Update, May 2012 Vol. 27, No. 5
FROM THE CHAIR
Eva Chalas, MD, FACOG, FACS
NSQIP: Improving Surgical Quality
Patient safety and improvement in outcomes are important and laudable goals, but until relatively recently, we had few effective methods or processes to help us. At the most recent ACOG Annual Clinical Meeting, the SCOPE program was unveiled to assist with enhancing patient safety in an office setting. I will report to you on that program in the near future, but for now, I wanted to bring to your attention a hospital based program aimed at evaluation and improvement of the system of delivery of surgical care. The National Surgical Quality Improvement Program (NSQIP) is a healthcare improvement program designed by the American College of Surgeons. It is the first nationally validated risk-adjusted, outcomes-based program to measure and improve the quality of surgical care. The program has a strong track record for significantly lowering morbidity and mortality in the more than 500 participating hospitals, which receive semiannual reports of their risk-adjusted data, compared to their peers. This methodology has resulted in development of many “best practices” I am happy to have had the opportunity to participate in developing the Gynecology Module for NSQIP. I now serve as a co-Champion for NSQIP the program at Winthrop–University Hospital, where we utilize it to continuously improve our outcomes.
Hospitals that participate in NSQIP track outcomes of inpatient and outpatient surgical procedures and collect data. Currently, the NSQIP collects data on specific significant variables, including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures in both the inpatient and outpatient setting. According to NSQIP, each year a hospital uses the program, on average, it has the opportunity to:
The American Board of Surgeons permits participation in NSQIP as validation of clinical performance for Maintenance of Certification (MOC). I would like to see the program become part of ACOG's MOC, since it has a proven track record and would not require physician input – the specially trained nurse extracts the information and report directly to NSQIP. We will keep you updated on this matter.
For more information on NSQIP, click here to visit its website. In addition, I invite you to click here to read an editorial I penned for Gynecologic Oncology entitled “NSQIP — The New Frontier?”
| LOBBY DAY 2012: SUCCESS, SURPRISES & SMILES
Thank you to the following members who traveled from across the state to Albany on May 15 for Lobby Day. Our physicians took part in back to back meetings at the Capitol – coming face to face with 90% of the legislators themselves.
Matthew Blitz, MD
Ana Cepin, MD, FACOG
Eva Chalas, MD, FACOG, FACS
Cynthia Chazotte, MD, FACOG
K. Michelle Doyle, CNM, LM
Leah Kaufman, MD, FACOG
Nicholas Kulbida, MD, FACOG
Ellen Landsberger, MD, FACOG
MaryAnn Millar, MD, FACOG
Howard Minkoff, MD, FACOG
Allen Ott, MD, FACOG
Lawrence Perl, MD, FACOG
Hartaj Powell, MD, MPH, FACOG
Mary Rosser, MD, FACOG
Naomi Ufberg, MD
Ronald Uva, MD, FACOG
Mary Margaret Wilsch, MD, FACOG
Lobby Day 2012 also provided a few surprises – and a lot of smiles. Assembly members and senators were more than happy to discuss proposed “dense breast” legislation (S.6769-A/A.9586-A) – but you should have seen the shocked look on their faces when our members explained that we were opposed to the bill. Click here to find out why.
It was also nice to have subspecialists in our midst discussing the issues of the day – ranging from the importance of collective negotiations to the Reproductive Health Act (S.2844/A. 6122). For example, District II Chair Eva Chalas, MD, FACOG, FACS brought a unique perspective, drawing from her expertise as a gynecologic oncologist in meetings with lawmakers.
Our ob-gyns were empowered to explain ACOG’s position on various topics – while relying on each other to get the message across to legislators. By the end of the day, our doctors were finishing each other’s sentences! There was clearly a Lobby Day “camaraderie” shared by our members. In fact, during lunch, the laughter from one of our tables could be heard throughout the Capitol Deli.
One of our members even brought her two children to Lobby Day. What a wonderful opportunity for them to see first-hand how their Mom is doing her part to give OB-GYNS a true voice within the halls of the NYS Capitol – and to witness the inner workings of our state government. We welcome other members to bring their children to future Lobby Days.
In the end, Lobby Day 2012 was a huge success. We informed, we debated, we educated, we asked tough questions – and we made a difference.
| DONNA MONTALTO, MPP - EXECUTIVE DIRECTOR
Save $20 by June 30th
Join us in the heart of the Big Apple at the Annual District II Meeting (ADM) October 19-21 at the Grand Hyatt NYC. Click here to register before June 30 and get $20 off your three day registration. The ADM Program Committee has developed an exciting meeting, featuring outstanding faculty from across the country. Robert Silverman, MD, FACOG and Dena Goffman, MD, FACOG, this year’s Scientific Program Co-Chairs, have put together an exceptional 2012 program that covers the broad range of the ob/gyn specialty.
You should be receiving the ADM preliminary program shortly in the mail – which is also available online by clicking here. This year we will feature distinguished faculty who are leaders in their respective fields. In addition, District II is pleased to once again offer hands-on obstetric simulation training to our annual meeting attendees.
While at the ADM, I encourage you to make plans to enjoy all NYC has to offer – from Broadway & museums to the very best cuisine. Click here to register today – and I hope to see you at the ADM in October!
An Amateur Lobbyist in Washington
Ronald Uva, MD, FACOG - Vice Chair
Every year ACOG selects two doctors to spend two weeks in Washington as a McCain Fellow, learning the ins and outs of the legislative process and to actively lobby for women’s health. This year I was one of the fortunate two who were selected.
The ACOG office of government affairs put together my agenda to get me involved in the process immediately. At my very first legislative breakfast I was told by the waiter, no less, "Remember, you are in the most powerful city on earth.” Indeed, the very scope of the federal government is exemplified by the size of the buildings and the huge staff that is necessary to make this whole process run. Only 435 congressman and 100 senators are elected and entrusted by three hundred million Americans to legislate everything from health laws and defense to the price of postage stamps. What became evident immediately is that much health care legislation is on hold while awaiting the decision of the Supreme Court and what it holds for “Obamacare”.
My own personal viewpoint and that of ACOG is that certain items in Obamacare are beneficial to women such as universal maternity coverage, preventative health services, and breast feeding rights. What is not good is the individual mandate and the Independent Payment Advisory Board – fifteen unelected officials with no accountability that will decide what treatments will be allowed under Medicare. We also need meaningful medical liability reform that has been demonstrated to save 42 billion dollars by the congressional budget office and a fix of the Sustained Growth Rate formula that if not enacted soon will result in cuts to doctors’ fees for Medicare that are so draconian that most doctors will not be able to afford to see Medicare patients.
So how did we do in Washington? I met with Congressmen Roakem and Pitts who were very supportive; Congresswoman Ellmers, a nurse who has a husband who is a surgeon and by extension understands the problems; Congressman Heck, a physician from Nevada who was very supportive. But since we live in a democracy with many people with very many different ideas formulated by their life experiences, there were those legislators who did not agree – such as Congressman Neal of Massachusetts who did not understand reimbursement issues or the impending crisis facing Medicare. At a breakfast with Senators Manchin, Murray and Brown I learned that there are many Democrats who are supportive of reducing health care costs through such means as electric medical records (EMR) that will improve safety for patients through legible record keeping, accurate prescribing and elimination of duplicate procedures. This was reflected at a meeting I attended at the National Press Club concerning electric medical records. However, they did not understand that without adequate reimbursement physicians cannot even begin to afford the high cost of these systems – especially given such uncertainty with the Supreme Court still out and a lame duck congress in sight.
I was fortunate to be invited to briefings concerning domestic violence and the Judiciary Committee hearings on both medical malpractice and the proposed tax on medical devices. As I am writing this at my cubby hole here in Washington, I just learned that female Republican congresswomen are starting a female caucus to address this very issue of violence against women which is more pervasive than I had originally thought.
I won’t bore you with minutiae of legislative details, but it was interesting to note that all these legislators are constantly surrounded by aides, lobbyists, lap top toting news junkies, hoards of smart phone bearing political science students and unidentified government employees feeding them policy statements, schedules, and up to the minute changes in legislation. “Washington is the only city where sound travels faster than light” and no one wants to miss a thing.
My visit included a tour of the Capitol – where a brief movie was shown that highlighted our nation’s democratic process and gave a history of the monumental laws that were passed in that building. The sense of history was overwhelming. “E Pluribus Unum”—“from many, one.” What better term to exemplify what goes on here. So many different viewpoints and opinions from such an ethnically, religiously and demographically diverse nation mandates that issues are to be debated and debated again so that the right solution can be found. I hope that my voice from one practicing ob-gyn from a small town in Upstate New York will be heeded by some legislator when he or she casts their votes – if that is not empowerment, nothing is.
Medicaid and Tort Reform Addressed at HOD
Clifford Elson, MD, FACOG represented ACOG District II at the 206th meeting of the Medical Society of the State of New York (MSSNY) House of Delegates (HOD) in Saratoga Springs last month.
“I enjoyed the opportunity to interact with physicians in different specialties from all over the state, and share ACOG Fellows’ concerns with them,” said Dr. Elson.
NYS Health Commissioner Dr. Nirav Shah addressed the opening session with remarks that focused on the accomplishments of the Medicaid Redesign Team. Dr. Shah favored replacing Fee For Service medicine with a capitated payment system, such as Kaiser or Intermountain Health. During a spirited one-hour Q&A, Dr. Shah said that Governor Cuomo was “on board” regarding tort reform but the Legislature stands opposed to change. He urged physicians to keep talking to state legislators, something he does “all the time.” Dr. Shah said that if physicians emphasize their commitment to quality and patient safety it would take away the largest “arrow in the quiver” that the trial lawyers use against tort reform.
Key resolutions that the HOD approved included: a call for a new Task Force on Medical Liability Reform, Medical Liability Expert Witness oversight, Out of Network payment transparency, Payment for Pre-Authorized services, and numerous measures aimed at ending unfair practices by some health insurance companies and unfunded state mandates placed on physicians.
Where do you think your patients get their health information on the web?
Click here. Answer in the June edition.
District II’s 39 Weeks Initiative Travels Across the State
ACOG District II would like to extend a warm “thank you” to the five Level 1 and 2 hospital pilot sites participating in the Elimination of Non-Medically Indicated Deliveries Prior to 39 Weeks Initiative. District II also extends its appreciation to the task force of medical experts who offered their expertise during five on-site review sessions this past month. Review sessions were conducted at the following sites:
Chenango Memorial Hospital, Norwich
Lawrence Hospital, Bronxville
Niagara Falls Memorial Medical Center, Niagara Falls
Oswego Hospital, Oswego
St. Anthony Community Hospital, Warwick
These sites have been instrumental in helping District II assess and identify barriers and current practice patterns surrounding deliveries prior to 39 weeks. Through this initiative, made possible by funding from the March of Dimes, District II provides hospitals with a special opportunity to collaborate by offering guidance and education to obstetrical providers, including hospital leadership and administrative staff to decrease elective deliveries.
The remaining six pilot sites (Level 3 and RPCs) have previously implemented mechanisms, such as hard-stop policies, to eliminate elective deliveries prior to 39 weeks and have made great strides within their institutions. To highlight the work at these hospitals and to learn more about their success, on-site visits to these facilities will take a slightly different approach and will be used as a means to showcase “best practices.”
ACOG District II will utilize lessons learned from this one-year pilot project to develop and disseminate successful strategies and best practices to all obstetric providers, clinical staff and hospitals across New York State for implementation. For more information on this topic, visit the ACOG District II website by clicking here.
District II's Preterm Birth Survey Sent Nationwide
District II’s preterm birth survey that was sent to all ACOG members in New York State in February was disseminated nationally by the College to garner even more robust data. Nearly 2,200 respondents in New York and across the country have provided their feedback and the results are strikingly similar. Data gathered from this survey will be used to help inform the work of District II’s Preterm Birth Task Force which is currently developing web-based, interactive clinical education on cervical length assessment.
Vaccinating Women of Reproductive Age Webinar Now Available
The New York State Department of Health’s webinar on vaccinating women of reproductive age is now available as part of its regular Immunization Update series. To listen to the webinar and to learn more about vaccinating your patients, please click here.
Progress in Cervical Cancer Screening: 2012 Guidelines
Presented by: Maureen Killackey, MD, FACOG, FACS
Deputy Physician-in-Chief and Medical Director Memorial Sloan-Kettering Cancer Center
Upon completion of this educational activity, participants should be able to understand:
The natural history of HPV infection and its oncogenic potential
The rationale used to develop the new cervical cancer screening guidelines, with a focus on harms and benefits of each testing strategy
When to start, stop cervical cancer screening and the frequency of testing
CME is being offered for this program. Click on your preferred location for further information:
May 22nd - White Plains, NY
May 23rd - Commack, NY
Please join us Wednesday, August 15, 2012 for a FREE audio conference on the MOREOB Program. MOREOB (Managing Obstetrical Risk Efficiently) is a three-year, comprehensive patient safety improvement & professional development program for providers and administrators in hospital obstetric units. To register, click here.
eRx GPRO Reporting Requirements
Department of Health and Human Services
Centers for Medicare & Medicaid Services
ACOG District II
Wishes to Congratulate
Eva Chalas, MD, FACOG, FACS
For being honored as a “Physician of Distinction for her compassionate demeanor, dedication to the field of cancer and commitment to helping her patients”
by the American Cancer Society
Awards and Recognitions
ACOG Outstanding District Service Award
Ronald Uva, MD, Chief Ob/Gyn at Oswego Hospital for his tireless efforts in the area of government
ACOG Robert Cefalo Leadership Institute
Peter Bernstein, MD, John Vullo, DO, and Hartaj Powell, MD to participate in the 2012 program in
Chapel Hill, NC April 18 through 22, 2012.
SOLD – Section Officer Leadership Development
Kristen Whitaker, MD (Section 1 JF Vice Chair)
Guillermo Marroquin, MD (Section 8 JF Vice Chair)
ACOG Mentor Award – Given to a Fellow who has mentored a Young Physician or Junior Fellow
Douglas Levine, MD and Jason Wright, MD
Ob-Gyn Reporter Program
Lori Homa, MD, University of Rochester Ob-Gyn
Jovana Lekovic Bijelic, MD, New York Presbyterian Hospital/Weill Cornell Medical College
David Kulak, MD, Albert Einstein College of Medicine Montefiore Medical Center
Nwamaka Onwugbenu, MD, Lutheran Medical Center
Sarah Morocco, MD, Albert Einstein College of Medicine at Beth Israel Medical Center
John McCain Memorial Fellowship Program
Ronald Uva, MD participated in the program
JSOG/ACOG Exchange Program
Brian Levine, MD, New York Presbyterian Columbia participated in the program in Kobe, Japan
April 13-15, 2012. (While in Japan, Brian won an award for having the best oral presentation - see article below)
Residency Review Committee (RRC) – JF Representative
Caitlin Parks, MD (Upstate Medical University)
John Gibbons Medical Student Award
Erin Higgins, NY Medical College
Melissa Figueroa, Albert Einstein College of Medicine
Sarah Fryc and Jessica Sassani, Upstate Medical University
DII Resident Receives Award in Japan
Brian A. Levine, MD, MS, of Columbia University Medical Center recently received quite an honor – half a world away in Kobe, Japan. As part of the Japan Society of Obstetrics and Gynecology (JSOG)/ACOG Exchange Program, Dr. Levine was invited to submit his research to the JSOG scientific meeting and selected to give an oral presentation. On April 13, Dr. Levine received the International
Scientific Award for that presentation: Disruption of Vascular Smooth Muscle Cells through Blockage of Notch Inhibits Gonadotropin-Dependent Follicle Growth. The project was his basic-science resident research project at Columbia, where he is a chief resident in Obstetrics & Gynecology.
“To be honest, I was absolutely humbled and honored to receive this award,” said Dr. Levine. “I cannot wait to see my new Japanese friends at this year's Annual Clinical Meeting in San Diego!”
Each year, all Districts select a 4th year resident to attend the Japan Society of Obstetrics and Gynecology meeting in Japan. Congratulations to Dr. Levine!
Call for Nominations
We are currently accepting nominations for the positions of Chair and Vice Chair for the following District II Sections: Section 2 (Brooklyn/Staten Island), Section 5 (Syracuse/Utica), Section 8 (Bronx), and Section 9 (Albany). The terms of office are three years, beginning in November 2013 and ending October 2016.
To become a candidate for office, your official address must be within the section in which you are running for office. Interested Fellows must submit the following materials electronically to firstname.lastname@example.org by June 1, 2012:
A letter from you stating the office or offices for which you would like to be a candidate
A one-page, single-sided, summary statement of your CV
A complete curriculum vitae
In addition, please remember that even if you are currently an officer, moving into another position is not automatic; therefore, you are required to submit candidate materials.