Changes to National Government Services Local Coverage Determination Process
In accordance with Section 4009 of H.R. 34-21st Century Cures Act (Public Law No: 114-255), CMS is updating the “Medicare Program Integrity Manual” with detailed changes to the LCD process.
Order FREE Posters and Postcards for Your Practice
Download FREE PSA materials now or order the quantity you need. Communications tools and office resources include:
MLMIC’s The Albany Report offers policyholders a concise, insiders’ view of pending legislative, regulatory, and political developments that have an impact on the New York State medical malpractice insurance marketplace.
Open or download the latest issue of The Albany Report: https://www.mlmic.com/why-mlmic/services-resources/albany-report
The State Legislature has concluded its 2019 Legislative Session. This was certainly one of the most memorable in recent years given the range of issues addressed following the democratic power-shifting election.
Be advised that we may be calling you to action during the summer to help secure vetoes from the Governor addressing the proliferation of e-scooters, e-bikes and unbalanced medical liability reforms.
NYSSOS wishes to thank our members who took the time to make phone calls, write letters and personally meet with legislators on this year's advocacy program. Every interaction matters and we will continue to address the orthopaedic community's concerns in the coming year. We are very proud of this year’s interactive advocacy day with the most attendees we’ve had in the past few years as well as those who participated in the federal visits.
We encourage you to reach out to your legislators and continue to build a relationship off session. You can always thank them for their efforts.
You may also contribute to the ORTHOPAC which supports candidates who understand the current and long-term challenges that orthopaedists face when practicing in New York.
At-A-Glance Orthopaedic Specific Issues
• Defeat of inappropriate scope expansions by podiatrists, chiropractors and physical therapists
• Defeat of efforts to impose a single payer system in NY
• Defeat of several mandates related to opioid prescribing that would have imposed even more requirements on physicians prior to prescribing opioids
• Defeat of numerous trial lawyer backed bills that would have: exponentially expanded awardable damages in wrongful death lawsuit; prohibited a defendant physician’s defense counsel from interviewing a medical malpractice plaintiff’s treating physician; and permitted the admissibility of certain “hearsay” statements of employees in civil actions. It should be noted that the Legislature did pass a couple of smaller measures opposed many groups that will affect certain cases involving multiple defendants and where an adverse judgment has been reached
• Advancement of efforts to license athletic trainers
• Passage of legislation to reduce insurer prior authorization (PA) requirements when a PA for a related procedure has already been received
Highlights on the behalf of the House of Medicine
• Enactment of legislation which ensures that medical contraindications are the only acceptable exception to vaccine requirements;
• Legislation that curtails health insurers making mid-year changes to their prescription formularies; or increasing patient cost sharing;
• Defeat of legislation which would have legalized adult use marijuana, as well as proposals that would have significantly expanded the medical marijuana program. Instead legislation was enacted that provides further “decriminalization” of small amounts of marijuana
• Defeat of the authorization of retail health clinics
Orthopaedic residents are invited to submit an abstract for a chance to present it at 2019 NYSSOS Symposium and Annual Meeting.
The meeting will take place on September 21-22, 2019 at the Gideon Putnam Resort and Spa in Saratoga Springs, New York.
Orthopaedic residents can submit abstracts in the following categories:
• Quality, Advocacy and Public Policy
The deadline to submit your abstract is Friday, August 9, 2019.
> See complete details
Opioid prescribing by New York State physicians has decreased 37.5% percent between 2013-2018 and opioid prescriptions also decreased by 11.2% from 2017 to 2018 according to data recently released by the IQVIA, Danbury, CT, a data collection firm within the healthcare industry. The data is available here.
Additionally, the American Medical Association (AMA) has released its 2019 Opioid Progress Report—the third year that the AMA has reported on actions that physicians have taken to help end the nation’s opioid epidemic. The report shows significant decreases in opioid prescribing as well as increases in PDMP use and naloxone prescriptions. In addition to the national data, the AMA also released state-level data for opioid prescribing and PDMP use. New York State physicians and other users of the prescription monitoring program logged 23,931,571 inquiries in 2018, a 42% increase since 2014.
AAOS effortsIn November 2015, the AAOS released an information statement titled "Opioid Use, Misuse, and Abuse in Orthopaedic Practice." The document says, in part, "The AAOS believes that a comprehensive opioid program is necessary to decrease opioid use, misuse, and abuse in the United States. New, effective education programs for physicians, caregivers, and patients; improvements in physician monitoring of opioid prescription use; increased research funding for effective alternative pain management and coping strategies; and support for more effective opioid abuse treatment programs are needed."
During the 2017 Annual Meeting, the AAOS introduced a multimedia public service campaign to highlight the potential dangers of opioids. The campaign includes display and radio ads, urging doctors and patients to exercise caution in prescribing and taking opioids (Fig. 2). For more information, visit http://orthoInfo.org/PrescriptionSafety
Additionally, the AAOS has developed a Pain Relief Toolkit that can be accessed here: https://aaos.org/painrelieftoolkit/
On Tuesday, May 28, 2019 the New York State legislature will hear public testimony on a proposal to create single payer system in the state.
The New York Health Act, A.5248/S.3577, would replace traditional health insurance coverage and public health coverage programs with single-payer health coverage, including long-term care, for all New Yorkers. The program would be publicly funded, including existing federal support for Medicaid and Medicare. New Yorkers would not be required to pay premiums, deductibles, co-pays, or out-of network charges.
This hearing is the first of a series of hearings that will provide an opportunity for comments and suggestions from stakeholders around the state on the New York Health Act.
NYSSOS President, James Slough, MD will testify on behalf of the Society. The Society plans to cite concerns regarding the impact on access to care should this proposal advance.
NYSSOS believes that expanding health care coverage and access should be implemented through a public-private partnership, and we strongly oppose proposals that create a federal health care authority or move health care
further in the direction of a single-payer health care system in New York State.
NYSSOS acknowledges the Sponsor’s efforts to add provisions that remove the requirement for prior authorizations for health care services. Additionally, we acknowledge the provisions to allow for health care providers to collectively negotiate with New York Health including payment rates and methodologies.
NYSSOS believes patients should receive access to health care coverage – including specialty care - without financial barriers or undue burdens placed on the patient or physician. The responsibility of financing appropriate
health care services must be a shared public-private cooperative effort that advances a patient-centered model for choosing affordable health care options
NYSSOS believes that as policymakers consider health care reforms they should:
To submit your own testimony, please visit this link for more details.
A new report from the Congressional Budget Office (CBO) detailed components and considerations that would be involved in implementing a single-payer healthcare system in the United States. Potential problems with a single-payer system include provider capacity issues and lack of health benefit and insurer choice, while benefits may include stronger purchasing power and reduced administrative costs.
Read the CBO Report
NYSSOS continues to promote and represent viewpoints of the orthopaedic community before Federal and State legislative, regulatory and executive agencies through a variety of mechanisms.
We encourage you to take advantage of the online software that quickly enables you to send a message to your legislator as well as help engage your patients in voicing concerns and recommendations to their own elected representatives.
Educate yourself on the current issues and contact your elected representatives
AAOS is now accepting nominations for the 2020 Diversity and Humanitarian Awards and the William W. Tipton Jr, MD, Orthopaedic Leadership Award. These awards are presented at the AAOS Annual Meeting. The respective award recipients are recognized for their endeavors to further encourage diversity or culturally competent care, participation in humanitarian activities, or leadership activities in the orthopaedic profession. The last day to submit nominations for the Humanitarian Award is May 17; the last day to submit nominations for the Diversity and Tipton Awards is June 14.
> Learn more
NYSSOS serves the interests of New York orthopaedists and their patients by helping to create an optimal practice environment in which to provide quality and efficacious orthopaedic care.
Address: PO Box 38004, Albany, NY 12203