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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 issue ofe-news, email New York ACEP at
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 Medicaid Begins Coverage for
Hospital Emergency Room Observation Services
Effective April 1, 2011, New York State Medicaid, including Medicaid managed care and Family Health Plus (FHPlus) plans, will provide separate payment in certain situations for hospital observation services provided in a distinct observation unit, in addition to payment for the emergency room medical visit. Payment will be made under Ambulatory Patient Group 450 (APG). Medicaid payment for observation services is limited to patients who are seen, evaluated and admitted to the Observation Unit via the hospital's emergency service and for whom a diagnosis and a determination concerning admission, discharge or transfer cannot be accomplished within eight hours of admission to observation status, but can reasonably be expected within 24 hours. In order to be reimbursed for observation services, a patient must be in observation status for a minimum of eight hours (with clinical justification). This is in addition to any time that the patient spent in the Emergency Room prior to admission to the observation unit. Hospitals may bill up to 24 hours of observation services, at which time the patient must be admitted as an inpatient or discharged. Medicaid will not reimburse for direct admits to observation (CPT/HCPCS code G0379).
The Department of Health is in the process of adopting regulations governing the operation of Observation Units. In the interim, to obtain Medicaid payment for such observation services, facilities must have a waiver approved by the Office of Health Systems Management (OHSM), Division of Certification and Surveillance (to initiate this process, please contact OHSM staff at 518-402-1003). Waivers are issued on a site specific basis. The OHSM waiver criteria are listed at the end of this article. Medicaid will not reimburse for observation services provided at hospital facilities that have not received a Department of Health waiver to provide such services.
The following Medicaid payment policy and reimbursement criteria will apply concerning Medicaid payment for observation services in an observation unit. Required documentation for Medicaid payment for observation unit services includes:
- a clinical justification for observation status;
- a working diagnosis;
- any tests or treatments administered while the patient is in observation status;
- progress notes by a responsible Physician, PA or NP; and
- final disposition of the patient from the observation unit.
Billing Guidelines and Requirements
Observation services should be billed under APG rate code 1402 and CPT/HCPCS code G0378 (hospital observation service, per hour). The number of hours in observation status must be coded in the units of service field of the claim line on which G0378 is coded. The appropriate CPT/HCPCS codes for all ancillary services provided to the patient while in observation status should also be reported on the claim. Facilities should code G0378 only when the length of stay in the observation unit is for 8 or more hours. If the length of stay in the observation unit is less than 8 hours, the observation portion of the stay is not reimbursable by Medicaid and the observation code should not be reported on the APG claim.
Only those hours that the patient is actually in the observation unit may be billed with G0378. Significant procedures or high intensity ancillaries (MRI, PET scans, CT scans) will cause G0378 to package, meaning it will not be paid separately. Low level ancillaries (X-rays, laboratory tests) and drugs will not cause G0378 to package and observation will be paid separately.
Observation unit services end when the patient is admitted as an inpatient, or is discharged from the hospital. If the patient is admitted to inpatient status, only the inpatient admission may be submitted for payment and the emergency room services and associated observation services should not be billed to Medicaid. If the patient must be transferred to another facility, the emergency room and observation services may be submitted for payment.
Managed care organizations (MCOs) may choose to utilize a criteria-based assessment tool for determining whether the observation stay is medically necessary. Approval of observation services may be subject to either prior authorization or a retrospective review process.
Observation Services Billing Examples
Hours in ED
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Hours in Observation Unit
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Provider Billing |
| 3 hours |
6 hours |
Payment for ED visit only - do not report observation services on the APG claim |
| 3 hours |
9 hours |
Payment for ED visit and Observation (9 units) |
| 8 hours |
24 hours |
Payment for ED visit and Observation (24 units) |
| 8 hours |
4 hours |
Payment for ED visit only - do not report observation services on the APG claim |
Note: Medicare's payment policy for observation services is different than that utilized by Medicaid. Nevertheless, Medicaid will continue to reimburse the Medicare Part B coinsurance amounts (to the extent permitted by State statute) for dually-eligible recipients.
Questions? Please call the Division of Financial Planning and Policy at (518) 473-2160 for any additional information or questions about Medicaid coverage policy for observation services.
EMERGENCY DEPARTMENT OBSERVATION UNIT SERVICES
Application and Review Criteria For Regulatory Waiver of Eight-Hour ED Length of Stay Limitation for Patients Assigned to Observation Units
The application must include a summary of the program proposed, that includes:
1. Program goals and objectives for the observation unit, which must include use of the unit only for observation, diagnosis and stabilization of those patients for whom diagnosis and a determination concerning admission, discharge, or transfer cannot be accomplished within eight hours, but can reasonably be expected within twenty-four hours.
2. Clinical Criteria/Indicators for Assignment and Discharge/Exclusion Criteria.
3. Clear Statement/Description of Oversight and Accountability, which must provide for:
a. Organization of the observation unit under the direction and control of the Emergency Service;
b. The integration of the observation unit and its services with the emergency service and other related services of the hospital; and
c. Medical staff adoption of policies and to assure appropriate use of the observation unit
4. Description of the Physical Space, which must include:
a. The size and location of the unit and number of beds. The total number of observation unit beds in a hospital shall be limited to five percent of the hospital's certified bed capacity, and shall not exceed forty, provided that in a hospital with less than 100 certified beds, an observation unit may have up to five beds.
b. A distinct physical space separate from the rest of the emergency service, except in a hospital designated as a critical access hospital pursuant to subpart F of part 485 of Title 42 of the Code of Federal Regulations or a sole community hospital pursuant to section 412.92 of Title 42 of the Code of Federal Regulations or any successor provisions.
c. Whether or not construction is required, a certification from a licensed architect or engineer' in a form specified by the Department, that the space complies with the applicable provisions of Parts 711 and 712-2 and section 712-2.4 of 10 NYCRR (Chapter 2.2, "Specific Requirements for General Hospitals," of Part 2, "Hospitals," of Guidelines for Design and Construction of Health Care Facilities, 2010 edition).
d. To the extent that construction is required for the observation unit, compliance with Part 710 of 10 NYCRR.
5. Defined staffing plan that:
a. Provides for staff appropriately trained and in sufficient numbers to meet the needs of patients in the observation unit;
b. At a minimum, provides for oversight of the medical care of the patients assigned to the observation unit by a physician, nurse practitioner, or physician assistant. The physician, nurse practitioner, or physician assistant assigned to oversee the observation unit must be immediately available to meet the needs of patients in the observation unit and must not be assigned concurrent duties that will interfere with such availability.
6. Quality Review/Improvement Activities -- to be established by hospital, but may include:
a. Tracking inpatient admissions from the observation unit;
b. Reducing returns to the ED;
c. Reducing any hospital admissions within 7 days of discharge from the observation unit;
d. Sample chart reviews/review of all deaths following an observation unit stay;
e. Patient satisfaction/assessment tool.
7. Hospitals operating observation units pursuant to waivers granted by the Department prior to May 1, 2011, may continue to operate those units consistent with the terms of their waivers.
Physician Reporting &
Electronic Prescribing Incentive Program
PowerPoint Presentation from August 16, 2011 Available
If you missed CMS’ PowerPoint presentation that was shown during the August 16, 2011 Physician Quality Reporting System & Electronic Prescribing Incentive Program, the materials are now available on the CMS website. This presentation provides an Overview Reporting System and the 2010 Incentive Payments and Feedback Reports for Electronic Prescribing Incentive Program. To access the presentation, click here or go to http://www.cms.gov/PQRS/, and select the CMS Sponsored Calls tab on the left side of the page. Next, scroll down to the section under the heading Downloads and select – August 16, 2011 National Provider Call Materials.
Penalties for Not Becoming an Electronic Prescriber
From calendar year (CY) 2012 through 2014, a payment adjustment that increases each CY will be applied to an eligible professional’s Medicare Part B Physician Fee Schedule (PFS) covered professional services for NOT becoming a successful electronic prescriber. The payment adjustment of 1.0% in 2012, 1.5% in 2013, and 2.0% in 2014 will result in an eligible professional or group practice receiving 99.0%, 98.5%, and 98.0% respectively of their Medicare Part B PFS covered professional services.
The 2012 eRx Payment Adjustment
The reporting period for reporting the electronic prescribing measure for purposes of the 2012 payment adjustment ended on June 30, 2011. However, on May 26, 2011, CMS released a proposed rule entitled “Proposed Changes to the 2011 Electronic Prescribing Incentive Program” to address concerns stakeholders have expressed regarding the implementation of the 2012 eRx payment adjustment.
The proposed rule proposes to do the following:
1. Modify the existing electronic prescribing measure to allow for the use of certified Electronic Health Record (EHR) technology as defined at 45 CFR 170.102.2. Provide the following additional significant hardships to the 2012 eRx payment adjustment:
(i) Eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Program and adopt certified EHR technology;
(ii) Inability to electronically prescribe due to local, state, or federal law or regulation;
(iii) Limited prescribing activity; or
(iv) Insufficient opportunities to report the electronic prescribing measure due to limitations in the measure’s denominator.
3. Allow eligible professionals until October 1, 2011 to submit a request for a significant hardship exemption.
Please note that CMS is not currently accepting exemption requests based on the proposed significant hardship exemptions stated above. If finalized, CMSwill provide instructions for submitting significant hardship requests in a final rule.
The proposed rule may be viewed at 2011 eRx Proposed Rule -- CMS-3248-P [PDF 224KB]. The public has until July 25, 2011 to provide comments on the proposed rule. Upon consideration of the public comments received, CMS will publish a final rule before these proposed changes would go into effect.
New York State Adopts
Emergency Department Coverage Rules
Regulations, published in December and effective immediately, allow for additional time for supervising physicians to respond onsite in smaller volume emergency departments.
The regulation allows the attending or supervising physician in a hospital emergency department with fewer than 15,000 annual visits to be available within 30 minutes, up from the current 20 minutes, as long as the emergency department is covered at all times by a nurse practitioner or registered physician’s assistant.
Federal requirements for Critical Access Hospitals also allow for a 30-minute response time for physicians covering the emergency department.
In a letter sent April 2010, New York ACEP stressed, "First and foremost, New York ACEP believes all patients seeking emergency care in a hospital receive the highest quality care when treated by a board certified emergency physician. It is our position that all New York State Emergency Departments regardless of volume be staffed 24 hours a day, seven days a week by a board certified emergency physician." To see the full letter, click here
New York State Department of Health Changes
Requirements for Stroke Centers for 2011
In a recent letter to CEOs, Medical Director, Office of Health Systems Management, John Morley, MD, provided data requirements for designated Primary Stroke Centers for 2011 and reviewed the data requirements for '09 and '10 and outlined changes to requirements for Stroke Centers for 2011.
Three additions to the reporting requirements in 2011 for data requirements for designated primary stroke centers include:
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CME requirements for stroke team members include eight (8) "Category 1" CMEs for all in year one and four (4) "Category 1" CMEs in year two and thereafter. Waivers of the four (4) CMEs will no longer be given based on Board Certificiation.
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Patients transferred out of a Primary Stroke Center must have the indication for transfer documented.
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All outliers of more than 30 minutes beyond time targets, that are not exceptions which have been explained, must include a corrective action plan.
To read the letter in its entirety, click here.
Ambulances Pack Cooling Technique
Democrat and Chronicle, by Patti Singer, staff writer
(January 3, 2011) The chain of survival for adults suffering cardiac arrest just got another link. Emergency medical service providers in Monroe and Livingston counties are now able to chill patients whose pulse returns.
The procedure has become the standard of care in hospitals to treat heart attack and other cardiac events. Moving therapeutic hypothermia into the field, where it is part of a response that includes CPR,will increase a person's chance of survival with less risk of long-term neurological damage.
Unlike on television shows, where a study several years ago found that nearly three-quarters of people who have cardiac arrest are fine at the end of the episode, real life isn't as rosy. Only about 10 percent of people get a pulse back, but that doesn't assure a full recovery.
"The whole purpose of this is that for the people we are able to get back, we give them every chance of being able to walk out of the hospital," said Dr. Jeremy Cushman, Monroe-Livingston Regional EMS medical director.
Cushman wrote the protocol, recently approved by the State Emergency Medical Advisory Committee, which on Jan. 1 made Monroe-Livingston among the first of the 17 state EMS regions to implement therapeutic hypothermia beyond a demonstration project.
Use by EMS personnel is another in the expanding applications for the procedure, which can be as low-tech as the ice packs and chilled saline that ambulance rigs will carry or as sophisticated as special cooling apparatus used in hospitals.
Over the past few years, therapeutic hypothermia has been used on an experimental basis with neonatal encephalopathy, stroke patients and people suffering brain or spinal cord injuries, including Buffalo Bills player Kevin Everett in 2007.
The main use of the procedure remains on cardiac arrest patients whose pulse has come back. The technique is practiced at Unity, Rochester General and Strong Memorial hospitals.
When a cardiac event strikes the heart, the brain is at risk from loss of oxygen. Cooling the body to 32 to 34 degrees Celsius (90 to 93 degrees Fahrenheit) slows down that need for oxygen. Rewarming begins 24 hours after the cooling process was started, and it takes about eight hours.
"The brain takes 20 percent of the body's energy needs," explained Dr. Bruce Thompson, director of prehospital care at Unity Health System. "If you can slow it down, the brain has a chance to recover."
Even though studies have backed up the theory, therapeutic hypothermia still sounds like science fiction to Wendy Schneider.
While riding in car with her boyfriend in March, the 45-year-old Bergen, Genesee County, woman suffered a heart attack. He performed CPR, and eventually she was transported to Strong Memorial Hospital.
After a series of cardiac arrests that caused concern about brain damage, cooling pads were placed on her torso and thighs and a computer regulated the temperature.
Schneider emerged a few weeks later from a medically induced coma with full neurologic function. During that time, she also received a device to assist her heart.
"These circulation support devices have allowed us to save people where they previously would have died," said Dr. Frederick S. Ling, director of the cardiac catheterization lab at Strong. "Raising someone from the dead, it's absolutely true."
Schneider was stunned when doctors told her they had initially cooled her body when she arrived at the hospital. "I'd never heard of anyone going through something like that, let alone I had to experience it."
But she didn't want the details. "I'm not a cold person. I like the heat."
Ambulance services in Monroe County alone get a few hundred calls a year for cardiac arrest, said Cushman, who also is the Monroe County EMS medical director.
Having paramedics start the cooling process is an exciting prospect for the doctors who will be treating the patient at the hospital. "This gives us a window of opportunity," said Unity's Thompson. "We're talking minutes here. Five or 10 minutes makes a huge difference."
Chris Gray, a paramedic who is deputy ALS chief for Rural/Metro Medical Services, said this is a big advance. "We are bringing all the cutting edge stuff that's done in the hospital out to the field."
Some agencies may add more expensive refrigeration units to their ambulances. Julie Jordan, Advanced Life Support chief of the Southeast Quadrant Mobile Critical Care Unit, said that it costs less than $200 to outfit the agency's eight rigs with Igloo coolers and ice packs. Rigs already carry saline, and it just has to be chilled to 4 degrees C.
Pregnant women, accident victims or people who've had surgery in the previous 14 days are not suitable for the treatment because of an increased risk of bleeding, Jordan said.
If paramedics can proceed, they would put the ice packs around the person's neck, under the armpits and at the groin, and start the chilled saline IV.
For all its benefits, therapeutic hypothermia isn't magic, said Reg Allen, Chief of Henrietta Ambulance. "If someone doesn't start CPR right away, the chances of us getting them back are greatly reduced. We need to get a pulse to cool them down."
Volume #8 (December 2010)
Workers' Compensation Board Improve Fee Schedule
and Updates Guidelines
Doctors who treat workers’ compensation patients will see some important, positive changes implemented shortly, including increases in reimbursement rates and treatment guidelines that authorize most testing and treatments without an insurer’s prior approval.
The Workers’ Compensation Board has proposed a new fee schedule that includes an across-the-board 30% increase to the Evaluation and Management services codes, effective December 1, 2010. Over the next twelve months, the Board will also conduct a comprehensive review and revision of the physician fee schedule, as well as other health care provider fee schedules. The Board has also moved the effective date of Medical Treatment Guidelines to December 1, 2010.
Excerpt from Provider Letter
The Workers’ Compensation Board (Board) is preparing to implement a major change in the manner medical care is provided to injured workers. The NYS Workers’ Compensation Medical Treatment Guidelines will become the mandatory standard of care for the mid and low back, neck, shoulder, and knee, effective for dates of service on or after December 1, 2010. These four body parts were chosen because they represent the most frequent claims and the highest medical costs.
The Medical Treatment Guidelines will:
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Establish a standard of medical care for injured workers,
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Expedite quality care for injured workers,
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Improve the medical outcomes for injured workers,
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Speed return to work by injured workers whenever possible,
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Reduce disputes between payers and medical providers over treatment issues,
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Increase timely payments to medical providers, and
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Reduce overall system costs.
The Medical Treatment Guidelines are mandatory for all work-related injuries or illnesses to these four body parts experienced by employees in New York State. With few exceptions, all treatment in accordance with the Guidelines is pre-authorized, so providers will no longer have to obtain prior approval if their treatment conforms to the Guidelines. The regulations require that insurers pay providers for services rendered in accordance with the Guidelines. Treatment that is outside the Guidelines will not be paid unless a variance is approved by the insurer or the Board.
HIV Testing Requirements for Patients Forms
and Information for Physicians
Key provisions of the new legislation include:
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HIV testing must be offered to all persons between the ages of 13 and 64 receiving hospital or primary care services with limited exceptions noted in the law. The offering must be made to inpatients, persons seeking services in emergency departments, persons receiving primary care as an outpatient at a clinic or from a physician, physician assistant, nurse practitioner or midwife.
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Standardized model forms for obtaining informed consent and providing for disclosure will be developed by the New York State Department of Health and posted on the DOH website.
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Consent for HIV testing can be part of a general durable consent to medical care, though specific opt-out language for HIV testing must be included.
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Consent for rapid HIV testing can be oral and noted in the medical record.
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Health care and other HIV test providers authorizing HIV testing must arrange an appointment for medical care for persons confirmed positive.
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HIV test requisition forms submitted to laboratories will be simplified.
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Deceased, comatose or persons otherwise incapable of providing consent, and who are the source of an occupational exposure, may now be tested for HIV in certain circumstances without consent.
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Confidential HIV information may be released without a written statement prohibiting re-disclosure when routine disclosures are made to treating providers or to health insurers to obtain payment.
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Letter to Providers
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Letter to New York City Providers
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Model for General Medical Consent that Includes Written Consent for HIV
Testing
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HIV Testing Law Frequently Asked Questions
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AIDS Institute Brief Update of the HIV Testing Legislation
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Legislation and Memo
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Implementation Outline.
Governor Appoints Health Care Reform
Advisory Committee
Governor Paterson invited 37 organizations to participate in a Health Care Reform Advisory Committee. As one of the organizations, the Medical Society of the State of New York (MSSNY) reached out to specialty societies through the creation of its own Advisory Committee to provide a collective perspective of all of medicine to the Governor's Committee. We are pleased to announce that New York ACEP was invited to participate on MSSNY's Committee. New York ACEP President, Joel M. Bartfield, MD FACEP, will serve as emergency medicine's representative.
Other groups include the Healthcare Association of New York State (HANYS), the Greater New York Hospital Association (GNYHA), the New York Health Plan Association, the New York State Business Council, the New York State AFL-CIO, and several patient advocacy groups.
The Governor’s office expects that several advisory work groups will be created to assist the work of the Advisory Committee. These include: public health insurance programs; commercial market reforms; the health insurance exchange, long-term care; and public health programs. Several groups attending the meeting also suggested that there be a workgroup to discuss outreach to assure awareness of new health insurance programs. The exact scope and issues to be addressed through these workgroups still need to be defined.
Take Care of Yourself and Your Family
 It's personal . . . legislation is passed every year that affects your practice and future. You can stand on the sideline and complain or you can get involved.
The 2011 Legislative Session will be laden with healthcare decisions. Seismic decisions get made at the state level. Emergency medicine needs to be there! We need all New York emergency physicians to be involved. The first step is to support NYEMPAC.
 Contribute to NYEMPAC . . . the New York Emergency Medicine Political Action Committee is your voice in Albany. Influence and access in the legislative arena takes cash! Make your contribution today and improve your practice. We welcome contributions in any amount, but please reach as deep as you can. NYEMPAC advocates on behalf of our patients, yes, but it also advocates on behalf of our specialty, our careers and our paychecks.
Contribution to NYEMPAC is an investment in our future.
Recommended contributions:
$250 emergency physicians
$20 residents
Volume #7 (October 2010)
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- Auto insurers required to cover care provided to intoxicated drivers in the emergency department
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- Family Health Care Decisions Act enabling the appointment of a surrogate to make health care decisions for incapacitated individuals
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- legislation permitting HIV testing of patients in cases of occupational exposure
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- managed care reforms enacted to expedite processing of physician claims
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- managed care reforms enacted to limit the ability of HMOs to deny claims and reduce payment
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- enactment of legislation to reinstitute insurance department review and approval of health insurance premium rates
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- two year freeze on physician liaiblity premiums
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- averted a $400 increase in physician registration fees
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- defeated HMO legislation to limit physicians' ability to refuse to participate in a plan
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- defeated legislation to repeal contingency fee limitations, extend statue of limitations and expand damages in wrongful death actions
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 Click icon for full report on the Legislation Highlights
Emergency Medicine Needs a Seat at the Table in Albany!
The election next month presents opportunities and challenges for emergency medicine. With a new Governor and Assembly and Senate representatives, time, energy and resources are required to educate and advocate on behalf of emergency medicine.
The 2011 Legislative Session will be laden with healthcare decisions. Seismic decisions get made at the state level. Emergency medicine needs to be there! We need all New York emergency physicians to be involved. The first step is to support NYEMPAC.
Contribute to NYEMPAC . . . the New York Emergency Medicine Political Action Committee is your voice in Albany. Influence and access in the legislative arena takes cash! Make your contribution today and improve your practice. We welcome contributions in any amount, but please reach as deep as you can. NYEMPAC advocates on behalf of our patients, yes, but it also advocates on behalf of our specialty, our careers and our paychecks.
Contribution to NYEMPAC is an investment in our future.
Recommended contributions:
$250 emergency physicians
$20 residents
HIV Source Testing Law
Takes Effect
On July 30, 2010, Governor David Paterson signed into law S.8227/A.11487, which allows patients to agree to HIV testing as part of a general signed consent to medical care that remains in effect until it is revoked or expires. The law also requires health care providers, including hospitals and emergency departments, to offer testing to all patients between 13 and 64 years of age, as recommended by the Federal Centers for Disease Control and Prevention (CDC), and facilitates authorization for testing in the case of certain occupational exposures to HIV infection. The new law takes effect September 1, 2010, but authorizes the New York State Commissioner of Health to adopt regulations necessary to implement the law prior to that date.
*This link will redirect you to the New York State Assembly - Bill Search.
Enter bill number "S08227" to read it in its entirety
New York Members
Leader National ACEP
New York ACEP member, Sandra M. Schneider, MD, FACEP, assumed the presidency of ACEP during National ACEP's Scientific Assembly earlie this month. Andrew E. Sama, MD FACEP was elected to serve as National ACEP Vice-President
 Sandra Schneider, MD FACEP
Dr. Sandra Schneider, a Rochester, New York, emergency physician, is the new president of the American College of Emergency Physicians. Schneider, a professor and chair emeritus of the department of emergency medicine at the University of Rochester Medical Center (URMC), called for government attention to reduce the problem of overcrowding in emergency departments. Schneider was the first chair of the URMC department of emergency medicne, serving from 1993 to 2007. She established a residency training program in emergency medicine and felllowship programs in pediatric emergency medicine and emergency sports medicine.
Andrew E. Sama, MD FACEP
Andrew E. Sama, MD FACEP, was elected as National ACEP Vice-President. Dr. Sama is currently Chief, Department of Emergency Medicine, Huntington Hospital, Huntington, New York; Vice President, Emergency Services, North Shore-Long Island Jewish Health System, Manhasset, New York.
Dr. Sama served as New York ACEP's president, from 2002 through 2004
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 the 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.
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.
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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.
We all know there is a lot happening in the field of emergency medicine. We strive to keep you informed of news that affects you.
If you have a topic you would like to see featured in a future issue of e-news, email New York ACEP at
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