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NYS SOciety of ORTHOPAEDIC Surgeons

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  • Thu, April 30, 2020 5:32 PM | Babette Atkins (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) issued another round of regulatory waivers and rule changes with the goal of increasing diagnostic testing and access to medical care during the COVID-19 pandemic.

    The AAOS Office of Government Relations has developed an overview for members with high-level key points

  • Wed, April 29, 2020 10:49 AM | Babette Atkins (Administrator)
    (as taken from the MLMIC website)

    Executive orders are a method for the state government to ensure all actions can be taken to respond effectively and efficiently to a state emergency without being impeded by state laws and regulations that ordinarily serve a purpose but during the emergency can often hinder the fastest and best response to an emergency. The executive order accomplishes this goal by suspending or modifying certain laws or regulations that are listed in the order.

    No. 202.24
    April 29, 2020

    This Executive Order authorizes, through May 25, licensed pharmacies to administer the tests to detect COVID-19 or its antibodies in patients suspected of having COVID-19 or of having recovered from COVID-19.

    Read the full executive order
    No. 202.18
    April 21, 2020

    This executive order suspends and modifies various public health law and education law provisions and regulations, until May 16, to maximize the pool of health care professionals available to assist the State in the response to COVID-19. Among those of particular note are the following:

    • Allows several health care providers such as physicians, nurses, and physician assistants licensed in Canada to practice medicine in New York State.
    • Permits retired respiratory therapists to practice along with numerous other retirees in various health care provider specialties not previously authorized by executive order.
    Read the full executive order
    No. 202.16
    April 14, 2020

    This executive order suspends or modifies certain laws through May 12, 2020. Among this order’s provisions are the following with an impact on health care:

    • Mandates that essential businesses (which includes physician offices) who remain open for business with one or more employees in the workplace must be provided, at no cost to such employees, face coverings that they must wear when in direct contact with customers or members of the public. This directive takes effect on Wednesday, April 15 at 8 pm.
    • Permits individuals meeting the federal requirement for testing personnel appropriate to the assay or device authorized by FDA or NY Department of Health to perform testing for detection of SARS CoV-2, or its antibodies, in specimens collected from persons suspected of suffering a COVID-19 infection.
    Read the full executive order
    No. 202.14
    April 7, 2020

    This executive order broadly continues the directives in previous executive orders issued since March 7 regarding the COVID-19 outbreak to May 7. Among the provisions that regard health care and malpractice liability are the following:

    • Allows graduating medical students to immediately begin practicing medicine under the supervision of a licensed physician
    • Continues the limited immunity from liability protections for physicians and certain other medical professionals in their rendering of medical services in support of the State’s response to the COVID-19 outbreak to May 7
    • Continues the tolling of the statute of limitations deadlines for filing civil lawsuits to May 7
    Read the full executive order
    No. 202.12
    March 28, 2020

    This Executive Order contains one health care matter directing hospitals and health care facilities to permit one person to be present who is a support person for a patient giving birth.

    Read the full executive order
    No. 202.11
    March 27, 2020

    Continuing the State’s efforts to ensure sufficient numbers of healthcare professionals, nursing graduates (RN and LPN programs) may be employed for 180 days with supervision of a registered professional nurse and endorsement from the employing hospital or nursing home, and midwives licensed and in good standing from any state or Canada may practice in New York State without penalty. Also, physicians assisting the State’s response in a SUNY facility are provided with the defense and indemnification, as if a state employee. This Order also declares a modification of EO 202.10 on the dispensing of hydroxychloroquine or chloroquine by pharmacist and declares that COVID-19 guidance issued by DOH are immediately effective and supersede any prior conflicting guidance issued, including local health departments.

    Read the full executive order
    No. 202.10 - Summary of Immunity Provisions
    March 25, 2020

    This Executive Order ensures that New York State has adequate hospital bed capacity, supplies, and providers to treat patients affected with COVID-19, as well as patients afflicted with other maladies. To assist in this goal, the Governor has provided immunities to licensed healthcare individuals through April 22, 2020.

    Read the summary by Mia D. VanAuken, Esq., Fager Amsler Keller & Schoppmann, LLP
    No. 202.10 - Executive Summary
    March 25, 2020

    New York’s Governor declared a state of disaster emergency for the entire State of New York on March 7, 2020, which authorizes him to temporarily suspend or modify, to the extent necessary, any statute, local law, ordinance, order, rule, or regulation of any agency and authorizes him to issue directives to cope with the disaster.

    Read the full article by Mia D. VanAuken, Esq., Fager Amsler Keller & Schoppmann, LLP
    No. 202.6
    March 18, 2020

    This executive order primarily mandates that most New York businesses reduce their in-office workforce by 50 percent. The order makes an exception for essential businesses providing essential services. The following is a list of essential health care operations:

    • Research and laboratory services
    • Hospitals
    • Walk-in-care health facilities
    • Veterinary and animal health services
    • Elder care
    • Medical wholesale and distribution
    • Home health care workers or aides
    • Doctor and dentist offices
    • Nursing homes, or residential health care facilities or congregate care facilities
    • Medical supplies and equipment providers
    Read the full executive order
    No. 202.5
    March 18, 2020

    This executive order contains numerous suspensions and modifications of New York laws and regulations. Among those of particular note are the following:

    • Allows physicians, physician assistants, and nurses licensed anywhere in the U.S. to practice medicine in New York State.
    • Allows NY licensed but not registered physicians to practice medicine in New York State.
    • Allows hospital staff who are privileged and credentialed to work in a hospital or health care facility in another state to practice in a hospital or health care facility in New York State.
    Read the full executive order
    No. 202.4
    March 16, 2020

    This Executive Order directed local and state employees whose position is non-essential to either work from home or take leave. In addition, the Order mandated closure of all New York State schools until April 1.

    Read the full executive order
    No. 202.3
    March 16, 2020

    This Executive Order limited gatherings in any one location to no more than 50 persons. The Order also required food service establishments to no longer serve food on premises but only via delivery or pick up and it closed all gyms, fitness centers and movie theaters in the state.

    Read the full executive order
    No. 202.2
    March 14, 2020

    This Executive Order concerned suspension and modification of law governing elections in New York State. It also imposed certain requirements on school districts closing due to a local state of emergency.

    Read the full executive order
    No. 202.1
    March 12, 2020

    This Executive Order suspends various laws and regulations in order to permit expansion of services and temporary facilities for health and human service providers. Also, the order suspended laws and regulations relating to child care to allow flexibility for providers while continuing to protect children’s health and safety.

    Read the full executive order
    No. 202
    March 7, 2020

    This Executive Order suspended or modified a variety of New York Education Law and Public Health Law provisions in order to accomplish the following:

    • Allow unlicensed persons to, upon training, collect swab specimens from persons suspected of having COVID-19.
    • Authorized the New York State Department of Health to enact emergency rules and regulations to, among other things, permit hospitals to most effectively prepare for, and treat, the influx of persons seriously infected with COVID-19.
    Read the full executive order
  • Sun, April 26, 2020 4:08 PM | Babette Atkins (Administrator)

    The US Health and Human Services (HHS) has indicated that the application portal is open for physicians to avail themselves of a portion of the $20 billion allocation from the CARES Act Provider Relief Fund.  

    The AMA has advised that  anyone who has a Billing TIN who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis, should be filling out this portal.   


    The AMA has also put together this guide to help physicians pull together the information they need to submit to the portal. Here is additional information from HHS regarding the distribution.

  • Sat, April 25, 2020 4:41 PM | Babette Atkins (Administrator)

    This week, both chambers of Congress passed and President Trump signed into law The Paycheck Protection and Health Care Enhancement Act, which allocates an additional $321 billion for Paycheck Protection Program (PPP) loans and an additional $60 billion for the Economic Injury Disaster Loan program. New applications can be submitted starting on Monday, April 27, 2020 at 10:30am. Any borrower that applied for a PPP loan prior to the issuance of this guidance and repays the loan in full by May 7, 2020 will be deemed by SBA to have made the required certification in good faith

    > Read our legal counsel's alert.

    Set aside in the $321 billion of additional funds approved for the PPP is $60 billion for small- to medium-sized banks and other financial institutions. The legislation also includes an additional $75 billion for the Public Health and Social Services Emergency Fund.

    Additional Resources:

    SBA Paycheck Protection Program

    April 24 -President Donald J. Trump signed a $484 billion COVID-19 relief package, the fourth passed by Congress, that provides $370 billion for small businesses and replenishes the Paycheck Protection Program. View AAOS Summary

    April 22 - 
    The Department of Health and Human Services awarded nearly $165 million to combat the COVID-19 pandemic in rural communities. Read the HHS press release, Check out AAOS Guidance 

  • Fri, April 24, 2020 5:34 PM | Babette Atkins (Administrator)

    President Donald J. Trump signed a $484 billion COVID-19 relief package, the fourth passed by Congress, that provides $370 billion for small businesses and replenishes the Paycheck Protection Program.

    > Access an AAOS Summary

  • Thu, April 23, 2020 4:52 PM | Babette Atkins (Administrator)

    NYSSOS penned a letter to the Governor, making him aware of issues concerning resumption of elective surgery and the necessity for ambulatory surgery centers to be included in the strategy.  

    NYSSOS stated that emergency and urgent surgeries have been proceeding at both hospitals and Ambulatory Surgery Centers (ASCs) but there are many patients with significant musculoskeletal problems that have received alternative conservative treatments that now require surgical intervention and appropriate time for recovery to get back into the workforce.  These patients have been unable to work and awaiting surgery before the massive layoffs and COVID-19 restrictions.

    NYSSOS advocated that ASCs need to be included with resumption of surgeries based off the community individual needs while collaborating with hospitals and health systems to coordinate care. 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.

    Resumption of elective surgeries in less affected counties has only referenced hospital settings. So far, there has been no direction about how this applies to other care settings such as ASCs in counties that are allowed to re-open or ASCs in general. We request additional clarification in order to assemble an adequate healthy workforce and sufficient resources to protect and care for these patients.

    Read the detailed letter
  • Wed, April 22, 2020 4:43 PM | Babette Atkins (Administrator)
    The AAOS Coding team has created a quick reference tool for telemedicine visits: AAOS Telemedicine Quick Guide
  • Wed, April 22, 2020 4:42 PM | Babette Atkins (Administrator)
    The Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary of Preparedness and Response (ASPR) released a new toolkit to help state and local healthcare decision makers maximize workforce flexibilities when confronting 2019 Novel Coronavirus (COVID-19) in their communities: COVID workforce virtual toolkit
  • Tue, April 21, 2020 4:59 PM | Babette Atkins (Administrator)

    The Chair has adopted on an emergency basis amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 to expand the telemedicine options for social distancing purposes due to outbreak of COVID-19 and to supersede the previous emergency telemedicine adoption filed on March 16, 2020. A Notice of Emergency Adoption will be published in the May 6, 2020, edition of the State Register.

    The text of the Emergency Adoption has been published to the Board's website. This emergency rulemaking is effective for 90 days upon filing April 20, 2020.

  • Tue, April 21, 2020 4:50 PM | Babette Atkins (Administrator)

    Governor Andrew M. Cuomo announced today that elective outpatient treatments can resume in counties and hospitals without significant risk of COVID-19 surge in the near term. Restrictions on elective surgery will remain in place in Bronx, Queens, Rockland, Nassau, Clinton, Yates, Westchester, Albany, Richmond, Schuyler, Kings, Suffolk, New York, Dutchess, Sullivan, Ulster, Erie, Orange and Rensselaer Counties as the state continues to monitor the rate of new COVID-19 infections in the region. 

    Hospitals will be able to resume performing elective outpatient treatments on April 28, 2020 if the hospital capacity is over 25 percent for the county and if there have been fewer than 10 new hospitalizations of COVID-19 patients in the county over the past 10 days. If a hospital is located in a county eligible to resume elective outpatient treatments, but that hospital has a capacity under 25 percent or has had more than 10 new hospitalizations in the past 10 days, that hospital is not eligible to resume elective surgeries. 

    If a county or hospital that has resumed elective surgery experiences a decrease in hospital capacity below the 25 percent threshold or an increase of 10 or more new hospitalizations of COVID-19 patients, elective surgeries must cease. 

    Further, patients must test negative for COVID-19 prior to any elective outpatient treatment. The State Department of Health will issue guidance on resuming elective surgeries. 

    AAOS Guidance

    The Academy believes that decisions regarding when and how elective surgery should begin are best decided on a local basis. To help members prepare for these conversations, they have developed clinical considerations for navigating COVID-19 and are recommending the following universally applied guiding principles:

    1. All decisions should be locally based as resource availability is locally determined. These resources include:

    a. Hospital beds,
    b. ICU beds,
    c. Ventilators,
    d. PPE, and
    e. Healthcare workers.

    1. Overall disease burden varies by location: Hot spots like New York City and New Orleans have high case rates.
    2. Stage of pandemic varies by location. (Reproductive number*: greater, equal or less than one. Is the curve increasing, flattening or decreasing?)
    3. Legal restrictions vary by location: We need to adhere to government mandates; however, these vary by state. (For example, New York State is in place until 4/30/2020, while Oklahoma is in place until 4/24/2020.)

    * Reproductive Number: It is the average number of secondary infections produced by a typical case of an infection in a population where everyone is susceptible. If the number is >1, then the case numbers increase. If it is <1, they decrease. 

    Once the decision is made to resume elective surgery, other important issues that must be addressed include:

    1. Velocity of return,
    2. Location of return,
    3. Prioritization of surgical cases, and
    4. COVID-19 testing (for both patients and staff).

    Again, decisions regarding these factors are best made on a local basis. For example, in areas of low disease burden, elective surgery may not need to be phased in and can start all at once. In other areas, where personnel and equipment have been repurposed, a more phased-in approach is necessary. The principles guiding velocity of return include:

    1. Resource availability (repurposed staff and equipment)
    2. Utilization of “COVID-19 free” hospitals or ASCs when possible
    3. Ambulatory cases first (to avoid hospitalization and COVID-19 exposure)
    4. Inpatient cases (ASA I and II)
    5. Inpatient cases (ASA III and IV), once COVID exposure as inpatient is minimized and COVID-19 testing is perfected

    There is much debate about the availability and utility of COVID-19 testing for patients and staff. Despite the debate, it is likely that perioperative patient testing and universal staff testing will be required.

    CMS Recommendations

    The new CMS recommendations for reopening facilities can be found here

    White House

    The Guidelines for Opening Up America Again can be found here

About the Society

Advocating for the orthopaedic surgeon, patients and musculoskeletal health in New York.

Contact Us

info@nyssos.org
1-518-439-0000
Address: PO Box 38004, Albany, NY 12203


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