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  • September 01, 2020 10:34 AM | Anonymous

    David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company Group, and Laura Kline, CPCU, MBA, Senior Vice President, Business Development, The Doctors Company (reposted with permission)hare

    Each year, The Doctors Company assembles healthcare leaders to discuss the most pressing issues affecting physicians, practices, and systems across the spectrum of care. The 2020 Executive Advisory Board meeting gathered top healthcare executives for a virtual discussion of shared pandemic experiences and lessons learned that can help healthcare organizations navigate through COVID-19 and beyond.

     Here are the top 10 meeting takeaways:

  • August 20, 2020 10:33 AM | Anonymous

    Urge Governor Cuomo to veto legislation (S.6678-A/A.7991-A) that would require every physician's office to post signage with information on how a patient can report a complaint to the NY Office of Professional Conduct (OPMC). 

    Let the Governor know that this proposal is unnecessary because the information is already publicly available on the OPMC website and could foster distrust in the physician-patient relationship.

    Take a moment to send an email to Governor Cuomo using the prepared editable letter. 

  • August 18, 2020 1:58 PM | Anonymous
    (reposted from ACS Bulletin Advocacy Brief - Aug. 13th Issue)

    The Centers for Medicare & Medicaid Services’ proposed rule on the Medicare Physician Fee Schedule describes previously finalized changes to its coding and billing policies for office/outpatient evaluation and management (E/M) visits. Beginning in 2021, CMS will eliminate the history and physical exam as elements for evaluation and management code selection and will instead allow physicians to choose the E/M visit level based on the extent of their medical decision making or on time spent on the day of the encounter. CMS also will increase the value of most office, outpatient and E/M services, but these increases will not apply to global surgery codes.

    To offset the increase in payment for E/M, CMS must cut reimbursement for other services. The agency therefore proposes to decrease the conversion factor from $36.09 to $32.26—a significant change of approximately 10.6 percent. CMS estimates a 7 percent reduction in total allowed charges for general surgery services relative to its proposals for 2021. The American College of Surgeons will continue to oppose CMS’ failure to increase payment rates for the E/M portion of 10- and 90-day global surgical packages.

    In addition, the MPFS includes proposed changes to coverage for telehealth services after the COVID-19 public health emergency ends. CMS proposes to add certain services to the Medicare telehealth list permanently, along with a series of services that may be added to the telehealth list temporarily and remain payable only through the calendar year in which the PHE expires. The agency also seeks stakeholder feedback on the development of permanent coding and payment for audio-only telephone E/M visits.

    The ACS is evaluating these and other proposals to determine the impact on surgery and will submit comments to CMS. The proposed rule is available for public review, along with a fact sheet on its payment provisions. Contact regulatory@facs.org with questions.

  • August 14, 2020 1:59 PM | Anonymous

    You can help stop the proposed Medicare Physician Fee Schedule cuts by writing to your senators and representatives in Congress. Call on your elected officials to enact legislation to waive Medicare's budget neutrality requirements for these E/M adjustments and to require CMS to apply the increased E/M adjustment to all 10- and 90-day global code values.

    Contact Congress today

  • August 12, 2020 2:01 PM | Anonymous

    In advance of the American College of Surgeons 2020 Quality and Safety Conference VIRTUAL, August 21–24, the College has posted the Best Practices Case Studies publication for 2020. The conference is being presented free of charge to ensure all can participate despite the economic hardships the COVID-19 has created.

    Through the Best Practices Case Studies, hospitals participating in ACS Quality Programs have an opportunity to share their expertise in implementing surgical quality improvement initiatives within their facilities, with the goal of showcasing how participating hospitals have used programmatic data to improve their performance and outcomes. The Best Practices Case Studies publication is intended to allow program participants to learn from the experience of others and develop similar quality improvement projects within their own organizations.

    Each Best Practices Case Study from the 10 hospitals highlighted in this year’s publication includes the following:

    • Description of the problem addressed
    • Context of the quality improvement process
    • Planning and development process
    • Description of the activity
    • Resources needed
    • Results
    • Tips for others

    View the 2020 publication, then review Best Practice Case Studies from previous years. And make sure to register for free for the 2020 Quality and Safety Conference, where you can expect much more content on how to improve quality and safety at your institution.

  • August 12, 2020 2:00 PM | Anonymous

    The Virtual American College of Surgeons Clinical Congress Program has been expanded to five days, starting on Saturday, October 3, and concluding on Wednesday, October 7. With the addition of Saturday and Sunday and the addition of an extra channel and extra slots each day, it has been possible to include all the previously approved Panel Sessions and Scientific Forum Sessions.

    The Program Committee, under the leadership of Henri R. Ford, MD, MHA, FACS, FAAP, FRCSEng(Hon), has created a blueprint of this five-day program, which will be available soon after all the moderators have confirmed their participation. New registration information also will be disseminated soon. Recordings of the five-day program will be available after the Virtual Clinical Congress.

    The ACS is pleased to offer this expanded Clinical Congress Program at no cost to all interested registrants in light of the economic impact the COVID-19 pandemic has had on health care professionals. We look forward to an exciting event and to your participation.

    For additional information about the program, contact Ajit K. Sachdeva, MD, FACS, FRCSC, FSACME, at asachdeva@facs.org or Richard V. King, PhD, at rking@facs.org.

  • August 05, 2020 2:06 PM | Anonymous

    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)

  • August 04, 2020 2:28 PM | Anonymous

    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.

  • July 31, 2020 2:03 PM | Anonymous

    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.

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