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  • June 18, 2021 10:23 AM | Anonymous

    On Tuesday, after 472 days, New York hit a vaccination milestone—70 percent of adult New Yorkers have received at least one dose of the COVID vaccine.

    After reaching this goal, the state lifted most of the remaining COVID restrictions.

    This means no more restrictions across commercial settings, including retail, food services, offices, gyms, entertainment, hair salons, barber shops, etc.—as well as no more social gathering limits.

    Existing COVID health protocols are still in place for some settings such as public transportation, health facilities, and indoor Pre-K-12 schools. 

  • June 01, 2021 12:54 PM | Anonymous

    Richard E. Anderson, MD, FACP, Chairman and Chief Executive Officer, The Doctors Company and TDC Group

    Artificial intelligence (AI) has proven of value in the COVID-19 pandemic and shows promise for mitigating future healthcare crises. During the pandemic’s first wave in New York, for example, Mount Sinai Health System used an algorithm to help identify patients ready for discharge.

    Pandemic applications have demonstrated AI’s potential not only to lift administrative burdens, but also to give physicians back what Eric Topol, MD, founder and director of Scripps Research Translational Institute and author of Deep Medicine, calls “the gift of time.”[1]

    Like any emerging technology, AI brings risk, but its promise of benefit should outweigh the probability of negative consequences—provided we remain aware of and mitigate the potential for AI-induced adverse events.

    AI’s Pandemic Success Limited Due to Fragmented Data

    Innovation is the key to success in any crisis, and many healthcare providers have shown their ability to innovate with AI during the pandemic. For example, AI has been used to distinguish COVID-19-specific symptoms: It was a computer sifting medical records that took anosmia, loss of the sense of smell, from an anecdotal connection to an officially recognized early symptom of the virus.[2] This information now helps physicians distinguish COVID-19 from influenza.

    However, holding back more innovation is the fragmentation of healthcare data in the U.S. Most AI applications for medicine rely on machine learning; that is, they train on historical patient data to recognize patterns. Therefore, “Everything that we’re doing gets better with a lot more annotated datasets,” Dr. Topol says. Unfortunately, due to our disparate systems, we don’t have centralized data.[3] And even if our data were centralized, researchers lack enough reliable COVID-19 data to perfect algorithms in the short term.

    AI Introduces New Questions around Liability

    While AI may eventually be assigned legal personhood, it is not, in fact, a person: It is a tool wielded by individual clinicians, by teams, by health systems, even multiple systems collaborating. Our current liability laws are not ready for the era of digital medicine.

    AI algorithms are not perfect. Because we know that diagnostic error is already a major allegation in malpractice claims, we must ask: What happens when a patient alleges that diagnostic error occurred because a physician or physicians leaned too heavily on AI?

    AI in Healthcare Can Help Mitigate Bias—or Worsen It

    Machine learning is only as good as the information provided to train the machine. Models trained on partial datasets can skew toward demographics that turned up more often in the data. Already during the pandemic’s first waves, multiple AI systems used to classify x-rays have been found to show racial, gender, and socioeconomic biases.

    It’s critical that system builders are able to explain and qualify their training data and that those who best understand AI-related system risks are the ones who influence healthcare systems or alter applications to mitigate AI-related harms.

    AI Can Help Spot the Next Outbreak

    More than a week before the World Health Organization (WHO) released its first warning about a novel coronavirus, the AI platform BlueDot, created in Toronto, Canada, spotted an unusual cluster of pneumonia cases in Wuhan, China. Meanwhile, at Boston Children’s Hospital, the AI application Healthmap was scanning social media and news sites for signs of disease cluster, and it, too, flagged the first signs of what would become the COVID-19 outbreak—days before the WHO’s first formal alert.

    These innovative applications of AI in healthcare demonstrate real promise in detecting future outbreaks of new viruses early. This will allow healthcare providers and public health officials get information out sooner, reducing the load on health systems, and ultimately, saving lives.

    [1] Topol E. Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. New York, NY: Hachette Book Group; 2019:285.

    [2] Cha, AE. Artificial intelligence and covid-19: Can the machines save us? Washington Post. Published November 1, 2020. Accessed November 9, 2020. https://www.washingtonpost.com/health/covid-19-artificial-intelligence/2020/10/30/7486db84-1485-11eb-bc10-40b25382f1be_story.html

    [3] Reuter E. Hundreds of AI solutions proposed for pandemic, but few are proven. MedCity News. Published May 28, 2020. Accessed October 19, 2020. https://medcitynews.com/2020/05/hundreds-of-ai-solutions-proposed-for-pandemic-but-few-are-proven/

  • May 25, 2021 12:57 PM | Anonymous

    by Cherisse Berry, MD, FACS, Governor, American College of Surgeons, Manhattan Council, Board of Governors Diversity Pillar

    Intersectionality: the intersection and interconnectedness of identities such as race, gender, ethnicity, sexuality and disability. It is a term coined in 1989 by Kimberlé Crenshaw, JD, a University of California, Los Angeles, law professor who published, "Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics" in the University of Chicago Legal Forum. Discussing three legal cases involving the co-existing issues of racial discrimination and sex discrimination, Dr. Crenshaw introduced the concept of intersectionality: a problematic consequence of the tendency to treat race and gender as mutually exclusive categories of experience and analysis. For example, Black women are both Black and female and thus subject to discrimination on the basis of race, gender and possibly a combination of the two.

    Read the complete article

  • April 16, 2021 8:48 AM | Anonymous
    The American College of Surgeons (ACS) has issued a call for abstracts to be presented at the 2021 ACS Quality and Safety Conference, July 12–16. The submission deadline is April 30.

    Individuals at participating sites are encouraged to submit a 250-word abstract for poster presentation. The abstract should relate to surgical quality improvement initiatives including the development, implementation, or validation of best practices. We are also interested in operational best practices relating to workflows around collecting data and reporting. Abstracts should utilize data from one or more of the following ACS Quality Programs.

    Please note: Abstracts that have been submitted or recently presented at other meetings are eligible for presentation at the ACS Quality and Safety Conference. In the view of the ACS, previous presentation of a paper does not prohibit the presentation or publication of the material at the Quality and Safety Conference.

    Submissions from the following categories will be welcomed:

    ·         Bariatric

    ·         Cancer

    ·         Collaboratives

    ·         Education

    ·         Efficiency and Value

    ·         Geriatrics

    ·         Pediatrics

    ·         PROs/Patient Centeredness

    ·         Trauma/Acute Care

    ·         Surgical Potpourri

    ·         Healthcare Informatics for Quality

    ·         Health Equity/Access

     Submit an abstract

    For questions, contact us at acsqsconference@facs.org or 312-202-5319.

  • April 13, 2021 11:13 AM | Anonymous

    NYS Department of Health Commissioner Dr. Howard Zucker released
    the following statement regarding the Johnson & Johnson vaccine:

    "Today the CDC and FDA issued a statement recommending a pause in the use of the Johnson & Johnson vaccine out of an abundance of caution. New York State will follow the CDC and FDA recommendation and pause the use of the Johnson & Johnson vaccine statewide immediately today while these health and safety agencies evaluate next steps. All appointments for Johnson & Johnson vaccines today at New York State mass vaccination sites will be honored with the Pfizer vaccine.

    "As the CDC and FDA have said, any adverse events related to the Johnson & Johnson vaccine 'appear to be extremely rare' and, 'People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider.'

    "I am in constant contact with the federal government and we will update New Yorkers as more information becomes available."

  • April 13, 2021 11:04 AM | Anonymous

    https://www.thedoctors.com/articles/telehealth-from-the-field-case-study-involving-remote-monitoring-problems/

    Even before the COVID-19 pandemic, the use of remote patient monitoring was expanding. The technologies offer many benefits, but they may also create potential malpractice risks. Consider the following case example and strategies that can help mitigate risks.

    Case Example
    During an annual physical, the physician recommended ambulatory electrocardiography for a patient with a history of prior cardiac arrhythmia. The physician told the patient he would receive the ambulatory monitor by mail and that the package would contain everything he needed.

    About a week later, the monitoring package arrived. opened it, read the instructions, and applied the device. After a few hours, the device fell off. He reapplied it multiple times, but the device continued to fall off. After several calls with the device manufacturer, the patient gave up, tucked the device in the box, and mailed it back to the manufacturer.

    A week later, the patient received a letter from the physician, stating that his monitoring results were normal. The patient—who was surprised to receive these results—followed up. During the discussion, the physician told him that the device manufacturer downloaded and evaluated the results and provided a report that the physician then shared with the patient. The physician
    was surprised to learn that the patient had not completed the monitoring period and the device had not performed as expected, but the results were still reported as normal. The patient lost confidence in both the physician and remote monitoring technology and did not return to the
    practice.

    Patient Safety Strategies
    Whether you have already implemented remote patient monitoring or are thinking about it, consider the following strategies:

    • Use a deliberate process to evaluate and select remote patient monitoring devices.
    • Determine how the data will be collected, transmitted, stored and reported. In the case example, the manufacturer reported the study as normal even thought the full monitoring period was not completed.
    • Ensure the patient is ready to participate. Advise patients to call the office about any device problems or concerns. In the case scenario, the device did not adhere properly to the patient’s skin.


    Plan and Prepare
    This case study highlights the importance of careful planning and preparation when incorporating remote technologies into the patient care services offered by a medical practice. Providers who recommend products and services to their patients have a responsibility to apply due diligence in confirming that the device manufacturer is reputable, the device is safe, and
    the information it produces is accurate and reliable. Once a decision is made to use remote technology, the next steps should be to develop appropriate use guidelines that include preparing patients, managing device concerns/troubleshooting, tracking results, and following
    up with patients.

  • April 12, 2021 9:11 AM | Anonymous

    Federally funded research from the perspective of public health has contributed to reductions in motor vehicle crashes, smoking, and Sudden Infant Death Syndrome. The ACS believes this same approach should be applied to firearm related injuries and gun safety.

    Under the Consolidated Appropriations Act of 2021 (H.R. 133), signed into law by President Trump on December 27, 2020, the Centers for Disease Control and Prevention and the National Institutes of Health each received $12.5 million to study firearms research funding. The continued allocation marks only the second year that federal funding has been specifically designated to firearms research in more than 20 years.

    This year, the College again joined more than 100 medical, public health and research organizations asking Congress to appropriate $50 million in funding for firearm morbidity and mortality prevention research. The College will continue its support for firearm injury prevention research as the federal funding appropriations process continues this year.

    Read the ACS letters of support for the funding to the House and the Senate. For more information on trauma advocacy, contact Kristin McDonald, ACS Manager of Legislative and Political Affairs, at kmcdonald@facs.org.

  • April 09, 2021 9:07 AM | Anonymous

    Last week, the ACS joined a letter of support for the Ensuring Lasting Smiles (ELSA) Act (S. 754/H.R. 1916). Introduced by Sens. Tammy Baldwin (D-WI) and Joni Ernst (R-IA) and Reps. Anna Eshoo (D-CA) and Drew Ferguson (R-GA), the bipartisan and bicameral legislation would address issues that prevent access to necessary diagnosis and treatment for patients with congenial craniofacial anomalies such as such as cleft lip and palate, skeletal and maxillofacial abnormalities, facial paralysis, microtia, hypodontia and craniosynostosis. ELSA would require all private group and individual health plans to cover medically necessary services that repair or restore a patient's anomaly.  For further information contact Kristin McDonald, ACS Manager of Legislative and Political Affairs, at kmcdonald@facs.org.

    Additionally, the New York Chapter ACS has also provided support for legislation that is reflective of the national bill.  It's called Carter's Law. We encourage all members to contact their legislators to advance this important bill! 

  • April 09, 2021 9:06 AM | Anonymous

    The American College of Surgeons Division of Advocacy and Health Policy, in collaboration with the College's General Surgery Coding and Reimbursement Committee, has released two in a series of webinars describing proper implementation of office and other outpatient evaluation and management codes, which were extensively updated for 2021.

    Major Changes for 2021 Office E/M Coding, Part 1: A Surgeon's Guide to Prepare for New Guidelines and Avoid Claims Denials outlines revisions made to the office/outpatient E/M code set by the Current Procedural Terminology Editorial Panel, including new requirements related to history and physician examination, physician time, and medical decision-making (MDM) associated with E/M visits.

    Major Changes for 2021 Office E/M Coding, Part 2: Implementation Tips describes proper office/outpatient E/M code level selection and documentation using MDM for common general surgery patient scenarios. 

    To access the free webinar recordings and download the slides used during each presentation, visit the ACS Office/Outpatient E/M Coding Changes Resource Center. Contact Lauren Foe, Senior Associate for Regulatory Affairs, at lfoe@facs.org with questions.

  • April 08, 2021 9:19 AM | Anonymous

    The legislature has reached a final agreed upon budget of $212 billion (largest budget to date).  The budget sharply increases spending, directing much of the new money to schools, health care, renters and small landlords, as well as to undocumented immigrant workers affected by the pandemic. Democratic lawmakers said the budget is meant to help boost the state's nascent recovery and aid those who were severely impacted by the crisis. Republicans blasted the plan for its tax increases, and argued it should have done more to aid small businesses and veterans. The new taxes include a corporate franchise tax increase and personal income tax increases for high income earners, which are estimated to raise $4.3B in additional State revenue. This will place New York above California as the highest taxing state in the country.

     

     MSSNY Summary:

     State Budget Finalized
    This week the Legislature was completing passage of a $212 billion Budget package that produced several “victories” for organized medicine following months of extensive advocacy by MSSNY working together with county and specialty medical societies. 

     These issues include:

    Excess Malpractice Insurance Program Extended

    The final State Budget provides full funding for an additional year for the Excess Medical Malpractice Insurance program, which provides 17,000 physicians with a bonus $1 million/$3 million layer of liability insurance above the primary layer purchased by a physician.  The State Budget restores the proposed $51 million cut in program funding and deleted an Executive Budget proposal strongly opposed by medicine to impose a 50% physician cost share requirement, which would have resulted in the imposition of thousands to tens of thousands of dollars of new costs on these 17,000 enrolled physicians.

    Physician Due Process Protected

    The final State Budget deleted several provisions proposed in the Executive Budget  to substantially curtail physician due process rights when a complaint has been filed against them with the OPMC.  The adverse provisions that were deleted included permitting the Commissioner to publicly disclose information regarding a complaint filed against a physician and creating a nebulous standard for imposing a summary suspension prior to the conclusion of disciplinary proceedings.

    Pharmacy Scope Changes Rejected 

    The final State Budget deleted several provisions opposed by MSSNY that would have expanded the scope of pharmacists, including proposals to greatly expand the physician-pharmacy Collaborative Drug Therapy program, permitted pharmacist self-ordering of lab tests, and significantly expanded the number of the immunizations that can be performed by pharmacists.

    Essential Plan Enhancements

    The final Budget contains provisions supported by MSSNY to eliminate the premium requirements for the over 800,000 New Yorkers enrolled in the State’s Essential Plan, as well as providing bonus pool funding for physicians and other care providers participating with these plans. 

    Protect Ability to Apply for E-Prescribing Waivers 

    The final State Budget deletes the Executive Budget proposal opposed by MSSNY to eliminate the ability for physicians and other prescribers to apply for a year-to-year waiver of e-prescribing requirements (availed by over 2,000 prescribers across the State of New York). 

    Protect Medicaid “Prescriber Prevails” 

    The final Budget deletes the Executive Budget proposal opposed by MSSNY to remove the statutory protection for the prescriber’s determination (not State Medicaid’s) to prevail for a medication prescribed to a patient covered by Medicaid.

    No-Fault De-credentialing Rejected

    The final Budget deletes the Executive Budget proposal MSSNY had raised concerns with to expand the power of the Superintendent of Financial Services to prohibit certain physicians from submitting claims for No-Fault services.

    Telehealth Expansion

    The final State Budget includes an expansion of site locations where telehealth services can both provided and received.  Importantly, it deletes a provision opposed by MSSNY advocacy that would have established an “interstate compact” of out of state health professionals to provide health care services to New York patients.  Unfortunately, the final Budget also did not include “parity” for the payment of telehealth services.

    Ensure Collaborative Practice by Nurse Practitioners with Physicians

    The final Budget includes a provision to extend for an additional year – until June 30, 2022 – the existing law permitting certain nurse practitioners to practice without a written collaborative agreement with a physician provided they have proof of “collaborative arrangements” with physicians in the same specialty practiced by the NP.  MSSNY has advocated for much stronger collaboration requirements for nurse practitioners in order to protect patients, however, with the sunset of the existing law coming up in two months, legislation (A.1535/S.3056) has also been introduced and strongly opposed by MSSNY that would repeal the requirements to even maintain proof of these collaborative arrangements. (DIVISION OF GOVERNMENTAL AFFAIRS)

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