COMMISSION ON PUBLIC HEALTH
MINUTES OF MEETING 10/20/07
KAATERSKILL MOUNTAIN CLUB
HUNTER, NEW YORK
Members Present: Robert Ostrander (Vice-Chair); Paul Damaske; Benjamin Friedell; Henry Francis; Lynda Hohmann; Thomas Kuettel; Sarah Nosal; Norman Wetterau; and Miranda Balkin (student); Satya Chelamkuri (Guest)
Agenda Item / Discussion / ActionMinutes / Will follow Sturgis Rules of Order. Will take votes on main motions.
A member may make amendments on the Minutes at the next meeting.
A member asked if there are guidelines for evaluating proposals brought to the PHC. It was clarified that issues brought before the PHC are evaluated through reasoned discussion. There are no specific requirements that decision be reached based in whole or in part on what is considered strict “evidence-based” evaluation, though that often is part of the discussion.
A motion was made to suspend the rules for a brief general discussion of each agenda topic before a specific motion was made and debated according to the rules. Second, & carried. / Motion to accept July 2007 Minutes. Passed with one dissent (Kuettle, who was not at the July meeting) and one abstention.
Single Payer
Single Payer (con’t) / Motion made to limit debate to 2 minutes per speaker when given the floor, second, carried.
Single Payer discussion:
Concern was expressed about government deciding which services are included. A public authority could decide which services, but the NYS AFP has avoided listing which services because that list could distract focus from the larger issue of enacting a single payer.
Concern was expressed about insufficient documentation in the Minutes about the past debate regarding the SP.
The PHC reviewed a suggested list of actions to advocate the single payer and educate our members:
Presidential Candidates - We will contact candidates about our single payer.
Flyer - A flyer was developed for NYS AFP members to place in their offices educating patients about the single payer. Members reviewed it. A single payer system will not eliminate all the forms and rules that we currently have as stated on the flyer, so change the wording accordingly. Focus on universality, portability, and that coverage will go from cradle to grave. Motion was made, seconded to adopt the flyer and distribute it to AFP members, carried (Dr. Kuettle opposed).
Congress – recommend to the Board that we have a panel of the pros and cons of the SP. Such a panel would help Members to better understand the concepts and mechanisms of the SP. Motion made, seconded, carried.
Research on collective bargaining & streamlined administration - staff will conduct research and then draft an article for the PHC to review before submission to our newsletter and web site, motion made, seconded, carried.
Letter to State Legislators - send a letter to each State legislator and the Governor advocating our SP proposal. Discussion about potential of AFP changing its position later and how that change would affect the letters being sent; we can always send another letter. Motion to send letters, second, carried (Kuettle opposed).
Consultant Study – provide information on our SP proposal to the State DoH consultant who is charged with looking at the costs of financing a universal coverage system. Motion made, carried, and passed (Kuettle –abstain).
Assemblyman Gottfried (Chair of Assembly Health Committee) – present differences to his office about his bill. After discussion, decision to table discussion until we meet with Advocacy Committee. / Contact Presidential Candidates (Prine, Rouse, Wamp)
Complete and distribute flyer (Nosal, Rouse)
Develop panel for 2008 Congress (Prine, Rouse)
Conduct research and develop article (Prine, Rouse)
Draft and send letters to Legislators (Prine, Rouse)
Submit information to the DoH consultant study (Prine, Rouse)
Follow-up with Advocacy Committee (Rouse)
Physician Shortages / Discussion of Physician shortages:
Admissions Criteria - Upstate is re-examining its Admissions Criteria process. It may grant rural and upstate students an interview as long as they achieve a minimum MCAT and GPA. No response from other SUNY medical schools.
We could take some steps to help rural physicians feel less isolated, e.g., providing broad band for video-conferencing, etc.
Perhaps we should have more discussions with private schools to convince them to improve their admissions criteria.
In the Bronx, a new grade school was opened to encourage students to eventually attend medical school. / We will continue working on the NYS Physician Workforce Planning Group (Prine, Ostrander, Rouse)
Reproductive Health & Privacy Protection / A number of NYS laws are still in force but have been rendered unenforceable because of the Supreme Court decision (Roe vs. Wade); however, if this decision is overturned, then these “dormant” laws will suddenly become “live.’ The Spitzer bill recognizes this situation and eliminates the outmoded laws. ACOG has concerns about allowing advanced practice clinicians to practice abortion. We have sent a letter to the Governor supporting the bill. Senate has introduced it but the Assembly has not. We are working with ACOG to see if their objections can be addressed. / Continue working with ACOG and other groups on the bill (Prine, Nosal)
Patient Confidentiality / A conference was held on this topic this past summer. Insurers are required by federal law and state law to provide an Explanation of Benefits to the primary insured, which conflicts with other laws to respect confidentiality; similarly, there are other conflicts between Federal regulations and State law and regulations. This topic is very complex and much more information is needed before the PHC can make recommendations on how to protect patient confidentiality. / Continue to work with the workgroup on “Providing Confidentiality for Adolescent Health Care” to obtain more information and a better understanding of the law and regulations. (Hohmann, Rouse)
Liability Coverage / We have been told by Physicians Reciprocal Insurers that it will not cover family doctors for medication abortion, labor, deliver, and any procedure involving entry into or penetration of the uterine cavity. Not only is this position completely inappropriate given the training and experience of family physicians, but it also greatly restricts women’s access to care.
We have been in communication with the State Insurance Department to address this situation. This issue has been referred to the State’s Task Force on Malpractice Insurance. / Request a meeting with the State Insurance Department and the Task Force. (Prine, Rouse)
Congestion Pricing/
Transportation Alternatives / A 3-page position paper was reviewed that explains the 3 public health benefits of NYC’s proposal for congestion pricing. No comments were offered at the meeting but members were asked to submit comments later to Ron if they had any. A motion carried to present the issue to the Board for its endorsement, but at the joint Advocacy/Public Health meeting, Advocacy stated that the Board had already endorsed the concept so no further action with the Board is necessary. Dr. Prine will be testifying in support of the NYC proposal at an upcoming hearing. / Present testimony at the appropriate public meetings (Prine, Rouse)
Place document on the AFP Web site (Rouse)
Distribute document and letters of support to appropriate organizations. (Rouse)
Tobacco
Tobacco (con’t) / Reducing number of smokers by 1 million by 2011 is one of our goals, one that is shared by the State DoH, American Cancer, and other organizations.
Letters on Tobacco Tax & Increased State Expenditures - Pursuant to our COD resolution, we will be sending letters to the Governor and State Legislators regarding our proposed $1 tobacco tax increase and our proposal to increase the State’s anti-tobacco program from $85 M to $150 M. We are hearing rumors that the Governor’s Office may be considering a tobacco tax.
The PHC reviewed a suggested list of new anti-tobacco actions:
Better collection of tobacco tax - on tobacco sold on Native American reservations to non-Native Americans. Discussion of pros and cons. Increasing the tax affects teens mostly but they do not go to reservations to purchase cigarettes. Motion to advocate support, seconded, discussed, and defeated.
Smoking Ban at NYS Parks - motion made and seconded to present a resolution to the 2008 Congress to support a ban; amendment proposed to amend the motion that the ultimate goal of NYS AFP is to ban use of all tobacco products; amendment defeated. Original motion to ban smoking in public parks carried (Opposed – Drs. Ostrander, Wetterau, and Friedell).
Cessation Reimbursement Codes – discussion on whether the Current Procedural Terminology (CPT) system or Healthcare Common Procedure Coding System (HCPCS) should incorporate separate reimbursement codes that would motivate physicians to engage more fully in advocating and managing cessation efforts by their patients. Further discussion on whether a separate code already exists. If one does, then we need to inform our members; if one does not exist, then we need to advocate creation of one. Ask insurers if this is a covered benefit. Motion made that if a separate code exists then we will inform our members, and if a separate code does not exist, then advocate its creation, seconded, and carried.
Other proposals, such as banning smoking in vehicles with children, banning tobacco in dormitories, and banning the sale of candy-flavored cigarettes were discussed but no action taken.
/ Draft and send letters (Prine, Rouse)
Develop resolution for 2008 Congress (Damaske, Rouse)
Conduct research on tobacco cessation reimbursement codes and then notify members if one exists; or, in the absence of one, then advocate its creation (Wetterau, Hohmann, Rouse)
Obesity / The PHC reviewed a suggested list of actions to advocate measures that will address obesity using the State’s highly-successful anti-tobacco campaign as a model. We discussed a tax on non-nutritious foods, a counter-advertising campaign, weight-loss programs, and an appropriation of $85 million to the State DoH to run the above programs. Members decided we should wait until Ursula Bauer (Director of the State Tobacco Prevention and Control Program) presents at our Winter Weekend on the success of the State’s programs. After hearing her presentation and meeting with her afterwards, we can then use that information as a starting point to determine which anti-tobacco strategies might be transferable to fighting obesity.
Also discussed environmental changes such as cycling and pedestrian lanes, worksite fitness programs, etc.
Sufficient evidence does not exist on the effectiveness of many obesity programs. We need to seek out evidenced-based strategies. / No action at this time.
Health Care Disparities / Health literacy is a prime issue that results in disparities. We should join MSSNY and promote methods to improve literacy.
Motion made and seconded to begin looking at health literacy as an approach that helps address disparities. An amendment was made to the motion that we define the term “health disparities.” The proposed amendment was ruled out of order, for lack of a second. A definition can be brought to the next meeting. Original motion carried (Dr. Kuettle opposed).
/ Conduct research on health literacy (Hohmann)
Substance Abuse / NYSAFP field tested a course on methadone prescribing for pain in Saratoga. This course was funded by the Federal Center for Substance Abuse Treatment. Drs. Wetterau and Morrow from NYSAFP helped to plan the course. CSAT will intends to place the course on the web next year, and develop some additional courses on prescribing other controlled substances.
MSSNY will provide training on screening on alcohol abuse. A doctor can obtain up to 20 hours of credit for implementing the screening program of patients in one’s office.
MSSNY has a “Youth at Risk” report available at MSSNY.org, click on “Public Health Concerns.” The report deals with multiple issues including substance abuse, mental health, and obesity. One of its recommendations pertains to doctors’ participation in local prevention coalitions. MSSNY will be having dinners around the State to help bring about wider participation. NYSAFP already supports involvement in substance coalitions and we would like to re-affirm our efforts to encourage our members to be involved in these coalitions.
MSSNY conducted a pain management course, and all MSSNY participants received 4 CD’s on the topic. The speakers are still available although the grant is expiring soon.
HPV Vaccine
HPV Vaccine (con’t) / We looked at mandating the HPV vaccine. ACP and the Advisory Committee on Immunization Practices (ACIP) recommend females be given vaccine at 11 years of age. Studies show it is cost effective.
Lack of Financial Access. NYS law requires that all ACIP recommendations for immunizations must be covered by insurance companies. Medicaid covers the vaccine although the threshold rate does not adequately cover the cost; and, private doctors do not even get the threshold rate. The HPV vaccine costs $360 per person even though the state reimburses much less. Perhaps all vaccines should be distributed by the State, which would lower the cost and better ensure fairer distribution to doctors.
Parental Consent. State DoH has ruled that Gardasil requires parental consent.
NYSAFP supports an Assembly bill that encourages providing information on the HPV vaccine. ACOG and ACP did not take a position supporting the bill.
A motion was made that we advocate a system in which all vaccines should be purchased by the State, and that HPV vaccine be a mandated vaccine. Discussion ensued. The two issues were separated.
Upon further discussion, a motion was made to make the HPV vaccine mandatory, seconded, carried.
Another motion was made to create a universal distribution system through DOH such that patient access is not limited by cost to the doctor and to the patient. Withdrawn and will be placed on next PHC agenda.
The Advocacy Committee then joined our discussion. The pros and cons of a mandate were discussed. On the one hand, the HPV vaccine offers great potential in preventing cervical cancer and pre-cancerous lesions, and its safety has been tested (see attachment). Concern was expressed over the fact that the science surrounding the vaccine is a “young science regarding a young population.” Also, HPV is not a disease that is caused by casual contact, which is the rationale for denying school entry for certain immunizations. ACP has not supported a mandate. We should educate and not mandate. After further discussion, both the PHC and Advocacy agreed to abide by the decision of the joint committee. A motion was then made by the joint committee to recommend to the board that no position be taken yet, seconded, Carried. / Continue conducting research on whether the HPV vaccine should be mandated. (Damaske)
Attachment