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.
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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 wcbformularyquestions@wcb.ny.gov.
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 President
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.
Employer Responsibility:
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.
Effective immediately, the AAOS Registry Program will begin collecting COVID-19 data through the capture of the ICD-10 code for COVID-19 confirmed diagnosis, U07.1. The new code is enabled across each of the AAOS registries, including: the American Joint Replacement Registry, the world’s largest national registry of hip and knee joint replacement data by annual procedural count; the Shoulder & Elbow Registry; the Musculoskeletal Tumor Registry, and the American Spine Registry, a collaborative effort between the American Association of Neurological Surgeons (AANS) and the AAOS.
WHY NOW?
The AAOS has taken swift action to understand COVID-19’s current and future impact on musculoskeletal care. With more than 1.97 million procedures across four registries, the AAOS Registry Program already collects clinical data to support orthopaedic surgeons, hospitals, health systems, and ambulatory surgery centers (ASCs) in providing the highest quality musculoskeletal care. Now more than ever, it is critical to collect data that will provide additional insights on the quality of care and outcomes of orthopaedic patients in the COVID-19 environment.
WHAT WILL THE DATA REVEAL?
By adding the ICD-10 code to the AAOS Registry Program, sites who contribute the data will have the ability to monitor the impact of COVID-19 on patients undergoing future joint replacement procedures. Tracking COVID-19 data will help analyze the impact of COVID-19 on outcomes, trends of surgery based on the pause in elective surgery, and the trends of patient-reported outcomes (PROMs) due to delayed procedures. It will also track the potential impact on CMS value-based payment models and coverage for patients recovering from COVID-19. On a broader scale, long-term data from the registries may allow for future insights into COVID-19 and its impact on clinical outcomes.
Key learnings from the AAOS Registry Program will be delivered to participants, the orthopaedic community, and the broader public throughout the coming years.
HOW ARE CURRENT AND NEW REGISTRY PARTICIPANTS IMPACTED?
Hospitals, health care systems, practice groups, and ASCs already participating in the registries will not need to join a new registry or engage in a new way to submit their data. Capturing this code will not change the site’s workflow since it was added as an accepted value for existing diagnosis or comorbidity code files. The ICD-10 code can be submitted as a pre-operative comorbidity or prior diagnosis present on admission and as a reason for readmission.
Participants who have questions about submitting the new code can reach out to AAOS Registry Support at RegistrySupport@aaos.org for assistance. To enroll in a Registry, contact an AAOS Registry Engagement Associate via email RegistryEngagement@aaos.org or phone 847-292-0530.
Our patients are finally getting the high-quality care they deserve as state and local governments continue to relax restrictions on surgical practices. Most importantly, this care is being provided in an environment that is safe for patients, staff, and society. All those involved in patient care—including the patients themselves—understand that certain aspects of our practices have changed. The need for social distancing requires that we see fewer patients and utilize telemedicine whenever possible. We are becoming accustomed to wearing masks during office hours and our patients welcome symptom screening before being seen. COVID-19 antigen testing is being required by many institutions prior to surgery and this has been well received by patients. Despite the inconvenience, they understand and appreciate the steps we are taking to protect them. In short, we are all getting used to the “new normal.”
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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
