In This Issue
Practice Redesign Strategies: Meeting Today's Healthcare Delivery System Changes
Save the Date
2013 District II
October 25 - 27
<39 Weeks Deliveries
FROM THE CHAIR
Eva Chalas, MD, FACOG, FACS
Practice Redesign Strategies: Meeting Today's Healthcare Delivery System Changes
Given the ever changing business landscape in the field of Ob/Gyn, District II is planning a conference Saturday, April 27th in New York City. This gathering of ob-gyns will feature experts from the state and national level. The goal of the conference is to objectively review current and future business models for physician practice, and discuss trends in practice integration (selling a practice to a hospital, joining a multi-specialty group, forming a women’s health network, etc.) While the primary focus of the conference will be evaluation of options for future ob-gyn practice models, we will also address major aspects of health care reform, hospital and physician integration/networks, and changes in payment methods. Click here for more information and to register.
Some of the topics covered in the course include:
Future reimbursement/practice models
Fragmentation/coordination in women’s health care delivery
Power in partnerships to improve quality
Alleviation of administrative burdens on providers
Interplay of new advances in medical technology
Insurance benefit designs and trends
Trends in market consolidation and competition
Health care legal and regulatory issues
I hope you had an enjoyable and peaceful holiday season and wish you and your loved ones all the best throughout the New Year!
Remembering Dr. Martin L. Stone
1920 - 2012
As we look forward to all that 2013 will bring, it is important to look back for a moment and remember Dr. Martin L. Stone, who passed away in November.
District II members are fortunate that Dr. Stone chose to spend his entire career in New York. We benefited from his insight, leadership and influence throughout his accomplished career and his life.
Click here for more...
Maximize Your Compensation in 2013
April 19, 2013 | Syracuse, NY
April 26, 2013 | Queens, NY
Click here for more information and to REGISTER
New Face of Government Relations
District II is happy to welcome Katie Gordon, our new Director of Government Relations. Katie comes to us with well over ten years of experience in New York State government and a master’s degree in public administration. She worked in the New York State Senate for ten years for two State Senators representing areas downstate and in western New York. Her familiarity with and ability to navigate the political environment in Albany has allowed her to hit the ground running - ensuring that ACOG continues to be a leader in women’s health care in New York. Welcome, Katie!
Women's Equality Act in State of the State
The New Year brings with it a new legislative session and an incoming class of 29 freshman legislators. Governor Cuomo’s 2013 State of the State address focused on the continued economic recovery of the state with a focus on revitalizing upstate, education reform, gun control, and disaster response and preparedness. However the most significant item discussed was his Women’s Equality Act which includes pay equity, ending family status discrimination, source of income discrimination, pregnancy discrimination, and passing the reproductive health act. Click here to see the Women's Equality Act (begins on page 128).
New Resident Advocacy Program
District II has launched the Resident Advocacy Program (RAP). The program will offer OB/GYN residents the opportunity to gain a greater understanding of policy and political factors that shape the future of obstetrics and gynecology. This experience will better prepare a new generation of physicians to influence the future of our healthcare delivery system and offer OB/GYN residents a unique opportunity to participate in the political process in Albany. Click here for more information. If interested in participating, please contact ACOG District II at firstname.lastname@example.org
Tell Your Patients: Dense Breast FAQs
This month, a new law takes effect in New York that requires mammogram providers to let a woman know when she has dense breast tissue. District II has launched a campaign to educate women about this issue. A public service announcement sponsored by District II is airing on radio stations, urging women to get information in their ob-gyns’ offices. Click here for a Frequently Asked Questions (FAQ) document. You are encouraged to print out several copies and disseminate to patients.
NEW RELEASE! Optimizing Protocols in Obstetrics
ACOG District II is pleased to announce the release of two new chapters in the Optimizing Protocols in Obstetrics series. While the first chapter addressed the use of oxytocin for induction, the second chapter’s content focus is on the Management of Obstetric Hemorrhage and the special edition chapter offers recommendations employed by best practice hospitals to optimize the management of Non-Medically Indicated Deliveries Prior to 39 Weeks Gestation.
It is important that obstetrician-gynecologists take the lead in collaboratively implementing standardized protocols and checklists in their hospital and office setting. Obstetric departments are strongly encouraged to utilize this series and work with their medical team to review existing policies and procedures and modify them if necessary to fit the needs of their hospital environment. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the facility.
The committee will soon release similar tools regarding the management of shoulder dystocia and hypertensive crisis in pregnancy. The outcome of this project will be a multi-chapter volume that offers educational resources including model hospital protocols, assessment tools, suggested checklists, posters, and relevant national specialty guidelines and committee opinions.
Series 1: Oxytocin for Induction
Series 2: Management of Obstetric Hemorrhage
Special Edition: Non-Medically Indicated Deliveries <39 Weeks Gestation
Workforce Update in District II
William F. Rayburn MD, MBA, FACOG
Consultant, Workforce Studies
ACOG Division of Fellowship Activities
Seligman Professor & Chair
Department of Obstetrics & Gynecology
University of New Mexico
As ACOG Fellows and Junior Fellows in practice, our goal is to ensure that all women have access to the best health care. However, the number of ob-gyn resident graduates has not increased, the average number of work hours is declining, and increasing numbers of ob-gyns are retiring from obstetrics early or altogether. Listed below are important workforce data to assist in health care planning in District II:
- New York has 2,613 ACOG Fellows serving a population of 10.1 million women.
- Professional liability premiums in New York remain well above the national average (2009: $122,000 vs. $81,000 per year).
- There are 3.2 ob-gyns per 10,000 women in New York, and 6.5 per 10,000 women age 15-45 (national average is 2.61 and 5.24 respectively).
- New York’s female population is expected to not increase (0.4% vs. 18% nationally by 2030).
- New York has the most ob-gyn residency programs (36), yet the number of graduates essentially has not changed since 1980.
- New York has the highest proportion of residents overall who are international medical school graduates.
- Only 15% of all counties in New York (9 of 62 counties) have no obstetrician-gynecologists, well below the national average (49%).
- Percentages of reproductive-aged women who live within a 30-minute drive (93.6%) or a 60-minute drive (99.3%) of a maternity center are well above the national average (87.5% and 97.3% respectively).
- Demand for ob-gyns by 2020 in New York is projected to be about the same in the next 10 years.
- The concentration of adult primary care physicians is among the highest in New York.
Click here to view a two-page 2012 ACOG Workforce Fact Sheet for District II. National workforce concerns especially as they relate to health care reform are described. ACOG’s initiatives and what Congress can do to address future ob-gyn workforce issues are also mentioned.
Calcium, Vitamin D & Postmenopausal Women
Ronald Uva, MD, FACOG
ACOG District II
The United States Preventative Task Force issued a statement in June that said, "Vitamin D and calcium supplements should not be prescribed for healthy postmenopausal women." It further stated, "400 IU of vitamin D and 1,000 milligrams of calcium carbonate do not reduce osteoporotic fractures and slightly increase the rate of kidney stones." This seems to be a shocking recommendation since most of us routinely advise calcium supplementation and vitamin D. We do this because we recognize the very large health problem that osteoporosis presents.
Ten million women have osteoporosis – and that results in annual health care costs of nineteen billion dollars – a figure that is projected to grow to twenty five billion dollars by 2025. Of those women who are age 50 today, 40% will experience an osteoporotic fracture in their lifetime. The risk factors are well documented and encompass low BMD, family history of fracture, Caucasian race, smoking and medications that include steroids, androgen inhibitors, proton pump inhibitors, sedative hypnotics, antidepressants and antiseizure drugs.
ACOG Practice Bulletin 129, citing a 2011 report of the Institute of Medicine (IOM), recommends a dietary allowance of calcium of 800mg/day in postmenopausal women and a vitamin D level of 20ng/ml. The IOM clearly states that fractures are reduced when the vitamin D level is greater than 30ng/ml.
A pooled analysis looking at vitamin D supplements and fracture risk in the New England Journal of Medicine in July 2012 reviewed 11,000 randomized trials in 30,000 individuals and focused on vitamin D taken, not prescribed. The conclusion was that greater than 800 IU daily of vitamin D resulted in a 30% reduction in hip fractures and a 14% reduction in nonvertebral fractures.
Concerning calcium, one must note the distinction between dietary calcium and calcium supplementation. With respect to my postmenopausal patients: when asked if they have adequate calcium in their diet, it is not uncommon to hear: “I hate cheese and milk but I have ice cream on Thursday nights with my friends.” Clearly, these women would benefit from calcium supplements remembering that dosages above 1200mg show no increased benefit. Bear in mind that calcium supplements have been known to increase cardiovasculatory events secondary to coronary artery calcification. So - it can be concluded that dietary calcium is a potentially safer source of calcium than supplements but much time and education needs to be spent with these patients to drive the point home.
Given these arguments it is clear that the statement from the United States Preventative Task Force should not be taken as an absolute proscription. Women with osteoporosis or at risk of osteoporosis should engage in weight bearing exercise, take “appropriate” amounts of vitamin D, increase dietary calcium, stop smoking, and reduce alcohol consumption. If increasing dietary calcium is difficult for the patient, then one can prescribe supplements within the dose range as noted above.
Further information can be found in the ACOG Guideline on Osteoporosis and in the ACOG FAQ Sheet on Osteoporosis.
Smoking Cessation eToolkit
We welcome you to visit www.acogny.org, to see District II’s new smoking cessation electronic toolkit (eToolkit). The eToolkit was developed through the Smoking Cessation Initiative, which concluded in December. The project, made possible through a grant from Pfizer, was designed to enhance early assessment, diagnosis and treatment of the occasional and casual smoker. The eToolkit offers effective tools and resources - such as how to develop an office-based smoking cessation program, coding and reimbursement information as well as a patient education video you are free to download and share with patients.
We would like to extend our thanks to the Smoking Cessation Task Force for their work on this project:
Smoking Cessation Task Force
Linus Chuang, MD, FACOG - Co-Chair
Sally Faith Dorfman, MD, FACOG - Co-Chair
Richard Aubry, MD, FACOG
Molly Cowgill, MD, FACOG
George T. Danakas, MD, FACOG
Katy Irani, MD, FACOG
Renee Mestad, MD, FACOG
Paul L. Ogburn Jr., MD, FACOG
Cheruba Prabakar, MD (JFT)
Carolyn L. Westhoff, MD, FACOG
Additionally, District II would like to recognize five pilot sites from across New York State that were instrumental in helping us assess and identify casual smoking habits by surveying patients during their annual Well-Woman visits:
Smoking Cessation Pilot Sites
Mary Wilsch, MD, FACOG, Howard Weinstein, MD, FACOG, Edith Westpfal, MD, FACOG - (Syracuse)
Laura Costello, MD, FACOG - (Albany)
George Danakas, MD, FACOG - (Buffalo)
Ben Kohanim, MD, FACOG - (Long Island)
Iffath Abbasi Hoskins, MD, FACOG, Ralph Ruggerio, MD, FACOG - (Brooklyn)
There is more to come on smoking cessation. An upcoming smartphone app will incorporate much of the eToolkit’s content. Stay tuned…
MORE OB Communication
Exciting News from Rochester General Health System
In February 2012, Rochester General Health System affiliates, Rochester General Hospital and Newark-Wayne Community Hospital, initiated a three-year comprehensive patient safety program, MORE (Managing Obstetrical Risk Efficiently). Adopting MOREOB at both RGHS hospital affiliates simultaneously reinforces RGHS’s ongoing commitment to clinical integration.
Under the direction of Abraham Lichtmacher, MD, FACOG the Rochester General Health System Obstetrics team is comprised of over 150 clinicians, 25 of those team members make up the “Core Team.” Throughout Phase I, "Learning Together", the individuals from RGHS have begun to learn core content and have attended valuable workshops as a team. This phase has developed a foundation of trust and respect.
During 2012, RGHS team members held workshops to discuss areas that needed improvement and also created a video which highlighted the teamwork, education, and quality that the MOREOB program has helped to create. This video currently has over 250 views on YouTube - Click here to see the video.
Building on Phase I, RGHS is now preparing to move onto Phase II and will practice emergency drills. Fostering a more efficient communication environment is the goal of Phase II.
“There is no upper limit when it comes to patient safety. We are always looking for new ways to help our nationally recognized clinical teams improve their processes for delivering top-quality care,” says Mark Clement, President & CEO of Rochester General Health System. “The MOREOB Program is another way for us to ensure that our patients receive the best care in the region.”
Junior Fellow News
Omar Duenas, MD
Junior Fellow Chair
Exciting Things are Happening in Our District!
In December we proudly nominated Randi Leigh, MD to receive the ACOG Community Service Award. This award was established by then President Richard Hollis and funded by Wyeth Pharmaceuticals in response to the fellows who have supported their community with no remuneration or recognition. The decision to nominate Dr. Leigh was based on her dedication in hosting a diaper drive - that collected 140 diapers and $400 - which was donated to Baby Buggy, a not for profit organization. This model is an example of a needed community service and we hope it will sensitize other Junior Fellows to join in this noble cause. If you would like to run a diaper drive at your hospital, please contact me, email@example.com.
ACOG Mentor Award
Submission deadline: Feb. 1, 2013
Robert Wood Johnson Foundation Clinical Scholars Program
Submission deadline: Feb. 28, 2013
Attention Medical Students
Interested in attending the 2013 Annual Clinical Meeting in New Orleans? The John Gibbons Medical Student Travel Award is available to provide financial help for medical students to attend. Click here for more information on the travel award.