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Update July 2013

ACOG District II
July 2013 | Vol. 28, No. 3    

   In This Issue


M
eetings

Patient Safety
Tools, Drills
& Protocols
July 25 - 26
Saratoga, NY

 
2013 District II
Annual Meeting
October 25 - 27
Grand Hyatt, NYC



Quick Links

Mobile Device
TIPS & TRICKS


Junior Fellow Call for Abstracts Now Open

Medicaid Updates

Advisory Council
Officers


D2 Newsletters


Follow DII

Facebook      YouTube

 

Contact DII 

 518.436.3461
info@ny.acog.org

 

 

Eva Chalas, MD FROM THE CHAIR
Eva Chalas, MD, FACOG, FACS

A Busy Summer for District II

I hope you are enjoying the summer season with loved ones and friends. As the weather continues to heat up, so are efforts by District II to reignite our Safe Motherhood Initiative (SMI), a program which aims to prevent pregnancy-related deaths through improved understanding of the causes and risk factors for maternal mortality. Last October, District II responded to a request from Merck for Mothers seeking proposals for state-wide initiatives to reduce maternal mortality and morbidity. Under the leadership of Dr. Mary D'Alton and Dr. Cynthia Chazotte, experts in maternal-fetal medicine, our three-year proposal was accepted. District II has assembled a team to develop and implement standard best practices for more than 10,000 obstetric providers and 131 labor and delivery units across New York State. You can read more about our new SMI efforts in the Medical Education section of the newsletter.

This summer, District II is also editing a transcript of the conference we presented in April entitled Practice Redesign Strategies: Meeting Today's Healthcare Delivery System Changes. National and regional experts traveled to New York City to educate more than 100 attendees on business models for physician practice, trends in practice integration, and how health care reform impacts physician practice. Attendees also received guidance on hospital and physician integration/networks, and changes in payment methods. The conference transcript will be available on the District II website in the coming months.

Finally, think ahead to our Annual District Meeting (ADM) - October 25-27 at the Grand Hyatt New York. Click here and register for an educational meeting that has truly become New York’s premier women’s health event. My deepest appreciation to this year’s Scientific Program Chairs, Dr. Abraham Lichtmacher and Dr. Camille Clare, who have organized an outstanding and robust three-day program. Click here for the preliminary program. I hope to see you in October. Until then, I hope you enjoy the rest of your summer!


MLMIC Announces 3% Dividend and Geographically Based Rates

The Medical Liability Mutual Insurance Company (MLMIC) has announced the implementation of a 3% dividend for all renewing physicians, and a 5% rate reduction for most insured physicians upstate and for downstate physicians in New York, Orange, Rockland, Sullivan and Westchester counties. When combined with a 5% base rate increase for all MLMIC insured physicians statewide, individual physician rate changes will vary from -0.25% to +5% before the dividend. After applying the dividend, more than half of MLMIC’s insured physicians will experience a reduction in premium payments and the remainder will experience a modest increase. The rate changes were established by the Department of Financial Services (DFS) effective July 1.


NEXT WEEK!
Patient Safety Conference-11 CMEs

OB Safety Tools, Drills and Protocols
Thursday, July 25 - Friday, July 26
The Hyatt Place, Saratoga, NY

Click here to REGISTER


Your Controlled Substance Prescriptions: NYS Department of Health Issues Proposed Regulations to Implement Enhanced Prescription Monitoring Program

Laurie Cohen, Esq.

 
Laurie Cohen, Esq.
Partner, Nixon Peabody and the Chapter’s Legal Counsel

With the stated goals of reducing “doctor shopping” and the “over prescribing” of controlled substances, New York enacted legislation in 2012 that will require real time reporting of controlled substances dispensed by pharmacists and practitioners and also require most practitioners to consult a prescription monitoring program (PMP) registry prior to writing a prescription for a controlled substance listed on Schedule II, III or IV. To implement the new law which is effective August 27, 2013, the NYS Department of Health (DOH) has issued proposed regulations which address the duty to consult the PMP registry as well as the reporting requirements.

Duty to Consult PMP Registry
Specifically, the proposed regulations provide that a practitioner must consult the PMP registry no more than 24 hours prior to prescribing or dispensing any controlled substance listed on schedule II, III, or IV for the purpose of reviewing a patient’s controlled substance history. Further, the proposed regulation states that a practitioner must document such consultation in the patient’s medical record.

Even if the practitioner is not required to consult the PMP registry because an exception to the consultation requirement applies (See list of exceptions below), the practitioner must document in the patient’s medical record the applicable exception. In addition, if the practitioner has not consulted the PMP registry based upon the exception it is not reasonably possible for the practitioner to access the registry in a timely manner and no other practitioner or designee authorized to access the registry is reasonably available and the quantity of controlled substance prescribed does not exceed a five-day supply, the practitioner must further document in the patient’s medical record “the conditions, occurrences, or circumstances that caused such consultation to be unreasonable” including “the barrier(s) to accessing the registry, and the efforts made by the practitioner to contact other designees”.

Furthermore, if the practitioner has not consulted the PMP registry based upon that exception that such consultation would, as determined by the practitioner, result in a patient’s inability to obtain a prescription in a timely manner, thereby adversely impacting the medical condition of such patient, provided that the quantity of the controlled substance does not exceed a five-day supply , the practitioner must document in the patient’s medical record “a description of the circumstances supporting the practitioner’s conclusion that consultation of the registry would adversely impact the patient’s ability to obtain a prescription in a timely manner and the relationship between that delay and the patient’s medical condition.”

Exceptions to the Duty to Consult PMP Registry
The specific exceptions to the duty to consult the prescription monitoring program registry include:

  • (i) veterinarians;
  • (ii) a practitioner dispensing for interim treatment for an addict on a waiting list for admission to an authorized maintenance program;
  • (iii) a practitioner administering a controlled substance whether by injection, inhalation, ingestion, or any other means, to the body of a patient or research subject;
  • (iv) a practitioner prescribing or ordering a controlled substance for a patient of hospital, clinic, nursing home or similar facility approved and certified by the department for use on the premises of, or during an emergency transfer from facility;
  • (v) a practitioner prescribing a controlled substance in the emergency department of a general hospital, provided that the quantity of controlled substance prescribed does not exceed a five-day supply if the controlled substance were used in accordance with the directions for use;
  • (vi) a practitioner prescribing a controlled substance to a patient under the care of a hospice,
  • (vii) a practitioner when:
    1. it is not reasonably possible for the practitioner to access the registry in a timely manner; and
    2. no other practitioner or designee authorized to access the registry is reasonably available; and
    3. the quantity of controlled substance prescribed does not exceed a five-day supply if the controlled substance were used in accordance with the directions for use;
  • (viii) a practitioner acting in circumstances under which consultation of the registry would, as determined by the practitioner, result in a patient’s inability to obtain a prescription in a timely manner, thereby adversely impacting the medical condition of such patient, provided that the quantity of the controlled substance does not exceed a five-day supply if the controlled substance were used in accordance with the directions for use;
  • (ix) a situation where the registry is not operational as determined by the department or where it cannot be accessed by the practitioner due to a temporary technological or electrical failure. In the instance of a temporary technological or electrical failure, a practitioner shall, without undue delay, seek to correct any cause for the failure that is reasonably within his or her control; or
  • (x) a practitioner to whom the commissioner has granted a waiver from the requirement to consult the registry. A waiver may be issued by the commissioner based upon a showing by a practitioner that his or her ability to consult the registry in accordance with this section is unduly burdened by:
    • technological limitations that are not reasonably within the control of the practitioner; or
    • other exceptional circumstance demonstrated by the practitioner.

Practitioner’s Ability to Designate another Person to Consult Registry
Consistent with the statute, the proposed regulations permit a practitioner to authorize one or more designees to consult the prescription monitoring program registry on his or her behalf. The practitioner must make the final decision as to whether or not to prescribe or dispense a controlled substance after considering the patient’s controlled substance history information obtained from the registry and may not delegate such decision-making to the designee.

Specifically, the proposed regulation states that “A practitioner may only appoint a designee if:

  1. such designee is located in the state of New York when accessing the prescription monitoring program registry;
  2. the designee is employed by the same professional practice or is under contract with such practice. For purposes of this subparagraph, professional practice shall include, but not be limited to, an institutional dispenser where the designating practitioner is employed, under contract, or otherwise has privileges or authorization to practice;
  3. the practitioner takes reasonable steps to ensure or has actual knowledge that such designee is sufficiently competent in the use of the registry and that such designee is aware of and conforms to all relevant federal and state privacy statutes;
  4. the practitioner remains responsible for ensuring that access to the registry by the designee is limited to authorized purposes and occurs in a manner that protects the confidentiality of the information obtained from the registry, and the practitioner remains responsible for any breach of confidentiality; and
  5. the practitioner selects and maintains all active designees authorized to access the prescription monitoring program registry in a format acceptable to the department.

The Practitioner will also be expected to notify the DOH immediately if the designee’s authority is revoked due to termination of the designee’s employment or otherwise.

Pharmacists are also permitted under the proposed regulations to consult the PMP registry in order to review the controlled substance history of an individual prior to dispensing controlled substances and may designate another pharmacist or a pharmacy intern to consult the PMP registry on the pharmacist’s behalf.

Reports Regarding Dispensing of Controlled Substances
The proposed regulations also provide that reports currently required to be made to the DOH Bureau of Narcotic Enforcement by pharmacists and dispensing practitioners would need to be filed electronically within 24 hours of the delivery of such controlled substances. In addition, pharmacies delivering prescriptions by mail or licensed express delivery services would be required to file the prescription information not later than 72 hours after the substance was shipped from the pharmacy.

Additional Exceptions to Patient Confidentiality
The proposed regulations will also permit increased disclosure of patient information regarding controlled prescribing and dispensing including to the Medicaid fraud control unit to investigate fraud, waste or abuse of the Medicaid program; to a local health department for the purpose of conducting public health research or education with certain additional conditions; to a medical examiner or coroner; to an individual for the purpose of providing such individual with his or her own controlled substance history; and to appropriate law enforcement agencies where the department has reason to believe that a crime related to the diversion of controlled substances has been committed.

The comment period on the proposed regulations expires on August 5, 2013.

In anticipation of the law’s August 27, 2013 effective date, physicians and other practitioners should:

  • Become familiar with using the PMP registry which can now be accessed by logging into their Health Commerce Systems account at https://commerce.health.state.ny.us
  • A licensed prescriber can also establish an account following the instructions at https://hcsteamwork1.health.state.ny.us/pub/top.html
  • Update login / passwords for existing accounts (you have an account if you are using State provided single script forms.
  • To the extent that the registry will need to be consulted no sooner than 24 hours prior to writing a prescription, practitioners should begin to plan possible changes to office procedures and work flow, including whether to use designees and which staff are best suited to serve as designees to consult the PMP registry.

Practitioners can find additional information about the PMP and future updates at
http://www.health.ny.gov/professionals/narcotic/practitioners/

Laurie Cohen, Esq., Partner at Nixon Peabody and the Chapter’s attorney provides members with support and direction by answering questions relevant to general practice. She has a broad range of health care experience providing services to physician groups. She also has extensive knowledge in the areas of professional licensure, group practice formation, employment and managed care contracting, provider joint ventures, self-referral, anti-kickback, and fee splitting.

 
Webinar: Implementation of Enhanced Prescription Monitoring Program
The Medical Society of the State of New York (MSSNY) will host a continuing medical education webinar on the Prescription Monitoring Program, also known as I-STOP, on Wednesday, July 24, 2013 from 6 - 7:30 p.m. and on Wednesday, August 7, 2013 from 8 - 9:30 a.m. The live webinar has been accredited for 1 AMA PRA Category 1 CreditsTM.

Terence O’Leary, Director of the Bureau of Narcotic Enforcement from the NYS Department of Health, will be the featured speaker. Registration is required and free for MSSNY members.There is a fee of $100 for non-members, which can be applied towards a MSSNY membership. Seating at this webinar is limited to 95 registrants.

To register for the July 24th session, please click here.

To register for the August 7th session, please click here.


Prescribing Information for 17-OHPC Injection
If you utilize an FDA-approved injection such as Makena® in women at risk for preterm birth in your practice, this important update provides relevant prescribing information for you. To read the FDA’s June 2012 public statement on the use of FDA-approved products versus those that are compounded, please click here.

ACOG District II will alert you to future prescribing or guidance updates as the need arises. For additional information on 17-OHPC and/or preterm birth please visit our website at www.acogny.org


Webinar: What Physicians Need to Know about New York's New Health Benefit Exchange

Register Here for the August 14, 2014 Webinar

Space is limited.

The NY Health Benefit Exchange will officially open its doors on October 1, 2013. Please join us for this opportunity to hear the latest on the implementation of the state's Exchange, and how physicians can best prepare to assist their patients in accessing this new marketplace for health insurance coverage. This program will feature a presentation by Donna Frescatore, Executive Director of the NY Health Benefit Exchange.

Title: What Physicians Need to Know about New York's New Health Benefit Exchange
Date: Wednesday, August 14, 2013
Time: 6:30 PM - 7:30 PM EDT

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 7, Vista, XP or 2003 Server

Mac®-based attendees
Required: Mac OS® X 10.6 or newer

Mobile attendees
Required: iPhone®, iPad®, Android™ phone or Android tablet

Register here to reserve your Webinar seat


Government Relations

Katie GordonCongratulations, Katie Gordon!
DII Director of Government Relations Honored

District II is happy to announce that Director of Government Relations Katie Gordon was honored June 28 by New York State Senator Ruth Hassell-Thompson at the Senator’s Annual Notable Women Award Breakfast in the Bronx. In describing why Katie was selected for the award, organizers stated:

“We wish to honor you for your commitment, dedication and unwavering passion and success in your fight for social justice in your work within government but recently at the American Congress of Obstetricians and Gynecologists. Your dedication, commitment and work ethic to providing and responding to the needs of the community you served is unwavering. You have demonstrated that with hard work you can achieve success at the highest level without compromising integrity.”

Prior to joining the District II office earlier this year, Katie worked in the New York State Senate for well over ten years. Please join us in congratulating Katie.

DII Advocacy in Action

District II’s June 4th lobby day was very effective in carrying our message to more than a dozen legislators. Our two primary asks:

  1. Support the concepts in the Women’s Equality Act (WEA), while ensuring that access to reproductive health choices are not limited. Click here for more.
  2. Do not legislate medical practice or interfere with the patient/physician relationship. Click here for more.

Resident Advocacy Program (RAP)
The end of session also marked the conclusion of the inaugural year of Resident Advocacy Program (RAP), with a total of 18 residents completing the program, from 7 different resident programs from across the state. Click here for an overview of the advocacy information presented to ob/gyn residents during RAP visits to the District II office. Click here to view a listing of the residency programs and those who participated in 2013 RAP. All residents will receive an award and their certificate of completion at the Residency Program Directors Meeting during the Annual Meeting on October 26th. Stay tuned for information on the 2014 RAP.

Session Wrap Up
The end of the legislation session brought a flurry of activity to Albany. District II was able to successfully negotiate the language of the reproductive health portion of the Women's Equality Act, but the bill failed to pass the Legislature by session’s end due to a political power struggle. Additional legislation supported by DII that passed both houses included a bill to establish maternal depression screening and a bill that prohibits smoking on playgrounds. The only bill ACOG opposed that passed both houses will require Hepatitis C testing be offered to anyone born between 1945-1965. This was the primary example of unwarranted and unnecessary legislating of medical practice. There were many other bills District II engaged in during the legislative session. For a detailed chart showing the progression of all DII legislative priorities, click here. Additionally, click here for an end of session message from Governor Cuomo.

 
News from MSSNY

Insurance Insights for New Doctors
The Medical Society of the State of New York (MSSNY) has these tips, which suggests how a physician may proceed when choosing a professional liability carrier. Additionally, this document provides a list of Risk Retention Groups currently registered in New York State. We hope you find this information useful.


Patient Safety

DII Invited to Harvard
Creation of ACOG PSO Explored

In late 2011, the ACOG National office formed the "Council on Patient Safety in Women’s Health Care" with the express aim of reducing harm to patients.

At a recent meeting, the Council discussed the possibility of creating a Patient Safety Organization (PSO) under the ACOG name. The primary activity of a Patient Safety Organization must be to conduct activities to improve patient safety and health care quality. Its workforce must have expertise in analyzing patient safety events, such as the identification, analysis, prevention, and reduction or elimination of the risks and hazards associated with the delivery of patient care.

District II was invited to attend a meeting in Boston to learn about the Harvard PSO called the American Medical Center Patient Safety Organization (AMC PSO). Valuable insight was gained regarding how the Harvard PSO was developed and how the organization functions as a national convener of clinicians and health care organizations to collect and analyze data, in a confidential and secure environment. The data has the ultimate ability to reduce liability risks and adverse events associated with patient care.

While the discussions of the Council on Patient Safety are still very preliminary, it is important to explore opportunities that assist Ob-Gyns in identifying common, systemic errors, reducing risks and sharing of best practices and knowledge to continuously improve the quality of patient care. The Harvard AMC PSO has developed Patient Safety Alerts to share insights and learnings gleaned from review of key issues affecting the field of obstetrics. The alerts are intended to support patient safety by sharing not only the risks but also innovative ideas and strategies for mitigating those risks.

We will continue to keep you updated as more develops in this area. To learn more about the AMC PSO, click here or for more information about PSOs, please visit www.pso.ahrq.gov.


Medical Education

Safe Motherhood Initiative to Reduce Maternal Mortality Formally Kicks Off
In our April newsletter, we told you about a meeting at Albert Einstein College of Medicine that brought together obstetric leaders from across the state to begin developing clinical tools on pre-eclampsia, hemorrhage, and pulmonary embolism. We are happy to report that our reignited Safe Motherhood Initiative has officially kicked off with generous funding from Merck for Mothers and will be delivering implementation tools to obstetric hospitals in New York State beginning spring 2014. These tools will be compiled into a bundle of guidelines, policies, best practices, checklists, and outcome assessments. Leading this charge are Mary D’Alton, MD, FACOG and Cynthia Chazotte, MD, FACOG, with enormous collaboration and support from multiple chairs and physician leaders at ACOG District II. The workgroups for these three obstetric emergencies are currently developing key elements for all obstetric hospitals, which will be finalized at the next meeting on July 25th.

In May, The College and SMFM announced the Maternal Health Initiative, a large multi-group collaborative effort aimed at reducing maternal morbidity and mortality in the US by 50%, as well as reducing the racial and ethnic maternal health disparities. The Safe Motherhood Initiative dovetails with these national efforts and in many ways will pave the way in standardizing protocols across institutions in New York and across the country. Included in this collaborative are the American Academy of Family Physicians, American College of Nurse Midwives, Association of Women’s Health, Obstetric and Neonatal Nurses, Health Services and Resources Administration, Society for Obstetric Anesthesia and Perinatology, US Centers for Disease Control and Prevention, as well as hospitals, birth centers, and blood banks. The group convened during the Annual Clinical Meeting in New Orleans.


Collaborative Practice Survey

Dear Residency Program Director,
 
Recognizing the unique relationship between obstetrician-gynecologists and certified nurse midwives (CNMs) and the integral role CNM's play in the delivery of women's health care, please take a moment and answer this brief, five question survey. Your participation will provide a better understanding of the role CNMs play within residency programs in New York State. Barry Smith, MD
 
Thank you for your time.
Barry Smith, MD, FACOG


Membership

ACOG National Committee Service
Apply Now

The Application Form for Committee Service for Congress and College committees that will be appointed to begin May 2014 is available. The Application Form for Committee Service can now be completed and submitted online. The deadline for receipt of applications is August 1, 2013. President Elect John C. Jennings, MD, will make appointments in November 2013.

Awards & Recognitions

  • Louis M. Hellman Midwifery Partnership Award - Recognizes a Fellow or Junior Fellow of The College who has been a champion and supporter of midwifery.
    Paul H. Kastell, MD, JD, MBA, FACOG, Woodhull Medical and Mental Health Center, New York, NY.
  • Residency Review Committee (RRC) – JF Representative
    Caitlin Parks, MD, Upstate Medical University

Click here to view the complete listing of Awards and Recognition.


Junior Fellow News

Omar Duenas, MDOmar Duenas, MD
Junior Fellow Chair

Junior Fellows to Collect Coats
at ADM

Every year around the wintertime, thousands of New Yorkers will be forced to make a choice between buying a warm coat and putting food on the table, heating their homes, or meeting other basic survival needs. That is why the Junior Fellows of ACOG District II will collect new and gently used winter coats during the Annual District Meeting - October 25 - 27 at the Grand Hyatt New York. The coats we collect will be donated to New York Cares and distributed to women, men and children who might otherwise go cold. This summer if you are cleaning your closet, please think about all the coats you don't need and bring them to the ADM. You could play a major part in keeping someone warm this winter!

Junior Fellow Opportunities at the Annual Meeting - Call for Abstracts Now Open!
District II is pleased to announce that the Junior Fellow Call for Abstracts being held in conjunction with the 2013 Annual District II Meeting, is now open. If you or your residents have a research project you would like to showcase, here is your opportunity. Contest awards include a $1,000 cash prize. Click here for complete information on this and all contest opportunities.

Attention Junior Fellows - Vote August 1 - 15!
VOTE for your 2013-2014 District II Junior Fellow Officers
Click here for voting instructions 
Click here to see the District II nominees
Click here to vote

2013 Ob/Gyn Reporter Program at the ACM
This year's Ob-Gyn Reporter Program was held at the 2013 ACOG Annual Clinical Meeting (ACM) in New Orleans, Louisiana. The Reporter Program, which is sponsored by Teva Women's Health, promotes connections between Junior Fellows from the United States, Japan, and South America. District II Junior Fellows who attended the 2013 ACM as Ob/Gyn Resident Reporters were Denise de los Santos, MD, Vinay Gunnala, MD, Johanna Kate Halfon, MD, Ervin Rene Riano Marin, MD, and Ashley Schiliro, MD.

Click here to read the experiences of our District's Junior Fellows at the 2013 ACM.


Help ACOG Recruit Women for CDC Smoking Ads
As you may be aware, the CDC ran a very successful Tips From Former Smokers ad campaign over the spring and early summer. The "Tips Campaign" has been promoted for the past 2 years, actually, but the majority of the ads do not resonate with the patients of most OB/GYNs. ACOG challenged the CDC to come up with some ads that OB/GYNs can promote to their patients. And in turn, the CDC has challenged ACOG to find the patients for their commercials.

If you know any patients who may be interested in the opportunity to share their experience with smoking, please respond to District II at info@ny.acog.org. In order to qualify, participants must be able to travel for filming in October, 2013 and be willing to submit to a criminal background check. Click here to read the CDC recruitment flyer for additional information regarding qualifications (Spanish version). The compensation for participating in this campaign is $2,500 and all travel expenses will be paid for.


Remembering Sterling B. Williams, MS, MD, PhD, FACOG - ACOG Vice President of Education
Sterling B. WilliamsSterling B. Williams, MS, MD, PhD, FACOG, Vice President, Education at The American College of Obstetricians and Gynecologists (The College), passed away in May, after a brief illness. He led The College’s Education Division and directed the Council on Resident Education in Obstetrics and Gynecology since 2001. Click here for more on this remarkable man and his career.


With Sympathy
Kenneth L. Noller, II, son of ACOG Past President Dr. Kenneth L. Noller, passed away on June 20, 2013. Click here to read the Nollers' tribute to their son. Condolences may be sent to the family homes at the following addresses:
 
2650 Cedar Springs Rd, Apt 4433
Dallas, TX 75201
 
14 Highridge Road
Shrewsbury, MA 01545