e-news
There is a lot happening in the field of emergency medicine and we want to keep you informed. E-news is an electronic communication to members with time-sensitive articles. See the latest e-news articles archived below:
If you have a topic you would like to see featured in a future
Volume #6 (July 2010)
Urge Governor to sign No-Fault Bill
Last week New York ACEP members received an important Action Alert regarding the No-Fault Bill passed by the Senate and Assembly. Governor Paterson has just two days left to sign or veto the bill. We need your help to get the Governor to sign this important bill, S.7845, into law. Bill A3103A (Koon) / S4018-A (Hassell-Thompson) (August 17, 2010) was signed by Governor Paterson. This bill adds registered nurses and license practical nurses to assault of emergency medical professionals and provides for class C and D felonies for physician injury to them. To read the bill in its entirety, click here (enter bill number and 2010)
Five New York City Hospitals Partaking in Pilot Program
Designed To Control Malpractice Costs
The
Wall Street Journal (7/23, A21, Sataline) reports that in New York City, Beth Israel Medical Center, Mount Sinai Medical Center, New York-Presbyterian Hospital, all Maimonides Medical Center, and Montefiore Medical Center have consented to partake in a pilot program designed to disclose medical mistakes, make settlement offers, and utilize special state "health courts" in which settlement agreements will be mediated by judges to avoid having cases go to trial. The Journal explains that the program was funded by the US government which contributed $3 million to fund the three-year effort to control malpractice costs.
First Medical Malpractice Insurance Rate Increase
in Three Years Only 5%
The average medical malpractice insurance rate increase for New York doctors this year is five percent, New York State Insurance Superintendent James J. Wrynn announced today. By law, Wrynn is charged with establishing the rates for medical malpractice insurance coverage. The increase, which took effect July 1, followed two years of rate freezes.
“I am pleased that we could keep the first medical malpractice rate increase in three years to an average of five percent,” Wrynn said. “This rate will help hold the line on costs for physicians while giving the insurance companies the resources to pay claims as they come due.”
Wrynn established new base rates resulting in five percent increases for Medical Liability Mutual Insurance Company (MLMIC), the largest medical malpractice insurer with almost 60% of the market, and Physicians’ Reciprocal Insurers (PRI), the second largest medical malpractice carrier with almost 30% of the market.
Two smaller specialty carriers, Hospitals Insurance Company (HIC) and Academic Health Professionals Insurance Association (Academic), also received five percent increases.
While the average rate will increase by five percent, some doctors’ increases can be somewhat more or less depending on their specialty and location.
The Medical Malpractice Insurance Pool (MMIP) is the State’s insurer of last resort. MMIP provides insurance for doctors and others who are not able to get insurance in the voluntary market. For the fewer than 300 doctors covered by the pool, rates will rise an average of 9.9%.
“In the short term, this increase will relieve the pressures on both doctors and insurers,” Wrynn said. “But long term, the system is still in crisis and needs to be reformed. We cannot afford to lose doctors because of high medical malpractice insurance rates
Sharing medical knowledge
It has long been a goal of New York ACEP to make available to all New York State emergency physicians and medical students, the free educational programming New York ACEP provides. Click
here for the latest medical information sharing.
Volume #5 (June 2010)
Joint response to Blue Cross/Blue Shield report is
based on misleading data
Together with National ACEP, New York ACEP took issue with a report released last week by Excellus Blue Cross/Blue Shield about emergency care in upstate New York with a joint press release.
To read the Excellus Blue Cross/Blue Shield news release, click
here.
To read the Excellus Blue Cross/Blue Shield fact sheet on unncessary ER visits, click
here.
----------------PRESS RELEASE
ACEP and its New York Chapter Take Issue with Blue Cross/Blue Shield Report that is Based on Misleading Data
For Immediate Release: May 27, 2010
Health Plans Historically Have Denied Coverage for Emergency Care
Washington, DC — The American College of Emergency Physicians (ACEP) and New York ACEP today took issue with a report released by Excellus Blue Cross/Blue Shield about emergency care in upstate New York. Saying the report is based on a method developed by the New York University’s Center for Health and Public Service Research, Dr. Sandra Schneider of Rochester, New York, and president-elect of ACEP, said it does not capture all the data necessary to analyze whether an emergency visit was appropriate, and it leads to false conclusions.
“It’s ironic that a health plan would release this report right after Congress enacted health care reforms that apply the prudent layperson standard to all health plans,” said Dr Schneider. “Health plans historically have denied coverage for emergency care, which is why this standard is needed. The nation’s emergency physicians have fought hard for many years to make sure health plans do not deny coverage for emergency care, for example, when they have the symptoms of a medical emergency, such as chest pain, but after examination, it is determined they have a hiatal hernia (nonurgent medical condition) and not a heart attack.” Emergency physicians have always advocated that nothing should prevent patients who believe they are experiencing a medical emergency from seeking immediate care at an emergency department, whether or not the ultimate diagnosis and treatment is for a non-life-threatening condition.
New York ACEP in April 2010 sent a letter to the New York State Department of Health expressing concerns about how the method relies on diagnosis at discharge, which does not reflect the potential severity and acuity of a visit. The chapter said the method has never been reviewed or tested for validity by any outside groups or peer review, which is a basic tenet of research validation. It also contradicts earlier studies conducted by the state health department and New York ACEP.
”There are serious and profound methodological flaws in the Excellus study, said Dr. Gerard Brogan, president of the New York ACEP. “Using the final discharge diagnosis rather than the presenting symptoms, ignoring that the patient with low back pain could have just as easily had a rupturing aortic aneurysm, as well eliminating all the patients that were admitted to the hospital from the ER due to the severity of their illness, unfortunately significantly weakens this analysis and calls into question its validity.”
The report defines nonurgent care as any patient who could wait at least 12 hours for treatment — unlike the CDC, which defines nonurgent care as anyone who could wait 24 hours for treatment. Patients should not be in the position of diagnosing their own medical conditions.
“Emergency care represents less than 3 percent of the nation’s $2.1 trillion in health care expenditures while caring for 120 million visits a year,” said Dr. Angela Gardner, president of ACEP. “Emergency physicians expect ER visits to increase with health care reform, due to growing physician shortages.”
The American College of Emergency Physicians has worked for more than 17 years for a passage of a national “prudent layperson” standard, to require health insurance plans to base coverage of emergency care on a patient’s symptoms, not the final diagnosis, which more accurately reflects the resources, time and expertise used to diagnose and treat these patients.
ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
New York ACEP supported source testing bill introduced
Assemblywoman Amy R. Paulin introduced a source testing bill (A.11291) May 26, 2010, that relates to tests performed for human immunodeficiency virus in situations involving occupational exposures.
This bill is an act to amend the public health law. Its purpose is to ensure that individuals who experince an occupational exposure creating a significant risk of contracting HIV are able to receive appropriate medical treatment.
New York ACEP will monitor this bill and if needed, send members an Action Alert asking for your help in contacting legislators to urge their support.
Read the bill in its entirety by clicking
here.
Read the memo in support of this bill by clicking
here.
Emergency department use varies by age, race, income and health coverage
About one-fifth of U.S. residents visited a hospital emergency department at least once in 2007, according to a report released by the Centers for Disease Control and Prevention and other government agencies. Adults aged 75 and over, African Americans, the poor and those with Medicaid coverage were more likely to visit the emergency department than those in other groups. Medicaid enrollees were more likely to have multiple emergency department visits than those with private insurance or the uninsured. Adults reporting fair or poor health were more than twice as likely to visit the emergency department as those reporting very good or excellent health.
To read the complete NCHS data brief, click
here.
Volume #4 (April 2010)
Bureau of Narcotic Enforcement Automating Practitioner Notification Program
The Department of Health (DOH), Bureau of Narcotic Enforcement is automating its Practitioner Notification Program. DOH representatives will be available to demonstrate the new program at the ED Director Forum May 7. This program allows practitioners secure online access to patients' recent controlled substance prescription history
DOH representatives will be available to demonstrate this new
Effective February 16, 2010, practitioners will be able to view controlled substance prescription information through their Health Commerce System (HCS) account if a patient has received controlled substance prescriptions from two or more practitioners and filled them at two or more pharmacies during the previous calendar month. Direct secure access to this information will allow practitioners to better evaluate a patient’s treatment with controlled substances and determine if there may be abuse or non-legitimate use.
In order to take advantage of the new automated system, prescribers of controlled substances must have or establish an HCS online account.
Note: The HCS is formerly known as the Health Provider Network (HPN) and is located at
https://commerce.health.state.ny.us. Instructions on how to access the Practitioner Notification Program will be found on the ‘Practitioners’ page online.
New York State Department of Health (NYSDOH)
Influenza Vaccine Provider Update
Continues to recommend that H1N1 vaccine be offered to patients
The NYSDOH reccommends that providers who have Sanofi Pasteur H1N1 vaccine that expires 3/2011-6/2011 should consider keeping it in order to:
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Vaccinate children who are less than ten years old and need a second H1N1 dose;
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Vaccinate children under ten years old, who have not yet received any H1N1 vaccine, and if vaccinated now will likely need only one seasonal influenza vaccine dose containing H1N1 influenza antigen in the fall;
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Vaccinate individuals in the early fall, in the event that there is a delay in production of the 2010-2011 trivalent seasonal influenza vaccine.
H1N1 Vaccine Inventory Survey
To dispose of H1N1 influenza vaccine at no cost to you, complete the vaccine inventory survey by calling 1-888-H1N1-VAC (1-888-416-1822) and choose Option 1. Your H1N1 PIN# is required to complete this survey.* You will be prompted to enter the number of H1N1 influenza vaccine doses in four categories:
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Total usable H1N1 doses on hand (not expired or recalled);
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Total usable Sanofi Pasteur H1N1 doses on hand;
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Total usable Sanofi Pasteur H1N1 doses with 2011 expiration dates that you would like to keep past June 1, 2010;
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Total H1N1 doses that have been wasted (including expired or recalled vaccine), whether or not they are still in your possession.
*If you do not remember your H1N1 PIN#, please click
here to retieve this information using your registration application number and professional license number.
Accounting for H1N1 Vaccine Doses Administered
The DOH ask that you complete reporting of all H1N1 vaccine doses administered if you have not already done so. Your H1N1 PIN# is required to complete reporting through the Online Reporting System and the IVR telephone system.* For instructions on how to report, click
here.
Any questions, contact eh Bureau of Immunization at (518) 473-4437.
Electronic filing of controlled substances
The Drug Enforcement Administration (DEA) recently revised its regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. In addition to permitting pharmacies to receive, dispense and archive electronic prescriptions, these regulations have the potential to reduce the number of prescription errors.
Click
here to view the The Interim Final Rule with Request for Comments from the Drug Enforcement Administration (DEA), Department of Justice on Electronic Prescribing of Controlled Substances, to be published Wednesday, March 31, 2010.
The Interim Final Rule specifies the rules that health care providers will need to follow in order to electronically prescribe controlled substances in accordance with the law. Since DEA published the Notice of Proposed Rulemaking for electronic prescribing of controlled substance, ONC, CMS, AHRQ and other HHS staff have worked closely with DEA to develop the policies in the Interim Final Rule. The Interim Final Rule is expected to be published in the Federal Register on Wednesday, March 31 and will include a 60 day comment period. If the federal Register is published on 3/31, you should have until May 30, 2010 to submit any comments you might have regarding this Interim Final Rule.
Comments may be sent to DEA by sending an electronic message to
dea.diversion.policy@usdoj.gov . Comments may also be sent electronically through
http://www.regulations.gov using the electronic comment form provided on that site. To ensure proper handling of comments, please reference “Docket No.DEA-218” on all written and electronic correspondence.
Summary: The Drug Enforcement Administration (DEA) is revising its regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. The regulations will also permit pharmacies to receive, dispense, and archive these electronic prescriptions. These regulations are an addition to, not a replacement of, the existing rules. The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances dispensing; additionally, the regulations will reduce paperwork for DEA registrants who dispense controlled substances and have the potential to reduce prescription forgery. The regulations will also have the potential to reduce the number of prescription errors caused by illegible handwriting and misunderstood oral prescriptions. Moreover, they will help both pharmacies and hospitals to integrate prescription records into other medical records more directly, which may increase efficiency, and potentially reduce the amount of time patients spend waiting to have their prescriptions filled.
Career catalog email sign-up NEW
Sign-up by clicking on the link below. You will receive an email alert each time a new career opportunity is posted on the New York ACEP website.
Read More
Volume #3 (March 2010)
Family Health Care Decision Act (FHCDA)
[March 16, 2010] Governor David A. Paterson signed the Family Health Care Decisions Act (FHCDA) into law. The FHCDA allows family members to make health care decisions, including decisions about the withholding or withdrawal of life-sustaining treatment, on behalf of patients who lose their ability to make such decisions and have not prepared advance directives regarding their wishes.
The New York State Senate and Assembly has passed legislation, that will now be sent to the governor for his consideration, that may have implications on emergency treatment of critically ill patients.
The legislation establishes procedures and standards to allow family members and others close to a patient or resident to make medical treatment decisions on a patient's behalf when they are not able to make those decisions themselves.
Medical Decisions for Individuals Without a Surrogate
The FHCDA authorizes the attending physician to act as surrogate for routine medical treatment. For major medical treatment, a physician may act only upon the concurrence of another physician that such major medical treatment is necessary.
A physician may withhold or withdraw life-sustaining treatment for individuals without a surrogate only upon the independent concurrence of another physician that life-sustaining treatment offers no medical benefit to the patient because the patient will die imminently and the provision of life-sustaining treatment would violate accepted medical standards.
Details of FHCDA
Appointing a Surrogate:
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To appoint a surrogate, the FHCDA requires a determination by an attending physician that the individual lacks decision-making capacity.
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In a nursing home, this determination must be confirmed by an independent determination by a health or social services practitioner that the individual lacks decision-making capacity.
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In a hospital, the independent determination is required only if the surrogate's decision concerns withdrawal or withholding of life-sustaining treatment.
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If there is disagreement about whether the individual lacks decision-making capacity, the matter is referred to the hospital or nursing home ethics committee for resolution.
Potential Surrogates (in order of priority):
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Court-appointed guardian;
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Individual designated orally by the subsequently incapacitated individual;
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Spouse or domestic partner;
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Adult son or daughter;
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Parent;
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Adult brother or sister;
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Close relative or friend.
Medical Decisions by a Surrogate:
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The surrogate has all the powers an individual has to make their own medical decisions, including the decision to withhold or withdraw life-sustaining treatment.
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The FHCDA directs the surrogate to make decisions in accordance with the patient's wishes, including the patient's religious and moral beliefs.
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If the patient's wishes are not reasonably known and cannot be ascertained, the FHCDA directs the surrogate to make decisions in accordance with the patient's best interests.
Decisions to Withhold or Withdraw Life-Sustaining Treatment:
- Decisions to withhold or withdraw life-sustaining treatment are governed by additional standards under the FHCDA.
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A surrogate may withhold or withdraw life-sustaining treatment for an individual if that individual will die within six months with or without treatment, as determined by two independent physicians, And treatment would be an extraordinary burden to the patient.
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A surrogate may also withhold or withdraw life-sustaining treatment if the patient has an irreversible condition, as determined by two independent physicians, and treatment would involves such pain, suffering, or other burden that it would be inhumane or extraordinarily burdensome to provide treatment under the circumstances.
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Decisions to withhold or withdraw life-sustaining treatment for minors
are made by the minor's parents.
Medical Decisions for Individuals Without a Surrogate:
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The FHCDA authorizes the attending physician to act as surrogate for routine medical treatment.
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For major medical treatment, a physician may act only upon the concurrence of another physician that such major medical treatment is necessary.
-
A physician may withhold or withdraw life-sustaining treatment for individuals without a surrogate only upon the independent concurrence of another physician that life-sustaining treatment offers no medical benefit to the patient because the patient will die imminently and the provision of life-sustaining treatment would violate accepted medical standards.
Individuals with Mental Retardation/Developmental Disability:
- Under the FHCDA, individuals with mental retardation or developmental disabilities are within the class of individuals for whom health care surrogates may be appointed.
Online opportunities
Looking for a new job opportunity?
Maybe your department is searching for a new ED Director. Enhance your search with our new
Online Career Catalog ~ linking emergency physicians with prospective employers.
New York State Department of Health Answers Questions on Acute Stroke Guidelines
Beginning January 1, 2010, acute strokes are defined as those for which there are continuous symptoms of six (6) hours or less. Read the FAQs ranging from . . .When did Stroke Designation begin in New York State? Who were the original demo hospitals in Brooklyn and Queens? How does a hospital become designated? What are the qualification requirements of the Stroke Medical Director? Can the Stroke Director serve in that position at more than one designated center?
To read more from the NYS DOH and their Frequently Asked Questions, click here.
iphone medical "apps"
Are you technologically savvy? Or maybe you are overwhelmed with the new crop of medical "apps" appearing almost daily. From smart-ICE (in case of emergency) to eye charts ~ there are hundres of medical applications from which to choose.
The smart-ICE (In Case of Emergency) app will talk for a patient when they can’t! These smart-ICE applications allow the owner to record a message with the most critical medical information that plays immediately upon opening or at the push of a “PLAY’ button. No time is wasted looking through all of the data stored and the owner can give EMS providers instructions on how to use the smart-ICE app more efficiently! Smart-ICE is available on iTunes.
Some top FREE medical apps
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medscape WebMD
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medical Encylopedia
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color Blind Test
Top PAID medical apps
- ipharmacy
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speed anatomy
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drugs-medications
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pocket lab values
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and more .. .
Volume #2 (January 2010)
New York State Legislature Passes Deficit Reduction Bills
December 2, the New York State Assembly passed three deficit reduction budget bills submitted by Governor Paterson. The Senate convened and also passed the three budget bills which the Governor is expected to sign.
Important to New York ACEP members, the enacted bills reject the Governor’s Deficit Reduction Proposal to cut all Medicaid provider rates including physicians and hospitals by 10%. New York ACEP member calls and letters to legislators in response to the November ACEP Action Alert attributed to this victory.
The total package addresses about $2.7 billion of the current year deficit. The Governor has already said that it could be up to $1 billion short of what is needed due to the growing deficit.
New York Earns a 9 out of 10 on State Preparedness Report
All Americans have the right to expect fundamental health protections during public health emergencies, no matter where they live. To help assess health emergency preparedness, this section of the Ready or Not? report examines a series of 10 indicators of preparedness in each state that, taken collectively, offer a composite snapshot of strengths and vulnerabilities.
This Ready or Not? report compiles indicators based on the best publicly available data or data received from surveying states directly. Each state receives a score based on 10 key indicators. States receive one point for achieving an indicator or zero points if they do not achieve the indicator.
New York State earned a nine out of ten on the preparedness report with the only exception being that the state has not enacted either entity liability laws or made a formal and official determination that existing law provides such protections.
To view the complete report click below
New York State Department of Health Makes Change to Board Certification Physician Profile
Effective October 25, 2009, an amendment was enacted to section 1000.1(a) of The Official Compilation of Codes, Rules and Regulations of the State of New York, Title 10 (Health). This regulatory subdivision defines “Board certification” for purposes of physician profiling. The New York State Department of Health no longer recognizes the College of Family Physicians of Canada (CFPC) as a board-certifying entity. This amendment was enacted to ensure that all board certifications meet consistent standards of education, training and experience.
Physicians who have been board-certified by CFPC will no longer be recognized as board-certified. Such information, therefore, is being removed from their New York State Physician Profile. All physicians affected by this regulatory amendment will be notified before their respective Profiles are updated to remove board certification.
More on e-prescribing
Big news was recently announced by the New York State Department of Health, New York State Medicaid will pay both ambulatory and inpatient physicians for using an e-prescribing system.
These incentives will be paid in addition to CMS’ 2% Medicare bonus for e-prescribing. Additionally, there is no paperwork to fill out- Pharmacies will provide this data during their claims process and your physicians will be paid by check on a quarterly basis. According to state HIT Policy Coordinator Phyllis Johnson, this program is expected to last roughly three years.
Additional Notes
In order to be eligible for incentives, a clinician and a pharmacy must be enrolled in New York State Medicaid Fee for Service, but incentives will be paid for patients enrolled in Medicaid Fee for Service, Medicaid Managed Care or Family Health Plus
Any drug on the Medicaid formulary is eligible for the incentives, as well as some pharmacy supplies.
Volume #1 (December 2009)
One stop resource for flu updates
An additional resource is the CDC hotline, 1-800-CDC-INFO (1-800-232-4636), which offers services in English and Spanish, 24 hours a day, 7 days a week.
From the New York State Department of Health
Emergency Department Interventions to Prevent Opioid Overdose
People who have a nonfatal drug overdose are at very high risk for another one. Emergency Departments (EDs) have a unique opportunity to save lives by preventing future overdose among patients who have experienced opioid overdoses and among patients at risk of an initial overdose (e.g., frequent ED visits for substance use-related reasons or for pain medicine). Providing optimal care
New York Medicaid Electronic Prescribing Incentive Program
Effective January 1, 2010, subject to CMS approval, New York Medicaid will provide incentives to encourage electronic prescribing (e-prescribing). As described in the New York State fiscal year 2009-2010 Health Budget, eligible Medicaid prescribers can receive an incentive payment of $0.80 per dispensed Medicaid e-prescription, and eligible retail pharmacies can receive $0.20 per dispensed Medicaid e-prescription.
The long-term goals of the program are to reduce medication errors,
encourage pharmaceutical practices that produce better patient outcomes, and yield savings. The following interim guidance is intended to assist prescribers and pharmacies to prepare for participation in the program. This program guidance will be updated as necessary to incorporate new Federal rules regarding electronic prescribing.
