NYSSOS penned a letter to the Governor, making him aware of issues concerning resumption of elective surgery and the necessity for ambulatory surgery centers to be included in the strategy.
NYSSOS stated that emergency and urgent surgeries have been proceeding at both hospitals and Ambulatory Surgery Centers (ASCs) but there are many patients with significant musculoskeletal problems that have received alternative conservative treatments that now require surgical intervention and appropriate time for recovery to get back into the workforce. These patients have been unable to work and awaiting surgery before the massive layoffs and COVID-19 restrictions.
NYSSOS advocated that ASCs need to be included with resumption of surgeries based off the community individual needs while collaborating with hospitals and health systems to coordinate care. Surgeons and providers should be the ultimate decision makers regarding the appropriate site of service for their patients keeping in mind quality, safety, and risks. With state guidance and coordination, hospitals and ambulatory surgical facilities should be given the data and guidance to allow the appropriate level of elective cases best indicated by their medical staff, administration and current needs of the community.
Resumption of elective surgeries in less affected counties has only referenced hospital settings. So far, there has been no direction about how this applies to other care settings such as ASCs in counties that are allowed to re-open or ASCs in general. We request additional clarification in order to assemble an adequate healthy workforce and sufficient resources to protect and care for these patients.
The Chair has adopted on an emergency basis amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 to expand the telemedicine options for social distancing purposes due to outbreak of COVID-19 and to supersede the previous emergency telemedicine adoption filed on March 16, 2020. A Notice of Emergency Adoption will be published in the May 6, 2020, edition of the State Register.
The text of the Emergency Adoption has been published to the Board's website. This emergency rulemaking is effective for 90 days upon filing April 20, 2020.
Governor Andrew M. Cuomo announced today that elective outpatient treatments can resume in counties and hospitals without significant risk of COVID-19 surge in the near term. Restrictions on elective surgery will remain in place in Bronx, Queens, Rockland, Nassau, Clinton, Yates, Westchester, Albany, Richmond, Schuyler, Kings, Suffolk, New York, Dutchess, Sullivan, Ulster, Erie, Orange and Rensselaer Counties as the state continues to monitor the rate of new COVID-19 infections in the region.
Hospitals will be able to resume performing elective outpatient treatments on April 28, 2020 if the hospital capacity is over 25 percent for the county and if there have been fewer than 10 new hospitalizations of COVID-19 patients in the county over the past 10 days. If a hospital is located in a county eligible to resume elective outpatient treatments, but that hospital has a capacity under 25 percent or has had more than 10 new hospitalizations in the past 10 days, that hospital is not eligible to resume elective surgeries.
If a county or hospital that has resumed elective surgery experiences a decrease in hospital capacity below the 25 percent threshold or an increase of 10 or more new hospitalizations of COVID-19 patients, elective surgeries must cease.
Further, patients must test negative for COVID-19 prior to any elective outpatient treatment. The State Department of Health will issue guidance on resuming elective surgeries.
The Academy believes that decisions regarding when and how elective surgery should begin are best decided on a local basis. To help members prepare for these conversations, they have developed clinical considerations for navigating COVID-19 and are recommending the following universally applied guiding principles:
a. Hospital beds, b. ICU beds, c. Ventilators, d. PPE, and e. Healthcare workers.
* Reproductive Number: It is the average number of secondary infections produced by a typical case of an infection in a population where everyone is susceptible. If the number is >1, then the case numbers increase. If it is <1, they decrease.
Once the decision is made to resume elective surgery, other important issues that must be addressed include:
Again, decisions regarding these factors are best made on a local basis. For example, in areas of low disease burden, elective surgery may not need to be phased in and can start all at once. In other areas, where personnel and equipment have been repurposed, a more phased-in approach is necessary. The principles guiding velocity of return include:
There is much debate about the availability and utility of COVID-19 testing for patients and staff. Despite the debate, it is likely that perioperative patient testing and universal staff testing will be required.
CMS Recommendations
The new CMS recommendations for reopening facilities can be found here
White House
The Guidelines for Opening Up America Again can be found here
In response to staffing and other changes put in place related to the COVID-19 pandemic, the Workers’ Compensation Board is updating some processes to ensure timely continuity of programs within the workers’ compensation system.
Health care providers have been instructed to submit prior authorization requests for medical procedures to their insurance carrier’s designated email contact as posted on the Board’s website, rather than a fax number. Fax submissions may not be able to be reviewed in a timely manner because many insurer staff members are working remotely. Prior authorization requests for non-formulary medications should continue to be submitted through the medical portal.
All insurance carriers, self-insured employers, and third-party administrators should forward their fax number to their designated email contact to ensure that these non-formulary prior authorization requests are received and acted upon accordingly.
The Board will only issue Orders of the Chair (OOC) for emailed prior authorization requests listed below that are not responded to in a timely manner. An OOC will not be issued for a faxed prior authorization request.
These instructions pertain to the following forms:
Form Type
Carrier's Email Address
Attending Doctor’s Request for Optional Prior Approval and Carrier's/Employer's Response (Form MG-1)
Contacts for Optional Prior Approval
Attending Doctor's Request for Approval of Variance and Carrier's Response (Form MG-2)
Contacts for Variance Approval
Attending Doctor's Request for Authorization and Carrier's Response (Form C-4 AUTH)
Contacts for Pre-Authorization
The NY Workers’ Compensation Drug Formulary Prior Authorization process will continue to be used for prescriptions that require prior authorization.
We also ask that your Medical Treatment Guidelines administrator verify your designated email contact and update it if necessary.
Thank you for your cooperation. Please contact the Board at WCBMedicalDirectorsOffice@wcb.ny.gov if you have any questions.
The Centers for Medicare & Medicaid Services (CMS) extended the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline to April 30 at 8 pm E.S.T.
CMS also announced that the MIPS automatic extreme and uncontrollable circumstances policy will apply to eligible clinicians who are unable to submit their data by the April 30 deadline.
Qualifying clinicians will be identified automatically, without having to take any additional action, and will receive a neutral payment adjustment for the 2021 MIPS payment year.
CMS also reopened the MIPS extreme and uncontrollable circumstances application. Individual clinicians and groups that started but cannot complete their data submission, as well as virtual groups that are unable to start or complete their data submission, should apply. Applications submitted between April 3 and April 30 citing COVID-19 will override all previous data submissions.
Contact the Quality Payment Program at 866-288-8292, Monday through Friday, 8 a.m. to 8 p.m. E.S.T. or by email at QPP@cms.hhs.gov.
Download the Quality Payment Program COVID-19 Response Fact Sheet…
AAOS released updated guidelines on elective surgery during the COVID-19 pandemic. These guidelines should be applied judiciously depending on your location, where your area/institution happens to be situated relative to the curve of the disease, and the availability or scarcity of your resources, including personal protective equipment, intensive care unit (ICU) beds, respirators, and personnel. It is AAOS’ position that every locality should be making their own decisions based on the availability of resources and personnel. In these situations, a panel that includes the head of the hospital (or the designee), chief of the ICU, chief of anesthesia, and chief of orthopaedic surgery should form a committee to review any prospective surgery. W
here feasible, input from the state department of health should be solicited.
Read the guidelines…
AAOS President Joseph A. Bosco III, MD, FAAOS, sent a letter to members detailing the online actions AAOS is taking to help manage and emerge from the COVID-19 pandemic as strong as possible.
AAOS temporarily pivoted off its Strategic Plan to devote nearly all of its resources to helping members mitigate the effects of COVID-19.
The three pillars of the AAOS COVID-19 Action Plan are: (1) communication, (2) advocacy, and (3) practice management.
Dr. Bosco said in closing, “I have faith that each of us will contribute in whatever way we can or have to. There is work and sacrifice to be made, and our profession has a rich history of selflessness in the face of adversity. I am certain that the upcoming weeks will be no exception.”
> Read the letter
Advocating for the orthopaedic surgeon, patients and musculoskeletal health in New York.
info@nyssos.org 1-518-439-0000 Address: PO Box 38004, Albany, NY 12203