Today the Governor began what will be a four-part series to his State of the State address. His rhetoric focused framing our current situation as war-like and calling on the Federal Government to provide financial relief.
Today’s overview included 7 areas that he wants to move forward simultaneously:
Of particular interest to the medical community, he mentioned:
What he didn’t mention in his overview but was released by his press office is a proposal to reform OPMC. According to the website: “The Governor will introduce legislation to update the Public Health Law to strengthen disciplinary actions for misconduct resulting in better misconduct enforcement and increased patient safety. In addition, the Governor will propose reforms to the investigation and hearing processes to ensure that the Office can act swiftly to hold physicians accountable, confirm investigations, and keep patients safe.” More details can be found here
He also spoke on mobile sports betting, increase in construction, affordable broad band, green energy, social injustice and housing.
A listing of the proposals can be found here: https://www.governor.ny.gov/keywords/2021-state-state
The NYS Legislature is scheduled for session today beginning at 2:30pm for the Assembly and 3:00pm for the Senate. They are scheduled to meet for a total of 60 session days, running through June 10. The legislature changed its rules to allow for virtual voting and meeting. A calendar of session days is found here.
The pandemic and increasing deficit will be the main issue for the Governor and Legislature so we will see how it influences policy, especially health care. Citing New York’s deficit, estimated at $15 billion in the current fiscal year and an additional $16 billion in the fiscal year beginning on April 1st, the Governor is calling for legalized marijuana and sports betting to bring in revenue. We will see how the legislature responds. Progressive advocates, including those in support of the New York Health Act, are pushing for a package of measures designed to increase taxes on the wealthy, including increasing taxes on billionaires, a tax on inherited wealth, a capital gains tax and taxes for Wall Street and corporations.
As you may already know, the New York State Workers’ Compensation Board is in the process of developing a new business information system, OnBoard, which will provide an intuitive, user-friendly system, increased accuracy and quality, and paperless transactions to our system participants. Since building a new, integrated system from the ground up takes time, we’re starting with some high-priority processes that will benefit from moving online in what we are referring to as OnBoard: Limited Release.
This email includes several OnBoard: Limited Release resources to help you continue to learn about the new system and prepare for a smooth transition when it becomes available.
Thanks to everyone who joined last month’s OnBoard: Limited Release introductory webinar series for health care providers, insurers and attorneys. Recordings and slide decks of these sessions can be found on the OnBoard: Limited Release resources page.
Based on the feedback and questions received during these sessions, we developed three new Frequently Asked Question (FAQ) documents that we hope you will find helpful:
We have also developed new fact sheets outlining what health care providers, insurers, insurer attorneys and claimant attorneys need to know about OnBoard: Limited Release, and what to do now to prepare:
Starting in January, the Board will be hosting additional OnBoard: Limited Release webinars for insurers, health care providers and attorneys. These webinars will include a brief project review and update, a walkthrough of the most frequently asked questions we have received, and plenty of time to answer any new questions you have.
No registration is required. To join, please select the "Join Webinar" link for each session below. Add it to your calendar so you don't forget! These webinar links will also be available on the Board's upcoming webinars page.
OnBoard: Limited Release for Insurers
Tuesday, January 19, 2021
12:00 p.m. - 1:00 p.m.
Add to your calendar!
OnBoard: Limited Release for Health Care Providers
Wednesday, January 20, 2021
12:00 p.m. - 1:00 p.m.
Add to your calendar!
OnBoard: Limited Release for Attorneys
Thursday, January 21, 2021
12:00 p.m. - 1:00 p.m.
Add to your calendar!
The NYS Society of Orthopaedic Surgeons (NYSSOS) strongly advises against the shutdown of medically necessary surgeries prior to the opportunity to review the criteria and provide surgical input and guidance.
Surgeons and providers should be the ultimate decision makers regarding the appropriate site of service for their patients keeping in mind quality, safety, and risks. With state guidance and coordination, hospitals and ambulatory surgical facilities should be given the data and guidance to allow the appropriate level of elective cases best indicated by their medical staff, administration and current needs of the community.
Email your elected officials today!
As you are aware, legislation was signed in 2017 that required the New York State Workers’ Compensation Board (Board) to establish a prescription drug formulary. After multiple public comment periods, the Board adopted the New York Workers’ Compensation Drug Formulary (Formulary) regulations in May 2019. These regulations required new prescriptions to comply with the Formulary by December 5, 2019, and refill prescriptions to comply by June 5, 2020. Due to the COVID-19 pandemic, the Board moved the date for refill compliance with the Formulary to January 1, 2021.
As with any formulary, providers must have a way to prescribe non-formulary agents to treat worker-specific issues. To accommodate that need, a prior authorization process, using the Board’s online Medical Portal, was implemented. To date, there have been nearly 40,000 requests by providers to use non-Formulary medications through the Medical Portal prior authorization process.
As the Board approaches the final step in Formulary implementation, refill compliance, it is taking some additional time to ensure that the Formulary and prior authorization process work for all stakeholders. Thus, the Board is temporarily suspending the January 1, 2021, date for refill compliance, and a new date (likely spring, 2021), will be announced soon. Between now and then, the Board will address feedback from providers and payers; make system and process improvements by aligning with the initial release of the Board’s new business information system, OnBoard; and continue outreach and education to key users.
In the meantime, if providers have any difficulty getting needed medications for injured workers, or if payers have questions, please reach out to the Board’s Medical Director’s Office at firstname.lastname@example.org.
A full description of the Formulary and the prior authorization process, including two sets of Q&As, are posted on the Board’s website http://www.wcb.ny.gov/content/main/hcpp/DrugFormulary/overview.jsp. You are encouraged to review the Q&As as a reminder of associated prior authorization requirements and parameters.
To reiterate key points associated with the prior authorization process:
Training is available for the new Medical Treatment Guidelines (MTGs) that are to go into effect on January 1, 2021.
The Board has developed training for each of the MTGs so that stakeholders can familiarize themselves with the new guidelines. Each training will provide an overview of the General Guideline Principles, conditions associated with the body part or disease, and treatment recommendations.
The training presentations are available as pdfs at Training for Non-medical and Administrative Staff
* Post-Traumatic Stress Disorder and Major Depressive Disorder have been posted for a 60-day public comment period starting on October 21, 2020. Training for these MTGs will be adjusted if needed based on the feedback received during the public comment period.
For more information, please visit the Board's website or call (877) 632-4996. You can also email MTGTrainings@wcb.ny.gov.
AAOS President Joseph A. Bosco III, MD, FAAOS, issued a statement in response to the newly released Hospital Outpatient Prospective Payment System (OPPS) proposed rule, which would eliminate the inpatient-only list beginning with nearly 300 musculoskeletal-related services, adjust the criteria for procedures covered in the ambulatory setting, and remove certain restrictions on the expansion and development of physician-owned hospitals (POHs). “While we are cautiously optimistic about the Centers for Medicare & Medicaid Services' (CMS) attempt to offer these flexibilities by promoting site neutrality and lifting restrictions on high-value POHs, we are concerned about the potential for unintended consequences associated with eliminating the inpatient-only list,” Dr. Bosco said. He emphasized that setting of care is best determined by physicians through the lens of patient safety and peer-reviewed evidence and strongly encourages CMS to carefully reassess this aspect of the proposal.
Read Dr. Bosco’s statement…
Structural inequities and barriers to health care existed prior to COVID-19. But the pandemic has put a spotlight on the problem, which has also recently become the focus of advocacy efforts nationwide.
In this episode, Movement is Life Chair Mary O’Connor, MD, FAAOS, explains how public policy and individual surgeons together can strengthen community-based programs to ultimately help narrow the health equity gap.
Listen to the podcast
Your state society is here for you and hopes people are healthy and safe and returning to closer to normal practice patterns. We would like to congratulate those residents finishing their training and welcome and look forward to the incoming residents embarking on their orthopaedic surgery careers.
New York State now has all counties open for elective surgery. Different counties are at different stages of phased reopening and these decisions have been somewhat arbitrary and inconsistent across the state without as much medical or physician input as there should have been.
Graduations and celebrations have been in parking lots or virtual and surgeries while resuming, are requiring changes in protocol, testing and PPE requiring more time, stress and energy which will continue for the foreseeable future. Telehealth visits while beneficial to patients in some cases is often requiring more time and is not the same as in an in-person visit for many problems.
Some of our patients are scared of COVID-19 exposure, others are tired of being cooped up, and others have a laissez-faire or blatant disregard of the virulence of this virus. It is our responsibility to educate and model good behavior.
The recent protests and responses from different organizations including the AAOS are important to encourage peaceful protests recognition and acknowledgment of racial disparities and biases. As orthopaedic surgeons, we strive to take care of patients regardless of race, color, sex or national origin. We, however, need to do a much better job of mentoring, actively encouraging and increasing diversity in our profession as well as understanding social determinants of health and how it impacts musculoskeletal care and treatments.
On behalf of NYSSOS, we would like to thank all of our brethren for those serving or who have served on the front lines of the COVID-19 pandemic, those physicians and residents taking care of known COVID-19 patients, and the different decision making processes needed in current reopening.
Your NYSSOS Board would like to thank all who wrote emails via our VoterVoice grassroots action center about the resumption of surgeries at ASCs being allowed in counties once hospitals could resume elective surgeries. Our 800 emails generated by our advocacy efforts followed by the campaign being taken up by MSSNY, the AAOS and others were all instrumental at adding ASCs to the reopening plans for counties.
As all counties have resumed surgeries and we are treating patients that have delayed care, let us continue to lead our groups, staff, ASCs and hospitals through the prioritization of surgery and different processes as we take care of current problems as well as scheduling and performing the postponed surgeries for our patients.
Estimates to perform the backlog of surgeries suggest 9-18 months to perform 90% of the postponed and rescheduled surgeries. Surgical resumption should be done in an efficacious manner leading and protecting our staff, ourselves, and our patients and requires significant physician input.
Your AAOS NY State Board of Councilor members and the NYSSOS Board were the only state Society this year submitting and getting approved Advisory Opinions to the AAOS that we will advocate on at both the Federal and the State level. These include telemedicine continuation s/p COVID-19 with payment equity equal to office visits or based on time spent, continued and enhanced medical liability protection for COVID-19 related claims regarding treatment and delays, ASC safety and efficacy education to legislators and regulatory bodies, and for the AAOS to support and advocate for bipartisan support of the Medicare Accelerated and Advanced Payments Improvement Act and/or advocate for legislation that includes Part B, extends the repayment period, includes decreased or no interest rates and discusses convergence of the program to grants.
Our NYSSOS Annual meeting is now virtual and scheduled for approximately 2 hour sessions November 5-7 consisting of 3 webinars with live and prerecorded symposiums, moderators, the ability to interact and asked questions, and allow resident/fellow presentations and discussions. This will be an exciting meeting format that should be engaging, informational and educative for participants. Please save the date and more information will be forthcoming.
Thank you for your membership, advocacy, collective expertise and responsiveness to the current pandemic. Please let us know of problems and ways we can be responsive and helpful in your districts.
- Jim Slough, MD, FAAOS
Today, the New York State Department of Health issued updated guidance for Resumption of Non-Essential Elective Surgeries and Non-Urgent Procedures in Hospitals, Ambulatory Surgery Centers, Office Based Surgery Practices and Diagnostic and Treatment Centers.
Key updates include:
Hospitals in all counties may resume non-essential elective surgeries and non-urgent procedures in both inpatient and outpatient settings. Waivers are no longer required.
Hospitals should continue to monitor metrics, however, original thresholds of ICU total bed capacity, ICU bed capacity, and COVID hospitalization rate based on the HERDS survey data will no longer be used to qualify hospitals to resume and continue to perform non-essential elective surgeries and non-urgent procedures.
There is no longer a requirement to submit information about the types and numbers of surgeries and procedures to the Department on a monthly basis however, hospitals should have a mechanism to report this information to the Department if requested in the future.
The test period may now be extended from three days to five days prior to the surgery or procedure. Test results should be received and reviewed before conducting the surgery or procedure. The only exception would be a nonscheduled emergent procedure where testing prior to surgery may not be feasible. In this case, a thorough screening and history should be taken as well as appropriate precautions. A test should be performed as soon as possible, and if positive, may result in the need for health care worker exposure protocols to be followed. Providers do not have to perform the test; it is allowable to accept a third-party test provided it is a viral molecular assay as described above and is performed by a laboratory with any required permits and approvals.
The intention was clarified for for ambulatory facilities to maintain ongoing confirmation of local hospital capacity (bed census, ICU census, and ventilator availability). The intention of this guidance is for ASC, OBS, and DTC providers to monitor capacity at the hospitals to which they would normally be transferring to and/or recommend patients visit post procedure, if necessary. Providers should establish their own policies for frequency of monitoring and may monitor local hospital capacity by region at the following link: https://forward.ny.gov/early-warning-monitoring-dashboard.
There has been no change to the requirement for ASCs, OBSs and DTCs to have adequate PPE and medical and surgical supplies appropriate to the number and type of procedures to be performed. Adequate PPE means that an ambulatory provider has at least a seven-day supply of PPE on hand, and the provider’s supply chain can maintain that level to support outpatient surgeries and procedures without resorting to contingency or crisis capacity strategies. To prepare for a potential future surge, providers should be working towards having immediate access to a 90-day supply of PPE.
If a worker reports that they are sick due to a workplace exposure, you must contact your workers’ compensation insurance carrier immediately.
The insurance carrier then has 18 days to act on the claim and must begin paying benefits within this time frame if the claim is accepted.
Advocating for the orthopaedic surgeon, patients and musculoskeletal health in New York.
Address: PO Box 38004, Albany, NY 12203