Update, January 2012 Vol. 27, No. 1
IN THIS ISSUE: FOLLOW US:
— Medical Education
— Patient Safety
FROM THE CHAIR
Eva Chalas, MD, FACOG, FACS
Our Quest for Work-Life Balance
Obstetrics and gynecology is one of the most physically demanding specialties in medicine. It’s very strength, the interesting combination of medical and surgical fields is also what makes the specialty unpredictable. Work hours are hard to contain into a specific block around which other activities could be planned. This steady encroachment of work into "free time" makes having a family meal, attending a social gathering, a school event or even running daily errands challenging. Despite this, we love our chosen field and are, generally, a very happy group of professionals. I have previously shared with you my own struggle with tackling work-life balance, but feel it is timely to revisit this very important issue.
At the most recent ADM, Dr. Ogburn presented information on fatigue of attending physicians and posed two questions to the audience. Of 62 respondents, 55 had experienced an adverse event when fatigued (including motor vehicle accidents), and two-thirds of the respondents wanted ACOG to help address this issue. Many of us believe that with the mandated limitations in resident work hours and decreasing reimbursement to hospitals and physicians resulting in a less robust infrastructure, the workload for attending physicians has increased significantly. I believe that because our patients are also older and have more medical comorbidities, caring for them is time consuming and requires a great deal more expertise.
We will be establishing a Task Force in early 2012 to address the issue of physician fatigue and help identify strategies which could provide relief. Given the current economic environment driving the need for cost-cutting measures, and aging of our population, an adverse impact on healthcare systems is likely. The pressure on the medical profession will continue to mount. Defining the toll that existing regulations have already taken on attending physicians is a timely goal, and will provide us with data to share with legislators before they impose new regulations. The information we gather can also be used in a constructive way - help us find ways to continue to enjoy our chosen field of specialty and provide the best of medical and surgical care for women, who deserve nothing less.
While we investigate this issue, you may wish to avail yourself to some tools others have found to be helpful. You may want to read this in the American Medical News. There are some great tips for physicians on striving to achieve balance at work. The article also cites a survey that appeared in Obstetrics and Gynecology – which found control over work schedule was the greater predictor of reported work-life balance. Here’s a look at various factors in order of how strongly they affect work-life balance:
- Control over schedule and hours worked
- Total weekly hours worked
- Number of children at home
- Total weekly hours "on call"
As we begin 2012 – I wish you and your loved ones a happy new year. I also wish you well on your quest to find the right amount of balance in all aspects of your life.
Donna Montalto, MPP - EXECUTIVE DIRECTOR
Well-Woman Website Launches
While it was not a white, snow filled season in Albany, I hope everyone enjoyed their holidays. I want to share my gratitude to each of you for the incredible growth that District II has experienced in 2011. We have had an outpouring of member activism and involvement and we have produced some extraordinary educational resources. Thank you for all your support. Great things are coming your way in this new 2012 year – things that I hope will make a difference in the lives of more women and the ob-gyns who care for them!
Did you know? We now have a new Well-Woman website, www.nywellwoman.org, that allows women to sign up to receive free, age specific health information! Women can easily join the network via the site’s automatic pop-up registration page. Once signed on, women will receive periodic updates and communication about specific health topics that they want to learn about. We also provide a link to Facebook and Twitter accounts so viewers can spread the word about being a “well-woman.”
The new website also features a section for health care providers which offers current, up-to-date primary care education on such topics as smoking cessation and immunization.
The Well-Woman website will ultimately feature a section dedicated to health care policies of interest including medical liability reform. Women who have signed up for the Well-Woman Network, may become politically active with us and their voices will speak for ACOG’s advocacy efforts.
District II will be launching a marketing campaign to tell the world about the Well-Woman website. Please take a moment to visit the site and while you are there, post the site to your Facebook account with comments encouraging your friends to join the Well-Woman website: www.nywellwoman.org. Help us tell women: Be a smart woman. Be a healthy woman. Be a well-woman.
CODING COURSE - Register Today!
Coding in New York: What You Need To Know
April 20, 2012 | East Elmhurst, NY
April 27, 2012 | Fayetteville, NY
Click Here for more information and to REGISTER
2012 ACOG SURVEY ON PROFESSIONAL LIABILITY
The 2012 ACOG Survey on Professional Liability is now in progress. Please click here to take the survey now, OR visit ACOG’s website at www.acog.org at a later date and click on the survey announcement. Results are vital to our educational efforts with lawmakers and the public.
All Fellows and Junior Fellows in Practice who complete the survey by March 9, 2012 will have a chance to win a $100 gift card to the ACOG bookstore. Five winners will be chosen at random.
Please contact Jeffrey Klagholz with any questions or comments: firstname.lastname@example.org.
Save the Date for Lobby Day
Monday, May 14th and Tuesday, May 15th
New York State Capitol
2012 Legislative Activities:
Hear Judge McKeon speak about the NYC/Federal Medical Court Demonstration.
Lobby for the Healthcare Consumer and Provider Protection Act -Collective Negotiations legislation.
Lobby for the OB Premium Reduction Course.
Meet with the Executive Branch, Commissioner of Health Dr. Nirav Shah and Assembly and Senate Members of the Legislature.
Consumer Protection Act-Collective Negotiations Bill
The Health Care Consumer and Provider Protection Act Relating to Collective Negotiations is on the Assembly Health Committee agenda for January 31, and is expected to pass. However, District II is asking for all members to reach out to the Chair of the Health Committee, Assembly Member Richard Gottfried and the health committee members urging the passage of this legislation. With your help this legislation will pass and become law in 2012. Email as many committee members as possible below. Tell them to VOTE YES on A2474a.
Richard Gottfried, Chair
Cuomo Delivers 2012 State of the State and Budget Addresses
Governor Andrew Cuomo addressed New Yorkers in his second State of the State Address on January 4 and the Budget Address on January 17, 2012.
Enjoying some of the highest approval rates of any governor, his speeches were crucial in proving to New Yorkers that he not only had a successful legislative and budgetary first year, but that he continues to lead the way for real changes for New York. District II is committed to working with the Governor this year on positive changes that will benefit ob-gyns and the women they serve.
Governor Cuomo focused his State of the State Address and much of his Budget Address on education reform, job creation, no new taxes and bringing back the Empire State to the grandeur it once enjoyed.
This is good news for all New Yorkers – including our membership. Many of ACOG’s obstetricians and gynecologists own and operate their own practices and are dealing with tremendous overhead costs such as higher taxes, lower medical reimbursements, and skyrocketing medical liability premiums.
Governor Cuomo also vowed to protect a woman’s right to choose by fighting for passage of the Reproductive Health Act and to establish the Health Insurance Exchange in New York State as required by the federal health care reform law.
District II will be meeting with the Cuomo administration in the coming weeks to discuss the Medicaid Redesign Team’s legislative recommendations and other topics of interest such as authorizing physicians to collectively negotiate in managed care.
Governor Andrew Cuomo’s Health Budget Highlights
$132.5 Billion 2012/13 Fiscal Budget
Excess Medical Liability Insurance Program will continue to be funded at $127,400,000
Medicaid expansion of coverage will include-services provided by certified lactation consultants to pregnant and postpartum women
Establishment of the New York Health Insurance Exchange
Medicaid Redesign Team’s 2011-2012 Final Report
ACOG District II attended the final Medicaid Redesign Team (MRT) meeting in Albany in December. In a packed room, which included Commissioner of Health Dr. Nirav Shah, Legislators, Department of Health policy advisors, CEOs and healthcare advocates, the MRT met one final time to approve recommendations set forth by the 9 Work Groups. Missing from the final report was the Medical Liability Work Group which failed to hold its third and final meeting and did not provide a final report to the Medicaid Redesign Team.
District II worked closely with the Commissioner of Health on one key recommendation, brought forth by the Basic Benefit Review Work Group: reductin of payments for elective C-sections or elective inductions - less than 39 weeks unless a documented medical indication is present. Dr. Shah stated in the meeting that best practices and guidelines from ACOG would be followed in determining medical indication and stated specifically that lack of physicians (for example, in rural areas of upstate New York) would also be included as an acceptable early induction indicator.
Med Mal Spotlight: Sharing YOUR Stories
This month we hear from Joan Huss, MSED, RN, who speaks directly from the heart about the struggles she and her husband (an ob-gyn) faced regarding the rising cost of practicing obstetrics and gynecology in New York State.
In her own words…
“In late September, the quarterly medical malpractice payment was due. Even though we moved the office four times to cut over-head, cash reserves were low. I had to sell family gold jewelry to cover the short-fall. Yes, we love our work but we're running out of crisis intervention measures. Women's access to their OB is in peril. Our Governor knows this and addressed Tort Reform. Let's roll, Legislators!” Joan C. Huss, MSED, RN, Adm. Asst. H. Huss, MD, PC, Rockland County, NY
Do YOU have a med mal story to tell? Let us know at: email@example.com. Please include your name and where you practice. Your story may be used in a future Med Mal Spotlight or other District II publication.
District II Awarded Funding for Cervical Length Screening Education
District II is proud to announce funding for a new project that would offer the ob-gyn generalist clinical education on cervical length screening and measurement and the subsequent administration of vaginal progesterone as a pre-term birth prevention strategy. This education will be delivered in the form of a second, complementary chapter to District II’s widely recognized Preventing Pre-Term Birth physician resource guide. Enduring educational materials such as lectures, webinars, and/or papers will accompany the chapter. Look for a knowledge, attitudes, and practices (KAP) survey coming to your inbox over the next few weeks.
New York’s Preterm Birth Rate On The Decline; District II’s 39 Weeks Initiative Takes Off
As part of ACOG District II’s initiative with the March of Dimes to eliminate non-medically indicated deliveries prior to 39 weeks, a baseline provider survey was conducted with a 12.5% (n=540) response rate from the District II membership.
First and foremost, we would like to thank those of you who participated in this survey as the data collected will help determine the success of our project's outcomes (Starbucks card winners listed below).
The ultimate goal is to focus on changing the attitudes and behaviors of ACOG members, including hospital leadership and administration, with training and education to help avoid non-medically indicated (elective) deliveries before 39 weeks.
The survey addressed topics related to elective deliveries <39 weeks, including scheduling policies, practices, patient and provider knowledge, and anticipated challenges and successes of implementing relevant education. Below is a brief summary of the survey findings:
Response n (%)
Do you offer or perform non-medically indicated deliveries <39 weeks?
When is the earliest gestational age that you feel it is safe to deliver for non-medical reasons?
Do you think it is safe to delay scheduled non-medically indicated deliveries (elective inductions and elective cesareans) until after 39 + 0 weeks?
If you do think it is safe to delay scheduled non-medically indicated deliveries until after 39 + 0 weeks, please explain:
Top 2 reasons:
Respiratory Distress Risk Factors
Fetal Lung Maturity
Does the possibility of a malpractice lawsuit play a role in your decision for an early term induction?
What is your preferred method for calculating gestational age for your patients (choose one)?
First Trimester Ultrasound
Last Menstrual Period
Rank the barriers that your hospital faces in trying to decrease < 39 weeks non-medically indicated deliveries (1= largest barrier & 6= smallest barrier)
Patient Knowledge on non-medically indicated early term delivery health outcomes vs. full term delivery outcomes.
Physicians’ knowledge of early delivery outcomes vs. full term. 182 (34.9%)
According to a recent National Center for Health Statistics Report (NCHS), the U.S. preliminary preterm birth rate in 2010 was 11.99 percent, slipping below 12 percent for the first time in nearly a decade. Below is a recap of the Big 5 State (A March of Dimes Initiative that brought the five largest states in the country (New York, California, Florida, Illinois and Texas) together to address issues related to prematurity) preliminary rates:
New York’s preterm birth rate has declined from 12.2% in 2009 to 11.5% in 2010. This represents a 7% decline in the preterm birth rate since 2006.
California’s preterm birth rate has declined from 10.3% in 2009 to 9.9% in 2010. This represents a 7% decline in the preterm birth rate since 2006.
Florida’s preterm birth rate has declined from 13.5% in 2009 to 13.3% in 2010. This represents a 4% decline in the preterm birth rate since 2006.
Illinois’ preterm birth rate has declined from 12.4% in 2009 to 12.2% in 2010. This represents an 8% decline in the preterm birth rate since 2006.
Texas’ preterm birth rate remained the same from 2009 to 2010 with a rate of 13.1%. There has been a 4% decline in the preterm birth rate since 2006.
While the report demonstrates declining rates, there is much room for positive change through ongoing provider and patient education. Over the coming months, District II will continue to highlight initiative implementation efforts at the 10 hospital pilot sites. Please contact the District II office at firstname.lastname@example.org should you have any questions regarding this topic.
The following participants won a $5 gift card from Starbucks:
C. D. Hsu
Deborah M Davenport
Jonathan S. Kusnitz
Myles S. Kibren
Rehan Bin Asif
Richard M. Wind
Soman Mary Wong
NEW PUBLICATION! Optimizing Protocols in Obstetrics Series 1: Oxytocin for Induction
The District II Patient Safety and Quality Improvement Committee is proud to announce the release of a new clinical quality improvement initiative entitled: Optimizing Protocols in Obstetrics Series 1: Oxytocin for Induction
This initiative focuses on enhancing your existing hospital obstetric protocols. Utilizing this resource, you are strongly encouraged to work with your medical team to review your existing policies and procedures, and modify them if necessary to fit the needs of your hospital environment.
The outcome of this project will be a four chapter volume that offers educational tools and resources including model hospital protocols, assessment tools, suggested checklists, posters, and relevant national specialty guidelines and practice bulletins. The remaining topics include managing hypertensive crisis, managing massive obstetric hemorrhage and preventing shoulder dystocia. Click here to view Series 1: Oxytocin for Induction.
ACOG’s Safety Certification for Outpatient Practice Excellence
Joseph Sclafani, MD, FACOG
Dr. Sclafani, a representative on ACOG’s SCOPE Program Committee, answers frequently asked questions about the program below.
What is SCOPE?
The SCOPE Program (Safety Certification for Outpatient Practice Excellence) was developed by ACOG’s Committee on Patient Safety and Quality Improvement. It was established to assist ACOG fellows and other providers of OB-GYN care in improving the quality of women’s healthcare in the outpatient setting. The program employs fundamental quality and safety principles that have been effective in hospitals in reducing medical errors and improving patient outcomes. Offices that meet SCOPE’s standards will be awarded a two year SCOPE certification by ACOG.
How can my office participate?
Practices that wish to participate first undergo a detailed application process to evaluate existing office policies and procedures that are key to maintaining safety and quality. These include practitioner credentialing of office based surgical procedures, peer review, medication safety, review of adverse events, and tracking mechanisms for laboratory results. This review is followed by an on-site evaluation by a trained SCOPE reviewer that employs interviews, observation and documentation review to measure compliance with the practice’s quality and safety program.
How much does it cost?
During the pilot phase of the SCOPE Program, there is no charge for an office review. However in the future, it is anticipated that the cost will be scaled by the size of participating practices and by assessing other practice data elements.
What are the advantages of participating in a SCOPE office review?
Although physicians frequently participate in quality assessment and patient safety activities at their hospitals, they may not have established the same principles and standards in their own offices. The SCOPE certification program provides a systematic process to build an effective office quality and safety program, or to improve an existing program. This will lead to better care, a reduction in medical errors, and reduced liability. In the future, it may lead to discounted premiums from malpractice carriers.
Experience from a New York State Pilot Site at Guthrie Clinic in Corning, NY
J. Michael Scalzone, MD, FACOG, MHCM
Dr. Scalzone volunteered as a pilot site for the SCOPE program and discusses his experiences and lessons learned from implementing the program below.
How did your office become a pilot site?
I attended an ACOG post-graduate course where the pilot program was discussed. Joanna Cain, MD, Special Consultant in Women’s Health, Patient Safety and Quality and director of the SCOPE program, added details about the goals of the program and the role of the pilot sites. Our department at Guthrie is part of a large integrated healthcare system. I proposed being involved with my organizational leadership, and they were very interested, and supportive of the process.
What is the first task required for participating in the program?
After submission of the basic demographics of the office, there is an application with approximately 60 items that needs completion. The items include such topics as policies regarding staff and physician competencies, lab tracking, procedural safety and documentation.
Did you receive buy-in from your office team and were they willing to participate?
Absolutely. The application process is very thorough and full cooperation is required to effectively and efficiently complete it. To gain the most from the site visit, preparation is essential. The office staff and administration were critical logistically, particularly in planning schedules for interviews at the site visit, generating time for demonstrating drills, review of licensure and credentials, etc.
What did you discover about your office that you didn’t recognize before the program was implemented?
Even before the site visit, the process of completing the application demonstrated several places in the office where we could improve. We realized that many good ideas for improving safety had been started in the past, but had not been fully implemented. Out site surveyor was able to add insight from an outside perspective. Most of us have developed workflows in our office that generally work well, yet, are not a best practice from a safety standpoint. In addition, it was an excellent opportunity for all levels of our staff to have input into the day to day practices that provide safe care.
What changes have you implemented since the site visit?
Almost immediately, we became more consistent with the use of our checklists for procedures. We also began using a ‘time-out’ pre-procedurally, much like what we are all familiar with in our hospitals. We added nursing and ancillary staff to our quality of care reviews, generating different perspective on where we can improve. We have several other items underway.
How will this change your office setting going forward?
Our office is already more safety focused. We feel that the SCOPE program gives us structure and guidance on how to maintain and continuously improve office care. The SCOPE program leverages the experience and expertise of ACOG leaders and fellows, to deliver ideal, safe, effective, efficient and patient centered care.
Would you recommend the program?
Absolutely, I think every office could benefit from participation.
Click here to learn more about the program and how your office can participate. Let’s be the District that has the highest SCOPE certification rate in 2012!
United Hospital Fund Awards Hospital Associations Funding to Conduct OB Quality Projects
The United Hospital Fund recently announced five grants totaling $285,000 to improve health care services in New York City. These strategic grants are part of the Fund’s program aimed at supporting the development of model projects, sponsor research to analyze systemic problems, and foster innovative solutions.
The United Hospital Fund awarded funding for a collaborative quality improvement initiative between HANYS and GNYHA to further reduce the incidence of hospital-acquired conditions and preventable readmissions. The initiative, the New York State Partnership for Patients (PFP), will provide both hospital associations with the opportunity to strengthen and expand the scope of their collective quality and patient safety interventions by establishing a comprehensive statewide approach to improve hospital care across New York State. The PFP will also address obstetrical adverse events.
Montefiore Medical Center has also received funding to pilot test a multidisciplinary “care map” to reduce the incidence of adverse obstetrical and neonatal events in high-risk, underserved, minority populations who have especially high obesity rates Montefiore’s risk management organization, FOJP, will collect baseline data on care map compliance as well as outcomes data for pregnant women with a BMI over 40. These data findings will be shared with ACOG.
ACOG District II will continue to stay well-informed on the status of these new initiatives and update you as activities develop.
ACOG DISTINGUISHED SERVICE AWARD
Please nominate an outstanding individual in ob/gyn who has made important contributions within the College/Congress or in government, research, teaching or in direct patient care. This award may not be given to an ACOG past, current or incoming President or a current ACOG Executive Board member.
Deadline: FEBRUARY 1, 2012
Submit to: email@example.com
Info Required: 2 letters of nomination; current CV of nominee
ACOG MENTOR AWARD
Nomination form located on ACOG Junior Fellow website
This award requires a nomination by a Young Physician or Junior Fellow. Please nominate an ACOG Fellow who has mentored you (Young Physician or Junior Fellow). Faculty including physicians in private practice who also serve as clinical faculty are eligible for nomination. Recipients will receive a certificate, a lapel pin and be recognized in ACOG Today, District Newsletters and the ACOG Junior Fellow and Young Physician Website.
Deadline: FEBRUARY 1, 2012
The nomination forms should be submitted to ACOG National via the ACOG Department of Junior Fellow Services by February 1, 2012.
$500,000 AWARDED THROUGH DOCTORS ACROSS
NEW YORK: $12.5 MILLION STILL AVAILABLE
The Department of Health (DOH) has announced five Doctors Across New York (DANY) practice support awards, totaling $500,000. Three of the five awards went to member hospitals (Ellis Medicine, Nathan Littauer Hospital, and Geneva General Hospital), providing $100,000 to each physician for a two-year commitment to under-served communities.
DOH still has $6.7 million available for approximately 65 new practice support awards, which can also be used toward loan repayment.
Additionally, DOH awarded two loan repayment awards, leaving $5.8 million in unspent funds, enough funding for approximately 40 additional awards of $150,000 for a five-year commitment.
DANY is a very important tool that can be used to attract new physicians to communities in need of primary care physicians and particular specialties. Last year, DANY funded nearly 100 new physicians. Bringing an additional 100 new doctors to the state this year will help to ameliorate the physician shortage.
Welcome From DII Young Physician Representative
Hartaj Powell, MD, MPH, FACOG
Hello and Happy New Year to all of our District’s Young Physicians! I’m so excited to be taking on this new role within our District. I hope to encourage you to consider your role as an advocate for women’s health as you navigate your new world to shape your identity in your new practice, hospital, institution, and your community.
Although advocating can seem a daunting task, participating in state politics to affect positive, meaningful change by engaging your local legislator or participating in Lobby Day can make a crucial difference in how our patients access and obtain the care we recommend.
I hope you’ll join me in Washington DC this February for ACOG’s annual Congressional Leadership Conference where we will meet with legislators to advocate for our patients and our profession.
ACOG District II Resident-Medical Student Mixer
Maria B. Schiavone, MD, District II Jr. Fellow Section 1 Chair
This past August, the ACOG District II JFCAC held its annual resident-medical student mixer at the Columbia campus of New York Presbyterian Hospital. This annual event, started in 2009, provides interested medical students the opportunity to discuss the upcoming residency match process with current OB/GYN housestaff and mingle with other students interested in a career in Obstetrics and Gynecology. All medical students and residents from the greater New York City area were invited to attend. The mixer proved to be a great success with students from Columbia, Mt. Sinai, Einstein and SUNY Downstate in attendance to meet and greet the OB/GYN residents of Columbia. The District II JFCAC would like to extend a special thanks to Joanne Stone, MD, New York Section 1 Chair for her continued support of this endeavor.
Ovarian Cancer Survey: Your Input Needed
Jamie Kramer, MD
My name is Jamie Kramer and I am in my final year of Ob/Gyn residency at New York Presbyterian Weill Cornell Medical Center. As part of my Chief Project for graduation I am conducting a survey of Ob/Gyns regarding their practice patterns and willingness to modify them in light of emerging evidence about ovarian cancer. The survey is anonymous, there is no incentive and should take less than 10 minutes to complete. Click Here to take the survey.
Remembering Vincent Tricomi, MD, FACOG