We're closer to getting full insurance coverage for congenital anomalies than we've ever been. Our bill has been introduced in both houses and now we need to get as many assembly members and senators to sign on as co-sponsors. That's where you come in. We need you to reach out to your legislators and ask them to co-sponsor the bill in their respective houses.

It's quick and easy--you can either email or send a message over social media. Just enter your information on the form and you'll be on your way to letting your legislator know how important this bill is to children across New York State.

1in38 Advocacy Day - Join us on 2/25/2020

Bull Moose Club
150 State Street, Floor 4 (Franklin Room)
Albany, NY 12207

8:00am    Opening Remarks and Briefing
10:00am  Legislative Appointments Begin
4:00pm    Conclude

> REGISTER TODAY!

Support A.8890 (Simon), Give Kids A Chance–Carter’s Law so that New York health insurance companies can no longer routinely deny coverage for medical procedures and therapies they consider not medically necessary.

Take a stand and help kids get a chance at a full and productive life!
> Sign the Petition

Background
In New York, 1 in 38 babies are born with a congenital anomaly. On average, children with congenital anomalies can expect anywhere from three to five surgical procedures throughout their childhood to restore a more normal appearance and function.

Although insurance carriers may provide coverage for the initial procedures, they may resist coverage of the later stage procedures, claiming they are cosmetic and not medically necessary. Denial or delay of these procedures – which by definition are reconstructive – could lead to long-term physical, functional, and psychological injuries.

To a layperson, repair of a congenital anomaly may seem cosmetic in nature. However, reconstructive surgery is performed to treat structures of the body affected aesthetically or functionally by congenital or developmental abnormalities, trauma, infection, tumors, or disease. It is generally done to improve function and ability, and may also be performed to achieve a more typical appearance of the affected structure.

Coverage should also be provided for healthcare services that help an individual keep, learn, or improve skills and functioning for daily living. Habilitative services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

 The NYSDOH’s Office of Quality and Patient Safety has developed a new electronic adverse event reporting (AER) tool that will be easily accessible and assist OBS practices in reporting adverse events as required by Public Health Law § 230-d.

The new electronic AER is designed to assist OBS practices in reporting adverse events and submitting medical records more efficiently.  It will also allow the OBS program to identify trends in adverse events and opportunities for quality improvement in OBS practices. 

The OBS program anticipates launching the electronic AER tool February 3, 2020.  Additional information will be provided to the practices as we move closer to the launch date of the electronic AER tool including written & video instructions for using the tool. 

Should you have any questions, please contact the Office of Quality & Patient Safety, OBS Program at (518) 408-1219 or at obs@health.ny.gov.

CMS final rules recently went on display updating payment polices for services furnished in a physician office or in a hospital outpatient setting. These final rules address some of the concerns ASPS and other medical societies raised, while others are yet to be fully addressed.

Plastic surgeons should be aware of new Medicare Prior Authorization policy, set to become effective on July 1, 2020, that will require hospitals to show the medical necessity of blepharoplasty, botulinum toxin injections, panniculectomy and rhinoplasty procedures before Medicare will provide reimbursement. For private practices to obtain prior authorization, medical information will need to be forwarded to the hospital before the procedure can be scheduled. 

> Learn more about the new payment policies

The Fraser Institute in Canada released their annual "Waiting Your Turn" report. Researchers found that wait times for medically necessary treatment increased in 2019. Specialists surveyed reported a median wait time of 20.9 weeks between referral from a general practitioner and when the individual received the treatment. That's up from 19.8 weeks in 2018. 

The longest wait is for orthopedic surgery, at 39.1 weeks. Plastic surgery and ophthalmology have the second and third longest waits, respectively. 

The New York Health Act has overwhelming support in the Assembly and is gaining ground in the Senate. Hearings have taken place across the state and NYSSPS was there represented by founding NYSSPS member, Dr. Scot B. Glasberg. While in strict opposition to this bill, we recognize that there is a distinct possibility of it becoming the law of our land. The impact will be a complete overhaul of healthcare in NYS and the eventual elimination of private health insurance. We have been actively involved to try to shape the language in the bill and in particular, to ensure that if this bill does pass, that reimbursement will be in excess of the cost required to provide care. You can see Dr. Glasberg’s testimony HERE

Sponsors of the New York Health Act often point to Canada's healthcare system as a model that New York State should seek to move toward. However, the Fraser Institute research shows that such a system can lead to problems like longer wait times, which then leads to poorer medical outcomes and higher costs to individuals.

The American Society of Plastic Surgeons and the The American College of Surgeons are offering an annual scholarship to subsidize attendance and participation in the Executive Leadership Program in Health Policy and Management at Brandeis University. The course takes place June 14–20, 2020. 

The award is in the amount of $8,000, to be used toward the cost of tuition, travel, housing, and subsistence during the period of the course. Indirect costs are not paid to the recipient or to the recipient’s institution

Eligibility
The award is open to surgeons who are active members in good standing of both the American College of Surgeons (ACS) and the American Society of Plastic Surgeons (ASPS). Applicants must be at least 30 years old, but under 60, on the date that the completed application is filed

Some of the requirements include sending in a cover letter, a one-page essay discussing why the applicant wishes to receive the scholarship, how the scholarship will fill a gap in the applicant's training/experience and the applicant's curriculum vitae.

Applications are currently being accepted with a deadline of February 3rd. Eligible members are encouraged to apply.  All applicants will be notified of the outcome of the selection process by early April 2020.

Learn more: https://www.plasticsurgery.org/documents/Health-Policy/ASPS-ACS-Health-Policy-Scholarship.pdf

In 2020, plastic surgeons from across the country will be heading to Washington, DC to advocate on behalf of the specialty during the two-day ASPS Regional Fly-In events. The Southeast & West Regional Fly-In will take place on February 4-5, 2020 and the Northeast & Midwest Regional Fly-In on June 10-11, 2020. ASPS members are encouraged to register for the Fly-In for their respective state, however, if they are unable to attend their region's designated Fly-In event they are welcome to register for the alternative Fly-In event.

The ASPS Regional Fly-Ins will be focused only on congressional meetings on Capitol Hill and will not feature the extra day of educational programming that's part of the ASPS Advocacy Summit. The ASPS Regional Fly-Ins will occur in even years – election years – going forward, while the ASPS Advocacy Summit will be held in odd years and is scheduled to return in 2021.

During the ASPS Regional Fly-Ins, ASPS members will:

• Meet with the members of Congress and their staff on Capitol Hill to educate them about critical healthcare policies
• Participate in an exclusive dinner discussion with a prominent member of Congress
• Influence and help shape ASPS's 2021 state and federal policy priorities to help determine the Society's advocacy agenda
• Network with their plastic surgery colleagues and ASPS leadership in the nation's capital

To register or learn more about the ASPS Regional Fly-Ins, please visit here. Please contact Darcy McLaughlin at dmclaughlin@plasticsurgery.org with any questions.

Resources

• Event Page: ASPS Regional Fly-Ins

As Congress moves to merge multiple pieces of out-of-network billing (OON) legislation into a final package, too much of what is gaining favor will reduce your reimbursements – for both out-of-network encounters and your contracted rates – and reduce your leverage in contract negotiations with carriers. Right now, bills that pay all OON emergency care at the median in-network rate ban elective out-of-network care in some situations, or contain no recourse for providers who receive an unfair payment all have a legitimate chance of becoming law.

ASPS continues to work on several fronts to improve the policies. As part of that effort, the Society is joining with other medical societies impacted by out-of-network billing to elevate the voices of our members who can least afford lost revenue – our solo and small practice owners – through a combined letter from them to congressional leadership.

By signing up to add your practice’s name to the letter, you will help amplify and emphasize the acute impact current proposals will have on small businesses like yours and the patients that rely on them. If you have not signed on already, please do so by noon on December 5, 2019.

> Learn more about this issue

Every member of the New York State Society of Plastic Surgeons has the opportunity to provide input regarding the development of policies and positions impacting plastic surgeons and we encourage you to get involved!

Working with our Executive Council, NYSSPS members have created and advocated for Resolutions that have covered a variety of issues including: 

• Insurance Coverage for Congenital Anomalies
• All Payer Database (APD) Not Appropriate as Reimbursement Standard
  
• Protection of Clinical Decision Making and Ownership of Medical Practices
• Percentage-Based Billing Services Arrangements
  

What is a Resolution?

Resolutions set forth background information and propose a course of action or statement of policy.  Resolutions begin with background information ("Whereas" clause/s) and conclude with a specific proposal ("Resolved" clause/s).

When Crafting a Resolution Keep in Mind the Following:

• What do I want to change?
• Is there existing policy, statute or regulation?
• Who can effect the desired change?
• Are there potential allies?
• What are the financial consequences?

If you would like to work directly with our Executive Council in crafting a resolution to submit at this year’s MSSNY House of Delegates Meeting, please email Babette Grey, Executive Director at nyssps@gmail.com

Draft Resolutions need to be submitted to NYSSPS for consideration by Friday, February 7, 2020

NYSSPS has worked together with MSSNY and other physician and patient advocacy groups in support of multiple pieces of legislation to reduce physicians’ administrative burden relating to ensuring their patients can receive the care and medications they need.

However, additional work and laws are still needed to reduce the need for unnecessary and repetitive prior authorizations that take time away from patient care delivery, as well as ensuring that current laws to reduce administrative burdens are being adhered to by health insurers. 

Please take just a few minutes to complete the below survey and identify the impact prior authorizations have on your practice. 

Take the survey