During these unprecedented times, a significant focus has been placed on implementation and integration of telemedicine within the traditional framework of in-person orthopaedic practice. Although the growth of telemedicine was expected previously, the COVID-19 pandemic has rapidly accelerated its widespread implementation. Recent publications have focused on pre-visit technical considerations, including obtaining requisite equipment and fostering pathways for viewing imaging studies. There remains a dearth of orthopaedic literature reporting on the prevalence of adverse events encountered in the setting of virtual visits. This lack of information presents a patient safety concern that must be addressed before telemedicine is considered a mainstay of everyday practice.
Defining such red flags is essential for a successful telemedicine program, given that a major disadvantage of telemedicine is the limited physical exam. Although surrogate examination maneuvers have been described for the upper extremity (pushing oneself up from a chair) and lower extremity (hopping in place on the involved leg) to conform to the video format, they may not be specific enough for particular diagnoses. Conditions that can potentially be missed because of a lack of in-person interaction include: > Read article
On Monday, February 8th, NYSSOS issued a memorandum in opposition to A273 (Gottfried) which Requires a practitioner to consider and prescribe non-opioid treatment alternatives for treatment of neuromusculoskeletal conditions.
NYSSOS stated the following:
The Society agrees that physicians should be looking at non-opioid alternatives to analgesia and work within the patient encounter to consider alternatives available before choosing an opioid prescription. However, legislating medical treatment or guidelines interferes with the doctor patient relationship. Advancing this type of legislation will negate the physician's expertise regarding treatment for neuromuscular problems. Mandating provisions like this will supersede the existing training and measures to reduce inappropriate prescribing of opioids. Going forward, physicians, public health officials, policymakers and health insurance companies must work together to take meaningful action and create an integrated approach to combat the opioid epidemic. Legislating a medical encounter will not achieve the shared goals of improving care to patients and supporting a sustainable, predictable and resilient public health system.
The opioid crisis is real, and steps are being taken within the profession to address it. Programs like ISTOP, although cumbersome as it was being set up, has helped prescribers to identify drug seeking patients and control prescribing. We do not agree with the principle to institute mandates of this nature which restrict a licensed physician from making decisions based upon their medical training and in their best judgement. This bill will limit the ability to appropriately treat patients in pain and can lead to additional liability. As such we are in opposition.
To see a copy of the full memo - please email bgrey@nyssos.org
Amid the COVID-19 pandemic, social media allows us to stay connected to loved ones. Beyond that, physicians have begun using social media platforms as tools in their practices—from offering medical information to the public to highlighting career achievements, social media has become personal marketing tools for the 21st-century doctor. With that in mind, this article provides five helpful tips for using social media as a part of your orthopaedic practice.
> Read the complete article
The next chapter in the modernization of the New York State Workers’ Compensation Board, the OnBoard Project, is well underway. The Board, with its integration partner CapTech Consulting, is building a new claims system that will replace the multiple legacy, paper-based claims systems, such as CIS and eCase, with a single, web-based platform.
The new system will offer improved and expanded access to real-time claim data, new electronic self-service features for interacting with the Board, and a reduction in the amount of overall paper forms to improve system responsiveness to stakeholder needs.
To learn more please visit: http://www.wcb.ny.gov/onboard/
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. Join webinar Add to your calendar!
OnBoard: Limited Release for Health Care Providers Wednesday, January 20, 2021 12:00 p.m. - 1:00 p.m. Join webinar Add to your calendar!
OnBoard: Limited Release for Attorneys Thursday, January 21, 2021 12:00 p.m. - 1:00 p.m. Join webinar 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 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…
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
