proliferation of prior authorization activities is causing unnecessarily delays in care, harming patients and driving avoidable administrative burdens for practitioners. We are calling on state leaders to end the unnecessary patient suffering and debilitation that is directly caused by current prior authorization practices, and we are hopeful that the solution proposed by Senator Breslin and Assemblymember McDonald quickly makes its way through the Legislature and is delivered to the Governor ’s desk.” - John DiPreta, MD, FAAOS, NYSSOS President.
[1]https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policydatabase/2014/07/08/14/21/musculoskeletal-disorders-as-a-public-health-concern
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
