Smith WR, Atala AJ, Terlecki RP, Kelly EE, Matthews CA, Smith WR. Implementation Guide for Rapid Integration of an Outpatient Telemedicine Program during the COVID-19 Pandemic. J Am Coll Surg.

Smith and co-authors describe the process of developing and integrating telemedicine capability into a surgical practice. They note that during the COVID-19 pandemic, social distancing has been necessary to help prevent disease transmission. Consequently, medical and surgical practices have limited access to in-person visits. This approach poses a challenge to maintain appropriate patient care while preventing a substantial backlog of patients once stay-at-home restrictions are lifted.

In practices that are naive to telehealth as an alternative to in-person care, providers and staff are experiencing challenges with telemedicine implementation. This article provides a comprehensive guide on how to rapidly integrate telemedicine into practice during a pandemic.

The authors built a toolkit that details eight essential components to successful implementation of a telemedicine platform: provider and staff training, patient education, an existing electronic medical record system, patient and provider investment in hardware, billing and coding integration, information technology support, audiovisual platforms, and patient and caregiver participation.

Rapid integration of telemedicine was required to be compliant with the institution's COVID-19 task force. Within three days of documentation of compliance, the large specialty-care clinic converted to a telemedicine platform and completed 638 visits within the first month of implementation. Effective and efficient integration of a telemedicine program requires extensive staff and patient education, accessory platforms to facilitate video and audio communication, and adoption of new billing codes outlined in this toolkit. 

(reposted from ACS August 4th Bulletin Brief)

Robert Morton, CPHRM, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management

True informed consent is a process of managing a patient’s expectations; it is not just a signature on a document. Achieving an accurate diagnosis requires the patient to provide accurate information to the physician. The physician must then provide sufficient information to the patient so that he or she can make a reasonable and informed decision regarding a comprehensive plan for medical or surgical treatment. This physician responsibility cannot be delegated.

Informed consent cannot eliminate malpractice claims, but an established rapport between the patient and the physician based on robust exchanges of information can prevent patient disappointment from ripening into a claim.

Avoid medical jargon. Define and explain medical words and concepts using simple pictures and analogies.

Identify any uncertainty and risk involved with a specific treatment plan, including the probability factors, if possible. Discuss reasonable assumptions the patient may make about the treatment plan.

Encourage questions. Questions provide a better understanding of the patient’s comprehension of the information and facilitate the dialogue between the patient and the physician.

Documentation is another key component of the informed consent process that cannot be entirely delegated to a nurse or another member of the healthcare team. If the doctor-patient discussion proceeds successfully and the patient requests treatment, the doctor is required in some jurisdictions to write a note in the patient’s record.

The consent form must be signed and dated by the patient

Consent forms should also include statements to be signed by the patient and the physician. The patient attests that he or she understands the information in the treatment agreement. The physician attests that he or she has answered all questions fully and believes that the patient/legal representative fully understands the information. These statements help defend against any claim that the patient did not understand the information.

The informed consent process for same-day surgery patients may occur in the physician’s office before scheduling the procedure. That will allow the patient time to think about the information, ask questions, and make an informed decision.

Hospitalized patients must be informed as far in advance of the procedure as practicable. If the patient is incompetent or otherwise cannot consent, the physician is legally bound to obtain informed consent from the incompetent patient’s authorized representative, except in an emergency.

Every physician should develop his or her own style and system for the informed consent process, making it easier to avoid omissions.

Do not speed through the process. Give the patient and the family time to absorb and comprehend the information.

Assess the patient’s level of understanding just before documenting the process. This will increase the likelihood that you will be able to manage the patient’s expectations effectively.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

The U.S. Department of Health and Human Services July 23 formally extended the COVID-19 national public health emergency declaration, which was set to expire on July 25, for another 90 days. The declaration will remain in effect through October 23. This extension will allow for continued implementation of certain waivers and flexibilities issued to assist providers in responding to the COVID-19 pandemic, such as expanded coverage and payment for telehealth, site-neutral payment exceptions and scaled-back  practice limitations for nonphysician health care professionals, among others. 

Contact regulatory@facs.org with questions.

The New York Chapter is proud to be part of a coalition urging the Governor to sign lifesaving measures for motorists into law.

FOR IMMEDIATE RELEASE: July 29, 2020

 CONTACT: Pete Daniels / pdaniels@saferoads.org / 301-442-2249 (C)

 S. 4336/A. 6163 will save lives, reduce injuries and curb costs

 As organizations representing traffic safety, public health and medical professionals, emergency responders and the insurance industry, we are united in urging Governor Andrew Cuomo (D) to sign Senate Bill (S.) 4336 / Assembly Bill (A.) 6163 into law to improve the state’s current seat belt requirement.  Passed by the State Legislature on March 3, 2020, S. 4336/A. 6163 was sponsored by Senator David Carlucci (D) and Assemblyman Walter Mosley (D) to close a gap in New York’s seat belt law.  Since 1984, when New York became the Nation’s first state to enact a primary enforcement seat belt law for drivers and front seat passengers, rear seat passenger safety has lagged behind.  It is time for New York to join the 19 states and Washington, D.C. that have already taken this essential action to protect all occupants.

Over the last decade, lack of seat belt use by rear seat passengers has contributed to significant numbers of fatalities and injuries in New York, with 300 people killed and over 29,000 people injured.  The absence of a rear seat belt requirement leaves young people particularly vulnerable because rear seat occupants ages 16-24 have the lowest rate of belt use and account for approximately half of the state’s motor vehicle crash fatalities.  A more comprehensive seat belt law will help protect all occupants and keep teenagers and young adults safe on the roads.

Read the entire release

Patrick V. Bailey, MD, MLS, FACS, Medical Director, Advocacy, ACS Division of Advocacy and Health Policy, Washington, DC, interviews Mark Aeder, MD, FACS, associate professor, transplant and hepatobiliary surgery, University Hospitals, Cleveland Medical Center, Ohio, about the biggest financial mistakes that surgeons can make. Topics include the importance of dedicated savings; managing debt, both “good” and “bad”; setting a financial plan; having appropriate insurance to cover various stages of life and more.

The Young Fellows Association (YFA) of the American College of Surgeons (ACS) is seeking applications from Fellows of the College who would like to apply for the year-long YFA Mentorship Program.  We are in special need of mentors this year. 

Mentoring teams are made up of three people:

1. Early career surgeon – an Associate Fellow (an ACS member out of training, but not yet FACS) or a young Fellow in practice less than 5 years, who traditionally will serve as a mentee in this triad relationship
   
   
2. Mid-level career surgeon – a Young Fellow (an ACS Fellow under the age of 45) who might serve as a mentor to the early career surgeon and a mentee alongside an advanced professional
   
   
3. Advanced professional – a ACS Fellow who holds a leadership within the ACS or an ACS Fellow who has been practicing for more than 10 years

 The mentorship relationship will extend from October 2020 through October 2021. 

Visit the Young Fellows Association webpage for more details and to access links to the Mentor and Mentee applications at 

https://www.facs.org/member-services/yfa/mentor/annual

Questions can be directed to Alison Powers apowers@facs.org

As you may know from recent ACS communications, finalized policies from the Centers for Medicare and Medicaid Services (CMS) will result in significant cuts to physician payment for most surgical services delivered to Medicare patients beginning in January of 2021. If implemented, these policies could also destabilize health system financing and drastically diminish the opportunity for hospital and physician offices to recover financially from COVID-19. For more information, visit https://www.facs.org/advocacy/federal/medicare/prevent-cuts.

The ACS and other surgical associations have urged Congress to intervene and introduce legislation that would waive budget neutrality, effectively preventing the cuts. The ACS will also continue to aggressively push Congress, but only strength in numbers from surgeon advocates at-large will help elected officials understand the importance and time sensitivity of this issue.

Recognizing the profound impact that cuts to physician payment could have on practices and Medicare patients seeking surgical services, please take immediate action and contact Congress via SurgeonsVoice! For more information, contact the ACS Division of Advocacy and Health Policy staff at ahp@facs.org.

As health care facilities resume operations paused due to COVID-19, a new survey shows a majority of people are reluctant to undergo procedures and may not reschedule necessary care while COVID-19 continues to circulate in communities. To help surgeons and hospitals address patient concerns, the American College of Surgeons (ACS) has released a new resource:

Preparing to Have Surgery during the Time of COVID-19.

Surgeon Toolkit
(Download the Word version)

• Introduction
• Template Press Release
• Template Social Media Copy
• Template Social Media Images
• Template Video Script
• Template Article
• Additional Considerations

Surgeon-Patient Discussion Guide 

Surgeon-Patient Discussion Worksheet 

This award is offered through the generosity of The Clowes Fund, Inc., of Indianapolis, IN. Its purpose is to provide support for the research of a promising young surgical investigator. The award consists of a stipend of $45,000 for each of five years and is not renewable thereafter.

The award is restricted to a Fellow or Associate Fellow of the College who has completed an accredited residency in general surgery within the preceding seven years, not including time off for maternity leave, military deployment, or medical leave, and has received a full-time faculty appointment at a medical school accredited by the Liaison Committee on Medical Education in the United States or by the Committee for Accreditation of Canadian Medical Schools in Canada. The applicant’s academic appointment may not be above the level of assistant professor. Applicants should provide evidence (by publication or otherwise) of productive initial efforts in laboratory research.

For addition information about the award, please visit the George H. A. Clowes, Jr., MD, FACS, Memorial Research Career Development Award webpage.

The Centers for Medicare & Medicaid Services (CMS) recently released the 2020 Quality Payment Program (QPP) Exception Applications Fact Sheet. The fact sheet explains how to apply two types of exceptions: the Promoting Interoperability (PI) Hardship Exception and the Extreme and Uncontrollable Circumstances Exception. If individual clinicians, groups, and virtual groups meet certain criteria for a PI exception or experience extreme and uncontrollable circumstances—such as a natural disaster or public health emergency (including the COVID-19 pandemic)—they can submit an application to reweight their Merit-based Incentive Payment System (MIPS) Quality, Cost, Improvement Activities, and/or PI performance categories.

The fact sheet also explains situations where the automatic extreme and uncontrollable circumstance policy would be applied to individual clinicians located in a CMS-designated area affected by an extreme and uncontrollable event during 2020. However, CMS has not yet announced the COVID-19 pandemic as a triggering event for the automatic extreme and uncontrollable circumstances policy for the 2020 MIPS performance year. Therefore, if your 2020 MIPS data collection and reporting has been disrupted by the COVID-19 pandemic, you should submit application(s) for the extreme and uncontrollable circumstances policies.

To learn more, view the 2020 MIPS Exceptions Applications Fact Sheet here. Additional questions can be directed to QualityDC@facs.org.