200.988 Supporting International Medical Graduates
The Medical Society of the State of New York opposes laws and regulations that would broadly deny entry or re-entry to the United States of persons who currently have legal visas, including permanent resident status (green card) and student visas, based on their country of origin and/or religion. MSSNY opposes policies that would broadly deny issuance of legal visas to persons based on their country of origin and/or religion.
A copy of this resolution will be immediately forwarded to the American Medical Association. (HOD 2017-207)
200.989 MSSNY Union Affiliation
MSSNY will open talks with the National Guild for Medical Professionals, Office and Professional Employees Union to ascertain if membership in the union would further the interests of New York State Physicians. (HOD 2017-206)
200.990 Voluntary Contributions by Life Members
The Membership Committee of MSSNY recommends that MSSNY not impose dues for future Life Members, but instead make annual requests to all Life Members for Legacy Donations in the form of financial or service contributions. (Adopted Council September 17, 2015)
200.991 Special Requests for Life Membership
The appropriate place for determining the merits of special requests for Life Membership is the county medical society. The following criteria are essential for any special requests for Life Membership and are intended as guidelines for counties to follow in determining whether or not requests should be submitted to the Council:
-At least 10 years of membership in good standing
-Personal issues determined by the county society to warrant granting of free life membership locally and a recommendation that MSSNY do the same. (Adopted Council September 17, 2015)
200.992 MSSNY Minority Physician Mentor Database:
-create a field within its current database (IMIS) system that will designate MSSNY physicians who are interested in serving as mentors to MSSNY members and that such information be easily accessible by the use of a key word in the IMIS database;
-conduct a survey of physicians to voluntarily agree to be listed as mentors to MSSNY members;
-record each interested physician’s name, specialty, location, contact information and non-MSSNY professional memberships for inclusion in this mentor database, as well as an additional section for physicians to voluntarily identify race/ethnicity and LGBT affiliation;
-monitor this information and resurvey MSSNY members annually to ascertain their continued interest in serving in the program. (HOD 2011-164)
MSSNY Privacy Statement;
MSSNY is committed to protecting and preserving the privacy interests of physicians, and is committed to using data about physicians in a secure and responsible manner. In order to more effectively serve physicians, MSSNY will collect, use and disclose physician data in ways that are determined to be appropriate and responsible. This Privacy Statement generally describes how data about physicians is collected, used or disclosed by MSSNY. This Privacy Statement also provides physicians the opportunity to opt-out and make changes to the data collected.
What Information Does MSSNY Collect?
Medical Directory of New York State
The Medical Directory of New York State (“Medical Directory”) is currently published online as a reference source of demographic and professional information accessible only by members of the Medical Society of the State of New York. Since its first publication in 1899, it has been a recognized and trusted source. The biographical data included in the Medical Directory are extracted from MSSNY’s master database and can be updated online by the physician. The Medical Society of the State of New York is not responsible for validating any information published by physicians. Additional sources of data in MSSNY master files include data obtained from county medical societies and other organizations/institutions.
Since the purpose of the Medical Directory is to provide information on physicians’ professional background and contact information MSSNY does not undertake to maintain the privacy of the professional data included in the Directory. Such data provided by the physician includes: name, office address, phone, fax, email, medical school, specialty, board certification, hospital affiliation, languages, insurance plans, practice website, and membership in other state and national medical societies.
Demographic, Professional and Contact Data
The MSSNY master file includes information obtained from physicians, county medical societies and other medical organizations/institutions. The physician master file includes member and non-members of MSSNY. Sample information in the master file includes:
Physician name (first, middle, last)
NY State medical license number
Date of birth
Year of medical school graduation
Resident year & place of residency
Specialty (primary specialty plus 2 sub-specialties)
Other state or national medical society membership
Preferred mailing address, phone, fax, email
Office address (up to 3 office addresses, phone, fax, email)
Insurance carrier plans accepted by office
Hospital affiliation, title, department
MSSNY may use the demographic data it stores to communicate with physicians and to enhance member services. MSSNY may use demographic data to conduct demographic studies. If a demographic study is published, the study will not provide data that will identify any individual physician or medical practice unless consented by the physician or medical practice, but, the data may be aggregated such as by specialty, county or locality.
MSSNY may share data with county medical societies in order to assure the highest possible level of accuracy in the MSSNY-county medical society list of physicians.
IMIS is MSSNY’s database that stores membership, demographic and contact data. MSSNY stores membership data pertaining to category and status of members and the preferred mailing address for all MSSNY correspondence. The membership related fields store dates relating to when a physician joined MSSNY, the date when a MSSNY member paid membership dues, and the county medical society the physician has joined. The IMIS data base includes the information listed above as well as the following
IMIS identification number
MSSNY membership category and type
Physician’s full name
Preferred mailing address
Dues payment date and amount
County Medical Society membership
Continuing Medical Education data
MSSNY uses the IMIS database for internal purposes, as a means to communicate with its member physicians and to enhance member services. MSSNY may provide pertinent membership information to the physician’s county medical society. In addition, MSSNY may provide to the AMA information regarding new student members who join AMA and MSSNY concurrently.
MSSNY will use e-mail addresses voluntarily provided by physicians to notify them about MSSNY’s services, products, activities or upcoming events. Physicians who do not wish to receive notifications by e-mail may opt-out of receiving such information at any time by contacting MSSNY Information Services Department at 516-488-6100 ext. 367 or 365.
Electoral Data Obtained from Outside Vendor
MSSNY has retained an outside consultant to search and compare NYS Board of Elections data with MSSNY’s database of physician members. This information will assist MSSNYPAC and county medical societies in soliciting potential MSSNYPAC donors and potential direct candidate supporters who are already members of MSSNY or have a past relationship with MSSNY. Preliminary results from matching the datasets produced 3,650 matches to persons who have not previously contributed to MSSNYPAC within the last 5 years. The data we will receive includes the committee to which the individual has contributed, the amount contributed and date of contribution dating back to 2010. In addition, we will receive similar information on physicians who have contributed to MSSNYPAC since 2010 whether or not they are currently members of MSSNYPAC.
The BOE Data is used by MSSNY to enhance political participation my MSSNY members in MSSNYPAC and thereby enhance MSSNYPAC’s finances and ability to make political contributions.
MSSNY does not release members’ email addresses except to the physician’s county medical society or by the physician’s permission, and generally does not rent or sell phone numbers, fax numbers, or personal identifying information to third parties. The only information that MSSNY sells is mailing lists/labels and other contact information as negotiated with the third party. The third party must demonstrate to MSSNY that the intended use of this information is in the interest of the physician. Third parties must agree that the mailing lists and contact information provided may not be duplicated, and must adhere to MSSNY Privacy policies.
Opt-Out and Making Changes to Demographic and Membership Information
As noted in the above sections, most of the demographic and membership data collected by MSSNY is provided by the physicians, their county medical societies, groups, associations or institutions. Physicians have the opportunity to view and modify their data by calling the MSSNY Information Services Department at 516-488-6100 ext 367 or 365. Physicians can also e-mail changes and corrections to the Information Services Department: ISdept@mssny.org
Physicians can also request to opt-out of mailings, publications and e-mail by contacting the MSSNY Information Services Department.
If you have any questions or wish to have your name and contact information removed from specific mailing lists and/or electronic email communications, please contact our Information Services Department.
MSSNY will disclose personal information to third parties if MSSNY believes in good faith that the law requires MSSNY to do so.
MSSNY reserves the right to amend this policy at any time. Amendments will be posted on the MSSNY website. (Council 9/21/06, Amended HOD 2016)
200.994 Communications with Non-members and other Health Care Professionals:
When MSSNY believes it is necessary for legislators to be contacted on issues of importance to organized medicine or to address specific pending legislation either in Albany or Washington, that communication be forwarded to ALL physicians identified on the MSSNY data base, irrespective of membership status and that similar communications be forwarded to other health professionals who may share our same agenda, i.e., physician assistants, in an attempt to elicit their support in conveying organized medicine’s message to appropriate state and Congressional representatives. (HOD 2006-211; Reaffirmed HOD 2016)
200.995 Innovative Methods to Improve Membership via Periodic Credit Card
MSSNY will look at innovative ways to reduce the burden of membership dues and that urgent, innovative and aggressive measures to increase membership in MSSNY must be undertaken, including automatically charging membership payments to credit cards on a periodic basis subject to the agreement of the physician. (HOD 2006-206; Reaffirmed HOD 2016)
200.996 Credentials and Election of New Members:
MSSNY urges county medical societies to find ways of meeting existing credentialing requirements that do not place the burden of compliance on the applicant, and to use online resources for reviewing applicants’ credentials.
MSSNY urges county medical societies to review their credentialing requirements and to remove any that are unnecessary and, as such, may be a barrier to membership. It is recommended that requirements for membership be outlined in a general way in county society bylaws, but that processes for determining eligibility be contained in a “policies and procedures” document that is easier to amend.
MSSNY urges county medical societies to review any materials they send to applicants for language. (e.g. “Submit proof of Board Certification” implies that such certification is a requirement for membership) or requirements (e.g. photographs) that might serve as a serious barrier to completing the application.
MSSNY offers an on-line application for membership and encourages county medical societies to do the same. Applicants should not be required to submit any documents, physical signatures or other materials with their applications (other than dues payment), as this renders the on-line concept useless.
MSSNY encourages county medical societies to accept payment of dues by credit card.
County medical societies are reminded that Article XVIII, Section 2 of the MSSNY Bylaws provides as follows: “…all county medical societies shall utilize a universal membership application form which shall be approved by the Council. Component county medical societies shall act upon the receipt of a membership application in a timely manner not to exceed sixty days.”
MSSNY recommends that a new goal be established that allows for processing of new members at all three levels of the federation within 60 days.
MSSNY will assist any county medical society in amending its bylaws or revising its credentialing and election procedures so as to remove any requirements which can act as a barrier to membership for qualified individuals or interfere with the speedy processing of new members.
Recommendations of Ad Hoc Subcommittee re Resolution 2002-203 – Improve Member Services by Streamlining Membership and Dues Processing Systems Throughout MSSNY and the County Medical Societies (HOD 2003; Modified and Reaffirmed HOD 2013)
200.997 International Medical Graduates (IMGs):
MSSNY continues to discourage any form of discrimination toward International Medical Graduates (IMGs) and is expanding its efforts to identify and address the issues of major concern to IMGs. In order to encourage IMGs to join the mainstream of organized medicine, MSSNY is sending a loud and clear message that it vigorously opposes discrimination, will work diligently to establish equity in all professional standards including, but not limited to, licensure, reciprocity, academic and medical staff appointment, jobs, promotions, and hospital privileges, and that it will afford IMGs the same opportunities as non-IMGs to become involved in the policy making processes at all levels of organized medicine. (HOD 1992-62; Reaffirmed HOD 2014)
200.998 CME Requirements for Membership:
SUNSET HOD 2013
MSSNY is unalterably opposed to the denial of membership in component county medical societies and the State Medical Society to any physician practicing or residing in the State of New York, because of race, color, religion, gender, or sexual orientation, ethnic affiliation, or national origin. . The Judicial Council of MSSNY, pursuant to Section 2 of Article VII of the Bylaws, shall hear appeals from applicants for membership in a component county medical society who have been excluded from membership in such society for any reason, including discrimination. (Council 12/16/76; Modified and Reaffirmed HOD 2013)
205.989 Third Party Payment for Evaluation and Management of Developmental Disorders
The Medical Society of the State of New York will work with the New York Chapters of the American Academy of Pediatrics to:
1) advocate to ensure that health insurers comply with the law that requires them to provide coverage for autism screening and treatment including for pervasive developmental disorders not otherwise specified; and
2) advocate to ensure health insurers and Medicaid take the steps necessary to include a sufficient number of physicians and other appropriate providers in their networks to provide such necessary screening and treatment; and
3) work with the AMA and other medical societies to advocate for federal legislation to require self-insured plans to provide such coverage; and
4) work with similarly interested organizations to identify gaps in services and treatment for children believed to have autism or other developmental and/or learning disabilities that may not specifically meet the statutory definition of “autism spectrum disorder” and to advocate for identified solutions including but not limited to insurance coverage for these children. (HOD 2015-60; referred to Council; amended and adopted 11/5/2015)
205.990 Changes to Article 81 of New York’s Mental Hygiene Laws
In an attempt to rectify what has become a financially motivated practice of filing for guardianships employed by nursing homes having incapacitated residents who have incurred huge outstanding medical bills, the Medical Society of the State of New York will seek immediate changes to Article 81 of the New York Mental Hygiene Law which would allow courts to grant full guardianship to nursing homes for incapacitated residents only when the health and well-being of a patient is in jeopardy and no family member is capable of making such a decision; not when motivated strictly by nursing home financial concerns. (HOD 2015-110)
205.991 Office of People with Developmental Disabilities
MSSNY will seek legislation or regulation that has the website for the Office of People with Developmental Disabilities clearly delineate all steps involved in their process, including:
- Requirements for eligibility
- A list of sites individuals may contact to obtain evaluations
- Program benefits
- Establishment of a hotline and online chat services to answer questions for interested parents and providers. (HOD 2015-206)
205.992 Health Services Upon Release for Prisoners with Mental Illnesses:
MSSNY will advocate to ensure that the New York State Division of Parole afford prisoners with serious mental illnesses effective discharge planning services to ensure that continuity of care will be provided. (HOD 2007-111; Reaffirmed HOD 2017)
205.993 Increased Funding for School and Pre-School Services for MRDD Children:
MSSNY will support increased New York State funding for services for pre-school and school-aged mentally retarded/developmentally disabled children in the educational setting. (HOD 2005-159; Modified and reaffirmed HOD 2015)
205.994 Developmental Disability and Autism Spectrum Disorder:
MSSNY will support increasing the funds available for research and treatment for developmental disabilities and autism spectrum disorder. (HOD 04-164; Reaffirmed HOD 2006-163; Amended HOD 2016 with title change)
205.995 Increased Funding for Physician Training and Reimbursement for the
Health Care of Mentally Retarded/Developmentally Disabled (MRDD)
SUNSET HOD 2015
205.996 Integrated Services for Public Mental Health Care:
SUNSET HOD 2014
205.997 Outpatient Certification:
SUNSET HOD 2014
205.998 The Need for Adequate Community Facilities Prior to Discharge of Mentally Ill from
SUNSET HOD 2014
207.967 Recommendations of the MSSNY Task Force on Physician Stress and Burnout
The Task Force recommended approval of a Memorandum of Understanding with the Federation of State Medical Boards for data analysis of burnout survey results. It was further recommended and approved that, under the guidance of the MSSNY Communications Division, that the burnout survey results be used in outreach to physicians and other target audiences. (Adopted Council, 6/22/17)
207.968 Development of Physician Burnout Programs
MSSNY will inform its members of the Council action supporting development of a program to assist physicians experiencing symptoms of stress or burnout due to administrative overload. The program would not constitute the practice of medicine and would preserve confidentiality for the physician.
The Medical Society of the State of New York (MSSNY) will request that the American Medical Association (AMA) produce a report summarizing current research and efforts to address physician practice sustainability and satisfaction.
The MSSNY Task Force on Physician Burnout and Stress will continue to meet and expand its work to include the development of information about the administrative and regulatory burdens placed on physicians with recommendations to reduce these burdens that may also then reduce physician burnout, depression and suicide, and report back to the Council or the House of Delegates. (HOD 2017-201, 202, 203)
207.969 MSSNY Physician Stress and Burnout Task Force
Develop CME programs on physician stress and burnout, as well as the peer support model, recruiting a cadre of doctors to do such CME presentations;
Seek grants or other funding to support CME, study of burnout, and program activities in an enduring way;
Continue collaboration with other organizations on burnout reduction and wellness efforts;
Develop a peer support model to all county societies, hospitals/hospital systems, and practices through grants or other funding (Adopted, Council 1/19/17)
Distribute to MSSNY membership burnout survey data coupled with a preliminary plan for interventions; beginning with distribution of survey results at the 2017 House of Delegates and CME presentations during the weekend;
Develop a program to assist doctors when they need to reach out for help to sustain their wellness before it progresses to mental health or substance use disorder, charging the MSSNY legal team and staff to devise a solution which meets the needs of our members and maintains the legal and financial integrity of the MSSNY organization. (Adopted, Council 3/7/17)
207.970 “Tabling” a Resolution Prior to Discussion
The Medical Society of the State of New York (MSSNY) will disallow the parliamentary mechanism of “tabling” a resolution prior to it being considered by a reference committee in its own House of Delegates. This will be forwarded to the AMA HOD in order to eliminate the use of the parliamentary tactic of “tabling” a resolution prior to debate in the AMA HOD or its assigned reference committee. (HOD 2016-217)
207.971 Partnering with Independent Practice Associations
The Medical Society of the State of New York (MSSNY) will explore partnering with independent practice associations (IPAs) to offer discounted IPA membership fees for MSSNY members, possibly in return for reduced medical society dues. (HOD 2016-205)
207.972 MSSNY Organized Medical Staff Section
The Medical Society of the State of New York (MSSNY) will request that all medical staffs with institutional membership agreements with MSSNY appoint a representative to the MSSNY Organized Medical Staff Section and that each MSSNY Organized Medical Staff Section representative be tasked with surveying his or her own individual medical staff and hospital administration to obtain the top educational priorities for his or her particular medical staff. When developing its education programs, the Medical Society of the State of New York (MSSNY), will factor in the educational priorities of medical staffs with institutional membership agreements. (HOD 2016-203)
207.973 Utilizing Social Media to Support Advocacy for Our Patients
The Medical Society of the State of New York will post links to action alerts of particular importance on its Twitter and Facebook pages. (HOD 2016-202)
207.974 Guidelines for Collaboration with Non-MSSNY Physician Groups
The MSSNY President may decide if a non-MSSNY physician group (such as the Out-of-Network Preservation Work Group) warrants creation of its own special committee within MSSNY. For each special committee created, the President shall:
- appoint the chair person and members of such a committee as the Bylaws currently authorize him/her to do for all committees of the Council, thereby determining the size of the Committee, subject to the approval of the Council;
- assure that all members of such a committee are membes of MSSNY; and
- assure that all special committees report to the Council and be subject to the Council unless otherwise instructed by the House of Delegates.
Each President-Elect of the Medical Society of the State of New York shall continue to analyze on an annual basis MSSNY’s committee structure with an intention to eliminate any committee not felt to be contributing directly to MSSNY’s mission and combining committees wherever possible to reduce duplication, confusion and cost.
MSSNY may sign on to letters with non-MSSNY groups when consistent with existing MSSNY policy and at the discretion of the President. In the absence of existing MSSNY policy, letters should be vetted by the President, who may exercise his or her prerogative to act on behalf of MSSNY, convene the Executive Committee of the Council for decision, or address the issue at the next Council meeting as time permits. Where there is a contentious issue or items should be reviewed, items should be brought to the Executive Committee or Council. (Adopted Council, 3/7/16)
207.975 Medical Society Dues as Part of Biennial Registration
The Medical Society of the State of New York will investigate logistics of including MSSNY and County Medical Society opt-out dues in the New York State Department of Education biennial registration billing and payment. (HOD 2015-113; referred to, amended and adopted Council 11/5/2015)
207.976 Informed Choices for MSSNY Elections
MSSNY will provide all voting members of the House of Delegates with the following information about candidates nominated for election to the Board of Trustees, the Council, Officers, and the AMA Delegation: Medical School, Residency/Fellowship, Specialty, Hospital Affiliations, Practice Setting, and Prior Experience in Organized Medicine.
MSSNY will provide candidates nominated for election to the Board of Trustees, the Council, Officers and the AMA Delegation the opportunity to provide a written statement for distribution to all voting delegates. (HOD 2015-209)
207.977 Conflict of Interest
MSSNY has adopted policy which strives to ensure that Councilors, Officers, Trustees, Committee Members or key employees will not act to further their personal benefit or in a way which is contrary to the interests of the organization. The Conflict of Interest Annual Disclosure Form will be submitted prior to election, by each officer, councilor, director, trustee, member, owner or employee on an annual basis. (Reaffirmed Council 5/22/2014)
207.978 Meeting Management Education for Physician Leaders
The Medical Society of the State of New York will continue to seek funding to provide meeting management education for leaders at all levels, including committee chairs and officers and all MSSNY leaders, appointed or elected, should be encouraged to participate in meeting management training. (HOD 2014-200)
207.979 MSSNY Committee Structure
The President-Elect of the Medical Society of the State of New York shall continue to analyze on an annual basis its committee structure with an intention to eliminate any committee not felt to be contributing directly to MSSNY’s mission and combining committees wherever possible to reduce duplication, confusion and cost. (HOD 2014-201)
207.980 Increasing Medical Student and Physician Interactions
MSSNY will encourage all county medical societies with medical student and resident physician members to include representatives of those membership segments within their leadership bodies and create outreach or mentorship programs for medical students by working with their medical student members. (HOD 2014-202)
207.981 Support of the MSSNY/ Dr. Duane and Joyce Cady Honor Fund
A flier explaining the MSSNY/Dr. Duane and Joyce Cady Honor Fund and its mission will be enclosed with the MSSNY dues bill, the fund will be explained in other MSSNY communications to the membership and a list of donors to the Fund will be published with feature articles on the scholarship recipients. (HOD 2014-203)
207.982 Nomination Process
The nomination process for Officers, Councilors and Delegates to the AMA will be posted on the MSSNY website and MSSNY will seek new ways of disseminating information on the nomination process to the membership. (HOD 2014-204)
207.983.1 Referred Resolutions
When a resolution is referred by the MSSNY House of Delegates to Council and subsequently referred to a MSSNY Committee, the author of the original resolution or a representative of the author or introducer may be invited to speak at the appropriate Committee meeting to ensure that the essence or reasoning of the resolution is fully understood by the members of the Committee. (Adopted Council September 12, 2013)
207.983: Develop and Market a Secure Message System for Healthcare
MSSNY will continue to work with health information exchanges, legal, medical hardware and software experts, and existing vendors of products that provide HIPAA compatible communication; and will pursue options to partner with such an existing company or companies in a manner that would be mutually beneficial to both MSSNY and our members. (HOD 2013-209)
207.984 Encouraging MSSNY to Produce Compliance Packages and
Make Them Available to Members at Reduced Cost
MSSNY will request from our General Counsel a compliance guideline website in electronic form that will be available to members for self-customization for each practice, both to enhance membership and to help protect our members from civil monetary penalties. (HOD 2013-263)
207.985: Increase MSSNYPAC “Opt-Out” Contribution for the 2013-14 Dues Billing Cycle
Starting with the 2013-14 billing cycle, all MSSNY active, regular dues paying members’ dues invoices will contain a voluntary $175 Political Action Committee contribution, with the amount for student and resident members to be determined by their respective constituency sections. This will appear on the dues bill as a line item with the opt-out contribution. (HOD 2013-203 and 219)
207.986: Positioning MSSNY for the Future: Streamlining and Cost Saving
MSSNY will establish a Committee on Long Range Planning and Development to develop recommendations to the MSSNY House of Delegates, Council, Board of Trustees and staff to best position MSSNY in an ever-changing environment. (HOD 2013-202 and 2013-217)
207.987: MSSNY Policy
MSSNY white papers will be presented to the House of Delegates for the body of the report to be either accepted or rejected as informational only. (HOD 2013-201)
207.988 Task Force for Patient Transitions
The Medical Society of the State of New York will create a multi-specialty task force to develop protocols for patient transitions between health care facilities and other sites. (Council 11/29/2012)
207.989 Following Up MSSNY House of Delegates Actions
The Medical Society of the State of New York will routinely and at least annually, prior to the HOD meeting, provide progress reports on all resolutions passed at the House of Delegates in the past year, including those referred to Council, showing what has been done and is planned for implementation of each resolution. (HOD 2012-202)
207.990 Dedicated Medical Liability Reform Web Site
The Medical Society of the State of New York will examine the medical liability reform component of the advocacy section of its website and ensure that it contains these components: position statements, talking points, research and data highlighting the need for reform, media clips, legislator votes and comments, and all other pertinent materials that will educate and equip our member to advocate effectively on this critically important issue. (HOD 2011-219)
207.991 Election of Officers for MSSNY
The Medical Society of the State of New York will make available to delegates the qualifications of those who are being nominated as officers and their vision for MSSNY. (HOD 2011-218)
207.992 Short Term Loan Program at Completion of Residency
MSSNY will explore a loan referral program for MSSNY members to assist resident physicians who are in their final year of training and who will stay to practice in New York in order to bridge the ongoing living and professional expenses which occur during the period between residency completion and the time when the physician has settled into a permanent position. (HOD 2011-217)
207.993 Examining Efficiency and Value to the Member
The MSSNY will utilize current vehicles to examine its procedures and structure to candidly assess and analyze how it is serving individual dues paying members in terms of exactly what benefits and services members receive in return for their dues. County medical societies are urged to display the same kind of transparency in concert with or independent of MSSNY. (HOD 2011-213)
207.994 YPS Chair in Each County or District Branch
Each county medical society with 150 or more dues paying members is urged to create the position of County Young Physician Section Chair and make every good faith effort to find such a physician to fill the position by 2012. Those counties with less than 150 members are urged to band together within their district branch to create a district branch YPS Chair position with every good faith effort being made to fill the position by 2012. (HOD 2011-212)
207.995 Professionalism in Terminology
The leadership and staff of the Medical Society of the State of New York shall not in written or spoken work, use the term “provider” in referring to physicians nor the term “reimbursement” when referring to payments to physicians. (HOD 2011-210)
207.996 MSSNY Peer-Reviewed Medical Journal
The Medical Society of the State of New York, for a period of time deemed appropriate by MSSNY’s Member Benefits Committee, enter into a business relationship with an entity which will provide daily electronic medical briefings for MSSNY member physicians. (HOD 2011-207; amended and adopted Council 1/12/2012)
207.997 MSSNY Dues
Starting with the 2012 cycle, the dues invoices for all MSSNY members will contain a $50 Political Action Committee contribution with an opt-out option, with the amount for student and resident members to be determined by their respective constituency sections. In order to maximize retention of MSSNY members, this provision shall not apply to delinquent members whose dues statements should reflect the minimum amount required for membership renewal. (HOD 2011-206; Amended Council 3/19/2012)
207.998 MSSNY’s Defined Benefit Pension Plan Funding
The MSSNY Board of Trustees, after performing the necessary due diligence which is to include independent actuarial and legal analysis and guidance, shall have the authority to decide whether the MSSNY shall borrow money from its Building Fund to fully fund its Defined Benefit Pension Plan. As part of the borrowing plan, the Board also shall include a plan for repaying the Building Fund, taking into consideration all of MSSNY’s other ongoing obligations and this plan shall only be approved by a supermajority of the Board of Trustees, defined as 5 of its 7 members. The Board’s plan shall be reviewed and approved by a supermajority of the Council, defined as 2/3 of its membership. The results of the study, including all options and the effect of each option on the fiscal solvency of MSSNY shall be presented to the House of Delegates at the 2012 meeting or in a special session if necessary for deliberation and decision. (HOD 2011-202)
A review and, as appropriate, sunset mechanism with a 10-year time horizon shall exist for all policy positions established by the HOD. Under this mechanism, a policy will cease to be viable after 10 years after HOD adoption unless the HOD affirmatively acts to reestablish it. Any HOD action that reaffirms an existing policy position shall reset the 10-year “sunset clock,” making the reaffirmed policy viable for 10 years from the date of reaffirmation. Further, any HOD action that modifies an existing policy shall similarly reset the 10-year “sunset clock,” making the modified policy viable for 10 years from the date of its adoption.
In the implementation and ongoing operation of this review and sunset mechanism, these procedures shall be followed:
- Each year, the Speakers, through the Office of the Executive Vice President, shall provide a list of policies that will be reviewed;
- The President shall assign each policy to the appropriate committee or subcommittee for review;
- Each committee or subcommittee shall submit a report to the HOD with recommendations on how each policy assigned to it should be handled;
- For each policy, the committee/subcommittee shall make one of these recommendations: 1) Retain the policy; 2) Allow the policy to sunset; or 3) Modify the policy;
- With each recommendation, the committee/subcommittee shall also provide a succinct justification for its recommendation, including specific proposed amendments to a policy that the committee/subcommittee is recommending be modified;
- Each policy for which modification or sunset is recommended shall be referred to the Office of Legislative Affairs (OLA) for further review regarding the impact of modification or repeal on MSSNY’s current legislative policy. If the committee/subcommittee’s recommendation differs from OLA, both recommendations and accompanying support shall be forwarded on the appropriate HOD reference committee;
- The Speakers, through the Office of the Executive Vice President, shall organize each committee/subcommittee report and assign each policy under review to the appropriate HOD reference committee. Such policies under review will become part of the Committee’s agenda for the current year’s HOD meeting and part of the Committee’s report to the full HOD;
- This policy shall take effect upon Council’s approval and shall be operative in the HOD meeting next following approval. All policies established or reaffirmed in 2001without having been modified, reaffirmed or revoked since 2001 shall first be addressed, with the backlog of review of pre-2001 policies completed no later than December 31, 2014. (Adopted Council 9/16/10)
210.994 Length of Time for Storing Medical Malpractice Data:
MSSNY will bring a resolution to the American Medical Association’s 2009 Annual House of Delegates meeting asking that the AMA work with the National Practitioner Databank so that there is a time frame for storing all entries regarding physicians. (HOD 2009-113)
210.995 Maintaining Restricted Access to the National Practitioner Data Bank:
MSSNY opposes all efforts to open the National Practitioner Data Bank to public access. (HOD 2000-70; Reaffirmed HOD 2001-87; Reaffirmed HOD 2011)
210.996 Opposition to Inclusion in the National Practitioners Data Bank:
MSSNY supports the mandatory and prompt notification of residents by the appropriate hospital authority when they are named along with a hospital and/or others in the hospital in malpractice suits.
MSSNY opposes the inclusion in the National Practitioner Data Book of information on liability payments made on behalf of residents named in malpractice suits for incidents which occur during the required activities of their residency training.
MSSNY should seek the immediate suspension of the policy whereby information on residents named in malpractice suits for incidents which occur during the required activities of their residency training is documented in the National Practitioner Data Bank when liability payments are made on their behalf. (Council 2/4/99; Reaffirmed HOD 2014)
210.997 Opposition to Expansion of the Medical Malpractice Cases Reported
to the National Practitioner Data Bank:
MSSNY will vigorously oppose adoption and implementation of the proposed National Practitioner Data Bank guidelines which would allow a hospital to affix blame among involved physicians and subsequently report the name of such physician to the National Practitioner Data Bank. (HOD 1999-97; Reaffirmed HOD 2001-87; Reaffirmed HOD 2011)
210.998 Expunging Disciplinary Actions and Other Adverse Data from the
National Practitioner Data Bank and State Databases:
MSSNY will support legislation requiring the National Practitioner Data Bank and state databases to expunge data relating to a physician five (5) years after the completion of any disciplinary penalty and five (5) years after any payment relating to a malpractice claim. (HOD 1999-96; Reaffirmed HOD 2014)
210.999 Liability Settlement Reporting:
MSSNY is working with appropriate agencies to establish a policy that medical liability settlements of less than $35,000 not be reportable to the National Practitioner Data Bank. (HOD 1991-10; Reaffirmed; HOD 2001-87; Reaffirmed HOD 2011)
215.000 NUCLEAR WAR, WEAPONS AND TERRORISM: (See also Public Health & Safety, 260.000; Volunteer Services of Physicians, 317.000)
215.996 “Safe Haven” for Illegal Gun Surrender:
MSSNY will actively promote through newsletters and the MSSNY web site awareness of “safe havens” for weapons at local police departments whereby illegal firearms and all ammunition can be surrendered without question and without fear of arrest and prosecution. (HOD 2011-117)
215.997 Better Hospital Cooperation During Disasters:
SUNSET HOD 2013
215.998 Arms Reduction:
MSSNY supports the process of bilateral and verifiable nuclear arms reduction. (HOD 1986-38; Modified and Reaffirmed HOD 2013)
215.999 Nuclear War and Weapons, MSSNYs Position on:
It is the position of MSSNY that no adequate medical response to nuclear war is possible, and the ultimate decision regarding a response to the implications of nuclear weapons and nuclear war is up to each individual physician’s conscience. (Council 5/19/83; Reaffirmed HOD 2013)
217.995 Nursing Home Inspections Should Include Physicians
The Department of Health of the State of New York (NYSDOH) should be required to assign at least one physician as a member of every health department nursing home inspection team and physicians involved in Nursing Home inspections should be involved in any appeals. NYSDOH physicians should be made available to review and answer questions and appeals from physicians who are working with patients in the home being reviewed. (HOD 2017-100)
217.996 Patient Rights in Skilled Nursing Facilities
The Medical Society of the State of New York will advocate to the Department of Health and the Legislature for patient rights in nursing facilities.
The Medical Society of the State of New York will encourage physicians to have informed consent discussions with patients in skilled facilities with regard to their dietary restrictions and medication protocols and when such patients express a judgment not to follow those protocols that they not be ordered for such patients.
The Medical Society of the State of New York will advocate for an inspection system of the inspectors to be sure there is consistency in the inspection process.
The Medical Society of the State of New York will solicit from its members, skilled nursing facilities and Article 28 facilities, examples of arbitrary and capricious enforcement of Health Department Code. (HOD 2012-211)
217.997 Quality of Care – Nursing Homes:
MSSNY will support the mandatory reporting of falls with serious injuries in all nursing homes in New York State to the New York State Department of Health in order to establish a data base to indicate where it is necessary to improve quality of care and reduce falls and injuries and to seek legislation or regulation in New York State to implement this policy that includes a provision that the data remain confidential and not subject to disclosure. (HOD 2007-260; Reaffirmed HOD 2017)
217.998 Quality of Care in Nursing Homes – Nursing Staffing Level:
MSSNY supports the CMS nurse staffing requirements as outlined in the Federal Register of October 28, 2005 and transmit this recommendation to the New York State Department of Health (NYS/DOH), the New York State Legislature and the American Medical Association and that MSSNY work with the NYS/DOH, and other long term care payers, to correct the payment methodology for nursing home care. (HOD 2006-252; Reaffirmed HOD 2016)
217.999 Quality of Care – Nursing Home Mandatory Reporting Serious Injuries:
MSSNY supports mandatory reporting of serious injuries in nursing homes as is required in New York State hospitals, and transmit this recommendation to the New York State Department of Health for implementation. (HOD 2006-251; Reaffirmed HOD 2016)
220.999 Deliveries Out of Hospital:
Labor and delivery while a physiologic process, clearly presents potential hazards to both mother and fetus before and after birth. These hazards require standards of safety which are provided in the hospital setting and cannot be matched in the home situation. We recognize, however, the legitimacy of the concern of many that the events surrounding birth be an emotionally satisfying experience for the family. We support those actions that improve the experience of the family while continuing to provide the mother and her infant with accepted standards of safety available only in hospitals which conform to standards as outlined by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. (Council 10/25/79; Reaffirmed HOD 2013)
225.000 PEER REVIEW:
225.988 Peer Review Protection:
MSSNY will advocate for a change in New York Education and Public Health Laws to allow the peer review process to accomplish its goals of enhancing patient safety and quality of care by protecting from discoverability the statements made by a reviewed physician during the peer review process. Such legislation is to be pursued distinctly and separately from its effort to effect global reform of the medical tort system.
Also, MSSNY will notify its members of the current discoverability of peer review activity. (HOD 2008-70; Reaffirmed HOD in lieu of 2017-101)
225.989 Pending Legislation to Make Office Procedure Complications
Sunset HOD 2011
225.990 MSSNY To Take Lead Re Quality Performance Improvement
Activities in Physicians’ Offices:
MSSNY will continue to participate in the development of quality performance improvement activities in physicians’ offices. (HOD 1999-173; Reaffirmed HOD 2014)
225.991 IPRO Citations, Mandatory Purging of After Specified Time Period:
MSSNY will request the Centers for Medicare and Medicaid Services (CMS) to establish policy which would provide that Peer Review Organization (PRO) citations for matters that are not currently defined as quality issues, or those issues which are considered remote, be expunged. (HOD 1996-128; Updated and Reaffirmed HOD 2014)
225.992 Confidentiality of Documents Submitted to Peer Review Committee:
MSSNY has adopted as policy that any materials or comments generated by a physician in response to a review by a Peer Review/Quality Committee of a hospital and/or a health care entity or organization should be confidential as regards discovery in a malpractice action.
MSSNY has pledged to work with other interested parties, the Department of Health, and the appropriate legislators to develop legislation and/or regulations that would ensure such confidentiality. (HOD 1994-59; Reaffirmed HOD 2014)
225.993 Fourth Scope of Work – PRO:
SUNSET HOD 2014
225.994 IPRO Reviewers:
MSSNY is taking all necessary and immediate steps to:
(1) Assure that IPRO disclose the names, qualifications and performance of its reviewers; (2) Assure that physicians in New York State be given information on the specific guidelines IPRO utilizes to assess the qualifications and performance of its reviewers;
(3) Require IPRO to utilize a board certified practicing physician of the same specialty from a like practice setting when PRO reconsideration determinations are conducted;
(4) Require IPRO to utilize the practice parameters as provided by the AMA and developed by its recognized specialty societies. (HOD 1991-62; Reaffirmed HOD 2014)
225.995 Physician Specific Data, Release to the New York State Department
of Health – PRO:
SUNSET HOD 2014
225.996 Review in Private Offices – PRO:
SUNSET HOD 2014
225.997 Physicians as Reviewers:
The MSSNY, in total cognizance of the rights and privileges of licensed practicing physicians, seeks legislation to require that all peer review activities, conducted under the auspices of the PRO, the New York State Department of Health, Office of Professional Medical Conduct, and/or any other authority commissioned to perform physician peer review, be performed by physicians currently engaged in that specialty or not more than five years removed from the practice of the same specialty. In addition, the physician conducting peer review should submit evidence of board certification by a specialty or subspecialty as recognized by the American Board of Medical Specialties.
MSSNY is seeking legislation that would include the performance of peer review within the definition of the practice of medicine. (HOD 1990-39; Reaffirmed; HOD 1991-62; Reaffirmed HOD 1996-52; Reaffirmed HOD 2014)
225.998 Review Under Medicare Law:
MSSNY, in an effort to ensure that the quality of peer review matches the delivery of quality medical care expected from its members, is seeking to achieve the following through the Board of Directors of the Empire State Medical, Scientific and Educational Foundation, Inc.: (1) Utilization of physicians only, with appropriate expertise, in all cases assigned for review; (2) Establishment of an acceptable due process protocol through interface with the Health Care Financing Administration – for physicians perceived to have provided substandard medical care, ensuring that: local physicians are afforded due process during sanction and denial appeals within the time constraints mandated by federal regulation; no quality of care letters of denial are sent to beneficiaries until due process has been completed.
MSSNY reaffirmed its support of the American Medical Association (AMA) House of Delegates’ action on this matter which led to a significant agreement providing major improvements in the PRO sanction process. The agreement was jointly announced on May 12, 1987 by the AMA, the Health Care Financing Administration, the American Association of Retired Persons and the Office of the Inspector General. (HOD 1987-30 & 1987-36; Reaffirmed HOD 2013)
225.999 Physician Controlled Peer Review:
MSSNY, along with the AMA, endorses peer review that is physician controlled and is applicable to all patients and not just specific groups as currently exists. Continual development and promotion of new procedures for physician assessment of the quality and efficiency of medical care must be sought. This development and assessment can best be accomplished by organized physician groups at the local level regardless of funding source. The local review approval by local physician- sponsored organizations must be coordinated on a statewide level, always keeping in mind that physician-controlled peer review through locally sponsored physician organizations is the basis for effective peer review.
It is, therefore, the position of the Medical Society of the State of New York that the State Society should coordinate and assist in implementing mechanisms for peer review for all patients and that such coordination will ensure the review being done by physicians at the local level. (HOD 1981; Reaffirmed Council 3/9/95; Reaffirmed HOD 2014)
227.996 Attorney Ads on Drug Side Effects
For attorney commercials that may cause patients to discontinue medically necessary medications, MSSNY, by legislation and/or regulation, will seek to require appropriate warnings that patients should not discontinue medications without seeking the advice of their physician. MSSNY will introduce a similar resolution to the AMA. (HOD 2016-211)
227.997 Pharmaceutical Advertising:
MSSNY will urge the U. S. Food and Drug Administration require prior approval for all direct-to-consumer advertisements and that such advertisements include disease-specific information rather than product-specific information. (HOD 2005-161; Reaffirmed HOD 2010-98)
227.998 Regulation of Media Advertising of Prescription Drugs
SUNSET HOD 2014
227.999 Cost of Drug Disclosure During Direct Advertising:
MSSNY has adopted the position that pharmaceutical companies include in the consumer advertisement of any pharmaceutical the suggested retail price of such pharmaceutical. (HOD 2001-51; Reaffirmed HOD 2003-252; Reaffirmed HOD 2013)
230.000 PHYSICIAN DISCIPLINE:
230.998 Confidentiality as a Key Element of the Physician Disciplinary
Process in New York State:
SUNSET HOD 2014
230.999 Maximizing Involvement of Physicians and Physician Organizations
in Review Process:
MSSNY is continuing to evaluate the physician discipline process as revised by Chapter 606 of the laws of 1991, and, if determined to be necessary, to make recommendations on additional legislative refinements that will further the principles of maximizing the involvement of licensed physicians and recognized physician organizations in the process pursuant to which professional conduct of physicians is reviewed, so as to expedite and simplify this process, thus making it more fair to the accused physician and to the public. (HOD 1991-9; Reaffirmed HOD 2014)
235.000 PHYSICIAN CREDENTIALING/RECREDENTIALING:
235.985 Maintenance of Certification/Licensure (MOC/MOL)
The Medical Society of the State of New York (MSSNY) will ask the American Medical Association (AMA) to reaffirm the AMA’s policy regarding Maintenance of Certification and Maintenance of Licensure programs. (HOD 2016-215)
235.986 Maintenance of Certification as Restraint of Trade
The Medical Society of the State of New York will seek legislation to prohibit board certification requirements for hospital medical staff privileges, insurer contracts and state licensure. (HOD 2016-214)
235.987 Maintenance of Certification
The Medical Society of the State of New York will advocate for a moratorium on the Maintenance of Certification and Maintenance of Licensure requirements of all medical and surgical specialties until it has been reliably shown that these programs significantly improve patient care.
The New York delegation to the AMA is to advocate for a moratorium on the Maintenance of Certification requirements of all medical and surgical specialties until it has been reliably shown that these programs significantly improve patient care; and the delegation will join efforts to make specialty board recertification requirements practical, affordable and effective, such as an open book exam or demonstrated CME or meeting equivalent QI requirements. (HOD 2015-211)
235.988 Alternative Maintenance of Certificate
The Medical Society of the State of New York will introduce a resolution at the next American Medical Association meeting asking the AMA to explore the feasibility of developing an alternative Maintenance of Certification (MOC) program as a member benefit. (HOD 2014-66)
235.989 Restricting Prescriptions to Medicare Beneficiaries
The Medical Society of the State of New York will advocate, and seek legislation if necessary, to ensure that health insurers and hospitals do not limit network participation, staff privileges, employment, or payments solely as a result of not having specialty board certification and any measure that would require specialty board certification as a condition of licensure will be opposed. (HOD 2014-54)
235.990 American Board of Medical Specialties (ABMS) Should Adhere to its Mission
The Medical Society of New York will oppose the establishment of scope of practice limitations through the use of board certifications by the American Board of Medical Specialties and its member organizations and will forward this resolution to the next American Medical Association Annual meeting. (HOD 2014-55)
235.991 Less Costly Alternatives to “Maintenance of Specialty Board Certification”
The Medical Society of the State of New York will encourage the American Medical Association to actively work to enforce existing policies with regard to reducing exorbitant costs and effort required for the maintenance of certification. (HOD 2012-163)
235.992 Eliminate Costly Monopoly for State Medical Licensure Credentialing
by For-Profit Entity in New York and Enable Use of Alterative
The MSSNY will work with the New York state licensing board so that the costly for-profit FCVS service no longer has an exclusive monopoly on credentialing physicians and charging physicians hundreds of dollars to be licensed in New York; that the complimentary AMA Physician Credentialing service which is recognized and used for state licensure credentialing verification in over 40 other states is also offered as an alternative to state licensure credentialing verification ion New York; and ensure the complimentary primary verification obtained directly from medical schools and post-graduate residency training programs, which is used throughout the country and which previously has been used in New York to credential physicians for licensure, is another alternative accepted to credential physicians for state licensure in New York. (HOD 2012-116)
235.993 Advertising for the Physician’s Performance of Specific Ancillary
MSSNY will seek legislation/regulation which would require that any advertisement for the performance of specific ancillary services/procedures, which may be unrelated to a physician’s true board certification (i.e., laser hair removal) clearly identify the physician’s actual ABMS board designation (or another country’s equivalent), so as not to mislead patients regarding the physician’s actual credentials. (HOD 2010-96)
235.994 Repeal of the Fifth Pathway:
MSSNY will support repeal of NY State Education Law Article 131, Section 6528 (The Fifth Pathway) effective December 31, 2009and support legislation allowing physicians who received the Fifth Pathway credential before December 31, 2009 to continue to be eligible for licensure and to practice medicine in New York State. (HOD 2009-152)
235.995 Hospital Mergers Resulting in Physician Exclusions:
MSSNY will work with appropriate agencies to ensure that where one or more hospitals are merged, a physician credentialed to perform services at any one of the merging hospitals shall be entitled to receive equivalent credentials at any of the other merging hospitals, provided that such physician meets the qualifications for credentialing at such other hospital. (HOD 1999-77; Reaffirmed HOD 2014)
235.996 Granting of Provisional Credentialing Status to New York Physicians by MCOs:
SUNSET HOD 2014
235.997 Physician Credentialing:
MSSNY adopts as policy the position that the NCQA is not the appropriate organization to determine criteria for physician credentialing and will ask the AMA to adopt a similar policy and seek to develop its own national physician credentialing criteria through AMAP. (HOD 1997-87; Reaffirmed HOD 2014; Reaffirmed HOD in lieu of 2017-111)
235.998 Physician Recredentialing:
SUNSET HOD 2014
235.999 MSSNY’s Non-Support of NYS Advisory Committee on Physician
The Report of the New York State Advisory Committee on Physician Recredentialing entitled “Phase One: General Principles, Proposed Process, Recommendations” was released in January of 1988. MSSNY does not endorse this report or its recommendations. Historically, quality assurance (optimal patient care) and physician competency have been the foundations upon which the policies and positions of the MSSNY have been developed. Over the past decade, the assurance of quality and maintaining of competence, a responsibility, which rightly belongs within the purview of the profession (all professions), has been gradually assumed to a large extent by agencies external to the profession. Perhaps well intentioned, the regulatory mechanisms developed by these external agencies have had a deleterious effect on the delivery of medical care but have had little impact on physician clinical performance.
MSSNY agrees with the statement, made on several occasions in the report, that the re-credentialing process broadly outlined in the report “is not designed to measure medical competence.” Indeed the report does little more than discuss those well-known methods used to evaluate those various, individual components which taken collectively are used to define knowledge and cognitive skills, not performance. We agree with the report that there does not exist a single methodology for measuring competency and agree that employment of a combination of methodologies to measure competency would be logistically and economically unrealistic. The evaluation of competence in the health professions has not yet reached maturity. Measurement of changes in practice as a consequence of additional education, assessment of the validity of examinations and the determination of goals for competence are all necessary parts of the ongoing development of competence evaluation. As stated in the beginning of this statement, MSSNY is committed to quality assurance and maintaining competence of health professionals. However, we do not need further government intrusion to do what already is being done. Accordingly, the MSSNY subscribes to the following recommendations of the “Health Policy Agenda for the American People”:
(1) Health professionals are individually responsible for maintaining their competence and for participating in continuing education; all health professionals should be engaged in self-selected programs of continuing education. In the absence of other financial support, individual health professionals should be responsible for the cost of their own continuing education.
(2) Professional schools and health professions organizations should develop additional continuing education self-assessment programs, should prepare guides to continuing education programs to be taken by practitioners throughout their careers and should make efforts to ensure that acceptable programs of continuing education are available to practitioners.
(3) Health professions organizations and faculty of programs of health professions education should develop standards for competence. Such standards should be reviewed and revised periodically.
(4) When reliable and cost-effective means of assessing continuing competence are developed, they should be required for continued practice. This should be done without government interference or control. (HOD 1988-25; Reaffirmed HOD 2013)
240.000 PRACTICE MANAGEMENT (See Vaccines, 312.000)
240.981 Formation of A MSSNY Clearinghouse
MSSNY will engage regional physician groups, IPAs and ACOs which have already adopted New York State payment reform principles, have entered into value based payment contracts, and are accepting new physicians, so that MSSNY can disburse information to its members needing to develop a relationship with other physician practices in order to gain leverage in value based payment negotiations with health insurers, managed care plans and governmental payers. (HOD 2016-104)
240.982 Written Confirmation of Insurers’ Verbal (Oral) Information
The Medical Society of the State of New York will urge the Centers for Medicare and Medicaid Services (CMS) and the New York State Department of Financial Services to require all federal, state and private/managed care insurers in New York State to provide physicians with written documentation to support any information conveyed verbally (orally) by telephone representatives at the insurer’s Provider Call Center (Telephone Unit, Enrollment Area or Coding Policy Unit) and further require that written confirmation be done by email and/or “fax back” systems. (HOD 2015-257)
240.983: Allow Physicians to Receive “Dual Use” Supplies for In-Office Blood Collection
MSSNY will propose and support new legislation allowing physicians to receive a limited supply of dual use supplies proportionate with the number of specimens received by the lab each month, and will transmit a copy of this resolution to the American Medical Association (AMA) for consideration at its next House of Delegates. (HOD 2013-120)
240.984 AMA Priorities and Private Group Practice
The Medical Society of the State of New York (MSSNY), through its Delegation to the AMA, will bring a resolution to the AMA Annual Meeting in June 2012, urging that the AMA utilize its resources to protect and support the continued existence of solo and small group medical practice, and the ability of these practices to provide quality care. (HOD 2012-208)
240.985 Policies Needed to Reduce Physician Burdens from Work Excuses
The Medical Society of the State of New York will study the issue of physician responses to work excuse requirements by employers and submit appropriate policy recommendations to the MSSNY Council or to the next House of Delegates. (HOD 2012-213)
240.986 Use of Testimonials in Physician Advertising:
MSSNY will seek to have the NYS Education Law, Section 6530, subdivision 27 amended by removing “testimonials” as part of advertising or soliciting by physicians for patronage that is not in the public interest, provided that the same protections that apply for testimonials by non-physicians pursuant to 29.1(12)(iv) will apply to testimonials by physicians. (HOD 2011-105)
240.987 Truth in Advertising:
MSSNY will advocate for proactive enforcement of New York State regulation that gives patients the necessary information to make informed decisions about who is providing their health care and also seek enactment of legislation to require all health care professionals in all health care settings to-wear identification tags that state their professional designation in large block letters PHYSICIAN, NURSE, PHYSICIAN ASSISTANT, etc. (HOD 2011-104); reaffirmed by Council Nov 3, 2016 in lieu of resolution 2016-108)
240.988 Patients’ Responsibility for Their Own Care:
MSSNY will advance the position that patients need to assume personal responsibility for their ongoing medical care, which includes keeping agreed upon appointments and also disclosing to the physician whether previously agreed upon treatments are being followed. (HOD 2009-104)
240.989 New Legislation, Regulation or Rule Impacting the Practice
MSSNY will seek legislation that would require a 90-day public comment period to respond to any non-emergent legislation, regulation or rule proposed by the State of New York or its regulatory agencies that will impact the care of the citizens of New York or impact the practice of medicine within the state. MSSNY also will clearly define as soon as practically feasible the financial impact of legislation affecting physician practice and ensure that such financial information is widely distributed. (HOD 2008-109)
240.990 Reimbursement for Use of Interpreters:
MSSNY will urge the American Medical Association to seek legislation to eliminate the financial burdens of physicians, hospitals and health care providers for the cost of interpretative services for patients who are hearing impaired or do not speak English. (HOD 2008-108)
240.991 Translation Services:
SUNSET HOD 2014 SME
240.992 Patient Responsibilities:
MSSNY has adopted the following principles of patient responsibility:
(1) Good communication is essential to a successful physician-patient relationship. To the extent possible, patients have a responsibility to express their concerns clearly to their physicians and be honest.
(2) Patients have a responsibility to provide a complete medical history, to the extent possible, including information about past illnesses, medications, hospitalizations, family history of illness and other matters relating to present health.
(3) In addition to explaining known medical background to their physician, patients have a responsibility to request information or clarification about their health status or treatment when they do not fully understand what has been described.
(4) Once patients and physicians agree upon the goals of therapy, patients have a responsibility to cooperate with the treatment plan. Compliance with physician instructions is often essential to public and individual safety. Patients also have a responsibility to disclose whether previously agreed upon treatments are being followed and to indicate when they would like to reconsider the treatment plan.
(5) Patients generally have a responsibility to meet their financial obligations with regard to medical care or to discuss financial hardships with their physicians. Patients should be cognizant of the costs associated with using a limited resource like health care and should try to use medical resources judiciously.
(6) Patients should discuss end of life decisions with their physicians and make their wishes known. Such a discussion might also include writing an advance directive.
(7) Patients should be committed to health maintenance through health-enhancing behavior. Illness can often be prevented by a healthy lifestyle, and patients must take personal responsibility when they are able to avert the development of disease.
(8) Patients should also have an active interest in the effects of their conduct on others and refrain from behavior that unreasonably places the health of others at risk. Patients should inquire as to the means and likelihood of infectious disease transmission and act upon that information which can best prevent further transmission.
(9) Patients should discuss organ donation with their physicians and make applicable provisions. Patients who are part of an organ allocation system and await needed treatment or transplant should not try to go outside or manipulate the system. A fair system of allocation should be answered with public trust and an awareness of limited resources. (10) Patients should not initiate or participate in fraudulent health care, and should report illegal or unethical behavior to the appropriate law enforcement authorities, licensing boards, or medical societies. (AMA Policy H-140.953 CEJA Rep. A, A-93; MSSNYCouncil 11/2/00; Reaffirmed HOD 2014)
240.993 Patient’s Responsibility for Keeping Their Appointments:
It is MSSNY’s policy that it is the patient’s responsibility to keep their follow-up and other assigned appointments. (Council 11/2/00; Reaffirmed HOD 2014)
240.994 Reimbursement for Missed Appointment:
MSSNY, consistent with the current opinions of the AMA Council on Ethical and Judicial Affairs, Section 8.01, reaffirms the position that “A physician may charge a patient for a missed appointment or for one not canceled 24 hours in advance if the patient is fully advised that the physician will make such a charge. The practice, however, should be resorted to infrequently and always with the utmost consideration for the patient and his/her circumstances.” (HOD 1996-263; Reaffirmed HOD 2004-274; Reaffirmed HOD 2014)
240.995 COLA (Commission of Office Laboratory Accreditation):
SUNSET HOD 2014
240.996 Fee Differentials:
MSSNY affirms the principle of equitable reimbursement to rural area physicians by all health insurance carriers in order to encourage establishment of physician practices in these traditionally medically underserved areas of the State. MSSNY encourages the retention and recruitment of physicians in rural and other underserved areas of New York State by removing the disincentive of lower fee schedules for physicians practicing in such areas. (HOD 1991-41; Reaffirmed HOD 2014)
240.997 Advertising and Solicitation:
Member physicians may ethically engage in advertising or solicitation so long as the communication is not materially false or deceptive. For example, a physician shall not make materially false or deceptive statements or claims relating to either the results the physician can achieve or his or her skill or ability. Advertising or solicitation may be conducted through the news media, directories, announcements, professional cards, office signs, or any other medium or means. The use of intimidation or undue pressure in connection with uninvited, in-person solicitation of actual or potential patients, who because of their particular circumstances are vulnerable to undue influence, is unethical. (Council 4/19/84; Reaffirmed HOD 2013)
240.998 Certificate of Need:
The MSSNY has adopted the policy that no mandatory Certificate of Need be required relative to the purchase of any equipment in a private physician’s office setting. (HOD 1978; Reaffirmed Council 6/26/80; Reaffirmed HOD 2013)
240.999 Delinquent Accounts:
A physician who has experienced problems with delinquent accounts may properly choose to request that payment be made at the time of treatment for non-emergent or urgent services or add interest or other reasonable charges to delinquent accounts. The patient must be notified in advance of the interest or other finance or service charges by such means as the posting of a notice in the physician’s waiting room or appropriate notations on the billing statement. The physician must comply with state and federal laws and regulations applicable to the imposition of such charges, i.e., the Truth in Lending Law. (Principles of Professional Conduct, Chapter 11, Section 8) (Modified and reaffirmed HOD 2013)
245.000 PRACTICE PARAMETERS:
245.998 In Office Ancillary Procedures
MSSNY will seek necessary rules or regulations in order that appropriate ancillary procedures such as radiation, x-ray, including ultrasound, pathology, physical therapy and lab work can be provided by the treating physician and his or her team and paid by third parties at reasonably negotiated rates. (HOD 2015-261)
245.999 Practice Parameters, Evaluation and Implementation:
SUNSET HOD 2014
250.000 PROFESSIONAL MISCONDUCT: (See also Medicaid, 175.000)
250.992 Amendment to OPMC Reporting Requirement Associated with
Physician Profile Updates
Under New York State Law, failure of a physician to update his/her profile within six (6) months of license renewal, can be considered as professional misconduct and reportable to the OPMC for immediate action. The Medical Society of the State of New York will seek regulation/ legislation to allow a 60-day grace period for physicians to comply after receipt of a warning letter, and if a physician still does not comply after the 60 days grace period, then and only then should it be considered a reportable event. MSSNY, county and specialty societies will immediately begin to notify their members about the importance and urgency of updating their individual profiles in a timely and expeditious manner.
In an effort to ensure that physicians comply with the requirement of updating their profile, MSSNY will request there be notification with a direct link to www.nydoctorprofile.com which must be completed prior to submission of the registration renewal when a physician renews his/her license online and for those physicians who may still renew their registration via paper, a copy of their updated profile must be included and sent together with the registration renewal. (HOD 2014-102)
250.993: Physicians Serving on the OPMC Hearing Committee
MSSNY will seek legislation or regulation requiring that at least one of the two physicians serving on the hearing committee of the OPMC charged with the responsibility of listening to and reviewing written and oral testimony alleging possible physician misconduct, be in active practice and of the same or similar specialty of the physician being charged, thereby assuring that the physician in question is being truly evaluated and judged by his peers and that the facts, as presented, are reviewed based upon appropriate sound medical decisions. (HOD 2013-119)
250.994 OPMC Administrative Review Board:
MSSNY will take steps to educate physicians regarding the Office of Professional Medical Conduct Administrative Review Board’s authority to strengthen the severity of the hearing committee determination or sanction. (HOD 2009-112)
250.995 OPMC and Medicaid:
MSSNY should encourage the Office of Medicaid Services to discontinue its policy of excluding physicians from its panel solely because they are on probation with the Office of Professional Medical Conduct. (HOD 2007-93; Reaffirmed HOD 2017)
250.996 Changes to OPMC Procedures:
If the complainant is an insurer, an employee or agent of any insurer, or an attorney, MSSNY should advocate for legislation that will require the disclosure of the name of the person or entity that has filed a complaint against a physician with the Office of Professional Medical Conduct. (HOD 2007-92; Reaffirmed HOD 2017)
250.997 Changes to OPMC Procedures:
(SUNSET HOD 2017)
250.998 Due Process for Physicians Accused by Hospitals of Professional Misconduct:
Any committee of a hospital that is duly constituted by the hospital to review matters involving professional misconduct should provide a physician who is accused of misconduct with notice of the charges, an opportunity to be heard, and any other safeguards that may be provided by the Bylaws. The committee is required to report to the Board of Professional Medical Conduct only if it has information which reasonably shows that the physician is guilty of professional misconduct as defined by section 6530 of the Education Law. (Joint MSSNY/HANYS Position Approved by Council 11/14/85; Modified and reaffirmed HOD 2013)
NB: Professional misconduct applicable to physicians is defined by Article 131-A of the Education Law. The firm which acts as General Counsel to the Medical Society of the State of New York should be consulted for specific information on any aspect of the definitions.
250.999 Guidelines for Reporting Professional Misconduct:
Paragraph (a) of Subdivision (11) of section 230 of the Public Health Law provides: “MSSNY, the New York State Osteopathic Society or any district osteopathic society, and statewide medical specialty society or organization, and every county medical society, every person licensed pursuant to articles one hundred thirty-one, one hundred thirty-one-B, one hundred thirty-three, one hundred thirty-seven and one hundred thirty-nine of the education law, and the chief executive officer, the chief of the medical staff and the chairperson of each department of every institution which is established pursuant to article twenty-eight of the public health law shall, and any other person may, report to the board any information which such person, medical society, organization or institution has which reasonably appears to show that a licensee is guilty of professional misconduct as defined in sections sixty-five hundred thirty and sixty-five hundred thirty-one of the education law. Such reports shall remain confidential and shall not be admitted into evidence in any administrative or judicial proceeding except that the board, its staff, or the members of its committees may begin investigations on the basis of such reports and may use them to develop further information.”
Questions have been raised concerning how county medical societies should process complaints received from the public either by telephone or in writing. It is questionable whether the mere receipt of a complaint by a county medical society, where the county medical society does not have first-hand or direct information regarding the alleged misconduct, and where the county medical society has not conducted any investigation of its own, constitutes information which reasonably shows that a physician is guilty of professional misconduct. The resources and ability of county medical societies to investigate complaints varies with each society.
The following are suggested Guidelines for the County Medical Societies In Reporting Complaints of Professional Misconduct:
Whether to make an investigation.
(1) Whether a particular complaint should be investigated must be a decision made by the county medical society. It is recognized that the county medical society may not have the resources to investigate all complaints.
(2)a If the county medical society investigates a complaint and finds that the evidence reasonably shows that the physician is guilty of professional misconduct as defined by section 6530 of the Education Law, the county medical society has an obligation to report to the Office for Professional Misconduct (OPMC). If the county medical society investigates and finds that the information does not reasonably show that the physician is guilty of misconduct, the county medical society need not report to the OPMC. The complainant should be advised that if he is dissatisfied with the findings, he, as an individual, may file a complaint with the OPMC against the physician.
(2)b The word “reasonable” cannot be defined for the purposes of these guidelines, and, whether information “reasonably” shows that a physician is guilty of professional misconduct depends upon the facts and circumstances of the case. The county medical society should be prepared to show that its findings were objectively made. According to the law, any person, organization or medical society who reports or provides information to the OPMC in good faith and without malice shall not be subject to an action for civil damages or other relief as the result of such report.
(2)c It should be understood that in any case where the county medical society investigates a complaint, the OPMC may at a later time subpoena the records of the county medical society.
(3) If the county medical society does not investigate a complaint, the following procedures are suggested:
(a) If a complaint is made “verbally,” the complainant should be advised that the individual can file a complaint with the OPMC on his own. The county medical society should provide information regarding whether the complaint should be forwarded. If the complainant prefers, the county medical society may forward the complaint to the OPMC on behalf of the complainant, if he will submit the complaint in writing. “Do not forward a complaint unless it is in writing.”
(b) If the initial complaint is received by the county medical society in writing, the complainant should be contacted and informed that he can either file a complaint with the OPMC on his own, or, if the complainant prefers, the county medical society will forward the complainant’s letter to the OPMC.
(c) If the county medical society forwards a written complaint of the complainant to the OPMC without having made its own investigation, both the complainant and the OPMC should be informed in writing that the county medical society has made no investigation, and in forwarding such complaint, the county medical society takes no position regarding the alleged misconduct of the physician.
(d) In lieu of paragraphs (a)-(c), if the county medical society prefers not to forward a complaint which it has not investigated, the county medical society should provide information to the complainant regarding how he, as an individual, may file a complaint with the OPMC.
255.999 Opposition to Protests Which Impede Access to Health Care:
MSSNY is vehemently opposed to any interference with patients’ access to desired health care services by demonstrators or protesters. (HOD 1990-30; Reaffirmed HOD 2014)
260.000 (See also Acquired Immunodeficiency Syndrome, 15.000; Environmental Health, 90.000; Health Insurance Coverage, 120.000; Mental Illness, 205.000; Nuclear War, Weapons and Terrorism, 215.000; Peer Review, 225.000; Reimbursement, 265.000; Vaccines, 312.000; Violence and Abuse, 315.000; Weight Management & Promotion of Healthy Lifestyles, 320.000)
260.901 Policy on Quarantine
The Medical Society of the State of New York policy supports state and local government quarantines that are developed based from evidence-based medicine and which have strong due process protections. MSSNY supports the collaboration of the medical profession with state and local public health officials, taking an active role, to ensure that quarantine and isolation interventions are evidence-based. A copy of this resolution will be forwarded to the AMA House of Delegates for its consideration. (HOD 2017-154)
260.902 Treatment of Onychomycosis
The Medical Society of the State of New York (MSSNY) recognizes onychomycosis of the toenails as an infectious disease that may cause pain, reduce mobility, create ulcerations, and may cause secondary infections leading to serious health complications. MSSNY recognizes fungal infections of the toenail have a high incidence in the general public, and specifically at-risk diabetic patients, creating a public health issue. The Medical Society of the State of New York (MSSNY) supports the treatment of onychomycosis by all physicians and properly licensed providers including doctors of podiatric medicine. (HOD 2017-250)
260.903 Smart Guns and Firearm Safety
The Medical Society of the State of New York continues to support background checks for firearm purchases and will advocate for firearm safety education in all settings as a component of firearm licensing and supports expansion and implementation of technologies to improve gun safety. (HOD 2016-154 & 155)
260.904 Protecting Public Health from Natural Gas Infrastructure
The Medical Society of the State of New York recognizes the potential impact on human health and environment associated with natural gas infrastructure and supports governmental assessment of the health and environmental risks that are associated with natural gas pipelines.
A copy of this resolution will be transmitted to the AMA for consideration by its House of Delegates. (HOD 2015-159)
260.905 Prohibiting Sale of Powdered Caffeine
The Medical Society of the State of New York affirms as policy that pure powdered caffeine should not be available for consumer retail sale or its distribution. One of MSSNY’s public health committees will issue a statement about powdered caffeine and its potential for misuse, overdose and harmful effects upon individuals and forward the statement to members of the legislature and state officials. (HOD 2015-152)
260.906 Child Proof Packages for E-Cigarette Liquid Refills
The Medical Society of the State of New York will support regulations and/or legislation to create a requirement by the Food and Drug Administration (FDA) that liquid nicotine be only available in child-resistant packages, that the sale of nicotine come with appropriate warnings of the dangers of nicotine and instructions on its safe storage; and that the sale and distribution in the U.S. of liquid nicotine be prohibited to anyone under the age of 21.
A similar resolution will be transmitted to the American Medical Association for consideration at its next meeting of the House of Delegates. (HOD 2015-151)
260.907 Child Resistant Caps
The Medical Society of the State of New York will support state legislation requiring child-resistant packaging on all high energy drinks manufactured for sale in New York State and will urge the U.S. Food and Drug Administration and/or U.S. Congress take similar action on the federal level.
A copy of this resolution will be transmitted to the American Medical Association for consideration at its next meeting of the House of Delegates. (HOD 2015-150)
260.908 DVT and Air Travel
The Medical Society of the State of New York (MSSNY) will request that the American Medical Association (AMA) encourage the Federal Aviation Administration (FAA) and the airline industry to alert passengers to the flight-associated risk of deep vein thrombosis (DVT) and that they provide recommendations to passengers to reduce their risk of developing DVT. (HOD 2014-153)
260.909 Protecting Public Health from Elevated Radon Exposure
The Medical Society of the State of New York supports policy that limits exposure to radon and its decay products which are known to cause primary lung cancer in non-smokers and potentiate the likelihood of lung cancer in smokers.
The Medical Society of the State of New York supports legislation that protects public health by ensuring that New York State is committed to reducing sources of excess radon emissions, and monitoring radon gas exposure levels to confirm that these radon gas levels do not exceed the recommended levels set by the Environmental Protection Agency. (HOD 2014-154)
260.910 Support for the Breast Cancer Patient Education Act
The Medical Society of the State of New York supports the American Society of Plastic Surgeons’ campaign to pass the Breast Cancer Patient Education Act (Council 1/30/2014)
Note: summary copies of the Act are available from the Executive Headquarters office
260.911: Maintaining Public Safety and Trust in Medicine
The MSSNY delegation to the AMA will bring to the AMA House of Delegates concern over the inappropriate testimonials and dissemination of dubious or inappropriate medical information through the public media including television, radio and print media. (HOD 2013-216)
260.912: Public Health Implications of Natural Gas Extraction Using Hydraulic Fracturing
MSSNY reaffirms policy 90.992 and supports the planning and implementation of a health impact assessment to be conducted by a New York State school of public health. MSSNY will advocate for the establishment of an industry-funded, independently-arbitrated state trust fund for people who may be harmed as a result of hydraulic fracturing; and oppose any non-disclosure provisions related to the practice of hydraulic fracturing that interfere with any aspect of the patient-doctor relationship and/or the ready collection of epidemiological data for future health impact studies. (HOD 2013-171)
260.913: Regulation of Tattoo Procedures
MSSNY should petition the New York State Department of Health to expedite its development of statewide regulations on the training and licensure of tattoo artists, to require that tattoo licensees be conversant with infection control before they are licensed or when their license is being renewed; and urge the American Medical Association to encourage the Food and Drug Administration to set standards concerning the pigment and inks that are permitted to be used in the tattooing procedure. (HOD 2013-159)
260.914: Banning the Marketing and Sale of “High-Energy/Stimulant
Drinks” to Children/Adolescents Under the Age of 18
MSSNY supports a temporary ban on the marketing of “high stimulant/caffeine drinks” to children/adolescents under the age of 18 until such time as the scientific evidence regarding the possible adverse medical effects such drinks may have on children and adolescents is determined. This resolution should be forwarded to the American Medical Association for consideration at its next House of Delegates meeting. (HOD 2013-161)
260.915: Statewide “Don’t Text and Drive Initiative”
MSSNY supports ongoing federal, state and local initiatives to eliminate texting while driving and encourages county medical societies to become involved in “Don’t Text and Drive” initiatives similar to Suffolk County’s initiative.(HOD 2013-160)
260.916: Farm Use of Antibiotics
MSSNY will work with interested parties to develop new or to improve existing FDA guidelines concerning the prudent use of antibiotics in livestock to protect patients from the dangers of antimicrobial-resistant pathogens. (HOD 2013-158)
260.917: Pharmacy Practice of Medicine
MSSNY will work to oppose legislation or regulation that would enable retail clinics owned by publicly traded corporations to be established in the State of New York. (HOD 2013-109 and 110)
260.918 Warning New York State Citizens of Products known to Cause Cancer,
Birth Defects or Other Reproductive Harm
MSSNY will request that our AMA study California Proposition 65 which requires warning labels on products that inform citizens about products know to contain chemicals which are carcinogenic or teratogenic and report back to the AMA HOD 2013 regarding the appropriateness of encouraging similar legislation in the USA. (HOD 2012-167) (NB: AMA HOD did not adopt the resolution)
260.919 Ban on Tanning Devices for Children and Teens:
Pending passage of a complete ban on indoor tanning, the Medical Society of the State of New York supports legislation to bar anyone under the age of 18 years from indoor tanning without parental or legal guardian consent and will also ask the American Medical Association to urge the U.S. Food and Drug Administration to implement tougher restrictions on indoor tanning by minors, as recommended by its Advisory Committee. (HOD 2011-151)
260.920 Restoration of Funding for New York State Poison Control System:
MSSNY will advocate for restoration of full funding for the five Regional Poison Centers in New York State as well as urging its members to write similar letters of support. (HOD 2010-169)
260.921 Guidelines, Infrastructure and Educational Program re
Anal Intraepithelial Neoplasis:
-support the development of guidelines for an Anal Intraepithelial Neoplasia (AIN) screening program for high risk populations which would emphasize the development of an infrastructure for diagnosis and treatment;
-develop an educational program for physicians and health care providers on the use of High Resolution Anoscopy (HRA) contingent upon efforts being made to seek financial support for such a program;
-seek to have the guidelines, infrastructure and educational program supported by a multidisciplinary group of specialists (including primary care physicians, obstetricians/ gynecologists, colorectal surgeons, pathologists, and other leadership of diagnostic laboratories);
-continue to advocate for continued research in the area of screening, diagnosis, and treatment of AIN. (Council 6/25/09)
260.922 Patient Prescriptions:
MSSNY to work with the American Medical Association to study the issue of prescription labeling for visually or otherwise impaired patients to seek possible improvements. (HOD 2008-168)
260.923 Country of Origin of Medicines and Personal Products:
MSSNY will ask the American Medical Association to seek federal legislation requiring that (1) all medications and medicinal and self-care products be clearly and prominently labeled with country of origin; and (2) the parent company be held accountable for the safety of the products they market in the United States. (HOD 2008-165)
260.924 Expiration Dates:
MSSNY will ask the American Medical Association to study the problem of manufacturers of medical supplies and equipment using different methods to indicate expiration dates on their products, making it difficult for people to know the true expiration date. (HOD 2008-164)
260.925 Increase Funding for Lung Cancer Research:
MSSNY will support efforts to increase funding for lung cancer research to aid in prevention, early diagnosis and treatment methods. (HOD 2008-159)
260.926 Impact of the Medical Malpractice Crisis on Women’s Health:
MSSNY will approach the leadership of the National Organization for Women, the Susan Komen Foundation and other advocacy groups for women, so that MSSNY leadership and the leadership of these organizations may work jointly to improve the access of all women to timely, affordable and high quality health care. (HOD 2008-98)
260.927 Physician Reporting of Patients Who Should Not Drive:
MSSNY will promote passage of state legislation to establish a system to allow, but not require, physicians to confidentially report to appropriate governmental agencies or departments that a patient is not physically or mentally capable of operating a motor vehicle without jeopardizing his or her health or that of others, while also providing immunity from civil or criminal liability for reporting or not reporting when such is done in good faith. (Council 3/3/08)
260.928 Medical Certification of Drivers Covered by Article 19-A:
MSSNY will work with the New York State Department of Motor Vehicles to:
(1) produce standard, accessible guidelines that support a medically sound and administratively efficient process for medical certification of drivers covered by Article 19-A;
(2) increase the confidentiality of driver medical records by limiting their access to appropriate personnel; and
(3) provide physician oversight for the medical certification program, including careful revision of required forms and methods for submission of required medical information. (Council 6/25/07; Reaffirmed HOD 2017)
260.929 Increasing the Blood Supply:
MSSNY will advocate to the Food and Drug Administration that its guidance is discriminatory to large populations of potential blood donors and that this policy has not kept pace with screening technology and with the spread of specific diseases; and, also, that a uniform screening of donors be put in place for all populations and that the lifetime restriction for men who have had sex with men since 1977 be eliminated. (HOD 2007-160; Reaffirmed HOD 2017)
260.930 Irradiation of Food Products:
(Sunset HOD 2017)
260.931 Insurance for People Released from Prison:
MSSNY will advocate that the New York State Division of Parole assures that parolees are enrolled in public or private insurance programs for which they are eligible at the time they are released. (HOD 2007-111; Reaffirmed HOD 2017)
260.932 MSSNY as a Patient Safety Organization:
(Sunset HOD 2017)
260.933 Manufacturer Labeling of Medical Supplies:
MSSNY will seek the passage of state regulation and/or legislation that mandates that all manufacturers of sterile medical equipment sold in the state of New York have an easily readable, clearly stamped expiration date on the package. (HOD 2007-100; Reaffirmed HOD 2017)
260.934 Retail Clinics:
(Sunset HOD 2016)
260.935 Reporting of Non-Communicable Illness:
(Sunset HOD 2016)
260.936 Lead Poisoning:
MSSNY supports efforts by the American Academy of Pediatrics and the American Academy of Family Practice to be strong advocates for blood lead testing at age 1 and 2; and the accomplishments of the New York State Health Department Plan “Eliminating Childhood Lead Poisoning in New York State by 2010.” MSSNY encourage county medical societies to join Coalitions to End Lead Poisoning in New York State, thus allowing their name and good works to be added to those of other members of the coalition in order to more effectively advocate for the end of lead poisoning in New York State. MSSNY continue its advocacy efforts for stronger legislative measures to prevent lead poisoning in children and adults, and for enhancing local state and federal funds allocated for prevention of lead poisoning in children and adults. MSSNY support efforts to educate physicians and other health professionals regarding the hazards of lead poisoning. (HOD 2005-164; Reaffirmed HOD 2006-168; Reaffirmed HOD 2009-166). See also Policy 260.945.
260.937 Amendment to Bankruptcy Legislation:
MSSNY will advocate that Congress restore protections to people devastated by the financial impact of medical illness and convey this position to the AMA. (HOD 2005-94; Modified and reaffirmed HOD 2015)
260.938 Individuals with Autism and Intellectual Disability:
MSSNY will seek the passage of state and federal legislation increasing the funds available for research and treatment of individuals with autism and for individuals with an intellectual disability. (HOD 2004-164; Modified and reaffirmed HOD 2014)
260.939 Impaired Drivers: The Physician’s Dilemma:
(White Paper Recommendations)
1) Support of Department of Motor Vehicles regulations that promote reaffirmation and verification of the minimal driver standards at each renewal cycle.
2) Support of the role of the Medical Advisory Board of the N.Y.S. Department of Motor Vehicles in its goal to establish “total driver qualifications” and a scale that measures medical conditions affecting driver safety (MCADS) for all drivers in N.Y.S.
3) Encourage physicians to assess patients’ physical and mental impairments that may affect driving abilities, and in situations where clear evidence of substantial driving impairment implies a strong threat to patient and public safety, it is desirable and ethical for physicians to notify the Commissioner of Motor Vehicles and release clinically pertinent information to help determine whether or not the patient can continue to drive safely.
4) Make available to physicians, information to help them assess their patients, as well as information for their patients to self-assess their driving skills.
5) Provide information to physicians to give to caregivers of impaired patients to help them access services and transportation for their loved-one who cannot safely drive.
6) Help to identify programs to rehabilitate those drivers who can be made safe drivers with training or therapy.
7) Support legislation that would allow physicians, family members and caregivers to report impaired drivers to the Commissioner of Motor Vehicles for reevaluation and provide immunity from civil or criminal liability for reporting or not reporting when such is done in good faith.
8) Work to assure that physician members of MSSNY are aware of the Physician’s Guide to Assessing and Counseling Older Drivers, a joint publication of the AMA and the National Highway Traffic Safety Administration, which is an excellent tool for physicians to use and provides up to 3 category 1 CME credits.
9) Distribute copies of Impaired Drivers: The Physician’s Dilemma to New York State physicians. (Council 11/13/03)
10) That an attestation be included with the license application verifying that the driver is free from any impairments which may interfere with the safe operation of a motor vehicle posing potential threats to others. (HOD 04-155) Reaffirmed HOD 2011-157)
MSSNY supports legislation which would permit physicians to report to the Department of Motor Vehicles those patients whom the physician believes should not operate a motor vehicle and to provide civil and criminal immunity for good faith reporting. (HOD 2011-157)
260.940 Automated External Defibrillators:
MSSNY supports state and federal efforts to increase funding for the purchase of automated external defibrillator devices so that they are available in the community. (HOD 2004-166; Modified and reaffirmed HOD 2014)
260.941 Adequate Cell Phone Service Throughout New York State:
MSSNY will continue to support all appropriate efforts of the state and municipalities to eliminate cell phone dead zones in all service areas of New York State in the interest of public safety. (HOD 2004-158; Reaffirmed HOD 2014)
260.942 Free Access to Fresh Water at Food Establishments:
SUNSET HOD 2014
260.943 Government to Support Community Exercise Venues:
MSSNY encourages towns, cities and counties across New York State to make recreational physical activity more available by utilizing existing or building walking paths, bicycle trails, swimming pools, beaches and community recreational and fitness facilities; and encourage municipalities to provide tax breaks and grants toward these community projects in the same way that they support the building and maintenance of highways, shipping harbors, railroad lines, and airports. (HOD 2004-152; Modified and reaffirmed HOD 2014)
260.944 Lead Poisoning:
MSSNY will advocate for stronger governmental and non-governmental measures to prevent lead poisoning in children and adults and enhancing the local State and Federal funds allocated for prevention. Participate in the effort to educate physicians and other health professionals regarding the hazards of lead poisoning and collaborate with both professional and non-professional organizations on prevention. (HOD 03-154; Reaffirmed HOD 04-162; Reaffirmed HOD 2009-166) See also Policy 260.936.
260.945 Identification of Slave-Made Products:
MSSNY is opposed to slave labor throughout the world. (HOD 2003-157; Modified and Reaffirmed HOD 2013)
260.946 Potassium Iodide (KI) Distribution:
MSSNY supports emergency plans at nuclear plants and within the surrounding communities for the distribution of potassium iodide (KI) for those people within a 50-mile radius of a nuclear reactor site together with the appropriate guidelines for use. (HOD 2002-155; Modified and Reaffirmed HOD 2013)
260.947 Mammography Screening for Breast Cancer:
SUNSET HOD 2013
260.948 Mammography and Breast Cancer:
The CDC’s Cancer Prevention and Control, the National Cancer Institute and Memorial Sloan Kettering recommend that women age 40-49 receive a mammogram every one to two years. The American Cancer Society, Susan G. Komen Breast Cancer Foundation and the American College of Obstetricians and Gynecologists (ACOG) recommend that annual screening mammograms begin at age 40. The Medical Society agrees with the recommendation for mammography screening for women 40 years and older and supports legislation that will enable these women to receive insurance coverage for annual mammograms. (White Paper on Women’s Health Initiatives, Council 11/2/00; from 2010-163; Reaffirmed Council 1/20/11)
260.949 Post Disaster Mental Health Consequences of Concern:
MSSNY will educate practicing physicians to help them a) reach out to those potentially harmed by the natural, made-made or terrorism-related disasters b) counsel those in psychological need, c) detect, refer, and treat post-traumatic stress disorder, depression, substance abuse, and other conditions arising from the events. (HOD 2002-165; Modified and Reaffirmed HOD 2013)
260.950 Further Integration of Mental Health and General Health:
MSSNY supports the position of executive deputy commissioner within the New York City Department of Public Health be filled by a board-certified psychiatrist. (HOD 2002-164; Modified and Reaffirmed HOD 2013)
260.951 Physician Use of Health Commerce System:
MSSNY will continue to work with the New York State Department of Health in promoting and helping facilitate the use of the Health Commerce System to provide urgent information to physicians throughout the state. (HOD 2002-163; Modified and Reaffirmed HOD 2013)
MSSNY will seek the passage of state and federal legislation requiring the insurance industry to cover all therapy services needed by autistic individuals. (HOD 2001-167; Reaffirmed HOD 2011)
260.953 Illegal Pesticides:
MSSNY will work with other agencies to promote a statewide and/or national educational awareness program to alert the public to the dangers of using, unregistered, illegal pesticides anywhere that people, particularly children, may be exposed to their toxic and deadly effects. (HOD 2001-159; Reaffirmed HOD 2011)
260.954 Emergency Management Preparation for Bioterrorist Attacks:
MSSNY will continue to work with appropriate state and federal agencies to ensure that all of New York State has appropriate emergency preparedness plans, including bioterrorist attacks. (HOD 2001-158; Reaffirmed HOD 2011)
260.955 Treatment Options of Fibromyalgia:
MSSNY will encourage efforts to seek additional funding for research projects into the physiologic basis and treatment options of fibromyalgia syndromes. (HOD 2001-153; Reaffirmed HOD 2011)
260.956 Assisted Living Program Access:
MSSNY will seek legislation or regulation that would ensure that Assisted Living Programs in New York State be made accessible to the elder population via subsidization where necessary and appropriate. (HOD 2001-89; Reaffirmed HOD 2011 with recommendation for re-evaluation by the Long Term Care Committee)
260.957 Bone Density Tests and Osteoporosis:
The Medical Society of the State of New York believes early detection and prevention, diagnosis and treatment can effectively combat osteoporosis. The Medical Society is committed to educating physicians and New York State residents about this disease. The Medical Society will support legislation or regulation that will ensure that women and men are able to receive insurance coverage for bone density tests and for the hormone and other therapies that are recommended by physicians. (White Paper on Women’s Health Initiatives, Council 11/2/00; Reaffirmed HOD 2002-162; Modified and Reaffirmed HOD 2013)
260.958 Herbal Substances:
SUNSET HOD 2014
260.959 Avian Monitoring for Encephalitis Viruses:
MSSNY will support and encourager the ongoing efforts of the New York State Department of Health regarding monitoring for encephalitis viruses. (HOD 2000-165; Reaffirmed HOD 2014)
260.960 Pain Management:
MSSNY will communicate with the New York State Department of Health and recommend the following: (1) that the New York State Department of Health coordinate educational activities on pain management with the Medical Society of the State of New York and national medical specialty societies in structuring voluntary educational programs for physicians on pain management; and (2) that the New York Sate Department of Health avoid threatening, punitive measures in dealing with the question of inadequate pain management. (HOD 2000-164; Modified and Reaffirmed HOD 2014)
260.961 Folic Acid and the Prevention of Neural Tube Defects:
SUNSET HOD 2014
260.962 Irradiated Food:
SUNSET HOD 2014
260.963 Medical Errors Data:
MSSNY will urge that the New York State Department of Health provide to MSSNY statistical data identifying the five (5) most common medical errors that occur in New York.
MSSNY will study the medical error data provided by the DOH and, through the Committee on Interspecialty, the MSSNY Bioethical Issues Committee, and other appropriate MSSNY committees, develop systems and/or surgical/medical protocols which will result in the reduction of erroneous medical outcomes and ultimate prevention of medical errors.
MSSNY will urge the Medical Liability Mutual Insurance Company (MLMIC) to include in risk management seminars for their insured physicians education with respect to a reduction of medical error rates in the State of New York. (HOD 2000-87; Reaffirmed HOD 2014)
260.964 Organ/Tissue Donation Information on Health Insurance Cards: SUNSET HOD 2014
260.965 Prevention of Pneumococcal Disease:
SUNSET HOD 2014
260.966 Asthma Warning Labels for Yellow Dye Number 5 Food Coloring: SUNSET HOD 2014
260.967 FDA Regulation of Nutritional Supplements:
SUNSET HOD 2014
260.968 Prominent Notice of Product Reformulation on Cosmetic
SUNSET HOD 2014
260.969 Prudent Layperson – 911 Calls:
SUNSET HOD 2014
260.970 Improving Asthma Outcomes While Reducing Costs:
SUNSET HOD 2014
260.971 Women’s Health Training:
SUNSET HOD 2014
260.972 Needles and Syringes, Over-the-Counter Sale of:
SUNSET HOD 2014
260.973 Chlamydia Infection Sexually Transmitted, Screening for In
SUNSET HOD 2014, see policy 15.957
260.974 Calcium, Optimal Intake of:
MSSNY supports efforts to educate both patients and the public about the need for optimal dietary calcium intake in all age groups to prevent osteoporosis. (HOD 1996-159; Modified and Reaffirmed HOD 2014)
260.975 Scented Inserts in Magazines and Mailings, Prohibition of:
MSSNY will advocate to prohibit the unsolicited distribution of scented inserts and other odor-emanating materials in magazines and through the mail because of the deleterious effects it has on the health of many individuals. (HOD 1996-171; Modified and Reaffirmed HOD 2014)
260.976 Mammography Recommendations:
SUNSET HOD 2014, see policy 125.966
260.977 Domestic Violence As A Public Health Threat:
MSSNY recognizes domestic violence as a public health threat in the State of New York and supports legislative, regulatory, and other efforts in the State that will lead to protection of domestic violence victims, and abatement of domestic violence. (HOD 1995-163; Modified and Reaffirmed HOD 2014)
260.978 Maternal And Newborn HIV Testing And Care:
SUNSET HOD 2014
260.979 Tuberculosis Screening of Immigrants:
SUNSET HOD 2014
260.980 Tanning Salons:
MSSNY supports a complete ban on tanning salons in the State of New York and will introduce or support legislation to accomplish such a ban. (HOD 1995-182; Reaffirmed HOD 2011-151)
260.981 Public Health Law – Obliged Disclosure:
MSSNY will seek to amend the New York State Civil Practice Law and Rules to mandate disclosure of the name, or names, of a prosecution’s expert witness prior to trial for purposes of deposition. (HOD 1994-85; Reaffirmed HOD 2014)
260.982 Vitamin K Prophylaxis in Newborn:
SUNSET HOD 2014
260.983 AZT Intervention in Pregnancy:
SUNSET HOD 2014
260.984 Respirators for Nosocomial TB Control:
SUNSET HOD 2014
260.985 Brand Certification Process, Opposition to:
SUNSET HOD 2014
260.986 Chlamydial Infection, Screening for In Routine Care:
SUNSET HOD 2014, see policy 15.957
260.987 Right Heart Catheterization:
SUNSET HOD 2014
260.988 Prisoners – Medical Care For:
MSSNY affirms the position that each person arrested and detained, even overnight, has the right to needed medication, medical attention and protection against exposure to contagious disease. (HOD 1993-71; Modified and reaffirmed HOD 2014)
260.989 Folic Acid (Dietary) For the Prevention of Neural Tube Defect
SUNSET HOD 2014
260.990 Case Management for TB, Increased Funding for:
SUNSET HOD 2014
260.991 Tuberculosis – Directly Observed Therapy:
SUNSET HOD 2014
260.992 Breast Feeding:
MSSNY supports the following initiatives in regard to breast feeding of infants:
(1) Educating its members about the process and benefits of breast feeding.
(2) Encouraging innovative and educational programs for use in medical training about the clinical benefits and process of breast feeding.
(3) Cooperating with other professional medical groups to encourage breast feeding education programs at national and regional meetings of pediatricians, obstetricians, and family physicians.
(4) Encouraging all of its members, regardless of specialty, to offer professional and emotional support for their patients who are breast feeding mothers.
(5) Continue to support the law that women may not be charged with indecent exposure or lewd behavior as a result of breast feeding in public. (HOD 1993-27; Modified and reaffirmed HOD 2014)
260.993 Food Labeling:
SUNSET HOD 2014
260.994 Air Quality Reports:
SUNSET HOD 2014
260.995 Blood Glucose Monitoring:
SUNSET HOD 2013
260.996 Scoliosis Screening:
MSSNY, along with the American Academy of Orthopedic Surgeons: (1) Supports the principle of school screening for scoliosis; (2) Believes that the school screening personnel should be educated in the detection of spinal deformity; and (3) Maintains its commitment to the appropriate use of spine x-rays. (Council 3/10/88; Reaffirmed HOD 2013)
260.997 Fluoridation Statewide:
MSSNY supports a comprehensive program of fluoridation of all public water supplies as a prevention method for dental caries. (Council 4/23/87; Modified and Reaffirmed HOD 2013)
SUNSET HOD 2013
260.999 Fluoridation – Fluoride Rinse Program:
MSSNY endorses the concept of school fluoride programs and encourages New York State schools to participate in fluoride rinse programs in those communities without fluoridation of drinking water. (HOD 1980-12; Modified and Reaffirmed HOD 2013)
262.993 AMA Guidelines for Reporting Physician Data
MSSNY supports the use of the AMA’s Guidelines for Reporting Physician Data to create data reports that physicians can easily understand and use to enhance data-driven decision making. (Council 5/24/2012) The Guidelines are available upon request from the Administrative Headquarters office of MSSNY.
262.994 Physicians’ Control of Quality Monitoring:
MSSNY will support and actively promote quality evaluation programs under the aegis of appropriate medical organizations including specialty societies, and insist that these programs be substituted for those controlled by the managed care industry so that the best interests of physicians and patients are protected. Also, these existing evaluation programs should be upgraded or expanded as required to perform these quality evaluations. (HOD 2009-95)
262.995 MSSNY Task Force on Quality Medicare Care:
MSSNY supports regulatory or legislative efforts which require physicians to complete a certain number of continuing medical education course credits periodically as evidence of competence and diligence in medical practice. (Council 11/17/05; Reaffirmed HOD 2015)
262.996 Maximum Medical Improvement:
MSSNY will work with insurers to develop clinical guidelines and best practices for maintaining therapies for chronic conditions using an evidence-based model. (HOD 2005-263; Reaffirmed HOD 2015)
262.997 Tracking Improvement of Medical Error Evidence:
MSSNY supports efforts by the American Medical Association to enact comprehensive patient safety legislation which: 1) Creates a confidential, voluntary reporting system in which physicians, hospitals and other health care providers can report information regarding errors or “near misses” to patient safety organizations (PSOs); 2) Allows PSOs to collect and analyze patient safety data and then provide feedback on patient safety improvement strategies; and 3) Ensures that patient safety data will be confidential and legally protected. (HOD 2005-172; Reaffirmed HOD 2015)
262.998 AMA Specialty-Specific Quality Analyzing Committees:
MSSNY supports and endorses the work of the American Medical Association’s Physician Consortium for Performance Improvement which has developed evidence-based performance measures. (HOD 2005-171; Reaffirmed HOD 2015)
262.999 Task Force on Quality Medical Care:
SUNSET HOD 2014
265.000 REIMBURSEMENT: (See also Abortion and Reproductive Rights, 5.000; Managed Care,
165.000; Medicare, 195.000; Nursing Homes, 217.000; Surgery, 295.000; Vaccines,
312.000; Workers’ Compensation, 325.000)
265.840 All Payer Database (APD) Not Appropriate as Reimbursement Standard
The Medical Society of the State of New York will ensure that the payment data collected in an All Payer Database (APD) NOT form the basis for a reimbursement standard to health care providers, because the APD does not include payment data from ERISA plans, which results in an artificial narrowing of the range of fee data collected by the APD. (HOD 2017-60)
265.841 Collection of Deductible and Co-Insurance
Seeking enactment of legislation or regulation if necessary, the Medical Society of the State of New York will ensure that:
Health insurance companies and their vendors provide easy to understand written notice to their enrollees regarding out of pocket costs they may face in their insurance coverage;
A physician’s office can easily and accurately determine a patient’s out of pocket costs from their health insurer;
Physicians are permitted to collect out of pocket costs from patients at the time of delivery of services, as well as waive collection of such costs when warranted based upon each patient’s circumstances. (HOD 2017-58)
265.842 Study and Promotion of Telemedicine Payment Parity
MSSNY will work with individual legislators throughout the state to introduce legislation that would require parity of payment between services provided in-person and via telemedicine. (HOD 2017-109)
265.843 Copying and/or Scanning Costs
MSSNY will forward a resolution to the AMA to seek changes to the federal HIPAA regulations so that charges related to providing patient records defer to state law for searching, retrieval and matters relating to determining charges which may be imposed for providing patients with medical records. (HOD 2017-102)
265.844 Office Based Surgery Reimbursement
The Medical Society of the State of New York will seek legislation to require health plans to provide facility fee reimbursement to physicians and/or medical practices that obtained State-mandated accreditation for their office-based surgical suite(s). The new legislation should mandate that facility fee reimbursement paid to physicians and/or medical practices issued by the health plan be fair and equitable, which means that payment by plans be no less than 50% of the rate paid to Ambulatory Surgical Centers (ASCs) or Hospitals for the room use of the ER, OR, OPD or Clinic, which will enable the plans to realize cost containment savings by paying physicians and/or medical practices, rather than paying the full ASC or Hospital room use rate. (HOD 2017-255)
265.845 Reimbursement for In-Office Administered Drug
MSSNY will take the necessary steps to ensure that in-office physician administered medications be reimbursed at no less than the cost of the medication, which includes the cost of the purchase, storage, spoilage and professional administration. (HOD 2017-251)
265.846 Expansion of Independent Dispute Resolution Process
MSSNY will seek legislation and/or regulation to require the New York Department of Financial Services to create and Independent Dispute Resolution process, similar to that established under the 2014 law for resolving emergency and “surprise” out of network claims, to resolve allegations of inappropriate care denials or reductions in payment by health insurers that cannot be resolved timely through existing statutory relief processes. (HOD 2016-53; substitute resolution adopted Council Nov 3, 2016
265.847 Arbitrary Relative Value Decisions by CMS
The Medical Society of the State of New York (MSSNY) will work with the AMA, other state medical and specialty societies and the national specialty societies, to change federal law by creating new checks and balances in the Centers for Medicare and Medicaid Services (CMS) regarding the Relative Value scale and other fee determination methodologies; and providing an appeal process both within CMS and the courts regarding fee and Relative Value determinations for specific procedures. (HOD 2016-265)
265.848 Ensuring Physicians Get a Fair Share of Bundled Payments
The Medical Society of the State of New York will pursue regulation or legislation in the State of New York to fairly compensate the voluntary/private physicians for the work that they do at the hospital and share the bundled payment with the voluntary/private physician in at least the same proportion to the employed physicians in the same geographic area. (HOD 2016-264)
265.849 Development of a CPT Code for PMP Look-Up
Since 2013, New York State has required that physicians check the Department of Health (DOH) Prescription Monitoring Program (PMP) registry prior to prescribing or dispensing any Schedule II, III or IV controlled substances, a process which is not currently reimbursable but involves physicians’ time and medical judgment in consideration of providing controlled prescription medications; the New York Delegation will submit a resolution to the 2016 Annual AMA House of Delegates, calling for the development by the AMA and CMS of a Current Procedural Terminology (CPT) code so physicians in all States can be appropriately paid for their time and effort in consulting the PMP registry. (HOD 2016-253)
265.850 UCR-Based Out-Of-Network Policies
MSSNY will continue to advocate strongly for preservation and expansion of usual, customary and reasonable (UCR) based out-of-network benefits available to our patients; and energetically and proactively educate physicians on the importance of a meaningful UCR-based out-of-network environment in order to maintain an acceptable practice environment for physicians desiring to practice in-network as well as those physicians who are employed by an institution.
MSSNY will include in the educational materials, the identification of access to other information including links to social media as well as successfully implemented business strategies concerning how the meaningful UCR-based out-of-network environment may be a viable option for physicians who wish to maintain independent out-of-network practices.
MSSNY will proactively educate patients, employer groups and insurance agents on a UCR- based out-of-network plan. (HOD 2016-105 & 106)
265.851 Medicare and Insurance Takeback Procedures
The Medical Society of the State of New York will collaborate with the Healthcare Association of New York State (HANYS) and the AMA to ensure when a patient hospitalization is retrospectively found not to meet criteria for inpatient admission, then the take back amount be only the difference between the cost of the admission and the cost of necessary observation for that patient stay.
MSSNY will collaborate with HANYS and the AMA to ensure that, for any care provided to hospital patients who have Medicare, managed Medicare, or commercial insurance, hospitals have the option to rebill denied inpatient claims as outpatient claims, when a physician using clinical judgment makes a prospective decision to admit a patient who is later found to not meet admission criteria.
MSSNY will also advocate to ensure that the time frame for a public or private payer to audit a claim after payment be limited to the time period that a physician or hospital has to submit the claim to a public or private payer following the delivery of care.
The New York Delegation to the AMA will introduce this resolution for consideration at the next AMA Annual House of Delegates Annual Meeting. (HOD 2016-66)
265.852 Ensuring FAIRHEALTH Integrity
The Medical Society of the State of New York will continue to work with Fair Health to assure optimal physician charge data collection and presentation. (HOD 2016-59)
265.853 Underpayment Reconciliation
The Medical Society of the State of New York will seek legislation which will mandate insurers identify underpayments discovered through an audit, and return such payment to the physician with accrued interest, and if a pattern of underpayments is discovered in an insurer audit, that such findings be extrapolated across the entire time period reviewed in the audit and used to offset overpayment amounts due to the insurer. (HOD 2016-57)
265.854 Protection from Underpayment for Services
The Medical Society of the State of New York will urge the NYS Department of Health, NYS Department of Financial Services and Attorney General’s office to require health insurance companies to provide complete fee schedule information to physicians upon request; and also advocate for legislation, regulation or other appropriate policy intervention to ensure health insurers pay physicians for medical services in accordance with the fees specified in the physician’s contract even if the physician’s submitted charge is less than the fee schedule amount. (HOD 2016-56)
265.855 Health Insurance Guarantee Fund
The Medical Society of the State of New York will continue to advocate for the enactment of a Health Insurance Guarantee Fund to pay outstanding claims in the event of insolvency by a health insurance company. MSSNY will also continue to advocate to ensure the availability of funds to pay the outstanding claims of Health Republic, either through a Health Insurance Guarantee Fund or use of other state monies; and the Medical Society of the State of New York will continue to work with the Department of Financial Services to ensure strong oversight of the financial integrity of health insurance companies operating in New York State. (HOD 2016-54 & 55)
265.856 Managed Care Contracts and “All Products” Clauses and Silent PPOs
As MSSNY continues to advocate for prohibition of health insurer “all product” clauses any such legislation will: (1) require that the insurer must set forth separate terms (including compensation terms) for each of the insurer’s products that exist when the contract is signed; (2) require that if an insurer introduces a new product after the contract is signed, the insurer will not be permitted to unilaterally designate the physician as a participant in that product; (3) enable that the physician be allowed to choose either to participate or not participate in that new product; and (4) ensure that if the physician chooses to participate, the insurer must reach an agreement with the physician on business terms for that new product. (HOD 2016-52)
265.857 Reimbursement for Non-Bundled Lab Tests
The Medical Society of the State of New York will seek federal legislation to ensure that as the government moves forward to value based payment and reform, that the legislature and federal agencies seek direct physician input to ensure that bundled payments result in quality care and best patient outcomes rather than concentrating solely on the cost of care. (HOD 2015-253, substitute resolution adopted by Council, 1/21/2016)
265.858 Site of Service Parity
The Medical Society of the State of New York (MSSNY) will seek legislation or regulation which would eliminate Medicare and commercial insurance payment differentials for routine and non-emergency physician services based upon site of service and MSSNY will encourage the AMA to seek similar legislation on a national level. (HOD 2015-264)
265.859 Payment for Physicians’ Work: Appealing Insurance Company Denials for Payment
The Medical Society of the State of New York, by legislation or regulation, will seek payment for physicians’ time and effort which is involved in preparing appeals for reversal of denials of payment for medical care, procedures and medications by insurers and other third party payers on behalf of their patients. (HOD 2015-259)
265.860 Right to Compensation
The Medical Society of the State of New York will seek legislation to eliminate the subsequent reversal of authorization and denial of payments for procedures that had been previously approved and when verification of eligibility had been confirmed by the Managed Care Company. And in case of non-payment of a claim, the physician who has provided the care is entitled to obtain compensation from the patient, if he or she so chooses. (HOD 2015-258)
265.861 Forced Use of “Virtual” Credit Card Payments to Physicians
The Medical Society of the State of New York will educate its members, via E-news and the News of New York, that as of January 1, 2014, HIPAA regulations require health plans to offer physicians an Automated Clearing House (ACH) Electronic Funds Transfer (EFT) payment option that does not charge percentage-based fees and if a plan does not send payment by the HIPAA approved EFT ACH standard, the physician can demand that the plan revert to paper checks until such time that the HIPAA transaction standard is available. (HOD 2015-256)
265.862 Eliminating Denials Due to Documentation of Dental Pathology
MSSNY will seek to eliminate insurance denials based on the inclusion of diagnosis codes otherwise classified as dental and require payment to the provider if the patient presented with any condition that can lead to medical concerns. (HOD 2015-251)
265.863 New York State Attorney General’s Office Physician Phone Call Policy
The Medical Society of the State of New York will work with the New York State Attorney General’s Office to ensure physician complaints regarding inappropriate care denials and other deceptive practices by health insurers are properly investigated.
So that physicians are aware, the Medical Society of the State of New York will routinely publish information regarding the appropriate process to file a prompt payment complaint with the New York State Department of Financial Services when insurers do not make timely payment of physician claims. (HOD 2015-66)
265.864 Prompt Payment
The Medical Society of the State of New York will work with the New York State Department of Financial Services to ensure prompt payment complaints from physicians against health insurers are resolved expeditiously, preferably within 30 days of the complaint; and MSSNY will advocate for legislation that would increase the current prompt payment interest penalty above the current 12% per year threshold. (HOD 2015-61)
265.865 Payment for Services to Pharmacy Benefit Managers
The Medical Society of the State of New York will ask the AMA CPT Editorial Panel to determine the necessity of developing a new CPT code for the purposes of billing insurers for necessary communications with these insurers and/or their contracted pharmacy benefit managers, or whether existing codes could be used for this purpose. (HOD 2015-56)
265.865 Payment for Services to Pharmacy Benefit Managers
The Medical Society of the State of New York will ask the AMA CPT Editorial Panel to determine the necessity of developing a new CPT code for the purposes of billing insurers for necessary communications with these insurers and/or their contracted pharmacy benefit managers, or whether existing codes could be used for this purpose. (HOD 2015-56)
265.866 Use of Patient Satisfaction Surveys to Determine Payment for Medical Services
The Medical Society of the State of New York urges that health plans which use customer satisfaction surveys not use them to determine payment for medical services rendered but rather to educate providers in order to improve patient experiences. (HOD 2014-258)
265.867 Cost Concerns Used to Downgrade Physician Designation and Listing
on Insurance Panels
The Medical Society of the State of New York urges health plans to use cost analysis only as an educational tool for providers and not to downgrade physician designation or listing on insurance panels. (HOD 2014-259)
265.868 USE OF GUIDELINES AS ABSOLUTE OVER CLINICAL JUDGMENT BY THE PROVIDER
The Medical Society of the State of New York will seek through legislation, regulation or other relief, a prohibition against insurers using the existence of a clinical guideline to force an appeal. (HOD 2014-108)
265.869 Development of a Transparent and Fair Payment Process for ERISA Plans
MSSNY will introduce a resolution at the AMA House of Delegates seeking legislation through the Congress or through regulation by the Department of Labor which would require ERISA Plans develop and administer a transparent and fair process, similar to States prompt payment laws and CMS regulation, for the payment of claims to providers,. (HOD 2014-61; Reaffirmed HOD 2015 in lieu of res 62)
265.870: Development of A Fair and Transparent Recoupment Process to be
Used by Third Party Payers for Physicians
MSSNY will support legislation in New York State that mandates third party payers develop a standardized transparent recoupment process similar to the process outlined in CR6183 Section 935 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), and that prohibits third party payers from suspending payments to physicians without credible evidence of fraud and abuse. (HOD 2013-269)
265.871: Revision of AMA Current Procedure and Terminology (CPT) to
reflect EHR/EMR documentation and work processes
MSSNY recommends that the AMA review the CPT coding guidelines with the aim of developing a new model of payment that reflects 21st century EHR technology, and that the AMA make immediate revisions to the current CPT practice performance reporting process aimed at preparing the infrastructure for new models of paying for the delivery care. (HOD 2013-268)
265.872: Improvement in Coordination in Care in End of Life Patients
MSSNY should petition the American Medical Association to urgently provide a meaningful and continuous coordination between home, hospital and nursing home palliative processes, allowing for adequate reimbursement for all and avoiding disconnects such as the subacute wait to resume palliative care. MSSNY believes it urgently necessary that all medical insurance carriers be required to provide palliative care benefits that are consistent across all carriers and that do not create a complicated variable requirement and rules simply to hinder the process and avoid reimbursement. MSSNY also believes that nursing home palliative care reimbursement must be such that neither the nursing home nor the hospice suffers and that care can easily be coordinated within the last weeks and months of life. (HOD 2013-255)
265.873: Managed Care Contract Payment Should be above Medicare Fees
MSSNY should seek legislation and/or regulation to prevent managed care companies from utilizing a physician payment schedule below the updated Medicare professional fee schedule. The MSSNY delegation to the American Medical Association (AMA) should introduce a similar resolution at the next meeting of the AMA House of Delegates. (HOD 2013-254)
265.874: Use of Fair Health Database
MSSNY will advocate that any alternative payment structure of payments from private or public payors for episodes of care assure fair payments to the physicians who are providing the care, using the FAIR Health database as a reference. (HOD 2013-59)
265.875 Transparency in Out-of-Network Coverage
The Medical Society of the State of New York will seek legislation, regulation or other appropriate means to require greater transparency for all health insurance policies which provide out-of-network coverage so that consumers and physicians have a thorough knowledge and understanding of:
- Available benefits by the treating physicians and any restrictions on access to these benefits, either in-network or out-of-network;
- Physicians’ ability to review and discuss all available treatment options, out-of-network referrals, non-formulary medications, etc.;
- Methodology of payment and anticipated out-of-pocket expenses, etc.
And this legislation, regulation or other appropriate means should assure that health insurance companies selling out-of-network policies not be permitted to change or modify benefits or coverage provisions during the time the policy is in force. (HOD 2012-54; Reaffirmed HOD in lieu of 2017-111)
265.876 Reimbursement for Cost of Sign Language Interpreters
The Medical Society of the State of New York (MSSNY) will seek legislation and/or regulation to require health insurers to adequately reimburse physicians and other health care providers for the cost of providing sign language interpreters for hearing impaired patients in their care and the MSSNY Delegation to the American Medical Association (AMA) will introduce a resolution to the AMA House of Delegates asking the AMA to adopt similar policy (see AMA policy D-160.992). (HOD 2012-250) see MSSNY policy 240.990
265.877 Clear and Definitive Definitions of Abusive Billing Practices as
Stipulated in PHL 3224-b
Once a clear understanding of what is considered “abusive billing,” has been established, MSSNY will seek to have all health insurance carriers in the State of New York comply with the following provisions as agreed upon by MSSNY and United Healthcare:
- The physician will receive a letter notifying him/her that he/she has been selected for audit. The letter will explain the methodology used to make the determination. Importantly, only those physicians who, when compared against other physicians practicing in the same specialty in the same region are deemed to be the greatest statistical outliers, will be selected for audit. MSSNY has asked that this letter state very clearly how the physician was selected for audit;
- Carrier will initially request only two years of records selected by a random sample;
- Carrier will have the option to request agreement to toll the six years request option to reserve its right to do so at some time in the future;
- The physician will have the opportunity to challenge the findings in the claims randomly selected for the audit as to why they are “outliers;”
- The proposal outlines three possible courses of action depending upon the percentage of records reviewed that do not substantiate the services billed. Of particular note, if less than 40% of the medical records selected in the random sample do not substantiate the services billed, the only step that United will take will be conducting provider education. (HOD 2012-251)
265.878 Fair Compensation Mechanism for Changing Medications at Insurance Plan Request
The Medical Society of the State of New York will work towards developing a solution that equitably and safely allows medication changes to be made without penalizing the patient while fairly compensating the physician for their work involved in decision-making. (HOD 2012-252)
265.879 Directing Hospital Billing Payments to Physician of Record
The Medical Society of the State of New York will educate the membership, through an article in the News of New York, regarding the proper billing of non-physician practitioners (NPP) in the hospital setting dependent upon who is paying the salary of the NPP. (HOD 2012-256)
265.880 Time Limits for Recovery Audit Contractor (RAC) Reviews
The Medical Society of the State of New York will petition CMS to limit RAC reviews to less than one year from payment of claims and will send this resolution to the American Medical Association (AMA) at the next AMA House of Delegates (see AMA policy D-70.953). (HOD 2012-261; Reaffirmed HOD in lieu of 2017-108)
265.881 United Health Care Proposed Policy Concerning Overpayment Audits:
The MSSNY approved, but did not endorse, United Health Care’s newly proposed policy concerning overpayment audits. The revised policy included the following important provisions:
- Physicians will receive a letter notifying him/her that he/she has been selected for audit. The letter will explain the methodology used to make the determination. Importantly, only those physicians who, when compared against other physicians practicing in the same specialty in the same region are deemed to be the greatest statistical outliers, will be selected for audit;
- United will initially request only two years of records selected by a random sample;
- United will have the option to request a Tolling Agreement at any time to preserve the original six years look back if the error rate is very high.
- The proposal outlines three possible courses of action depending upon the percentage of records reviewed that do not substantiate the services billed. Of particular note, if less than 40% of the medical records selected in the random sample do not substantiate the services billed, the only step that United will take will be conducting provider education.
Council additionally approved that a report be provided every six months with data on each and every component of the new policy. Staff will follow up with United. (Council 11/3/11; Reaffirmed HOD 2013-269)
265.882 Direct Payments to Physicians by Insurance Carriers:
MSSNY will pursue regulation and/or legislation to compel third party payers to remit insurance payments directly to the non-participating physician when the insurance company is directed by the patient to do so. (HOD 2011-252)
265.883 Physicians and Evidence-Based Medicine (EBM):
MSSNY, in its deliberations and advocacy, will support the development and use of high-quality evidence-based medicine as a guide to treating patients, provided, however, that the ultimate decision for care for each patient must rest with the physician determining the most appropriate care and treatment for their patient based on the patient’s unique health care needs; and that evidence-based guidelines should not form the sole basis for health plan payment policies or liability. (HOD 2011-65; Reaffirmed HOD 2014-108)
265.884 Hospital Readmissions:
MSSNY will work with the Healthcare Association of New York and the Greater New York Hospital Association to amend state and federal law to exclude know and expected complications from “quality adjustment in DRG payment.” (Denial or reduction in payment when appropriate cause has been provided.) (HOD 2011-64)
265.885 Out-of-Network Reimbursement:
MSSNY will support and advocate for legislation and/or regulation that:
Requires managed care organizations to use the FAIR Health benchmarks as the basis for reimbursement for out-of-network charges for any policy that provides out-of-network benefits;
Prevents health insurance companies from selling policies that purport to but, in fact, fail to adequately cover out-of-network health care benefits;
Requires health insurance companies to “crosswalk” their out-of-network reimbursement methodology to true UCR (such as that being developed under FAIR Health). (HOD 2011-58)
265.886 Denying Reimbursement Based on Volume of Procedures Performed:
MSSNY is asked to challenge the Department of Health (DOH) on the current lack of quality data as it reflects solely on currently defined low volume threshold; request that the DOH re-examine the policy and reverse its denial of reimbursement based on new quantifiable data gathered since the policy has been in place; and communicate to the DOH its concern with the nature of the policy, the appeals process and the denial of reimbursement to the physicians who contract with the Medicaid fee for service and managed care Medicaid programs. (HOD 2010-262)
265.887 Re-evaluation of Evaluation and Management Codes:
MSSNY will urge the American Medical Association to conduct a study regarding the Evaluation and Management (E&M) process to assure fairness among specialties and classification of documentation to reduce irrelevant documentation and reduce audit risk. (HOD 2010-256)
265.888 Denial of Reimbursement Based on Volume of Procedures Peformed:
MSSNY will communicate its concern to the New York State Commissioner of Health, as well as to the Governor and State Legislature, regarding a newly implemented health department policy whereby payment for procedures or treatments performed at certain hospitals will be discontinued based on the volume performed within a calendar year, and work with the Department to monitor the impact of this policy on patient access to quality care within their community; and will create a multi-specialty work group to study the scientific relationship, if any, between low volume procedures and patient access to and the delivery of quality medical care. (Council 11/19/09)
265.889 Claims Denial Although Accurately Coded:
MSSNY will seek legislation that (1) would mandate the health care provider discuss denials based on policy, utilization or medical necessity with a physician of the insurance company rather than a non-physician representative and (2) the discussion between the health care provider and the Medical Director of the insurance company take place within a reasonable length of time after the request for such is made. (HOD 2009-265)
265.890 Medical Certification Paperwork:
MSSNY will study the issue of physician reimbursement for medical certification forms and advise physicians as to the ethical and legal options available in regard to this increasingly unwieldy, time-consuming issue for physicians. Also, MSSNY is to address the issue of medical certification paper work with third party payers and strongly urge them to provide reimbursement to physicians for the service of providing medical certification and medical reports for patients. (HOD 2009-261)
265.891 Adjustments Made to Relative Value Scale to Include Increased Paperwork for Physicians:
MSSNY will seek reconsideration of Work Relative Value Units for all AMA-CPT codes from the Relative Value Update Committee (RUC) to capture the additional work forced upon physicians by voluminous documentation requirements resulting from regulatory mandates when reimbursement rates are calculated and to transmit a similar resolution to the American Medical Association seeking passage of federal regulation and/or legislation to accomplish this reconsideration. (HOD 2009-258)
265.892 Medical Home Model:
MSSNY will study the medical home model through an existing committee or by establishing a Task Force on Medical Home Models with these directives:
- define medical home, including payment models, after considering American Medical Association Policy H-160.919;
- research successful medical home pilot projects;
- monitor the progress of medical home pilot projects in New York State;
- make policy and legislative agenda recommendations on this subject to the MSSNY Council; and
- develop a program to educate physicians in New York State about the opportunities and threats inherent in medical home pilot projects. (HOD 2009-94)
265.893 Assist Physician Practices to Move Toward Electronic Billing:
MSSNY will (a) work with National Government Services (NGS) to find and identify which physician practices continue to bill NGS via paper claims; (b) work at assisting member physician practices that file paper claims to move forward toward electronic billing; and (3) assist small member physician practices with being in a better position to afford HIPAA compliance. (Council 9/7/09)
265.894 Recovery of Damages Resulting from the Use of Flawed UCR Data:
MSSNY will support efforts to recover damages due participating physicians that resulted from the use of the flawed Usual Customary & Reasonable (UCR) (Ingenix) database. (Council 6/25/09)
265.895 United Health Group Policy Change:
MSSNY will contact the United Health Group immediately demanding that it halt and reverse its policy change of deletion of the use of UCR for determining reimbursement and replacement with the terminology of allowed charge and that it abide by the letter, spirit and intent of the Attorney General’s agreement, which they signed less than three months prior to MSSNY’s 2009 House of Delegates. Also, MSSNY to contact he Attorney General’s office alerting them of the action to be taken by United Health Group in what is a clear attempt to circumvent the terms of the Ingenix agreement. (HOD 2009-76)
265.896 Legal Flexibility to Offer Uninsured Patients Structured Pre-Payment Options:
MSSNY will support innovative strategies and physician initiatives that allow or enhance universal access to medical care, including permitting physicians legal flexibility to offer otherwise uninsured patients structured pre-payment options for accessing care in their office. (HOD 2009-65)
265.897 Inappropriately Constrained Provider Reimbursement,
Increasing Health Insurance Premiums and Increased Patient Cost-
MSSNY should continue to advocate to the Legislature, the Governor, the Department of Health and other relevant policymakers to address these problems facing physicians, businesses and patients which at the same time that health plans are generating enormous and excessive profits. (Council 3/03/08)
265.898 Universal Explanation of Benefits (EOB):
MSSNY will seek the enactment of legislation, regulation or other appropriate means to (1) require health plans to use a universal Explanation of Benefits (EOB) form for patients and physicians and (2) assure that such universal EOB form provide detailed, easily understandable explanations for patients and physicians as to why a particular claim or a portion of a claim will not be paid by a health plan. (HOD 2008-60; Reaffirmed HOD 2009-70)
265.899 Payment for Procedures:
MSSNY to seek legislation, regulation or other appropriate means to require health insurers to pay for any and all procedures clinically indicated pursuant to specialty society guidelines that are prudent and unanticipated at the time of performing pre-approved procedures. (HOD 2008-57)
265.900 Non-Participating Physicians Who Accept Assignment:
MSSNY should seek to assure that legislation to protect the ability of a patient to assign payment to a non-participating treating physician also preserves the ability of such non-participating physician to be reimbursed their usual and customary fee. (HOD 08-56; Reaffirmed HOD 2009-63; Reaffirmed HOD 2016-50)
265.901 New Federal Legislation re Prompt Payment and Amendment of
New York State Prompt Payment Law:
MSSNY will work with the American Medical Association for the introduction of federal legislation that imposes a strong federal standard for prompt payment, following the AMA’s recommendations which include:
- requiring payment within 30 days for clean paper claims and 14 days for clean electronic claims;
- imposing stiffer fines than those currently in state laws, for insurers that fail to comply with the federal prompt payment law;
- requiring that interest be assessed on the amount of payment outstanding, and that interest increase with the length of time the claim has been delinquent;
- requiring that the insurer absorb any fees and costs that the physician may incur due to the lack of prompt payment of the claim, provided that the physician can document that these fees or costs might not have been incurred if the claim had been paid within the mandated timeframe.
MSSNY also will work with the AMA for a federal law that:
- sets a statutorily defined time limit for insurers to notify physicians that additional information is needed to process a claim;
- requires the insurer to specify, in the notice, all problems with the claim and give the physician an opportunity to provide the information needed;
- requires the insurer to pay any portion of a claim that is complete and uncontested.
Also, MSSNY will work towards amending New York’s Prompt Payment Law to:
- include all applicable provisions of the federal law mentioned above;
- provide that where New York law is stronger than federal law or addresses an issue that is not part of federal law, the state law should take precedence. (HOD 2008-55; Reaffirmed HOD 2015 in lieu of res 62)
265.902 Charge for Referrals and Prior Authorizations:
MSSNY to seek the introduction of regulation/legislation to allow physicians to be paid by health insurers for referrals and prior authorizations reflecting their costs in time and personnel for each and every referral or prior authorization sought. (HOD 2008-53)
265.903 Complexity of the RBRVS Evaluation and Management Codes:
MSSNY to submit a resolution to the American Medical Association calling for the simplification of the RBRVS Evaluation and Management coding assisted by the use of specialty-specific vignettes, by focusing on the complexity of decision making, uncoupling it from the history and physical and, thereby, eliminating the counting of elements in the history and physical exam. (HOD 2008-257)
265.904 Reduced Hassle for the Hassle Factor Form:
MSSNY will develop a mechanism. in conjunction with the county societies, to more effectively collect insurance hassle data from aggrieved physicians and, when necessary, provide guidance and assistance in completing the form, in order to remove any hurdles and to improve data collection to more accurately represent our members. (HOD 2008-255)
265.905 Availability of Cornea Donor Tissue:
MSSNY to ask the New York State Health Commissioner, the Superintendent of Insurance and any and all other appropriate authorities to review and reconsider reimbursement policies in the state pertaining to cornea donor tissue procedures. (HOD 2008-167)
265.906 Physician Reimbursement for Home Care:
MSSNY will work to assure appropriate reimbursement to physicians, by all health insurance plans, including Medicaid, for rendering in-home care to homebound individuals so that hospital length of stay is reduced and there is greater flexibility in managing care and the potential for decreasing cost and improving quality. (HOD 2008-161)
265.907 Promotion of the Hassle Factor Form:
MSSNY will promote the Hassle Factor Form to hospital faculty practice plans so that MSSNY is able to garner more data from both member and non-member physicians for referral to the appropriate authorities for action. (Council 3/3/08)
265.908 Impediments Imposed by Health Insurance Companies to Obtaining Pre-Authorization:
MSSNY will take appropriate steps including, if necessary, seeking the enactment of legislation and regulation, to eliminate unnecessary impediments imposed by health insurance companies to obtaining pre-authorization, including reducing the need and time for obtaining pre-authorizations. (Council 3/3/08; Reaffirmed HOD 2008-50; Reaffirmed HOD 2016-262)
265.909 HMOs Decreasing Reimbursement & Patient Co-Payments:
MSSNY will continue to advocate to the Legislature, the Governor, the Department of Health and other relevant policymakers to address the problem facing physicians, businesses and patients regarding inappropriately constrained provider reimbursement, rapidly increasing health insurance premiums and increased patient cost-sharing at the same time that health plans are generating enormous and excessive profits. (Council 3/3/08)
265.910 Publicizing the Hassle Factor Form:
Deleted (HOD 2007-264, Combined with 265.915 as single policy, HOD 2017)
265.911 ERISA Plans and the United States Department of Labor:
MSSNY will seek the support of the American Medical Association in proposing an amendment to federal legislation that would modify ERISA law to incorporate a clause that addresses timely payment of medical claims of health care practitioners who provide treatment in good faith to the members of self-funded group employer-sponsored health plans; and
When the federal law is amended, the Medical Society of the State of New York will work with the United States Department of Labor to devise and implement a formalized appeal process at the United States Department of Labor, with a specific dedicated service center and contact persons. (HOD 2007-251; Reaffirmed HOD 2017)
265.912 Reimbursement for Participation:
MSSNY adopts the American Medical Association’s Principles for Pay-for-Performance and Guidelines for Pay-for-Performance, H-450.947:
PRINCIPLES FOR PAY-FOR-PERFORMANCE PROGRAMS
Physician pay-for-performance (PFP) programs that are designed primarily to improve the effectiveness and safety of patient care may serve as a positive force in our health care system. Fair and ethical PFP programs are patient-centered and link evidence-based performance measures to financial incentives. Such PFP programs are in alignment with the following five AMA principles:
- Ensure quality of care – Fair and ethical PFP programs are committed to improved patient care as their most important mission. Evidence-based quality of care measures, created by physicians across appropriate specialties are the measures used in the programs. Variations in an individual patient care regimen are permitted based on a physician’s sound clinical judgment and should not adversely affect PFP program rewards. 2. Foster the patient/physician relationship – Fair and ethical PFP programs support the patient/physician relationship and overcome obstacles to physicians treating patients, regardless of patients’ health conditions, ethnicity, economic circumstances, demographics, or treatment compliance patterns.
- Offer voluntary physician participation – Fair and ethical PFP programs offer voluntary physician participation, and do not undermine the economic viability of non-participating physician practices. These programs support participation by physicians in all practice settings by minimizing potential financial and technological barriers including costs of start-up.
- Use accurate data and fair reporting – Fair and ethical PFP programs use accurate data and scientifically valid analytical methods. Physicians are allowed to review, comment and appeal results prior to the use of the results for programmatic reasons and any type of reporting.
- Provide fair and equitable program incentives – Fair and ethical PFP programs provide new funds for positive incentives to physicians for their participation, progressive quality improvement, or attainment of goals within the program. The eligibility criteria for the incentives are fully explained to participating physicians. These programs support the goal of quality improvement across all participating physicians.
GUIDELINES FOR PAY-FOR-PERFORMANCE PROGRAMS
Safe, effective, and affordable health care for all Americans is the AMA’s goal for our health care delivery system. The AMA presents the following guidelines regarding the formation and implementation of fair and ethical pay-for-performance (PFP) programs. These guidelines augment the AMA’s “Principles for Pay-for-Performance Programs” and provide AMA leaders, staff and members with operational boundaries that can be used in an assessment of specific PFP programs.
Quality of Care
– The primary goal of any PFP program must be to promote quality patient care that is safe and effective across the health care delivery system, rather than to achieve monetary savings.
– Evidence-based quality of care measures must be the primary measures used in any program.
- All performance measures used in the program must be prospectively defined and developed collaboratively across physician specialties.
- Practicing physicians with expertise in the area of care in question must be integrally involved in the design, implementation, and evaluation of any program.
- All performance measures must be developed and maintained by appropriate professional organizations that periodically review and update these measures with evidence-based information in a process open to the medical profession.
- Performance measures should be scored against both absolute values and relative improvement in those values.
- Performance measures must be subject to the best-available risk- adjustment for patient demographics, severity of illness, and co-morbidities.
- Performance measures must be kept current and reflect changes in clinical practice. Except for evidence-based updates, program measures must be stable for two years.
- Performance measures must be selected for clinical areas that have significant promise for improvement.
– Physician adherence to PFP program requirements must conform with improved patient care quality and safety.
– Programs should allow for variance from specific performance measures that are in conflict with sound clinical judgment and, in so doing, require minimal, but appropriate, documentation.
– PFP programs must be able to demonstrate improved quality patient care that is safer and more effective as the result of program implementation.
– PFP programs help to ensure quality by encouraging collaborative efforts across all members of the health care team.
– Prior to implementation, pay-for-performance programs must be successfully pilot-tested for a sufficient duration to obtain valid data in a variety of practice settings and across all affected medical specialties. Pilot testing should also analyze for patient de-selection. If implemented, the program must be phased-in over an appropriate period of time to enable participation by any willing physician in affected specialties.
– Plans that sponsor PFP programs must prospectively explain these programs to the patients and communities covered by them.
– Programs must be designed to support the patient/physician relationship and recognize that physicians are ethically required to use sound medical judgment, holding the best interests of the patient as paramount.
– Programs must not create conditions that limit access to improved care.
- Programs must not directly or indirectly disadvantage patients from ethnic, cultural, and socio-economic groups, as well as those with specific medical conditions, or the physicians who serve these patients.
- Programs must neither directly nor indirectly disadvantage patients and their physicians, based on the setting where care is delivered or the location of populations served (such as inner city or rural areas).
– Programs must neither directly nor indirectly encourage patient de-selection.
– Programs must recognize outcome limitations caused by patient non-adherence, and sponsors of PFP programs should attempt to minimize non-adherence through plan design.
– Physician participation in any PFP program must be completely voluntary.
– Sponsors of PFP programs must notify physicians of PFP program implementation and offer physicians the opportunity to opt in or out of the PFP program without affecting the existing or offered contract provisions from the sponsoring health plan or employer.
– Programs must be designed so that physician nonparticipation does not threaten the economic viability of physician practices.
– Programs should be available to any physicians and specialties who wish to participate and must not favor one specialty over another. Programs must be designed to encourage broad physician participation across all modes of practice.
– Programs must not favor physician practices by size (large, small, or solo) or by capabilities in information technology (IT).
- Programs should provide physicians with tools to facilitate participation.
- Programs should be designed to minimize financial and technological barriers to physician participation.
– Although some IT systems and software may facilitate improved patient management, programs must avoid implementation plans that require physician practices to purchase health-plan specific IT capabilities.
– Physician participation in a particular PFP program must not be linked to participation in other health plan or government programs.
– Programs must educate physicians about the potential risks and rewards inherent in program participation, and immediately notify participating physicians of newly identified risks and rewards.
– Physician participants must be notified in writing about any changes in program requirements and evaluation methods. Such changes must occur at most on an annual basis.
Physician Data and Reporting
– Patient privacy must be protected in all data collection, analysis, and reporting. Data collection must be administratively simple and consistent with the Health Insurance Portability and Accountability Act (HIPAA).
– The quality of data collection and analysis must be scientifically valid. Collecting and reporting of data must be reliable and easy for physicians and should not create financial or other burdens on physicians and/or their practices. Audit systems should be designed to ensure the accuracy of data in a non-punitive manner.
- Programs should use accurate administrative data and data abstracted from medical records.
- Medical record data should be collected in a manner that is not burdensome and disruptive to physician practices.
- Program results must be based on data collected over a significant period of time and relate care delivered (numerator) to a statistically valid population of patients in the denominator.
– Physicians must be reimbursed for any added administrative costs incurred as a result of collecting and reporting data to the program.
– Physicians should be assessed in groups and/or across health care systems, rather than individually, when feasible.
– Physicians must have the ability to review and comment on data and analysis used to construct any performance ratings prior to the use of such ratings to determine physician payment or for public reporting. 1. Physicians must be able to see preliminary ratings and be given the opportunity to adjust practice patterns over a reasonable period of time to more closely meet quality objectives. 2. Prior to release of any physician ratings, programs must have a mechanism for physicians to see and appeal their ratings in writing. If requested by the physician, physician comments must be included adjacent to any ratings.
– If PFP programs identify physicians with exceptional performance in providing effective and safe patient care, the reasons for such performance should be shared with physician program participants and widely promulgated.
– The results of PFP programs must not be used against physicians in health plan credentialing, licensure, and certification. Individual physician quality performance information and data must remain confidential and not subject to discovery in legal or other proceedings.
– PFP programs must have defined security measures to prevent the unauthorized release of physician ratings.
– Programs must be based on rewards and not on penalties.
– Program incentives must be sufficient in scope to cover any additional work and practice expense incurred by physicians as a result of program participation.
– Programs must offer financial support to physician practices that implement IT systems or software that interact with aspects of the PFP program.
– Programs must finance bonus payments based on specified performance measures with supplemental funds.
– Programs must reward all physicians who actively participate in the program and who achieve pre-specified absolute program goals or demonstrate pre-specified relative improvement toward program goals.
– Programs must not reward physicians based on ranking compared with other physicians in the program.
– Programs must provide to all eligible physicians and practices a complete explanation of all program facets, to include the methods and performance measures used to determine incentive eligibility and incentive amounts, prior to program implementation.
– Programs must not financially penalize physicians based on factors outside of the physician’s control.
– Programs utilizing bonus payments must be designed to protect patient access and must not financially disadvantage physicians who serve minority or uninsured patients.
(2) Our AMA opposes private payer, Congressional, or Centers for Medicare and Medicaid Services pay-for-performance initiatives if they do not meet the AMA’s “Principles and Guidelines for Pay-for-Performance.” (BOT Rep. 5, A-05; Reaffirmation A-06; Reaffirmed: Res. 210, A-06; Reaffirmed in lieu of Res. 215, A-06; Reaffirmed in lieu of Res. 226, A-06; Reaffirmation I-06; Reaffirmation A-07). (HOD 2007-94; Modified and Reaffirmed HOD 2017)
265.913 Managed Care and Medicare “Carve-Out” Services:
In those instances where an insurance company has “carved out” specific services, and has contracted with an outside party to arrange and pay for these services, and then denies reimbursement on the basis that such payment is no longer their responsibility, MSSNY to (1) advocate for a physician’s ability to seek payment directly from the patient without being considered a violation of the physician’s participation agreement; and (2) seek legislation, regulation or other appropriate means to assure that participating physicians and patients are given advance written notification by payors that the plan has carved out the provision of and payment for specific services such as radiology or diagnostic studies to a specific third party. (HOD 2007-66; Reaffirmed HOD 2017)
265.914 Electronic Payment or Funds Transfer Systems:
MSSNY will: (1) urge insurance companies initiating electronic payment or funds transfer systems to allow physicians with fewer than 10 Full-Time Equivalent (FTE) Employees to claim an exemption to mandatory electronic payment or funds transfer system; (2) seek to assure that physician practices of all sizes have the option to receive payments electronically; and (3) work with appropriate regulatory agencies to assure that health insurers may not withdraw funds from a physician’s account, except with the express written authorization of the physician. (HOD 2007-63; Reaffirmed HOD 2017)
265.915 Insurance Companies and Publicizing the Hassle Factor Form:
That MSSNY monitor unfair business practices of health plans though the use of the new MSSNY Hassle Factor Form (HFF), creating or joining with a coalition of stakeholders (to include physician groups and leaders of industry and business who bear the burden of health care costs) and dependent upon the anticipated reports culminating from the use of the HFF and the work of the coalition seek passage of state regulation and/or legislation to rectify these unfair business practices. MSSNY will take whatever steps it can to maximize use of the Hassle Factor form and disseminate its findings to all concerned. (HOD 2006-269; Reaffirmed Council 12/13/07; 265.915 Amended by inclusion of 265.910 and Reaffirmed HOD 2017) (265.910 -HOD 2007-264) deleted and combined with 265.915 HOD 2017)
265.914 Electronic Payment or Funds Transfer Systems:
MSSNY will: (1) urge insurance companies initiating electronic payment or funds transfer systems to allow physicians with fewer than 10 Full-Time Equivalent (FTE) Employees to claim an exemption to mandatory electronic payment or funds transfer system; (2) seek to assure that physician practices of all sizes have the option to receive payments electronically; and (3) work with appropriate regulatory agencies to assure that health insurers may not withdraw funds from a physician’s account, except with the express written authorization of the physician. (HOD 2007-914)
265.915 Insurance Companies:
That MSSNY monitor unfair business practices of health plans though the use of the new MSSNY Hassle Factor Form (HFF), creating or joining with a coalition of stakeholders (to include physician groups and leaders of industry and business who bear the burden of health care costs) and dependent upon the anticipated reports culminating from the use of the HFF and the work of the coalition seek passage of state regulation and/or legislation to rectify these unfair business practices. (HOD 2006-269; Reaffirmed Council 12/13/07)
265.916 NYS DOH Review of Provider Contracts:
That MSSNY seek legislation, regulation or other appropriate means to assure that the Department of Health review health plan standard provider contracts to assure that the contract terms contained are fair to physicians and patients in those situations where the health plan holds a 10% market share in a particular region of the State; and to assure that the Commissioner of Health or the Superintendent of Insurance organize roundtable meetings between health insurance companies and physician representatives for the specific purpose of discussing and attempting to resolve problematic contract terms in standard health plan contracts. (HOD 2006-65; Reaffirmed HOD 2016)
265.917 Pay for Performance:
MSSNY recommend that all Pay for Performance (PFP) programs pay physicians a per-member-per-month fee for data collection for all lives covered in the program; that this policy be consistently articulated by all MSSNY representatives at any meeting regarding PFP; that MSSNY neither endorse any PFP programs nor encourage its members to participate in any PFP programs unless all participating physicians receive adequate compensation for data collection and submission; and that a similar resolution be sent to the American Medical Association. (HOD 2006-93; Reaffirmed HOD 2016)
265.918 Payment for Urgent and Emergent Health Care Services:
That MSSNY seek public policy, regulation or legislation that would require health care payers in New York to pay for all reasonable urgent and emergent medical services for their covered patients, that the definition of reasonable urgent medical services should carry the prudent layperson standard similar to what is already in effect for emergent medical services, and that health care payers reimburse out of network physicians for care provided on urgent or emergency basis at a level which the physician believes fairly reflects the costs of providing a service and the value of their professional judgment. (Council 1/26/06; Reaffirmed HOD 2017)
265.919 Hassle Factor:
MSSNY embark on the production and implementation of an electronic data collection program of insurance grievances; and create a mechanism to enable access for those members who are not electronically connected. (Council 1/26/06; Reaffirmed HOD 2016)
265.920 Payments for Urgent and Emergent Health Care Services:
Sunset HOD 2017
265.921 Unreasonable Taxes on Medical Care:
MSSNY proactively and vigorously opposes taxes on physician services including but not limited to cosmetic surgery, physician–owned facility taxes or “pass-through” taxes on medical services. (HOD 2005-88; Reaffirmed HOD 2010-68)
265.922 Supporting Legislation to Promote Telemedicine:
HOD 2005-53; SUNSET HOD 2015)
265.923 Legal Strategies to Combat Unsubstantiated Third-Party Payer Refund Demands:
MSSNY will continue to monitor refund demands stemming from carrier errors that appear to demonstrate unfair business practices that are deceptive, misleading or fraudulent and report these to the Office of the Attorney General. (HOD 2005-214; Reaffirmed HOD 2015)
265.924 Gross Receipts Tax:
MSSNY oppose the imposition of taxes and cuts in payment that hinder the ability of physicians to provide needed care to patients. (HOD 2004-81; Reaffirmed HOD 2014)
- Pay Physicians for Emergency Room Call:
MSSNY urges hospitals to compensate physicians for being “on emergency room call” unless they choose to work voluntarily. (Council 6/3/04; Reaffirmed HOD 2014)
- Single Set of Rules for Physician Reimbursement:
SUNSET HOD 2014
- Single Set of Rules for Physician Reimbursement:
265.927 Patients’ Out of Pocket Financial Responsibility for Emergency
Room Services Provided:
MSSNY opposes efforts, including legislation and regulation, to prevent an out-of-network physician who provides emergency care to a patient from receiving their full charge and that no patient out of network deductible/co-pay should apply. (HOD 2004-74; Reaffirmed HOD 2014)
265.928 Preventive Healthcare Reimbursement:
SUNSET HOD 2014
265.929 Elimination of Pre-Surgical Authorizations:
SUNSET HOD 2013
265.930 Reimbursement for Well Child Visits:
SUNSET HOD 2013
265.931 Out-of-Network Status Should be Applied Only to Specifically Out-
MSSNY will seek legislation that would prevent health insurance plans from refusing reimbursement to participating members of a medical team involved in the care of a patient when there is a non-participating member of the team involved in the patient’s care. Non-participating status would apply only to the non-participating provider. (HOD 2002-264; Modified and reaffirmed HOD 2013)
265.932 Amendment to the Definition of “Covered Service” for Third Party
MSSNY has adopted as policy the following definition of covered service for insurance payment purposes. A covered service is defined as: (l) separately identifiable by the American Medical Association Current Procedural Terminology code; (2) allowed, reimbursable, and paid by the third party insurer or plan; and (3) therefore, all other services be considered non-covered and be considered the responsibility of the plan subscriber.
MSSNY will seek legislation incorporating this definition in future legislative actions.(HOD 2002-261; Reaffirmed HOD 2003-268 & 278; Reaffirmed HOD 2013)
265.933 Automatic Crossover of Payment between Medicare and Medicaid:
MSSNY should seek changes in State regulation, to mandate that patients with both Medicare and Medicaid have their claims electronically forwarded from Medicare to Medicaid so that the claims are processed in a prompt and reasonable fashion. (HOD 2002-253; Reaffirmed HOD 2006-259; Reaffirmed HOD 2009-101)
265.934 Reduction of Surgical Aftercare Periods:
MSSNY will advocate for a maximum aftercare period of 30 days for reimbursement related to each surgical procedure. (HOD 2002-251; Reaffirmed HOD 2013)
265.935 Third Party Payors Held to the Same Standard of Payment:
MSSNY will seek legislation or whatever appropriate means are necessary to assure that third party payors are held to the standard of the Prompt Payment Law and that the provider should have the ability to collect payment from the patient if the claim is denied for reasons not due to the fault of the physician. (HOD 2002-80; Reaffirmed HOD 2003-268 & 278; Reaffirmed HOD 2013)
265.936 Support the Health Insurance Guarantee Fund:
SUNSET HOD 2013
265.937 Changing of Prescriptions by Managed Care Organizations or Pharmacies:
MSSNY will seek regulation and/or legislation to mandate that health insurers recognize and reimburse for existing CPT codes for patient management activities when the insurer and/or PBM request the substitution of a prescription drug for that which has been prescribed. (HOD 2002-51; Reaffirmed HOD 2013; Reaffirmed HOD 2015-56)
265.938 Contact Information Needed on EOMBs:
It is MSSNY’s policy that the New York State Department of Insurance should impose a new requirement on all third-party payers, requiring that these plans format their Explanation of Medical Benefits (EOMBs) to include the name and phone number of a responsible, readily available individual on the carrier staff.
MSSNY will urge the New York State Department of Insurance to require all third party payers to respond to telephone inquiries within twenty-four hours. (HOD 2001-260; Reaffirmed HOD 2009-259)
265.939 Electronic Billing:
SUNSET HOD 2013
265.940 Aetna/US HealthCare’s Use of a Primary Physician Communication Form:
Sunset HOD 2011
265.941 Addressing Third Party Payers’ Policy Regarding Modifier 25:
MSSNY will recommend that all third party payers pay for Modifier 25 submitted by physician practices. (Council 1/25/01; Reaffirmed HOD 2003-268 & 278; Modified and reaffirmed HOD 2013)
265.942 Costs to the Private Medical Practitioner of Complying with
New Unfunded Federal Mandate Called the Needlestick Safety and Prevention Act: Sunset HOD 2011
265.943 Coverage of Strabismus Surgery:
Sunset HOD 2011
265.944 Multiple Billing Addresses for Submission of Doctors’ Bills to
Individual Health Care Plans:
Sunset HOD 2011
265.945 Prevnar, Pneumococcal 7-Valent Conjugate Vaccine:
Sunset HOD 2011
265.946 Adequate Reimbursement for Screening Mammography:
MSSNY will seek regulation and/or legislation that ensures payment for diagnostic and screening mammography at a rate commensurate with the cost of services. (HOD 2001-254; Reaffirmed HOD 2013)
MSSNY will seek the passage of state and federal legislation requiring the insurance industry to cover scientifically-proven, effective therapy services needed by autistic individuals. (HOD 2001-167; Reaffirmed HOD 2003-276; Reaffirmed HOD 2015)
265.948 Vaccination Schedule Should be Accepted by All Insurance
SUNSET HOD 2014
265.949 Periodic Summary of Physician Submitted Claims:
MSSNY will seek legislation, regulation or other appropriate action that would require all insurance companies and managed care plans licensed in the State of New York to provide each physician who has submitted a claim to that company or plan with a periodic summary (weekly, monthly or quarterly) of all of that physician’s pending claims, including the status of each claim, regardless of the physician’s participation status with that company or the manner by which the claim has been submitted, i.e. paper or electronic format. (HOD 2001-83; Reaffirmed HOD 2011)
265.950 Insurance Company/Managed Care Plan Acceptance of Physicians
Sunset HOD 2011
265.951 Cost of Living Adjustment to Compensate for Rising Overhead
MSSNY supported a resolution to the American Medical Association House of Delegates requesting passage of federal legislation requiring that insurance reimbursement have an annual cost of living adjustment to compensate for rising overhead expenses. (HOD 2001-58; Reaffirmed HOD 2011)
265.952 HCFA Evaluation and Management Codes – Modifier 25:
SUNSET HOD 2014
265.953 Reimbursement for Baclofen Pump:
MSSNY will seek legislation to expand the Medicaid reimbursement formula for the Baclofen pump insertions to include the cost of the pump as an outlier in the DRG fee for this procedure. (HOD 2000-281; Reaffirmed HOD 2014)
265.954 Implementation of Carrier Advisory Committee (CAC) Functions
by Third-Party Insurers:
MSSNY will seek legislative or regulatory relief to require all third-party payers to implement a Carrier Advisory Committee (CAC) function, in order that carriers’ medical/surgical claims processing policies may be codified with the input of the specialty societies in New York State. (HOD 2000-269; Reaffirmed HOD 2003-268 & 278; Reaffirmed HOD 2013)
265.955 Managed Care Organizations Should Disclose Their UCR
SUNSET HOD 2014
265.956 Unfair Claims Filing by HMOs:
MSSNY will seek legislative action to prevent any Third Party Payer doing business in New York State from seeking repayment or refund through withholding of claim payments relating to treatment of other patients (offset). (HOD 2000-265; Reaffirmed HOD 2010-259)
265.957 Recognition of “Incident To” Services:
SUNSET HOD 2013
265.958 Authorized Assignment of Benefits:
MSSNY will seek legislation or regulation to: (a) ensure that third-party payers be required to issue payment directly to providers when the patient has signed an authorization for the assignment of benefits; (b) mandate that health plans notify physicians when claim payments are issued to the insured rather than the physician who has an assignment agreement; (c) develop a mechanism for health plans to have the legal responsibility for reporting claim payments made to insureds/patients to the Internal Revenue Service as ‘1099’ Compensation Income when payment has not been made to the physician who provided care.
MSSNY will seek federal legislation to have plans currently protected by ERISA produce the same ‘1099’ Compensation Income reports made to the beneficiary when health plan payments are made to the beneficiary rather than the physician who provided treatment. (HOD 2000-256; Reaffirmed HOD 2009-63; Reaffirmed HOD 2015 in lieu of res 63; Reaffirmed HOD-2016-50)
265.959 Insurance Companies Should Reimburse Physicians for Telephone Time with Pharmacies:
MSSNY will seek regulatory or legislative action to (a) require health care plans doing business in New York State to recognize, as a separate service, through the existing AMA-CPT coding nomenclature, telephone calls communicating with family members, medical entities, pharmacies, benefit management companies, case managers, and others as required for patient management and care; (b) require health care plans in New York State to disclose in the health plan’s benefit package that telephone management services for patients, as well as the time spent placing the phone call(s) is a separate service and specify whether the service is a covered or non-covered service.
If telephone management for patients, and the time spent making the phone call(s) is deemed to be a non-covered service, MSSNY will seek regulatory or legislative relief which would require health care plans to honor an Advance Notification Agreement between the physician and the patient through a formal Waiver of Liability, whereby payment for this service becomes the responsibility of the patient.
MSSNY will seek regulatory or legislative action mandating the provision of toll-free telephone and FAX numbers for physician use by all health care plans, products and mail order pharmacies doing business in New York State. Said legislation or regulation will include a provision that the waiting time for physicians and their office staff required by the payers to use these toll-free telephone numbers be no more than five (5) to ten (10) minutes. (HOD 2000-252; Reaffirmed 2014 HOD; Reaffirmed HOD 2015-56)
265.960 Reimbursement of Accutane:
MSSNY will urge the New York State Insurance Department to require insurance companies to reimburse for Accutane without forcing the physician to first prescribe unnecessary and potentially dangerous antibiotics. (HOD 2000-167; Reaffirmed HOD 2014)
265.961 Accountability of Management Service Organizations:
MSSNY will seek legislation which would (a) require that management service organizations that contract with health insurance entities to review, process and pay physician-submitted claims, grant authorizations and pre-certifications where appropriate, apply internal policy payment parameters frequently without physician input, be held accountable to the same State imposed standards, i.e. the Prompt Payment Law, as all insurance entities licensed in New York State, (b) mandate that the New York State Insurance Department have jurisdiction over management service organizations which contract with health insurance entities to review, process and pay claims.
It is MSSNY policy that insurance entities licensed in New York State that contract with management service organizations should be held accountable for the actions of these contracted organizations. (HOD 2000-88; Reaffirmed HOD 2014)
265.962 Enhancements to the Prompt Payment Law:
MSSNY will seek enhancements to the current Prompt Payment Law stipulating that when additional information has been requested and received from a physician and/or patient, that the health care plan requesting the information be required to process and pay that claim within a specified (reasonable) period of time, or be subject to severe monetary penalties.
Once an HMO places a claim in a “pended” category (awaiting additional information), the HMO should be required to continue written communications with the physician and/or patient, on a periodic basis (i.e., every 30, 60 or 90 days) until the requested documentation has been received. (HOD 2000-71; Reaffirmed HOD 2014)
265.963 All Products Clause in Insurance Participating Provider Contracts:
MSSNY will seek legislation to ban “all products” clauses in health care plan participating provider contracts, and to bar health care plans from requiring participation in any other products as a requisite for participation in Child Health Plus or Family Health Plus. (HOD 2000-68; Reaffirmed HOD 2014; Reaffirmed HOD 2016-52)
265.964 Review of Pre-Authorizations by a Licensed Physician:
MSSNY will seek legislation to require that all pre-authorizations for procedures be reviewed by a New York State licensed practicing physician who is board certified or board eligible in the same specialty as the requesting physician prior to any denial of pre-authorization. (HOD 2000-67; Reaffirmed HOD 2014)
265.965 Physician Appeal’s Mechanisms for Down Coded or Denied Claims:
MSSNY will seek legislation and/or regulation to ensure that physicians have an appropriate appeals mechanism which third party payors should make available to physicians when claims have been denied or “down coded” by such payors. Such legislation and/or regulation should require (a) all payors to notify the physicians of the appropriate appeals mechanism to be utilized when a claim is denied or “down coded” and (b) all third party payors to provide physicians with a clear and accurate explanation on all claims that have been denied or “down coded”. (HOD 2000-66; Reaffirmed HOD 2014)
265.966 Circumvention of the Prompt Payment Law in New York State:
MSSNY will seek amendment to the present Prompt Payment legislation to impose penalties on those carriers that have been determined to be circumventing the Prompt Payment law by “forcing claims to payment” to meet the prescribed deadlines and then demanding refunds well after the claims have been paid. (HOD 2000-65; Reaffirmed HOD 2104)
265.967 Recognition of Modifier 25:
SUNSET HOD 2014
265.968 Pre-Authorization Denials:
SUNSET HOD 2014
265.969 Proper Insurance Claim Protocol:
SUNSET HOD 2013
265.970 Prompt Payment Law:
MSSNY will seek legislation to amend the Prompt Payment Law so as to allow relief for physicians through a class action suit. (Council 9/30/99; Reaffirmed HOD 2014)
265.971 Guaranteed Trust Corporation for Health Insurance:
MSSNY will seek legislation or regulation requiring the information of a Guaranteed Trust Corporation for health insurance in New York State. (Council 2/4/99; Reaffirmed HOD 2014)
265.972 Responsibility for Carrier Errors on “Explanation of Benefits Forms:
SUNSET HOD 2014
265.973 Physician Responsibility for County Nursing Service:
MSSNY will seek federal and state legislative or regulatory relief requiring Medicare and other insurers based in this state to hold Nursing Service Agencies responsible for their billing practices and for the care decisions they make that either deviate from physician instructions, are devoid of related physician input, or are violative of HCFA guidelines. Physicians will be held harmless when their Home Health Certification and Plan of Care Forms (HCFA 485 form) differ from by the actual services rendered by the Nursing agencies, and MSSNY shall pursue every available avenue at both the state level and nationally through our representation with the American Medical Association to protect physicians from being held responsible for care provision and billing beyond their control pertaining to Nursing services. (HOD 1999-273; Reaffirmed HOD 2014)
265.974 Support of MSSNY President Ralph Schlossman’s Response to
HCFA’s “Fraud Seminars
SUNSET HOD 2014
265.975 Inappropriate Usage Of Correct Coding Initiative and HBOC Software
MSSNY will oppose the reduction of payment for medical services under Medicare without notice or the publication of regulations, including the continuing expansion of the Correct Coding Initiative (CCI) in concert with the “Black Box” edits produced by HBOC Software. MSSNY will communicate its objection to the reduction of payments for services by the continuous expansion of the CCI in conjunction with HBOC Software directly to HCFA and through its representatives on the New York Medicare Carrier Advisory Committee and the American Medical Association. MSSNY will instruct its Delegates to the American Medical Association House of Delegates to introduce a resolution at its next meeting asking the AMA to take all necessary steps to prevent the continuation of the reduction in payments or medical services under Medicare by inappropriate usage of the CCI and the HBOC Software or any equivalent process without notice to or comment by the public or Medical profession. (HOD 1999-256; Reaffirmed HOD 2000-268; HOD 2003-268 & 278 and HOD 2005-276; Reaffirmed HOD 2015)
265.976 Cost of Living Increases to Physician:
MSSNY will seek the introduction of appropriate state legislation calling for the levels of physician payments by public and private health insurers to be annually adjusted with a cost of living increase tied to the Department of Labor cost of living index, with this increase remaining independent of adjustments made for any rising costs of providing services. (HOD 1999-255; Reaffirmed HOD 2014)
265.977 Pre-authorization/Certification Binding Primary and Secondary Payers:
MSSNY will initiate legislative or regulatory efforts to enable the pre-certification of the primary insurance company to be binding on all secondary payers regardless of whether Coordination of Benefits or other supplementary medigap-type coverage is involved. If there is no Pre-Certification required by primary insurers, then secondary payers must honor their financial obligations. (HOD 1999-261; Reaffirmed HOD 06-259; Reaffirmed HOD 2016)
265.978 Reimbursement for Assistance at Surgery:
SUNSET HOD 2014
265.979 Insurance Companies Should Reimburse for Telephone Consultations:
MSSNY policy should be that insurance companies and the Health Care Financing Administration should reimburse physicians for telephone management of patients. (HOD 1999-258; Reaffirmed HOD 2005-273; Reaffirmed HOD 2015)
265.980 Enhancements to HMO Prompt Payment:
MSSNY will petition the Governor of the State of New York to modify the current Prompt Payment Law to provide for the imposition of a penalty of up to 20% of the amount billed, payable directly to the physician by the payor, for any clean claim not paid within the 45-day time frame. The Prompt Payment Law should also be modified to include payment to the physician of punitive damages for clean claims not processed or paid within 45 days when it can be shown that an intentional “pattern of abuse” exists on the part of the HMO, ERISA plan, or insurance company. When an intentional pattern of abuse is found to be exhibited by an HMO, ERISA plan, or insurance company in not paying physicians’ claims within the prescribed 45-day limit, that the HMO’s license be subject to suspension or revocation. The Prompt Payment Law be further amended to reflect that in the event suspension or revocation of license is not forthcoming, that the New York State Insurance Department be granted the legislative authority to mandate that these efficient HMO, ERISA plan, or insurance companies be required to increase their monetary reserves by 25%, and that managed care plans be required to provide written proof of “unclean claims.” (HOD 1999-72; Reaffirmed HOD 2014)
265.981 ERISA Plans Should be Held Accountable to the Same Reimbursement Requirements as other Insurance Carriers in the 1997
Prompt Payment Legislation:
The Medical Society of the State of New York supports legislation that would require ERISA plans to pay medical insurance claims in a timely manner as other insurance carriers in New York State are required to do. (HOD 1998-87; Reaffirmed HOD 2014)
265.982 Reimbursement Moratorium on Merged Health Maintenance Organizations:
MSSNY will seek appropriate legislation which, in the event of a merger or consolidation of one or more health maintenance organizations, would impose a one-year moratorium after the announcement of a new fee schedule, thereby precluding the lowering of reimbursement to participating physicians for this one-year period. (HOD 1998-273; Reaffirmed HOD 2014)
265.983 The Prudent Physician Paradigm:
It is MSSNY’s position that if a physician excises a clinically suspicious skin lesion, the insurer should be held liable for payment for the surgical procedure regardless of the subsequent pathology report.
MSSNY will request legislative or regulatory action that when a physician performs an indicated procedure based on a presumptive diagnosis, the third party payer reimburse the physician performing the procedure regardless of the final diagnosis. (HOD 1998-271; Reaffirmed HOD 2014)
265.984 Amend Managed Care Payment Policy for X-Ray Examinations:
SUNSET HOD 2014
265.985 Third Party Fee Schedule:
MSSNY will seek legislation at both state levels and national levels that would mandate insurers to make available their complete fee schedules, coding policies, and utilization review protocols to physicians prior to signing a participant contract and whenever any changes are made to the foregoing. (HOD 1998-262; Reaffirmed HOD 2014; Reaffirmed HOD 2016-56)
265.986 Physician Due Process in Managed Care:
Should a physician participant in one plan of an Insurance Company be denied access to other newly evolved plans that Insurance Company offers, the reason for such must be provided in writing and an appeals process be established to review that decision in a timely fashion. (Council 12/18/97; Reaffirmed HOD 2014)
265.987 AMA-CPT Coding:
MSSNY endorses AMA-CPT as the standard accepted coding system in New York and that proper use of CPT by insurance carriers requires adherence to all of its rules and guidelines; and will recommend that the Insurance Superintendent and the New York State Legislature require health insurance carriers processing claims from New York physicians, including Workers’ Compensation and No-Fault Carriers, to adhere to all CPT rules and guidelines, including code modifiers. MSSNY will request that the Insurance Superintendent make the necessary revisions of the inappropriate bundling edits in the software which erroneously processes claims from physicians and disallows legitimate claims for services. (HOD 1997-285; Reaffirmed HOD 2000-251, HOD 2000-257, HOD 2000-268, HOD 2003-268 & 278 and HOD 2005-254 & 276; Reaffirmed HOD 2013)
265.988 Payment Of Balance Of Bills By Secondary Health Insurance Agencies:
MSSNY will seek legislative reform in the New York State Insurance Law that would: (a) require all health insurance plans licensed in this state to include a Coordination of Benefits (COB) clause in their contracts clearly delineating their responsibilities as secondary insurers; (b) require that when a dually covered person complies with the provisions of a primary health insurance Plan by obtaining treatment from a participating physician, the secondary plan (by virtue of premiums paid for its coverage) must honor the liability for payment of deductible, coinsurance, co-payment and/or balance payment amounts (up to the highest payment level of the two insurance plans) regardless of the treating physician’s participation status with the secondary insurer; (c) require all health insurance plans licensed in this state to provide full and clear disclosure about a Plan’s secondary liability to its insured and its contracted physicians at the time of enrollment; and (d) require the New York State Department of Financial Services to review health insurers’ reports concerning savings they have accrued in their roles as secondary payers and to pass on these savings to consumers in the form of reduced premiums. (HOD 1997-279; Reaffirmed HOD 2000-264 & HOD 2006-259; Amended HOD 2016)
265.989 Changes In Reimbursement Rates And Payment Of Benefits Policies
Of Insurance Carriers Without Recourse By Participating Physicians:
MSSNY will actively seek, through legislation or whatever regulatory means necessary, the establishment of a mechanism whereby HMOs and other health insurers licensed in the State of New York be required to: (a) include in their annual financial reports to the Superintendent of Insurance any proposed changes in reimbursement schedules and withholds for physicians participation in their plans; (b) include in their participating physician agreements an anniversary date indicating the duration that the contracted fees, withholds, and payment policies will remain in effect. (HOD 1997-270; Reaffirmed HOD 2014)
265.990 Denial of Claims:
MSSNY will seek to have legislation introduced that will require carriers to send a copy of their examiner’s report to the treating physician with a provision that the denial cannot be issued until seven working days have passed from the time the report is mailed to the treating physician. (HOD 1997-263; Reaffirmed HOD 2014)
265.991 Physicians Should Be Informed By the Third Party Payor of the Reason for the Denial of the Claim:
MSSNY will seek the appropriate legislative or regulatory means to require that all third party payors, licensed to operate in New York State, be required to provide in a timely manner to the physicians with a rejected claim notice with an indication of the reason and the codes indicating why the claim was rejected. (HOD 1997-260; Reaffirmed HOD 2014)
265.992 Reimbursement of Alternative Therapies By HMOs:
MSSNY will support legislative action to prevent insurance coverage by managed care companies for unproven alternative therapies and unlicensed practitioners. (HOD 1997-163; Reaffirmed HOD 2014)
265.993 Denial of Payments, “No Fault” Insurance Carriers:
SUNSET HOD 2014; See 265.998
265.994 Determination of Where Medically Necessary Services Are to be
Provided to Patients Enrolled in Managed Care Entities:
MSSNY has adopted the position that in the event that a patient enrolled in a managed care program is referred to the emergency room of a local hospital following direct or verbal contact with a participating physician, this visit be covered and reimbursable whether categorized as emergent or not. (HOD 1994-262; Reaffirmed HOD 2014)
265.995 Balance Billing – Benefits in Health System Reform:
MSSNY supports the position that the practice of Balance Billing is in the best interest of: (1) Patients who will assume personal responsibility for a portion of their health care cost, and (2) Physicians and other providers who will be able to bill for an appropriate fee, yet still be subject to being monitored for such billing, and (3) Payers, government or other, who will have reduced financial liability, thus reducing the cost to third party payers.
MSSNY endorses the position that health system reform proposals include a provision that patients be free to contract with physicians of their choice to obtain medical services regardless of the insurance reimbursement. (HOD 1994-218; Reaffirmed HOD 2014)
265.996 Reimbursement Based on Outcome:
SUNSET HOD 2014
265.997 Benefits Denial by HMOs and Third Party Carriers:
SUNSET HOD 2013
265.998 “No Fault” Accident Victims: MSSNY continues to support legislation and all other means to amend the “no fault law” to ensure that physicians and hospitals are paid regardless of the involvement of alcohol as possible cause of the accident which resulted in the injury being treated. (HOD 1992-34; Reaffirmed HOD 2014)
265.999 Third Party Reimbursement Mechanism:
MSSNY recognizes the validity of a pluralistic approach to third party reimbursement methodology and that indemnity, as well as UCR, have positive aspects which merit further study. It will continue its analysis of the merits of indemnity, service benefits, UCR, capitation, salary and other approaches to reimbursement of physicians. The House of Delegates in 1983 reaffirmed support for the following policies: 1) Freedom for physicians to choose the method of payment for their services and to establish what they believe to be fair and equitable fees; (2) Freedom of patients to select their source of care; and; (3) Neutral public policy and fair market competition among alternative health care delivery and financing systems.
The Society encourages physicians to provide fee information to patients and to discuss fees in advance of services, where feasible. It urges physicians to continue and to expand the practice of accepting third party reimbursement as payment in full in cases of financial hardship, and to voluntarily communicate to their patients through appropriate means, their willingness to consider such an arrangement in cases of financial hardship or other extenuating circumstances. (HOD 1983-3 & 83-46; Reaffirmed HOD 2013)
267.996: Sudden Closure of Residency
MSSNY will urge the American Medical Association to advocate for the fair treatment of displaced residents from a hospital that closes or reduces a residency program by following these guidelines: (1)Work with the appropriate accrediting agencies to ensure that when there is a residency program reduction or closure, the sponsoring institution allows residents already in the program to complete their education, and honors the provisions of training commitments; and (2)Work with the Centers for Medicare and Medicaid Services, American Council on Graduate Medical Education (ACGME), AOL, and the appropriate specialty societies to ensure that where a residency program is reduced or closed, funding and resources are made available for relocation of the residents to new programs, in a manner that is minimally disruptive to the residents’ career and personal life. (HOD 2013-173)
267.997 Final Credentialing for Physicians Who Have Preliminary Training or
Transfer Training Programs and Graduate from the Final
MSSNY will work with the appropriate organizations in New York to streamline the credentialing process in this state so that credentialing forms, encompassing relevant information from any prior residency programs, are requested from the program which physicians completed their final residency training, the program that is in a position to provide a final recommendation about the physician’s qualifications and competencies to practice their chosen specialties.
MSSNY will also bring a similar resolution to the American Medical Association (AMA) at its 2010 Annual House of Delegates Meeting and work with the AMA to encourage the appropriate accrediting bodies to streamline the credentialing process so that credentialing forms, encompassing relevant information from any prior residency programs, are requested from the program which physicians completed their final residency training, the program that is in a position to provide a final recommendation about the physician’s qualifications and competencies to practice their chosen specialties. (Council 11/19/09)
267.998 Timely Submission of Credentialing Materials by Residency
and Fellowship Programs:
MSSNY will work with the American Medical Association to:
(1) encourage residency programs and fellowship programs to properly complete and promptly submit verification of resident education/training on credentialing and recredentialing forms to the requesting agency within thirty days of the request;
(2) encourage the Accreditation Council for Graduate Medical Education to add to the accreditation standards for residency and fellowship programs and to the Institutional Program Requirements the requirement of the proper completion and prompt submission of verification of resident education/training on credentialing and recredentialing forms to the requesting agency within thirty days of the request. (HOD 2008-213)
267.999 Credentialing Materials: Timely Submission by Residency and Fellow Programs:
MSSNY encourages: (a) residency programs and fellowship programs to submit credentialing and verification data requested on behalf of their graduating residents to the requesting agency within thirty days of the request; and (b) the Accreditation Council for Graduate Medical Education to establish an accreditation standard for residency and fellowship programs calling for submission of credentialing and re-credentialing verification data requested on behalf of their graduating residents to the requesting agency within thirty days of the request. (HOD 2007-201; Reaffirmed HOD 2017)
270.000 RIGHTS AND RESPONSIBILITIES OF PHYSICIANS
270.964 Truth in Advertising with Regard to the Title “Doctor”
The Medical Society of the State of New York will continue to work with the federation of medicine and the AMA to seek legislation or regulation to ensure that any advertisement for a health care provider specify the degree held by such health care provider. (HOD 2017-56)
270.965 Promote Legislation to Ensure Confidentiality of Peer Support
The Medical Society of the state of New York affirms as policy the confidentiality of peer support excluding reporting requirements which exist under current law. (HOD 2017-101)
270.966 Immunity from Federal Prosecution for Marijuana-Prescribing Physicians
The Medical Society of the State of New York will ask the American Medical Association to support legislation ensuring or providing immunity against federal prosecution for physicians who prescribe marijuana in accordance with their state laws. (HOD 2015-164)
270.967 Filming Patients for News or Entertainment
The Medical Society of the State of New York affirms as policy that efforts to disguise a patient (such as blurring the face, changing the voice, or any other technique) do not substitute for the need to obtain consent from a legally authorized person prior to publication of any material related to the treatment of a patient.
MSSNY will bring a resolution to the 2015 Annual meeting of the AMA House of Delegates which states that efforts to disguise a patient (such as blurring the face, changing the voice, or any other technique) do not substitute for the need to obtain consent for publication of any material related to the treatment of a patient as outlined in AMA Policy E-5.045. (HOD 2015-116)
270.968 Irresponsible Medical Reporting in the Media
MSSNY will encourage major media outlets to report on medical issues in a manner that is responsible and will make the media aware that the society is a potential source of expertise on issues relating to clinical practice. (HOD 2015-207)
270.969 Physician Liability and Patient Protection under the False Claims Act
The Medical Society of the State of New York together with the AMA will advocate for changes to the False Claims Act to ensure that physician liability under the False Claims Act is limited to those instances where the practitioner had actual knowledge that a claim presented is false and that this resolution be forwarded to the American Medical Association for consideration at its next Annual meeting. (HOD 2014-52)
270.970 Internet Review of Physicians
The Medical Society of the State of New York (MSSNY) will ask the American Medical Association (AMA) to seek federal legislation and/or regulation which would amend internet privacy laws so that websites hosting reviews of physicians will be required to: obtain the name of the person posting the review; keep this information on file; and inform the posting party that a physician requesting this information from the website host must be provided with the name of the person writing the review; and websites hosting reviews of physicians be required to post a warning against libelous and other legally inappropriate statements. (HOD 2014-206)
270.971 Limiting Liability for Test Results
The Medical Society of the State of New York will advocate to ensure that there is no legal duty for physicians to report test results to a patient if the physician did not order the test and if such physician was not involved in that patient’s episode of care which prompted the ordering of such tests.
MSSNY will educate member physicians about the efforts of the Monroe County Medical Society to establish Community Principles for Follow-up on Outpatient Diagnostic Testing, Laboratory and Imaging Studies so that physicians in different regions of the State may consider undertaking similar efforts in their communities. (HOD 2013-67, referred to, amended, adopted by Council 11/7/2013)
270.972 New York State Managed Care Reform Law Violations
The Medical Society of the State of New York will work with the Department of Financial Services to promote the availability of its current Consumer Services Bureau and Prompt Payment Hotline (1-800-358-9260) so that physicians have a greater awareness of its existence as well as its key staff who are charged with investigating health plan violations of existing provider protections currently in law.
Further, the Medical Society of the State of New York will work to assure the imposition of meaningful penalties on health insurance companies which violate provider protections currently in law. (HOD 2012-53)
270.973 MSSNY “Truth Squad”
MSSNY, working in conjunction and coordination with its communications department, should form a “Truth Squad” whose purpose is to act expeditiously in setting the record straight, publicly, forthrightly, and professionally, as it relates to any negative publicity, comments or statements which may be viewed as derogatory and/or, anti-physician.
MSSNY will forward a similar resolution to the AMA for implementation on a national level. (HOD 2012-210) (AMA policy H-445.995 reaffirmed)
270.974 Neutral Arbitration Process for Physician/Hospital Disputes
MSSNY will develop and identify resources that may assist physicians and their hospital medical staff to review, and where appropriate, to seek revisions or modifications to the medical staff bylaws in order to enhance the ability of the medical staff to organize and carry out its responsibility for the quality of care in the hospital as well as enhance due process protections to members of the medical staff. (HOD 2012-100)
270.975 Privacy of Physician Personal Information
MSSNY, working with the Healthcare Association of New York State (HANYS), the Greater New York Hospital Association (GNYHA) and the New York Health Plan Association, will seek solutions which would enable hospitals and health plans to fulfill their health code requirement while preserving the privacy of a physician’s personal medical records and maintaining compliance with ADA. (HOD 2012-104)
270.976 Protection of the Title, “Physician”:
The Medical Society of the State of New York will seek to amend current law or seek new legislation, as appropriate, that protects the title, “physician,” for the exclusive use of MDs and DOs, or their foreign equivalents, and that imposes penalties for those who mislead the public with unauthorized use of the title. (HOD 2011-216)
270.977 Physician Respect:
MSSNY will: 1) continue its efforts to promote and publicize the positive aspects of the medical profession in any and all media possible within the parameters of its budget; 2) be responsive and have a process for handling negative statements that are made about the Profession; and 3) have a dedicated mode of communication similar to its Hassle Factor Form to allow members to report abusive, negative and/or false attacks on the medical profession. (HOD 2010-209)
270.978 Cyberspace Evaluations of Physicians:
MSSNY will work with legislators to secure legislation that would:
require that all online sites purporting to evaluate licensed physicians have systems in place to substantiate the authenticity of the persons completing their online surveys to be sure that the persons completing the evaluations are real bonafide patients and to require that there are controls in place to track and limit the number of responses;
make it a crime for a company or an individual that does business or resides in New York State to initiate, facilitate or contribute to on-line slander, libel and misrepresentation of identity or cyberbullying through the internet;
require a company or an individual that does business or resides in New York State that maintains a Website which purports to offer evaluations of physicians to register with the Attorney General of the State of New York and to be the subject of routine review for the purpose of determining whether said Website facilitates on-line slander, libel and misrepresentation of identify or cyberbullying;
make it a crime for a company or an individual that does business or resides in New York State to violate Internet user agreements. (Council 9/17/09)
270.979 Right to Privately Contract:
urge the American Medical Association to continue to seek the enactment of federal legislation that ensures the fundamental right of physicians to privately contract with patients without penalty;
urge the American Medical Association to continue to seek the enactment of federal legislation to permit physicians to collectively negotiate with private sector and public sector health plans;
send a copy of this resolution to the American Medical Associations 2009 House of Delegates for its consideration. (HOD 2009-74)
270.980 Physician Prescribing Information:
(1) endorse the American Medical Association Prescribing Data Restriction Program (PDRP) and work with the AMA to disseminate information to physicians regarding their ability to ‘opt out’ of AMA programs which permit the sharing of physician prescribing information;
(2) oppose legislative efforts to enable physicians to sell patient prescribing data provided, however, that this prohibition shall not preclude physician participation in programs created by recognized physician organizations, data mining companies and pharmaceutical manufacturers which are directed to: (a) the establishment of aggregated data bases including databases created for use in identifying and monitoring drug utilization trends; (b) to enable physicians to become more fully informed relative to their comparative prescribing patterns; and (c) to enhance the quality of their practices including their performance in ‘pay for performance’ programs; and
(3) work to assure the continued use of physician prescribing data where all patient data have been de-identified prior to the collection and aggregation of this information. (Council 3/5/07; Reaffirmed HOD 2017)
270.981 Pharmaceutical Companies Tracking Methods:
MSSNY seek legislation or regulation to prohibit the sale or distribution of physician specific prescribing information and inform its members of the AMA Prescribing Date Restriction Program which will permit physicians to limit who can obtain their prescribing information. (HOD 2006-55; Reaffirmed HOD 2016).
270.982 Posting Physician License Numbers on the Internet:
MSSNY will seek legislation to prohibit the posting of physician license numbers on any New York State website. (HOD 2002-82; Reaffirmed HOD 2013)
270.983 Safeguarding Identity:
SUNSET HOD 2013
270.984 Professionals Profiling Website:
MSSNY will seek legislation which would provide for the establishment of a consumer oriented website devoted to the disclosure and identification of any final disciplinary actions against licensed professionals, similar to that which currently exists for physicians.
The availability and content of this website should be widely publicized to the general public. (HOD 2002-59; Reaffirmed HOD 2013)
270.985 Establishment of an Ad Hoc Committee to Explore the Concept of
the Existence of an Employer/Employee Relationship between
Independently Practicing Physicians and Managed Care Plans:
SUNSET HOD 2013
270.986 Cost to Physicians to Implement Government Mandated Rules
Sunset HOD 2011
270.987 Letter to Hospital-Employed Physicians Regarding Collective
Sunset HOD 2011
270.988 Physicians for Responsible Negotiation:
Sunset HOD 2011
270.989 Rapid Response Mechanism for Situations with the Media:
MSSNY will publicize to the members that mechanisms exist to:
- rapidly identify media coverage which reflects negatively on the medical profession or a specific physician;
- respond to stories in the media so as to refute negative publicity or unjustified or unsubstantiated allegations about a specific physician, regardless of how “local” they are in nature;
- raise the awareness of both the public and physician communities that MSSNY stands behind its members.
MSSNY has a network of local physicians who monitor coverage of health-related issues in the media and work with the Communications Division to respond appropriately. (HOD 1999-228; Reaffirmed with revision HOD 2014)
270.990 Protection from Discovery of Information Collected for Performance
MSSNY will pursue legislation that would protect information collected for and action taken related to quality improvement activities in a physician’s office in accordance with the New York State Department of Health’s Clinical Guidelines for Office-Based Surgery from discovery, similar to that which already exists for Article 28 institutions. (HOD 1999-101; Reaffirmed HOD 2014)
270.991 Collective Bargaining Unit (CBU):
SUNSET HOD 2014
270.992 MSSNY’s Support for Physicians in their Quest to be Considered
MSSNY will communicate to all appropriate physicians or state medical societies its support of the activities of such physicians seeking to establish their right to act collectively in defining the terms and conditions of such physicians’ relationships with managed care companies, insurers and/or other entities utilizing physician services. Such support be communicated in the News of New York and all other appropriate communication vehicles. (HOD 1999-84; Reaffirmed HOD 2014)
270.993 Disruptive Visits to Medical Offices by Government Investigators and
MSSNY will support legislation and/or other appropriate means to ensure that State and Federal investigators and/or agents give a physician written notice prior to a visit to a medical office so that such visit may be scheduled upon mutual agreement at a time when patients are not present in the medical office in any circumstance which lawfully permits a visit to a medical office without notice, such as a search warrant, arrest warrant or subpoena, investigators and/or agents should be required to initially identify themselves to appropriate medical staff in a quiet and confidential way that allows the physician an opportunity to comply in a manner that is least disruptive and threatening to the patients in the medical office at the time. (HOD 1999-57; Reaffirmed HOD 2014)
270.994 Collective Bargaining:
SUNSET HOD 2014
270.995 Physician Profiling:
SUNSET HOD 2014
270.996 Social Security Number, Use as Provider Identifier:
MSSNY will pursue legislation which will require the use of the physician’s UPIN numbers and prohibit the use of a physician’s social security number for identification purposes other than in tax-related documents.
MSSNY will also pursue legislation which will prohibit the publication of social security numbers in any form which has the potential to or will be available to the public. (HOD 1996-94; Reaffirmed HOD 2014)
270.997 Doctor of Medicine Degree:
MSSNY will seek legislation to revise the New York State Education Law to provide for the automatic conferral of the degree of Doctor of Medicine (M.D.) upon any individual who is licensed to practice medicine in the State of New York and who furnishes satisfactory evidence of completion of a medical education program in a foreign medical school which does not grant the degree Doctor of Medicine (M.D.) and in which the philosophy and curriculum are deemed equivalent, as determined by the New York State Board of Regents, to those in programs leading to the degree of Doctor of Medicine (M.D.) at medical schools in the United States.
Until the statute is changed, MSSNY will urge the State Education Department to discontinue the practice of informing licensed physicians who hold an M.D. equivalent degree to remove the title “M.D.” from behind their name or face possible disciplinary action. (HOD 1993-103; Reaffirmed Council 2/21/02; Reaffirmed HOD 2013)
270.998 Use of the Title “Doctor” by Physicians:
It is the position of MSSNY that all physicians routinely add the letters denoting their medical or osteopathic degrees following their names as part of their professional titles whenever using the title “doctor.” (HOD 1989-97; Reaffirmed HOD 2002-207; Reaffirmed HOD 2013)
270.999 Rights and Responsibilities of Physicians:
The Council of the Society adopted a document outlining the general principles of the rights and responsibilities of physicians. Copies of this document can be obtained by calling (516) 488-6100 or by writing to the Society Headquarters at 865 Merrick Avenue, Westbury, NY 11590. (Council 2/89; Reaffirmed HOD 2013)
Physicians should obtain consultation whenever they believe that it would be helpful in the care of the patient. When a patient is referred to a consultant, the referring physician should provide a history of the care and such other information as the consultant may need, and the consultant should advise the referring physician of the results of the consultant’s examination and recommendations relating to the management of care. A physician selected by a patient is encouraged to advise the patient’s regular physician of the finding or recommendations. (HOD 1984-62; Reaffirmed with modifications in lieu of HOD 2013-117)
280.000 SECOND OPINIONS/CONSULTATIONS-TERMINOLOGY:
280.999 Second Opinion:
MSSNY makes recommendations for and lends positive support to procedures and programs that promise improvement in quality care for patients. To clarify the terminology involved in Second Opinion Programs, the MSSNY offers the following statement: When a second opinion is requested on issues of medical necessity or feasibility of a specific treatment recommendation, this opinion must be provided by a physician or surgeon who has completed Accreditation Council for Graduate Medical Education (ACGME) approved residency training in the diagnosis and treatment of the disease or condition for which a specific treatment has been proposed. This should be termed a second opinion. An opinion relative to surgical technique on the other hand must be provided by a surgeon who has completed ACGME approved residency training in the specific treatment proposed. This option should be termed a second surgical opinion. If an opinion is desired regarding the relative merit of all treatment options, including the proposed treatment, such opinion should be termed a consultation. These opinions may be obtained from any physician who has completed ACGME approved residency training in the treatment of the disease process or condition involved. In keeping with the opinion of the AMA Judicial Council (Report A, A-85) the consultant should be provided with a history of the case and such other information as the consultant may need. (HOD 1987-15; Reaffirmed HOD 2013)
285.000 SEXUAL HARASSMENT/RACIAL/GENDER/DISABILITY DISCRIMINATION:
285.990 Reinstate the AMA Commission to Eliminate Health Care Disparities
The Medical Society of the State of New York will urge the American Medical Association to reinstate the Commission to Eliminate Health Care Disparities, with the inclusion of goals and objectives, and Specific, Measurable, Agreed upon, Realistic and Time Related (SMART) metrics. This resolution will be sent to the AMA for its consideration at the 2017 Annual AMA House of Delegates. (HOD 2017-166)
285.991 Development and Utilization of Clinical Decision Support Systems to Reduce Gender
Disparities and Bias in Healthcare
MSSNY will support implementation of clinical decision support systems designed to mitigate gender bias in diagnosis and treatment. (HOD 2017-165)
285.992: Specialty Society Committees to Eliminate Health Care Disparities
MSSNY strongly encourages all state specialty medical societies to form a Committee to Eliminate Health Care Disparities. These committees should share ideas and work together with MSSNY’s Committee to Eliminate Health Care Disparities as a coalition. MSSNY also strongly encourages all state specialty medical societies to incorporate, within their CME courses, lectures and other academic activities, relevant information about access to care, health literacy, cultural competency, workforce diversity, management options, compliance, outcomes and other factors that relate to healthcare disparities in their respective specialties, including race, ethnicity, sexual orientation and gender identity. In addition, MSSNY should develop a scientific accuracy rating system and report for all proposed New York State legislation impacting clinical services to include whether or not the legislation adheres to specialty practice guidelines and appropriateness criteria. (HOD 2013-163)
285.993 Discrimination in Child Custody Cases Against Parents with Disabilities:
MSSNY will support legislative efforts to change the New York State Social Services statutes to remove discriminatory disability language in child custody and parental termination cases. (HOD 2009-164)
285.994 Eliminating Religious Discrimination from Residency Programs:
MSSNY encourages the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) to require that all residency programs become aware of and make an effort to ensure that residents be allowed to practice in a manner that does not interfere with their religious convictions, including observance of religious holidays and observances, assuming that patient care is not compromised; and that a copy of this resolution be transmitted to the American Medical Association for consideration at its House of Delegates. (HOD 2005-157; Reaffirmed HOD 2015)
285.995 Affirming the Right of Medical Student Interest Groups to Promote
Medical Education in a Non-Discriminatory Manner:
MSSNY oppose any discrimination based on an individual’s sex, sexual orientation, race, religion, disability, ethnic origin, national origin or age. MSSNY support the right of medical student interest groups to organize and congregate for the purpose of furthering their medical education or enhancing patient care by improving their knowledge and understanding of various communities – without regard to their sex, sexual orientation, race, religion, disability, ethnic origin, national origin or age. (HOD 2005-156; Reaffirmed HOD 2015)
285.996 Improving Sexual History Curriculum in Medical Schools:
MSSNY encourage all medical schools in the state of New York to train medical students to be able to take a thorough and non-judgmental sexual history in a manner that is sensitive to the personal attitudes and behaviors of patients in order to decrease anxiety and personal difficulty with sexual aspects of health care; and that our American Medical Association support the creation of a public service announcement that encourages patients to discuss concerns related to sexual health with their physician and reinforces its commitment to helping patients maintain sexual health and well-being. (HOD 2005-155; Reaffirmed HOD 2015)
285.997 Sexual Assault Legislation:
Sunset HOD 2011
285.998 Equality in the Provision of Quality Health Care:
The Medical Society of the State of New York (MSSNY) reaffirms its longstanding principle that it is unequivocally opposed to any form of discrimination in the provision of quality medical care to any individual because of race, color, religion, sex, sexual orientation, ethnic affiliation, national origin, or underlying disease process. The Society calls upon all component county medical societies as well as its entire membership to: a) be vigilant as to the existence of any such discrimination in the provision of health care in their respective areas; b) expend every effort towards eliminating such discriminatory practices wherever they may exist, regardless of the settings in which the health care is delivered.
It is the position of MSSNY that the withholding of the best available care to any individual on a discriminatory basis is abhorrent to the Society, its membership, and the medical profession at large. The Society, therefore, vigorously affirms that equality of medical care should be scrupulously and compassionately afforded across the entire patient community, without exception.
MSSNY’s Committee to Eliminate Health Care Disparities will continue to work with the AMA Commission to End Health Care Disparities to encourage other State Medical Societies and Specialty Societies to establish standing committees to help eliminate health care disparities wherever they exist. (Council 1/20/00; Reaffirmed HOD 2004-174; Reaffirmed Council 9/9/04; Revised and reaffirmed HOD 2014)
285.999 Sexual Harassment Policy:
The rights, privileges and responsibilities of all members of the medical profession must be commensurate with the individual’s capabilities and ethical character and based solely on standards which promote optimum patient care and welfare. Discrimination in any form (race, sex, creed, color, national origin) as well as sexual harassment are totally unacceptable to the medical profession. For the purposes of this policy, sexual harassment is characterized by unwelcome or unwanted sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature where: (1) Submission to or rejection of this conduct by an individual is used explicitly or implicitly as a condition or factor in decisions affecting an individual’s employment or academic success; or (2) This conduct interferes with an individual’s work or academic performance or creates an intimidating, hostile or offensive work or academic environment. (Council 11/4/93; Reaffirmed HOD 2014)
290.000 SPORTS AND PHYSICAL FITNESS:
290.985 Pediatric/Adolescent Informed Concussion Discussion
The Medical Society of the State of New York supports amendment of the New York State Education Department (SED) “Guidelines for Concussion Management in the School Setting” to include informed consent prior to participation in intramural and interscholastic athletics and that this consent discuss the risk of short and long term impact of mild traumatic brain injuries. This resolution will be transmitted to AMA to seek similar federal regulation/legislation incorporating the informed consent provisions. (HOD 2017-155)
290.986 Support Mandating Protective Headgear (Helmets)
The Medical Society of the State of New York supports requiring approved protective headgear for all athletes participating in the sport of girls’/women’s lacrosse and that a similar resolution be transmitted to the American Medical Association for consideration at the next meeting of their House of Delegates. (HOD 2015-157)
290.987 Dangers of Tackle Football
The Medical Society of the State of New York will encourage the New York State Department of Health and the New York State Public High School Athletic Association to promote parental awareness of the potential dangers of tackle football. (HOD 2015-156)
290.988 Anterior Cruciate Ligament Injury Prevention
The Medical Society of the State of New York will encourage the New York State Education Department and the New York State Public High School Athletic Association to inform students and parents about the anterior cruciate ligament injury prevention program in order to prevent student injuries. (HOD 2015-155)
290.989 Support of Athletic Trainer Legislation
The Medical Society of the State of New York supports efforts which encourage athletic trainers to obtain continuing educational development. (HOD 2014-152)
290.990: Expanding Participation of Asthmatic Children in Physical Education or Exercise Programs
MSSNY encourages the New York State Education Department to educate physical education instructors on appropriate protocols, including physician follow-up, for ensuring that children with asthma achieve sufficient control in order to participate in physical education activities. (HOD 2013-170)
290.991 Head Injury Prevention In Hockey
The Medical Society of the State of New York will by submitting a resolution to the American Medical Association seek federal legislation that would effectively prevent head hits and dangerous checking at all levels of hockey. (HOD 2012-152)
290.992 Boxing/Mixed Martial Arts Safety:
The Medical Society of the State of New York urges adoption of regulation/legislation so that boxing/mixed martial arts at all levels comply with the following:
1) All competitors must wear protective head gear;
2) Competitions should not be based on knockouts as the standard of victory
MSSNY encourages the development and use of brain injury risk assessment tools to evaluate individual boxers and mixed martial arts participants and further encourage ringside physicians to halt the match when a participant has experienced concussive or sub-concussive blows that place him/her at imminent risk of more serious injury. (HOD 2012-151; referred to, modified and adopted by Council 3/4/2013)
290.993 Use of Nebulizers on School Athletic Fields:
MSSNY will seek an immediate change to the New York State Education Law § 919 to permit nebulizers to be available outside on athletic fields for individuals with a patient-specific script. (HOD 2011-161)
290.994 Non-Wooden Baseball Bats:
MSSNY opposes the use of non-wooden, specifically aluminum, bats by children playing baseball or softball through the age of 18. (HOD 2010-151)
290.995 Athletic Helmets, Removal of:
MSSNY’s official position on the removal of athletic helmets is as follows: (a) Athletic helmets should not be removed on the playing field, other than for rare circumstances of obstruction of emergency medical care; and (b) Shoulder pads should be removed at the time of helmet removal at an emergency facility following appropriate x-ray and clinical evaluation and with the removal done under the supervision of an experienced physician. (Council 7/18/96; Reaffirmed HOD 2014)
290.996 Drug Free Schools:
MSSNY advocates drug free schools, continues to condemn the use among student athletes of any and all performance enhancing drugs, and will recommend that the New York State Dept. of Education and all secondary school athletic associations adopt a policy of including educational programs on the dangers of drug use, and the use of nutritional supplements in athletics, in all interscholastic athletic programs, and advocates for closer self-scrutiny to monitor the effectiveness of programs.
Further, MSSNY will urge these same agencies to seriously consider and investigate the feasibility of reasonable suspicion or reasonable cause drug testing of athletes on all New York State championship teams, modeled after established Olympic drug testing protocols, with disqualification of an entire team if any member of the team test positive. (Council 3/9/95; Reaffirmed HOD 2014)
290.997 Mixed Gender Competition:
MSSNY maintains that gender specific sports participation, both before and after puberty, provides maximum opportunity and safety for a student athlete. MSSNY takes the position that students and their parents should be encouraged to select those sports that allow them the best opportunity for success in high school and beyond. However, in instances when a particular activity is not available for both genders, it is reasonable that an athlete be permitted to try out in a mixed gender interscholastic setting provided the following conditions are satisfied:
(1) The parents and student provide consent for participation and acknowledge understanding of the inherent risks of interscholastic, particularly contact/collision, mixed gender competition for their student athlete.
(2) The student has passed the basic routine pre-participation medical examination and interval health history.
(3) The school district enforces a strict disciplinary policy for sexual harassment or misconduct.
(4) The coach uses the same criteria for selecting and eliminating athletes as final team members based on athletic performance and capability alone.
Under the above conditions, there is no need for the student wishing to compete in a mixed gender activity to complete any additional tests or adhere to any different standards than are presently enforced for members of the opposite sex. The same rules, regulations, standards of conduct and expectations are upheld for all athletes regardless of sex. No special privileges or exemptions are granted based solely on sex, with the exception of appropriate separation of athletes for locker room. (Council 3/9/95; Reaffirmed HOD 2014)
290.998 Physician Coverage at Interscholastic Events:
The physician assigned and/or designated by the managing authority (i.e., New York State Public High School Athletic Association, school district, specific school or the New York State Education Department) of the interscholastic competition shall have the final decision making authority concerning the entry/re-entry of an athlete to competition at the particular contest. (Council 10/19/95; Reaffirmed HOD 2014)
290.999 Anabolic Steroids:
MSSNY opposes the prescription or distribution of anabolic steroids for the purpose of enhancing athletic performance. (HOD 1989-22; Modified and Reaffirmed HOD 2013)
292.997 Mandated Use of a Face Mask by those Not Receiving a Flu Shot
MSSNY will request that the New York State Department of Health conduct an evidence-based review of the hospital regulations on masks in preventing the transmission of influenza. (HOD 2017-169)
292.998 Sickle Cell Anemia Research and Management Funding
MSSNY will work with the New York State Department of Health to sustain a funding increase for Sickle Cell Anemia research and management. (HOD 2017-168)
292.999 Stem Cell Research:
MSSNY support biomedical research on multi-potent stem cells (including adult and cord blood stem cells) and the use of somatic cell nuclear transfer technology in biomedical research (therapeutic cloning). MSSNY oppose the use of somatic cell nuclear transfer technology for the specific purpose of producing a human child (reproductive cloning). MSSNY encourage strong public support of federal funding for research involving human pluripotent stem cells. MSSNY will continue to monitor developments in stem cell research and the use of somatic cell nuclear transfer technology. (HOD 2005-151; Reaffirmed HOD 2015)
295.992 Continued Surgical Care
The Medical Society of the State of New York (MSSNY) will seek legislation/regulation which would allow a physician who has performed an initial surgical procedure to continue to follow the patient and perform any necessary follow up surgery, regardless of the physician’s change in participation status and any follow-up surgery performed by a physician whose participation status changed from when the initial surgery was performed, be reimbursed on an out-of-network basis. MSSNY will forward this resolution to the AMA for implementation on a national level. (HOD 2016-263)
295.993 NYS DOH Regulation Concerning Operating Room Attire
The Medical Society of the State of New York encourages hospitals to use evidence-based guidelines for perioperative attire, and informing the physicians and staff of the policy that the hospital adopted. (HOD 2016-151)
295.994: Certificate of Need for Ambulatory Surgery Centers Owned by Physicians
MSSNY will petition the NYS Department of Health to reconsider their guidelines with the intention of removing barriers to obtaining a Certificate of Need for ambulatory surgery centers. (HOD 2013-100)
295.995 Payment for Office Based Surgeries
MSSNY will support legislation or regulation which assures payment of a facility fee which reflects the additional costs of accreditation and maintenance of an office-based surgical practice. (HOD 2012-114; Reaffirmed HOD 2015 in lieu of resolution 106)
295.996 Ambulatory Surgery Guidelines and Legally Discoverable Material:
The Dos and Don’ts, and Legislative Action:
MSSNY will work with the Medical Liability Mutual Insurance Company in developing guidance in documenting performance improvement activities in office-based surgery practices which would be available to all MSSNY members until such time as legislation is passed to protect such performance improvement information from discovery in any legal proceeding.
MSSNY will petition the legislature to make office-based performance improvement information non-discoverable. (Council 11/8/01; Reaffirmed HOD 2011)
295.997 Office Based Surgery:
MSSNY will promote the implementation of the report of the Public Health Council Task Force on Office-Based (Ambulatory) Surgery as guidelines and guidelines only, and will promote legislation to preserve the privacy and confidentiality of the office-based practice. MSSNY will oppose legislation regulating office-based procedures until we have had sufficient experience with the guidelines. (HOD 2000-93; Reaffirmed HOD 2014)
295.998 Special Assistant at Surgery:
SUNSET HOD 2014
295.999 Postoperative Care:
It is the position of the Medical Society of the State of New York that postoperative care is the physicians’ responsibility. MSSNY has urged the New York State Education Department to prevent inappropriate involvement by non-physicians in postoperative medical/surgical patient care. (HOD 1988-80; Reaffirmed Council 11/13/03; Reaffirmed HOD 2014)