COMMISSION ON PUBLIC HEALTH

MINUTES OF MEETING 8/08/09

Rye Town Hilton

Rye, New York

Members Present: Doctors William Klepack (Chair); Laura Martin (Vice-Chair); George Dunn; John Epling; Elizabeth Kwon (Resident); Christopher Murphy; Robert Ostrander; Ellen Reinheimer; Norman Wetterau; Leon Zoughlin; and Ron Rouse (staff)

Agenda Item / Discussion / Action
Introductions / All members introduced themselves and provided a brief personal background. / N o further action.
Minutes / No additions or corrections to the Minutes. Approved / No further action.
Tracking Opioid Use / 09-05: Prevention of Opioid Deaths - 10,000 deaths per year. In many states, a doctor can go online and find out if a patient is being prescribed opioids elsewhere. Such a system is confidential and it helps doctors to stop abuse. NYSDOH has been looking into developing such a system for a number of years. / Ask Board to encourage NYSDOH and other relevant bodies to implement steps to give MDs access to the appropriate data base on narcotic prescriptions being obtained by patients. (Wetterau)
Agenda Item / Discussion / Action
Obesity
Obesity (con’t) / BMI Reporting in Schools: Schools are mandated by State law to collect BMI data on students in grade levels K, 2, 4, 7, & 10. These data will be used to better understand the severity and distribution of obesity among age groups and geographic regions; and, data can be used to assess effectiveness of programs. Aggregated data will be reported to State DoH but a parent can request that a child's information be excluded in the aggregate report.
A letter should be sent to all school districts in the state advocating they use the significant elements in a school physical form developed by Dr. Ostrander in collaboration with school districts in his area. This form facilitates the communication of health problems between the school district and the family. It encourages the family to link back to the PCP for follow-up health care regarding these issues and, as such, promotes the patient-centered medical home. This action would also have the benefit of making districts more aware of FP’s role in child care.
Increased Taxes on Sugar-Sweetened Beverages: An estimated $12 billion is expended on obesity-related health problems in NYS; another $12 billion on lost productivity. Numerous scientific studies almost universally support a strong link between sugar-sweetened beverages and obesity. Doctors tell patients to cut back on soda. A modest tax is the single best way to change behavior. Taxing alcohol and cigarettes has proven to be highly successful in reducing consumption. A tax can produce a large change in behavior, far more than education although the best strategy is to do both. Producing behavior changes alone would cost hundreds of millions of dollars and take years. Furthermore, a tax would raise hundreds of millions of dollars.
Given the State’s financial crisis, we can expect a proposal to raise the tax on sugar-sweetened beverages next legislative session. The Academy may be asked to support such a proposal by writing a letter of support, being included in a press release or attending a press conference. The 2009 Congress supported a proposal only to repeal the tax exemption for junk food; thus, a sugar-sweetened beverage tax may be going
beyond the Congress’ position. On the other hand, the AFP may not want to exclude itself from supporting such a measure, especially while other organizations will probably support it. Given the COD position, the AFP should not pro-actively support a tax but if asked, it could state “any measure that will reduce the use of soda consumption is a measure we support. Revenue should be funneled back into promoting public health.”
Resolution 09-06: Statewide Campaign Against Obesity: The Congress passed Resolution 09-06 to create a Statewide campaign against obesity that is of the scope and magnitude of the State’s very successful anti-tobacco campaign. / Ask board permission to send a letter to all school districts suggesting a form on how schools should communicate with parents of children who are obese. If approved, use letter and form developed by Dr. Ostrander, with any necessary modifications. This action has a small fiscal impact due to postage. (Ostrander, Rouse)
Seek Board approval to prepare a public statement in anticipation that NYS AFP is asked to participate in a multi-organization effort to reduce consumption of sugar-sweetened beverages. Avoid a pro-active statement promoting a tax. (Klepack, Rouse)
Write and distribute an op-ed piece, press release, and letters to government officials and anti-obesity organizations. (Klepack, Rouse)
Tobacco / Reimbursement Codes. Tobacco cessation reimbursement codes (99406, 99407) are not being used by many insurance companies and many self-insured employers are not participating.
We could work with a State Legislator(s) to introduce a bill that requires all insurance policies sold in NYS to include reimbursement for the codes; we might partner with other organizations including MSSNY. That approach, however, still would not include self-insured employers. So, the bill could require that State DoH use their statewide cessation centers to work with self-insured employers, the Business Council, and other business-related organizations to encourage them to support use of the codes. The bill could also require that NYS use the codes for more than just Medicaid pregnant women to include all Medicaid recipients. In addition, we could write letters to anti-tobacco organizations to obtain their support, and we could meet with the Business Council, Health Plan Association, etc.
The State DoH says they are going to determine what the cost of the codes is per employee. / Work with MSSNY, anti-tobacco organizations, the Business Council, and the Health Plan Association on legislation to mandate reimbursement in all health insurance policies sold in NYS, to encourage self-insured employers to voluntarily participate in reimbursement, and to cover all Medicaid recipients. (Rouse)
Agenda Item / Discussion / Action
Tobacco (con’t) / CME for Tobacco Cessation Counseling - up to 20 hours of CME credit is available for Physicians, Physician Assistants, and Nurse Practitioners offered by their local New York State Tobacco Cessation Center. Currently, four CME-approved programs are available. Nursing contact hours are also available. / Promote awareness of this program. (Rouse)
Single Payer / Federal Congress: The Congress is on August recess, and NYS AFP should communicate its support of single payer to the NYS Congressional Delegation. Similarly, our rank-and-file members should communicate support to their local Members of Congress. These letters should be consistent with the COD resolution, i.e., reimbursement, collective bargaining, malpractice reform, etc.
Administrative Waste Survey: AFP needs to provide the public a better understanding of the nature and scope of administrative waste through op ed’s, letters to editors, public testimony, etc. In order to obtain better information on administrative waste, the Commission is asking about 30 doctors throughout the State to complete a survey. Some PHC members have completed the survey already. Although the doctors can easily complete the portions relevant to prior authorization and referrals, their billing staff will need to complete those portions relevant to billing and payment.
Brief discussion on the role employers play in other countries in terms of buying health insurance for their employees. / Send letter to Congressional delegation to support single payer. Send template letter to Members that they can send to their respective Congress member. Consider presentations at grand rounds, local groups, and chapters. (Klepack, Rouse)
Recruit more members to participate in survey, and work with their respective staff to complete. Also, conduct literature search on administrative waste.(Rouse)
Obtain information on role of employers in other nations. (Rouse)
Agenda Item / Discussion / Action
Preventive Services / Some simple measures could have a big impact on preventing illnesses, such as taking aspirin to prevent heart disease, advising smokers to quit and prescribing medication, immunizing adults against flu, increasing the number of people who are screened for colorectal cancer, and conducting alcohol screening and brief counseling. Various preventive services were ranked by the “Partnership for Prevention” (2007) in terms of highest impact and cost effectiveness. This ranking was funded by CDC and Robert Wood Johnson. Discussion ensued regarding how we might build consensus on which actions are best and then advocate various steps to promote those actions. Educating members on which services are most effective and how to deliver them would be a useful approach as would paying primary care doctors to focus on prevention and promotion in the Primary Care Healthcare Home. / Reach out to AAFP to develop a metric module to cover tobacco, nutrition, exercise, alcohol abuse. (Epling, Wetterau, Rouse)
Reproductive Health / An update provided by Dr. Prine was distributed. / Keep Members informed of developments. (Rouse)
Physician Shortages / We have many shortage areas throughout NYS, and the situation will only intensify since a third of doctors in NYS are age 55+. NYSAFP needs to play a stronger role to address these shortages. Among the problem areas discussed:
§  Medical schools in NYS do not use admission criteria that promote the admission of students who are likely to remain in the State and serve in high-need areas. SUNY Upstate Medical School (Syracuse) has been responsive and modified their admission criteria to admit more New York students and to more greatly emphasize primary care.
§  Doctors Across New York (DANY) has not yet provided doctors for all the geographic areas in need. In addition, the program has been funded only 2 years although it was intended to be an on-going program. Funding is needed to continue the program given the extensive shortages throughout the State.
§  The process for obtaining a license takes too long.
§  The payers’ credentialing process takes too long.
§  Too many primary care doctors are going into jobs as hospitalists.
§  J-1 Visa: only a small percentage is selected to stay. Need a better process. / A number of steps will be pursued:
- Meet with SUNY medical schools, perhaps a “summit meeting,” on modifying admission criteria that will succeed in retaining graduates in NYS. (Ostrander, Rouse)
- create or join a coalition that includes hospitals, chambers of commerce, medical schools, AHEC, etc. to advocate actions to address shortages.(Rouse)
-Advocate that program funding for DANY be continued and expanded. (Klepack, Rouse)
- Interact with State Rural Health Council advocating that the State study what worked in the first 2 rounds of DANY and improve the process accordingly. (Ostrander)
- Should have more urban and rural rotations, and AHEC needs to play a bigger role. (Dunn, Kwon, Rouse)
- Research other issues such as process for obtaining a license, credentialing, impact of hospitalists on supply, J-1 Visa. (Rouse)
Pandemic Flu / Members discussed the fact there will be vaccine distribution issues and doctors need information on how to proceed. The private sector cannot handle the immunization workload due to funding cutbacks and resource shortages. How can family doctors pick up the challenge? How can we promote the delivery of vaccine? Other issues include rationing, monitoring and reporting of adverse reactions, making the vaccine available in the primary care medical home, and providing economic safeguards to facilitate purchase and distribution of the vaccine given its economically risky nature (although a mechanism similar to VFC would be acceptable).
CDC issued a statement not advocating school closure and going back to one’s routine within 24 hours after symptoms are gone.
NYSAFP will be meeting with State DoH so PHC should forward its recommendations to Marcy.
Dr. Klepack has a PPT presentation that could be distributed to doctors and State DoH.
Many issues need to be discussed and resolved. / Make clear in testimony, letters, and other means of communication that the vaccine should be available in the PC medical home (ask Pediatrics Academy, ACP, and Osteopaths to join us), and that there should be economic safeguards to facilitate its purchase and distribution. This latter point should be one that AAFP also requests of Federal DHHS (Klepack)
Place Klepack PPT on NYS AFP web site. (Klepack)
Send letter to state DOH suggesting a change in format to facilitate communications. (Klepack)
Children & Youth with Special Healthcare Needs. / Dr. Ostrander reviewed the subject. Most doctors have few patients in this category so they may be unfamiliar with care regimens for these patients. Thus, we need to disseminate information to doctors, and perhaps the best approach is an educational session. / Schedule a quality improvement module and collaborate with Education Commission. Will also conduct a workshop at Winter Weekend on Promoting Medical Home for Children with Special Medical Needs. (Ostrander, Epling)
“Fracturing” for Natural Gas / The water used for this extraction process must be purified after it is used. Local systems must know which chemicals were used in order to purify the water more effectively.
The full disclosure of all chemicals coming in contact with ground and surface water systems should be an obligation of companies exploiting natural resources including those drilling the Marcellus Shale. Further, the NYS Department of Environmental Conservation (NYSDEC) should prohibit any exploration or extraction of natural resources until the disclosure of contact chemical is made, an assessment of the chemical impact on human health and the environment is provided, and public hearings to comment on such an assessment can be conducted. The public comment period following promulgation of the draft Supplemental Generic Environmental Impact Statement should be extended to ninety (90) days.
Also, the NYS Legislature should support federal bill, H.R. 7231, which would repeal the exemption for hydraulic fracturing where it pertains to the chemicals used in oil and gas drilling in the Safe Drinking Water Act. / Ask the Board to submit a letter pursuant to Dr. Klepack’s language. (Klepack)
Agenda Item / Discussion / Action
New Issues / Bicycling: would like to use the name of NYS AFP to promote it. – Zoughlin / Pursue it (Zoughlin)
Letter to Dr. Linda Prine / Dr. Prine led the Public Health Commission as chair for 3 years, advocating and advancing issues that promote and protect the public’s health status. We should recognize her hard work and successes. / Letter will be written to Dr. Prine (Klepack)
Neonatal Care / In the neonatal period a mother and child are separated routinely when care is required for one or the other at a different facility. The facilities can be several hours away in many instances. Presently, if the mother is healthy she may not go with her child, or vice versa, since dual transfer is not covered by insurance, interrupting much of the feeding, bonding, and joint decision- making for care. A proposal was made at NCSC which will be taken to the Congress, that we advocate to the payers that the mother and child be considered one unit, and when transfer of one is required the other person also is transferred. / Direct our delegates to support the resolution before AAFP COD. (Martin)
Medical Marijuana / MSSNY favors a limited use, but this may not be a good idea. / Obtain information and bring to PHC (Wetterau)

Adjourned at 1:06 PM.