written by: Kevin Johnson, MD, MS, University Professor of Biomedical Informatics, Computer Science, Pediatrics, and Science Communication at the University of Pennsylvania; Vice President of Applied Clinical Informatics in the University of Pennsylvania Health System

Artificial intelligence (AI) isn’t new: The first neural network computer appeared in the early 1950s. Hype about AI revved up in the 1970s, but early iterations of AI stalled out through a combination of too much hype, too much complexity, and too little attention to the human element.

We can learn from prior AI failures, not to mention failures of EHR implementation, to successfully integrate certain types of AI into daily healthcare operations. We will not solve the clinician burnout crisis or achieve equity in healthcare using AI alone, but strategic applications of AI can assist us in both areas.

The cornerstones of successful AI implementation will be people: Those who envision, lead, and train, and those who reskill, adapt, and integrate AI tools into frontline care, whether for administrative or for patient-facing purposes.

Four Main Types of AI

Right now, generally speaking, AI works in one of four ways:  read full article

By:  Robert E. White Jr., President, The Doctors Company and TDC Group

Explore the growing issue of nuclear verdicts in healthcare and how they threaten physician liability, increase costs, and limit patient access to care.

This article outlines actionable steps and advocacy efforts to combat this trend. 

Continue reading...

Please see the following link to view our updated NYSSPS Bylaws, which were approved at our 2024 NYSSPS Annual Meeting.

NYSSPS Amended and Restated Bylaws 2024

CHC's complete report on the end of the recently concluded NYS Legislative Session is enclosed. This provides an executive summary of our efforts on behalf of NYSSPS.

NYSSPS 2024 Legislative Successes

On Monday, October 16, 2023, members of the New York State Society of Plastic Surgeons (NYSSPS) gathered for the annual meeting and dinner at the Tribeca Wolfgang’s Steakhouse in New York City. The members, honored guests, sponsors and exhibitors filled the room to capacity – a sign of the success of the evening.

The evening commenced with a cocktail hour providing an opportunity for members to see old colleagues, network and meet representatives from our generous sponsors including Sientra, Organogenesis, Apyx/Renuvian, Allergan, and Irrimax/Irrisept. This first hour of the program was headlined by the presentation of the NYSSPS’ Legislative of the Year Awards to two distinguished leadership in the New York State Legislature: Senator Toby Ann Stavisky (D-Queens), Chair of the Senate Higher Education Committee, and Assemblymember Amy Paulin (D-Westchester), Chair of the Assembly Health Committee. NYSSPS selected Sen. Stavisky to be honored for her strong track record supporting physicians, patients and for her sponsorship of a law in 2022 requiring insurers and health plans to include coverage of chest wall reconstruction surgery in addition to breast reconstruction surgery. Asm. Paulin was honored for her longstanding efforts to expand access to care for women’s health, reducing healthcare disparities, and supporting those who are providing high quality care. In 2023, the assemblymember sponsored priority legislation for the NYSSPS requiring insurers to provide coverage for tattooing of the nipple-areolar complex pursuant to or as part of breast reconstruction surgery and legislation to authorize physicians to collectively negotiate.

Following the presentation of the Legislator of the Year Awards, the dinner was brought out and the annual meeting commenced with welcoming remarks from Executive Director, Lisa Alteri, the outgoing NYSSPS President S. Daniel Huang, MD and incoming President Haritha Veeramachaneni, MD. A very special Lifetime Achievement Award was presented to Paul Weiss, MD in recognition of his years of service and commitment to advancing the profession of plastic surgery, advocacy and support of patients. This was followed by the transition of power as the new officers of NYSSPS and the NYSSP PAC were also recognized as follows:

Society Officers

President - Haritha Veeramachaneni, MD
President-Elect - Diana Yoon-Schwartz, MD
Vice President - Samara Churgin, MD
Secretery - Mahira Tanovic, MD
Treasurer - Jeffrey Ridha, MD
Member at Large - Keith Blechman, MD
Past President - S. Daniel Huang, MD
Executive Director – Lisa Alteri

NYSSPS PAC Officers

Chair - Diana Yoon-Schwartz, MD
Vice Chair - Samara Churgin, MD
Treasuerer - Jeffrey Ridha, MD
Member at Large - Thomas Sterry, MD

NYSSPS’ goals for the coming year were presented to the members as the dinner service began, including maintaining a strong focus on legislative issues including out-of-network, prior authorization, truth in advertising, membership recruitment and retention, and replenishing the PAC as we head into 2024 – an important election year. NYSSPS has a robust agenda for each priority item and looks forward to engaging the broader membership in these efforts.

The four platinum sponsors supporting tonight’s event Sientra, Organogenesis, Apyx/Renuvian, and Allergan then got the opportunity to introduce themselves and highlight their work and ways they work with plastic surgeons and patients. We thank our generous sponsors and look forward to continuing to work them with them.

A lively conversation regarding the federal No Surprises Act and out-of-network care was had during dinner, led by Leslie Howard, Managing Partner and Amy Wilkins, COO of Cohen Howard. This important discussion will continue amidst regulatory developments the federal level and intersection with the New York State law and discussions with policymakers. The meeting closed with appointments, donations, and dessert. The Society appointed Ritchie Reich, MD to the Nomination committee, and Nilay Shah, MD and Ryan Neinstein, MD to the By-laws Committee. 

The evening also featured a raffle prize drawing for those who renewed their membership dues and/or contributed to the PAC. This resulted in strong support with 11 renewing their membership and 17 contributing to the PAC. A sugary dessert and coffee sent members home happy and looking forward to next year already!

Whether you measure success by the number of attendees, number of sponsors, revenue generated for society or the PAC, the night was a tremendous success. We thank all those who assisted. To help keep the momentum going, we urge you to help recruit a non-member to join! 2024 will be a pivotal year for NYSSPS. Edward Everett Hale, a famous author, historian, and minister once said, “Coming together is a beginning; keeping together is progress; working together is success.”

On August 21, 2023, the Centers for Medicare and Medicaid Services (CMS) announced a crucial decision to retain HCPCS Level II codes S2066, S2067, and S2068, encompassing DIEP, GAP, and SIEA flaps for autologous breast reconstruction. Initially scheduled for discontinuation on December 31, 2024, the CMS decision followed a public meeting where concerns about the complexity of transitioning and potential impacts on access to care were raised. CMS, having received feedback indicating the private insurance industry's attempt to reclassify microsurgical breast reconstruction as a lower-level procedure, cited these concerns in their decision. The meeting involved participation from diverse stakeholders, including ASPS President Greg Greco, member surgeons, and patients advocating that microsurgical autologous breast reconstruction is vital post-mastectomy, emphasizing the pivotal role of maintaining the S-codes for continued accessibility to the procedure.

Read more at ASPS

On Thursday, July 27, 2023, the Katz Women’s Surgical Center at Glen Cove Hospital hosted a special dinner to express gratitude and appreciation to the talented plastic surgeons who have played an instrumental role in establishing the center as a destination of excellence. The event also served as an opportunity for reflection on past achievements, celebrating successes and fostering discussions on continual improvements to enhance the patient and surgical experience.

Attended by twelve plastic surgeons, both employed and voluntary within Northwell Health, the dinner brought together key figures from Glen Cove Hospital Senior Leadership, Eastern Region Senior Leadership and Surgery Service Line leadership. The gathering of esteemed professionals set the stage for a productive roundtable discussion.

The roundtable discussion centered on the surgeon’s personal experiences and insights about operating at Katz Women’s Surgical Center at Glen Cove Hospital. Surgeons enthusiastically shared their most enjoyable aspects of working at the center, expressing appreciation for the supportive environment, cutting edge technology and collaborative atmosphere.

The dinner also provided an ideal platform for the surgeons to share any immediate changed they deemed necessary to enhance the surgical center’s functioning further. Open and constructive dialogue allowed for actionable feedback and immediate steps toward addressing concerns, reaffirming the commitment to continuous improvement.

Furthermore, the event aimed to envision the future of Katz Women’s Surgical Center. The surgeons offered valuable perspectives on potential modifications and enhancements, ensuring the center remains at the forefront of innovation and women’s surgical care. This collective vision for the future inspired all attendees to work together towards elevating the center to new heights of excellence.

Overall, the dinner served as a testament to the strong partnership between plastic surgeons and the leadership teams, reinforcing the shared commitment to delivering outstanding surgical Care. As Katz Women’s Surgical Center continues to thrive as a hub of excellence in plastic surgery, this event underscored the importance of collaboration, communication, and a patient- centric approach to achieving new milestones and offering the best possible care to patients.

Left to Right: Kerri Scalon CEO, Dr. Lauren Shikowitz-Behr, Dr. Haritha Veeramachaneni, Dr. Susan Palleschi, Dr. Diana Yoon-Schwartz

The Executive Council of the New York Society of Plastic Surgeons (NYSSPS), would like to thank all the residents and new members who joined us us at last week's Resident & New Member Night. We are honored to have had the opportunity to host such an great group of professionals.

We would also like to express our appreciation for your support of NYSSPS. Your participation within the association and your contributions to the plastic surgery community as a whole will shape the future of our field.

We look forward to continuing our collaboration and working together.

The New York State Society of Plastic Surgeons is busy growing and advocating for our members. 

This week NYSSPS spent the day at the New York State Capital and in the Legislative Office Building meeting with policymakers on issues affecting NYS Plastic Surgeons. 

The Albany Lobbying Day was a huge success.  The day was packed with meetings of the standing chairpersons of the Senate and Assembly health, insurance, and higher  education committees.  The Albany Agenda included priorities that affect physicians on a daily basis, such as prior authorization, truth in advertising, out-of-network reimbursement, access to breast reconstruction and patient safety, to name a few.   The coordination of the successful day was made possible by the organization of our Executive Director, Lisa Alteri and Capital Health Consulting with NYSSPS.  NYSSPS leadership thank the members that shared their time and their voice to advocate for NYS Plastic Surgeons.   We are excited to continue building relationships with New York State legislators and policymakers to create meaningful changes to improve plastic surgery care in the future!

Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company

Informal, or “curbside,” consultations among healthcare practitioners represent an important part of clinical practice and help to promote a collegial relationship in both the clinic and hospital settings. These types of informal consultations can increase knowledge among practitioners and may also improve the care and treatment of patients who present with complex comorbidities, often resulting in more favorable outcomes. Informal consultations do, however, include inherent risks for the consulting practitioner. This article answers questions that our patient safety risk managers routinely address about the potential liability of unofficial professional consultations.

Do practitioners who provide curbside consultations risk being sued?

 

Risks are involved if the expectations between the practitioners are not clearly communicated at the outset of the dialogue. In a classic scenario, the consulting practitioner is sued by a patient the practitioner has neither met nor examined—and certainly doesn’t remember months or years later after a problem has developed and litigation has been initiated.

Invariably, the consulting practitioner who offered the informal advice made no written record of the encounter that could later support the basis for the recommendations. As a result, the consulting practitioner has little evidence to defend the care other than possibly relying on an established routine or habit and practice when attempting to explain the recommendations discussed. The risk of being named in litigation increases significantly if the requesting practitioner identifies the consulting practitioner by name in the patient’s record and summarizes the general nature of the conversation.

 

What are the legal issues raised by curbside consultations?

 

A consulting practitioner who provides informal advice could be named in a lawsuit if a patient suffers harm because the requesting practitioner relied on the consultant’s information to make a treatment decision. Both practitioners could be liable if the information failed to conform to community standards and was a proximate cause of the patient’s injury. The probability that both would be named as defendants would depend on the content of the documentation made regarding the consultation, the nature and extent of the patient’s injury, and the information revealed during litigation.

The preliminary legal questions to be evaluated in cases involving curbside consultations are: (1) Did a practitioner-patient relationship exist between the consulting practitioner and the patient, and (2) did the consulting practitioner, therefore, owe a duty of due care to the patient consistent with what similarly trained practitioners would have done under the same or similar circumstances?

For each affirmative response to the questions below, the likelihood increases that a curbside consulting practitioner could be named as a defendant and face possible monetary exposure for civil damages should the matter proceed to trial or arbitration:

• Did the requesting practitioner provide detailed facts that included the patient’s history, comorbidities, and laboratory data?
• Did the consultant personally review any portion of the patient’s record?
• Did the consultant speak directly with the patient or conduct even a cursory physical examination at bedside?
• Did the consultant recommend or order any specific tests, therapies, medications, or other treatment modalities?
• Did the consultant follow up with either the requesting practitioner or the patient?
• Most importantly, did the consultant submit a bill for services rendered?

What kinds of informal consultation cases have been litigated?

 

Our closed claims analyses revealed multiple cases in which informal consultations took place between practitioners and the patient ultimately suffered serious cardiac, obstetric, neurologic, hemodynamic, or other untoward sequelae. Both practitioners were named in the subsequent malpractice action. In some cases, the consulting practitioner shared in liability for the final outcome based on the degree of involvement. (See the factors outlined in the question above.)

Curbside consults have also moved to electronic communications. Does a practitioner’s professional liability insurance cover consulting with other practitioners through electronic means?

 

It does not matter if the curbside consultation is electronic (via email, text, or telephone) or an in-person, face-to-face encounter. Due to the advent of metadata technology, the electronic footprint of the interaction exists virtually forever. The issues with informal consultations, regardless of the mode, remain the same. The fact that an email, text, or other electronic format allows practitioners who are miles—or states—apart to communicate can, however, also lead to other issues, such as privileging, credentialing, and licensure in the state where the patient resides. Professional liability insurance does not typically cover a practitioner for practice in a state where the practitioner is not licensed. 

What patient safety issues are raised by curbside consultations?

 

From a patient safety standpoint, a verbal or electronic exchange between practitioners may lack the patient’s complete clinical picture (which should include a detailed history, an explanation of presenting signs and symptoms, identification of prescription and nonprescription medications, comorbidities, findings on physical examination, and related issues).

By responding without having all the pertinent information, the consulting practitioner may provide advice that is not in the best interests of the patient. It may result in an incorrect diagnosis, the formulation of an incorrect treatment plan, or a delay in ordering and implementing appropriate therapies. If the patient is harmed as a result, the consulting practitioner could be named as a defendant in a claim.

In analyzing closed claims, we have learned that incomplete or poor communication among practitioners is one of the leading causes of bad outcomes. This represents a major risk with informal consultations: Communication of all the necessary information to obtain and provide good clinical advice is critical.

What criteria can be used to determine whether a situation is low risk or one that requires a formal consultation?

 

If the requesting practitioner’s questions go beyond the low-risk scenarios described below, a formal consult should be obtained instead.

• Questions are for the general education of the requesting practitioner and are not specific to the patient.
• No request is made to confirm or make a diagnosis.
• No record review is required.
• No questions are raised about ordering specific tests or studies.
• The questions are straightforward and require only simple answers and nonspecific advice.

What can practitioners do to protect themselves?

 

At the outset of the encounter, clear communication must take place between the practitioners that identifies the nature of the inquiry and the type of guidance being solicited. Curbside consultations are tempting to busy practitioners because they are convenient and speedy—the very reasons to avoid engaging in this practice. Also, consulting practitioners are not compensated for the time, expertise, and potential liability exposure involved. If you decide to assume this risk, consider the following strategies:

• Clarify the nature of the consult; advise the requesting practitioner that a curbside consultation should not be considered a formal consultation.
• Consider the facts not provided.
• Keep the consultation brief.
• Make sure the requesting practitioner is aware that the advice given is not a treatment decision.
• Refrain from using email or text messages as a method of informal consultation. (For more information, see our article “Smartphones, Texts, and HIPAA: Strategies to Protect Patient Privacy.”)

If the requesting practitioner continues to insist that you render a treatment decision or makes serial inquiries about the same patient, we advise that you firmly but respectfully request making a formal and documented consultation instead. This approach helps to promote optimum patient care and protects the practitioners from possibly frivolous malpractice claims in the event of an unexpected or adverse outcome.