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

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.

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."

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.

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.

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! 

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.

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.

•  Enclosed is the budget summary MSSNY has shared with its members.  Note that the OPMC proposal was rejected and there was an extension of full funding for the excess liability.  There were modifications in place for the telehealth but portions were passed. 
  
•  Legalization of marijuana passed outside of the budget. Here is the NYSDOH website on the new rules and regs. https://www.health.ny.gov/regulations/medical_marijuana/
  
•  In other news, Congressman Lee Zeldin has announced his run for Governor: https://spectrumlocalnews.com/nys/capital-region/ny-state-of-politics/2021/04/08/rep--lee-zeldin-to-run-for-governor-
  

 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)

Legislation in the New York legislature, A.1943 (Simon)/S.24(Kaplan), would require all private group and individual health plans to cover medically necessary services including habilitative and reconstructive services as a result of a congenital anomaly; the legislation includes inpatient and outpatient services, adjunctive needs and procedures for secondary conditions and follow-up treatment. 

Insurance companies have regularly denied follow-up or corrective procedures, claiming that they are cosmetic in nature–which fails to recognize the medical conditions of these patients. Delays in medically necessary care can negatively impact a child’s developmental milestones and coverage denials of a child’s reconstructive surgery, can result in families turning to safety net programs for coverage or paying out of pocket.

A.1943/S.24 recognizes the importance of ensuring access to the care and services necessary due to a congenital anomaly, such as cleft lip and palate, skeletal and maxillofacial abnormalities, facial paralysis, microtia, hypodontia, and craniosynostosis.

Ask your assembly member and senator to co-sponsor and pass A.1943/S.24.

Use the pre-written letter to send a message to your legislators today. https://facs.quorum.us/campaign/31038/

As COVID-19 cases continue to rise and fall across all regions of the United States, practices must adapt and adjust their operations according to regional mandates, which can transition overnight with the shifting environment. Since there is no one-size-fits-all approach to operating a medical practice during the pandemic, The Doctors Company has developed a checklist to help you manage your practice.

The checklist can be adapted to your practice’s needs.
https://www.thedoctors.com/articles/managing-healthcare-practice-operations-during-covid-19/