Download 5.000 abortion and reproductive rights

5.000
ABORTION AND REPRODUCTIVE RIGHTS:
(See also Drugs and Medications, 75.000; Health Insurance Coverage, 120.000; Reimbursement,
265.000)
5.992
Sale of Emergency Contraception Medicine Over-the-Counter: MSSNY
encourages physicians and other health professionals to play a more active role in
providing education about emergency contraception, including access and informed
consent issues, by discussing it as part of routine family planning and contraceptive
counseling. MSSNY will enhance its efforts to expand access to emergency
contraception, including making emergency contraception pills more readily available
through hospitals, clinics, emergency rooms, acute care centers, and physicians’
offices. MSSNY will support and monitor the application process of manufacturer’s
filing for over-the-counter approval of emergency contraception pills with the Food
and Drug Administration. (HOD 03-158)
5.993
Unintended Pregnancies: Women with an unintended pregnancy are less likely to
seek early prenatal care and could expose the fetus to harmful substances such as
tobacco, alcohol and other drugs. Harmful exposure and the lack of early prenatal care
can lead to low birth weight newborns due to premature birth and/or growth
retardation in utero. Low birth weight is the most important risk factor for infant
morbidity and mortality, and infant mortality is commonly used as a health status
indicator of the population. Unfortunately, this country has an infant mortality rate
that is higher than most industrialized countries.
The Medical Society of the State of New York will support legislation to require any
prescription drug plans offered by insurance companies and health maintenance
organizations to cover the cost of prescriptive contraceptives. Furthermore, the
Medical Society will support legislation to amend the insurance law to include direct
access for women to obstetric and gynecologic services. MSSNY will support
measures that would comport with legislation enacted in 1994 that gave direct access
to preventive obstetric and gynecologic services from physicians in health
maintenance organizations. (White Paper on Women’s Health Initiatives,
Council 11/2/00)
5.994
Infertility: MSSNY recognizes that infertility is a disease of the reproductive system
that impairs one of the body’s most basic functions, the conception of children, and
will support legislation which would require insurance coverage for infertility
treatments. (HOD 00-91; Reaffirmed HOD 02-152)
5.995
Contraceptive Prescription Drugs, Insurance Coverage for Payment of:
(Sunsetted HOD 2011)
5.996
Freedom of Choice: It is the position of MSSNY that reproductive choice, as any
medical decision, is one of an informed consent between the patient and his/her
physician. (HOD 89-27)
5.997
Abortion: Abortion is a medical procedure and should be performed only by a duly
licensed physician in conformance with standards of good medical practice. Neither
physician, hospital, nor hospital personnel shall be required to perform an act violative
of good medical judgment or personally held moral principles. In these circumstances
good medical practice requires only that the physician or other professional withdraw
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from the case so long as the withdrawal is consistent with good medical practice.
(Council 10/13/83; Reaffirmed HOD 03-158)
MSSNY opposes legislative proposals that utilize federal or state health care funding
mechanisms to deny established and accepted medical care to any segment of the
population. MSSNY recognizes the fact of legalized abortion and supports the right of
all women to safe and legal abortion. (HOD 82-5)
5.998
Contraceptive Sales: MSSNY approved support for legislation which would
liberalize the sale of contraceptives in New York State by the removing of age
restrictions and the limitation of sales to pharmacies. (Council 12/2/72)
5.999
Family Planning for Persons on Public Welfare Assistance: MSSNY believes
information and services on family planning should be as available to persons
receiving public welfare assistance as to other members of the community, and that the
State Department of Social Services should allow for reimbursement for costs of
family planning services and supplies to welfare clients. However, no welfare client
or worker, the Society feels, should be required to accept or make a referral for family
planning services if it is against his/her religious principles. (Council 1/21/65)
10.000
ACCIDENT PREVENTION:
(See also Public Health and Safety, 260.000)
10.969
Rumble Strips: MSSNY to petition the New York Department of Transportation to
use rumble strips only on major highways and on those roadways for which an
engineering study or crash analysis suggests the number of run-off-the-road crashes
would likely be reduced by the presence of rumble strips. (HOD 10-150)
10.970
Physician Reporting of Patients Who Should Not Drive: MSSNY to 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)
10.971
Medical Certification of Drivers Covered by Article 19-A: MSSNY to 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 6/14/07)
10.972
The Use of Helmets in Alpine Skiing and Snowboarding at N.Y.S. Resorts:
MSSNY support the use of properly certified helmets while alpine skiing and
snowboarding at New York State ski resorts; and that it encourage the inclusion of
helmets in the rental packages offered by New York State ski resorts and rental shops,
and work with the NYS Department of Health to develop an informational kit
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outlining the benefits of helmet use in reducing serious injury in ski and snowboarding
accidents. (HOD 06-151)
10.973
Require Backup Warning Devices On New SUVs As Standard Equipment:
MSSNY support legislation that would require the installation of back-up cameras,
sensors, or other warning devices as standard equipment on all new sports utility
vehicles, and other motor vehicles with rear blind spots; as well as educational
initiatives to prevent motor vehicle related backover injuries/death.
(HOD 05-174 & 175)
10.974
ATV Safety: MSSNY propose and endorse legislation to require sellers of ATV’s in
New York State to promote the sale of and use of suitable helmets to be used when
operating ATV’s and propose and endorse legislation and/or regulation requiring
suitable helmets to be worn when operating an ATV in New York. MSSNY’s
delegation to the American Medical Association annual House of Delegates meeting
seek national legislation to require (a) sellers of ATV’s promote the sale of and use of
suitable helmets when operating ATV’s and (b) a suitable helmet be worn by the
operator of the ATV. (HOD 05-170)
10.975
Use of Protective Headgear to Prevent Injuries: That MSSNY develop educational
material that urges schools in the state of New York to ensure that students use
protective headgear to prevent injuries, lacerations, and/or trauma to the face and neck,
and reduce the incidents of broken noses when participating in sports such as lacrosse
and field hockey and that MSSNY seek assistance from lacrosse and field hockey
helmet manufacturers to help subsidize the cost of developing and generating
educational material to NYS schools on the medicinal need for the use of protective
headgear. (Council 3/14/05)
10.976
Impaired Drivers: The Physician’s Dilemma: SEE POLICY 260.939
10.977
Safety in Sport and Leisure Activity: MSSNY will continue to work with other
appropriate agencies and organizations to encourage safety in sport and leisure activity
by advocating the use of protective equipment, and the proper training of coaches and
trainers. (HOD 01-161; Reaffirmed HOD 2011)
10.978
Physician’s Role in Driver Safety: MSSNY affirms its active role in driver safety in
New York State and (a) will support Department of Motor Vehicles regulations that
promote reaffirmation and verification of the minimal driver standards at each renewal
cycle; (b) support the role of the Medical Advisory Board of the 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 drives in New York State;
(c) 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, consistent with the American Medical Association Council on
Ethical and Judicial Affairs Report 1-I-99; and (d) support legislation that would allow
a 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.
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(HOD 00-171)
10.979
“Drive Now, Talk Later”: MSSNY will urge the New York State legislature to pass
legislation prohibiting the use of hand held cellular telephones while operating a motor
vehicle on the streets and highways of New York State. (HOD 00-170)
10.980
Ski Helmet Requirement: MSSNY supports the voluntary use of helmets and
protective headgear for children and adolescents during recreational skiing and
snowboarding. As of September 1997, there is insufficient scientific evidence to
support a policy of mandatory helmet use.
MSSNY will encourage further research into the epidemiology and outcome of head
injuries to children and adolescents from recreational skiing and snowboarding and
research on the development of helmets to prevent or reduce the severity of these
injuries.
MSSNY will encourage the American Society for Testing and Materials to finalize
standards for ski helmets and study the effectiveness of ski helmets in preventing
serious brain trauma. (Council 2/4/98)
10.981
Child Safety Seats: MSSNY will seek and support legislation that mandates that
automobile rental agencies provide child safety seats whenever needed, free of charge.
(HOD 98-167)
10.982
Expanded Use Of Safety Helmets: MSSNY will pursue legislation which would
require the use of helmets for all cyclists, inline skaters, skateboarders and roller
skaters, regardless of age. (HOD 97-176)
10.983
In-Line Skating Injuries: MSSNY supports the use of full protective equipment for
in-line skating and supports appropriate efforts to educate adults and children about inline skating safety, such as encouraging physicians to educate their patients about the
importance of safety equipment use, and working with organizations like the
American Academy of Pediatrics to promote widespread distribution on information
and educational materials about in-line safety, including the use of protective
equipment, to both medical and non-medical audiences.
MSSNY will urge state consumer protection agencies to require the availability of all
safety equipment at the point of in-line skate purchase or rental and will support
legislation requiring the mandatory use of full protective equipment for children 16
years of age and younger. (Council 12/14/95)
10.984
Air Bags in Automobiles: MSSNY is seeking enactment of legislation which would
mandate that all new vehicles registered in the State of New York have air bags for the
driver and for the front seat passenger. (HOD 92-71)
10.985
Handrailings in Hallways: MSSNY supports legislation which would mandate that
the hallways in all newly constructed and multiple dwelling buildings in the State of
New York be required to have hand railings on at least one wall of each floor.
(HOD 92-70)
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10.986
Jogging Attire: MSSNY has urged statewide and local running and jogging
organizations to popularize reflective tape on garments to increase the visibility of
runners. (HOD 91-71)
10.987
Reflective Tape for Clothing: MSSNY encourages the use of reflective clothing for
the protection of pedestrians, joggers, and bicyclists during times of poor visibility,
inasmuch as the use of reflective tape prevents accidents through increased visibility.
(Council 6/13/91; Reaffirmed HOD 07-153)
10.988
Videotaping Drunken Drivers: In the interest of accident prevention, MSSNY
encourages the more extensive trial use of videotaping as evidence, in conjunction
with other indication of intoxication, in the arrest and prosecution of drunken drivers.
(Council 10/25/90)
10.989
Bicycle Helmets: MSSNY supports legislation requiring the use of approved helmets
by all bicyclists on New York State roadways, regardless of age, and has urged the
Commissioner of the Department of Motor Vehicles to establish standards for bicycle
helmets. (Council 1/26/89; HOD 92-16 & HOD 07-154)
10.990
Low Beam Headlights: In an effort to reduce multi-vehicle accidents, MSSNY
encourages the use of low beam headlights on all present vehicles. The Society favors
the installation on all vehicles sold in the United States by foreign and domestic
manufacturers of a system which will automatically turn on low beam headlights with
the ignition switch. (HOD 87-77)
10.991
Safety Regulations for Motorcycle Operators: MSSNY encourages legislation on
the national level which would require the manufacturers of motorcycles to emphasize
the dangers involved in the operation of these vehicles. (HOD 84-58)
It is the position of MSSNY that the Legislature should make the wearing of helmets
mandatory for operators of motorcycles, trail bikes, mopeds, and similar motorized
vehicles, and that the New York State Legislature should take action to require that all
motorcycle operators, including operators of trail bikes, mopeds, and similar
motorized vehicles, meet State regulations concerning the age of the operator,
operational skills, and safety standards, including helmet provisions. MSSNY
continues to oppose repeal of the law requiring all operators of motorcycles to wear
helmets. (HOD 76-86, 77-61, 78-20)
10.992
Safety Belt Usage: MSSNY urged the New York State Legislature to pass legislation
requiring the use of seat belts in school buses. (HOD 86-15; Reaffirmed HOD 99-166)
10.993
Shoulder Harnesses for Outboard Rear Seat Occupants: The Society favors the
installation of shoulder harnesses for outboard rear seat occupants in all cars sold in
the United States, and the use of safety belts by all rear seat occupants of automobiles
(including convertibles). (HOD 86-34, and 86-48; Amended by Council 7/20/89)
10.994
Safety Belts for Front Seat Occupants: MSSNY reiterated its support of the current
New York State Vehicle and Traffic Law requiring the use of safety belts by front seat
occupants of motor vehicles, and has undertaken steps to ensure that the current
legislation remain law in New York State. (HOD 85-9)
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10.995
Additional Death Benefits for Deceased’s Use of Safety Belts: The Society,
through its relationships with business and industry, agreed to encourage insurers to
develop and provide additional death benefits on the basis of the deceased’s use of a
safety belt at the time of a fatal automobile accident. (HOD 85-52)
10.996
Leadership for Successful Promulgation of Mandatory Safety Belt Law: The
House of Delegates approved the position that as an adjunct to the Mandatory Safety
Belt Use Law, the Society continue to provide leadership and support for the New
York Coalition for Safety Belt Use to insure successful promulgation of the law.
(HOD 84-42)
10.997
Call for Mandatory Safety Belt Usage: MSSNY called upon the legislature to enact
laws mandating safety belt usage. The New York Coalition for Safety Belt Use was
organized with the Medical Society of the State of New York in a leading position.
(HOD 82-19)
10.998
Proper Use and Design of Car Seats: The Medical Society favors the education of
physicians, parents and other users of child restraints in their proper and safe use.
MSSNY encourages manufacturers to modify the design of child restraints to facilitate
their proper use and urges the National Highway Traffic Safety Administration of the
US Department of Transportation to modify federal standards for child seating systems
to make such improved design changes available to the public. (HOD 83-37)
10.999
Car Seats for Children: MSSNY supports the use of protective passive restraint
systems for children under 5 years of age. (HOD 81-47)
15.000
ACQUIRED IMMUNODEFICIENCY SYNDROME - (AIDS):
(See also Children and Youth, 30.000; Medicaid, 175.000; Public Health & Safety, 260.000)
15.953
Support of a National HIV/AIDS Strategy: MSSNY to request the American
Medical Association’s support of the creation of a National HIV/AIDS strategy and
the following guiding principles as outlined by the Coalition for a National AIDS
Strategy:
1. Improve prevention, care, and treatment outcomes through reliance on evidencebased programming;
2. Set ambitious and credible prevention, care, and treatment targets and require
annual reporting on progress toward goals;
3. Identify clear priorities for action across federal agencies and assign
responsibilities, timelines, and follow-through;
4. Include, as a primary focus, the prevention and treatment needs of African
Americans and other communities of color, women of color, MSM of all races
and ethnicities, and other groups at elevated risk for HIV;
5. Address social, economic, and structural factors that increase vulnerability to
HIV infection;
6. Promote a strengthened and more highly coordinated HIV prevention and treatment
research effort; and
7. Involve many sectors in developing the Strategy, including government, business,
community, civil rights organizations, faith-based groups, researchers, and people
living with HIV/AIDS.
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MSSNY to also request that the AMA work with the White House Office of National AIDS
Policy and other relevant bodies to develop a National HIV/AIDS strategy. (HOD 09-169)
15.954
HIV Testing for Those Incarcerated, Prior to Release: MSSNY to advocate to the
New York State Department of Corrections and the New York City Department of
Corrections that both be required to routinely offer voluntary HIV testing to all
inmates prior to discharge; and, upon a positive test finding, (1) appropriate therapy be
initiated and case management be instituted to prevent the interruption of treatment;
and (2) the appropriate partner notification be implemented in the usual confidential
manner to protect all parties. (HOD 09-160)
15.955
Condom Availability in Jails and Prisons: MSSNY supports a policy of making
condoms accessible to all incarcerated persons. (HOD 09-159)
15.956
Rapid In-Office HIV Testing and Public Health Law 27F: MSSNY supports
legislative efforts to eliminate separate written informed consent and pre-testing
counseling in order to comply with the Centers for Disease Control and Prevention’s
2006 guidance on HIV testing. (HOD 08-156)
15.957
Support for the Practice of Expedited Partner Therapy for Persons Infected with
Chlamydia Trachomatis to Prevent Reinfection: MSSNY to -- (1) support the
Centers for Disease Control and Prevention’s guidance on expedited partner therapy
(EPT) that was published in its 2006 white paper, Expedited Partner Therapy in the
Management of Sexually Transmitted Diseases; (2) support legislation that would
allow physicians diagnosing Chlamydia trachomatis in an individual to prescribe or
dispense antibiotics to that person’s sex partner; and (3) seek provisions within the
legislation to ensure that physicians participating in the delivery of EPT are protected
from liability. (HOD 08-155)
15.958
Disclosure and Exchange of Health Information Among Providers: MSSNY
concludes that given the advances in comprehensive treatment and drug therapy of a
patient with HIV/AIDS from 1986 to 2007, the exchange of HIV/AIDS information by
one medical provider to another treating/consulting medical provider of the patient is
routinely necessary for proper evaluation and treatment of the patient by that second
treating/consulting medical provider.
In keeping with its support of the CDC’s “Revised Recommendations for HIV Testing
of Adults, Adolescents and Pregnant Women in Healthcare Settings – 2006,” MSSNY
supports the policy that general consent is sufficient for disclosure of health
information, including HIV/AIDS information, through electronic means among
providers for treatment purposes. (Council 6/14/07)
15.959
Expanding HIV Screening: MSSNY to endorse the Center for Disease Control and
Prevention’s “Revised Recommendations for HIV Testing of Adults, Adolescents and
Pregnant Women in Healthcare Settings - 2006” and take the necessary steps to
promote and implement these recommendations on the state and federal level.
(Council 1/25/07; Reaffirmed HOD 07-159)
15.960
Exchange/Disclosure of Health Information re HIV/AIDS Patients: MSSNY
concludes that given the advances in comprehensive treatment and drug therapy of a
patient with HIV/AIDS from 1986 to 2007, the exchange of HIV/AIDS information by
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one medical provider to other treating/consulting medical provider of the patient is
routinely necessary for proper evaluation and treatment of the patient by that second
treating/consulting medical provider.
Also, MSSNY, in keeping with MSSNY’s support of the CDC’s “Revised
Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in
Healthcare Settings – 2006,” supports the policy that general consent is sufficient for
disclosure of health information, including HIV/AIDS information, through electronic
means among providers for treatment purposes. (Council 6/14/07)
15.961
Center for Disease Control’s Revised Recommendations for HIV Testing of
Adults, Adolescents and Pregnant Women in Healthcare Settings - 2006:
MSSNY promote and implement the following recommendations on the state and
federal level:
∼
∼
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HIV Screening is recommended for all patients in all health-care settings after the
patient is notified that testing will be performed unless the patient declines (optout screenings).
Persons at high risk for HIV infection should be screened for HIV at least
annually.
Separate written consent for HIV testing should not be required, general consent
or medical care should be considered sufficient to encompass consent for HIV
testing.
Prevention counseling should not be required with HIV diagnostic testing or part
of HIV screening programs in health-care settings.
HIV screening should be included in the routine panel of prenatal screening tests
for all pregnant women. (Council 1/25/07)
15.962
Non-Consented HIV Testing: MSSNY supports changes to New York State law to
ensure that non-consented HIV testing be allowed whenever the physicians determine
that tests for HIV infection and immune dysfunction are likely to alter the patient’s or
affected individual’s diagnostic or therapeutic management in a clinically meaningful
way and the patient or affected individual is unable to consent to or refuse HIV testing.
(Council 3/6/06)
15.963
Amend HIV Laws: MSSNY support efforts to permit the local public health official
or department to implement the necessary procedures to ascertain whether the
HIV/AIDS patient is obtaining treatment and the preservation of the right of a
physician to make appropriate clinical judgments without interference from local and
state health officials. (HOD 06-170)
15.964
New York State Department of Health’s New Guidelines Pertaining to HIV
Counseling and Testing: MSSNY endorses and supports efforts by the New York
State Department of Health to streamline the HIV counseling and testing procedures
and will widely disseminate information about these new HIV procedures and
encourage physician participation in recommending HIV testing to appropriate
patients during a routine office visit. MSSNY also supports the NYS/DOH’s efforts to
collect additional surveillance of HIV data directly from laboratories, including viral
loads, resistance testing, and CD-4 counts and the analysis dissemination of this data
to the appropriate public health officials, public health departments and physicians, in
an effort to improve the lives of the people who have HIV infection.
8
(Council 6/9/05; Reaffirmed HOD 06-170)
15.965
Expansion of HIV Prevention Programs in Prisons: MSSNY will urge the New
York state Department of Corrections to develop and implement comprehensive HIV
prevention and education programs specifically designed for the prison population.
(HOD 97-157)
15.966
MSSNY Position on HIV Surveillance and Partner Notification:
• The Medical Society supports reporting of HIV infection by names and opposes
using “unique identifiers”.
• The Medical Society supports the provision for partner notification as it currently
exists under the law and would oppose a change in the law which would mandate
that a physician conduct partner notification.
• We support:
1. Establishing the right of a physician to do contact notification of third parties
at risk of HIV infection and to do so with legal immunity and to have the
option of referral to a health official;
2. Permitting local health officials to act to control the transmission of HIV and
to require physicians to report all cases of AIDS/HIV-related illness and HIV
infection to municipal district health officers; and
3. Permitting health officers to conduct investigations as warranted, including
notification and counseling of affected individuals and also contact tracing.
• The Medical Society supports declaring AIDS/HIV as a sexually transmitted
disease and supports physicians’ authority to test patients for HIV antibodies when
screening for sexually transmitted disease.
• The Medical Society supports continuing free, publicly funded anonymous test
sites.
• The Medical Society also supports repeal of laws which prohibit possession and
sale of needles and syringes without a prescription.
• The Medical Society is supportive of increased funding to implement HIV
surveillance by name and supports the need for increased resources to be
committed to outreach and educational programs. (Council 2/5/98)
15.967
Physician Discussion of AIDS with Patients 50 and Older: It is the policy of
MSSNY to encourage physicians to discuss risk factors, obtain sexual and drug
histories, and consider HIV infection in the differential diagnosis (where clinically
appropriate), in all persons, including those aged 50 and older. (HOD 98-159)
15.968
HIV Testing to be Part of a Routine Physical: MSSNY will petition the New York
State Legislature and the Department of Health to consider HIV testing, when
indicated, as with other disease testing, to be performed without specific written
informed consent. (HOD 97-154; Reaffirmed HOD 98-157; Reaffirmed HOD 06-170)
15.969
HIV Status Disclosure To Occupationally Exposed Health Care Workers and
Others: MSSNY supports disclosure of a patient’s HIV status to the treating
physicians of health care workers or others occupationally exposed, when the
information already exists in the hospital records, and will seek legislation or a change
in the New York State Department of Health regulations which will allow an ability to
test patients without specific consent and provide disclosure to the occupationally
exposed worker’s physician. (HOD 97-171; Reaffirmed 06-159; Reaffirmed
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Council 3/6/06)
15.970
Limited Disclosure of Patient’s HIV Status: MSSNY supports; (a) limited
disclosure of a patient’s HIV status in cases of health care worker exposure or others
occupationally exposed, when the information already exists in the hospital record
and; (b) that there be the ability to test patients without consent and provide limited
disclosure to the occupationally exposed worker’s physician. (Council 12/19/96)
15.971
Prophylactic Drug Treatment for Health Care Workers: MSSNY endorses that
CDC and NYS DOH recommendations for the treatment of health care workers
exposed to HIV with three prophylactic drugs and will request that the Hospital
Association of New York (HANYS) establish these as uniform standards for the
treatment of health care workers. (Council 12/19/96)
15.972
Needle Exchange Program, Expansion of: MSSNY supports the expansion of
existing needle exchange programs and encourages the establishment of additional
needle exchange programs to meet the HIV prevention and drug treatment needs of
injection drug users throughout New York State. (HOD 96-153)
15.973
HIV Reduction Through Harm Reduction Measures: MSSNY will advocate for a
pilot project wherein a comprehensive program will be offered to drug users to reduce
their risk-taking behavior. Such a pilot project to include treatment in drug free
programs, methadone maintenance programs and needle exchange programs, as part of
a unified effort to reduce illegal drug use, the spread of HIV and Hepatitis B, and the
incidence of violent crimes related to illegal drugs. MSSNY will advocate for
increasing the number and types of treatment programs available for those who use
illegal drugs, without fear of criminal prosecution. (HOD 96-160; Reaffirmed
Council 9/11/03)
15.974
HIV Testing Mandatory to Prevent Prenatal Transmission of: MSSNY supports
mandatory HIV testing of all pregnant women at the earliest prenatal visit.
(HOD 96-161)
15.975
HIV Infection, Counseling for as a Part of Routine Health Maintenance: MSSNY
supports routine HIV counseling and testing at the discretion of the physician without
written consent. (HOD 96-164)
15.976
HIV Testing, Mandatory in Criminal Cases: MSSNY will actively support the
passage of legislation in New York State which provides crime victims with the right
to demand HIV testing in criminal cases when warranted by the particular
circumstances of the crime, and the right to receive the results of such tests upon their
completion. (HOD 96-175)
15.977
Epidemiologic Control Measures Against Aids: It is the Official Position of
MSSNY that all findings of AIDS testing be made available to all treating physicians
involved in the care of the patient. (HOD 95-185)
15.978
Testing - Mandatory of all NYS Prison Inmates for HIV and Tuberculosis
Infection: MSSNY is supporting and seeking to implement through legislation and or
rules and regulation, with all due speed, the mandatory testing of all New York State
prison inmates for HIV and tuberculosis infection, not only on initial entry into the
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prison system but every six months thereafter so long as the prisoner is incarcerated.
The results of such testing, as well as all other pertinent medical records, are to be
made immediately and concurrently available to hospitals and health care workers who
may be responsible for the medical care of such prison inmates. (HOD 93-93)
15.979
Physicians’ Duty to Treat HIV Seropositive Patients: MSSNY endorses the
position of the AMA Council of Ethical and Judicial Affairs that a physician may not
ethically refuse to treat a patient whose condition is within the physician’s current
realm of competence solely because the patient is HIV seropositive. Physicians who
are unable to provide the services should make referrals to physicians or facilities
equipped to provide such services. Person who are HIV seropositive should not be
subjected to discrimination based on fear or prejudice. (Council 1/31/91)
15.980
Responsibilities of HIV Positive Physicians and Other Health Care Workers:
(1) All persons (including physicians and other health care personnel) engaging in
high risk behavior have a responsibility to withdraw from or modify these practices, to
notify sexual or IV drug abuser partners, to seek counseling and to consider having a
determination of their HIV antibody status. (2) Physicians and medical students have
the responsibility to prevent transmission of communicable diseases to their patients.
Physicians and medical students should, whenever appropriate, determine their HIV
status. If a physician’s ability to practice medicine is impaired, either physically or
mentally by HIV infection or any other disease, he/she should not practice medicine.
If a physician or medical student is HIV seropositive but not impaired, he/she should
not engage in any professional activity for which there is scientific evidence of disease
transmission to the patient. Adequate disability insurance coverage should be
available to physicians and medical students who voluntarily limit their medical
activities to reduce the risk of infecting patients with HIV. (3) Physicians should not
take upon themselves responsibility for determining the limitations to be placed on
their medical practice. This should be the judgment of a peer review group
representing the institution or locale of the physician’s practice. Physicians are
entitled to confidentiality no less than others, and safeguards to assure this must be put
in place. (4) The risk of transmission of HIV in health care settings is so
infinitesimally small that, pending review of an individual practitioner by an
appropriate panel, the Medical Society of the State of New York believes that
universal disclosure of HIV status by physicians is not required.
(Council 5/10/90; Council 1/31/91)
15.981
Ambulatory Treatment of HIV Infection: MSSNY endorses the position that HIV
ambulatory treatment, where possible, be integrated not only with existing health care
facilities such as hospitals, drug treatment programs and sexually transmitted disease
treatment centers, but also with community-based private toward significant
enhancement of remuneration of community-based private physicians and those
hospital outpatient services that are not a part of Designated AIDS Centers programs.
(HOD 90-14)
15.982
Condoms, Use and Advertising of: For sexually active persons, the only instance
when condoms are unnecessary for reduction of infection risk is within a longstanding, mutually monogamous relationship in which neither partner uses IV drugs
and neither partner is infected with HIV. This applies to any sexual activity where the
exchange of semen and/or blood is possible, including vaginal, anal, and oral sex.
Natural membrane condoms do not protect against infection from the HIV virus.
11
Therefore, the FDA allows only latex condoms to be labeled for the prevention of
STDs, including AIDS.
MSSNY urged the Chairmen of the major television networks to allow the advertising
of condoms on television as a public health measure to protect against the spread of
AIDS. (HOD 90-27)
15.983
Communicable/Sexually Transmissible Disease - Designation of: MSSNY is on
record as follows: (1) That AIDS and HIV is a communicable/sexually transmissible
disease which must be evaluated and treated according to sound medical and
epidemiological principles. Current State law, which requires separate and specific
informed consent prior testing for HIV, is inconsistent with accepted public health
principles and sound epidemiological methods. (2) That the New York State
Commissioner of Health officially declare AIDS and HIV to be a communicable/
sexually transmissible disease. (3) That it is appropriate for a physician to inform the
patient that a test for HIV will be performed. The decision to test for HIV should be
based on the same criteria as any other medical test, i.e. medical indication and/or
danger to others. (4) Has initiated legislation to implement the intent of the above
positions. (HOD 89-30; Council 3/21/91; Reaffirmed HOD 95-159; Amended HOD
06-153; Reaffirmed HOD 06-153; Reaffirmed HOD 09-161)
15.984
Confidentiality of Test Results: MSSNY strongly endorses the observation of strict
precautions in safeguarding the confidentiality of test results, except as permitted
under current state and federal laws. Model confidentiality laws must be drafted
which can be adopted at all levels of government to encourage as much uniformity as
possible in protecting the identify of AIDS patients and carriers, except where the
public health requires otherwise. (HOD 89-54; Council 3/10/88, 6/2/88)
15.985
Reporting HIV Status to Public Health Officers: MSSNY supports key concepts in
legislative proposals to: (1) Establish the right of physicians to do contact
notification of endangered third parties at risk of HIV infection, to do so with legal
immunity, and to have the option of referral to a health official; (2) Permit local
health officials to act to control the transmission of AIDS, and to require physicians to
report all cases of AIDS, HIV related illness and HIV infection to municipal district
health officers; (3) Permit health officers to conduct investigations as warranted,
including notification and counseling of affected individuals and also contact tracing;
MSSNY urged the New York State Department of Health to consider requiring
confidential reports of any form of HIV infection under the rubric of HIV disease or
HIV infection, with the term AIDS to be added if needed for State and Federal
accounting purposes. Individuals who prefer anonymous testing to confidential testing
should be allowed to use pseudonym or other identifier to assure completeness of data.
(HOD 89-54)
15.986
Testing - Mandatory for HIV: MSSNY supports mandatory testing for: (1) Donors
of blood and blood fractions, organs and other tissues intended for transplantation; (2)
Donors of semen or ova collected for artificial insemination or in vitro fertilization;
(3) Immigrants to the United States; (4) Inmates in federal and state prisons; not only
on initial entry into the prison system but every six months thereafter so long as the
prisoner is incarcerated. The results of such testing, as well as all other pertinent
medical records, be made immediately and concurrently available to hospitals and
12
health care workers who may be responsible for the medical care of such inmates; (5)
Military personnel; (6) Sex offenders and disclosure of the results to victims of sex
offenses. (HOD 89-55)
15.987
HIV Infected Children, Immunization of: MSSNY supports CDC guidelines to
administer MMR vaccine for all HIV infected children, regardless of symptoms.
Symptomatic HIV infected children should receive MMR at 15 months. When there is
increased risk of exposure to measles these children should receive vaccine at younger
ages. At such times, infants 6 to 11 months of age should receive monovalent measles
vaccine and should be revaccinated with MMR at 12 months of age or older; children
12 -14 months of age should receive MMR and do not need revaccination.
(Council 1/28/88; 6/2/88)
15.988
HIV Infection and Drug Abuse: To curtail transmission of HIV infection in
intravenous drug abusers, their sex partners and offspring, MSSNY approved AMA
recommendations which called for: (1) Increasing funding for drug treatment;
(2) Retaining HIV positive and AIDS symptomatic patients in drug treatment
programs as long as clinically appropriate; (3) Reevaluating regulations governing
methadone maintenance and detoxification treatment of drug dependents; (4)
Assessing recovery rates, pinpointing of effective strategies (including needle
exchange programs) collecting ethnographic data, executing outcome evaluations and
tracking recidivism rates in programs aimed at reducing HIV infection among IV drug
abusers; (5) Developing educational, medical and social support programs for
pregnant IV drug users; (6) Designing special education programs to reduce the risk
of HIV infection in, and provide appropriate treatment to, adolescent substance
abusers, especially homeless, runaway, and detained adolescents who are seropositive
or AIDS symptomatic, and those whose lifestyles place them at risk for contracting
HIV infection; (7) Encouraging public authorities to identify, bar access to, or
disinfect “shooting galleries” and other places where drugs are injected; (8)
Developing appropriate organizations to provide comprehensive training of primary
care physicians and other front line health workers, specifically those in drug treatment
and community health centers and correctional facilities, focusing on basic knowledge
of HIV infection, modes of transmission, and recommended risk reduction strategies.
(Council 7/21/88)
15.989
HIV Infection Status of Patient, Right of Health Care Workers to Know: The
health care worker has the right to know the infection status of the patient if he is
exposed to blood and body fluid of that patient. Consent agreements provide for this.
If there is denial of consent, competent medical authorities should make the
determination whether testing should be done and if done should note the rationale in
the medical record. (Council 10/20/88)
15.990
HIV Testing Laboratories: MSSNY opposes the State regulation restricting the
testing for HIV to laboratories certified by the State for that purpose. No barrier
should exist to accessibility to quality testing and counseling. MSSNY supports the
concept of the use of “approved” clinical laboratories to perform HIV testing.
(HOD 88-3; 88-36)
15.991
Blood Transfusions Contaminated by HIV: MSSNY urged the New York Sate
department of Health to issue emergency regulations to require hospitals to identify
13
and physicians to notify and counsel patients who had blood transfusions contaminated
by HIV. (HOD 87-1)
15.992
HIV Transmission in Health Care Setting: MSSNY approved CDC advisory
statements which emphasize the need for health care workers to consider all patients as
potentially infected with HIV and/or other blood borne pathogens and to adhere
rigorously to infection control precautions for minimizing the risk of exposure to
blood and body fluids of all patients. (Council 10/29/87)
15.993
Testing - Voluntary for Persons at High Risk of AIDS: Persons at high risk of
AIDS should be encouraged to be tested. Testing should be provided to the following
types of individuals who give informed consent: (1) Persons who may have sexually
transmitted disease (STD) and patients at STD clinics; (2) IV drug abusers and
patients at drug abuse clinics; (3) Sexual partners and those who share needles with
HIV infected persons; (4) Women of childbearing age with identifiable risks; i.e.,
those who have used IV drugs; have engaged in prostitution, have sexual partners who
are bisexual, IV drug abusers or hemophiliacs, are living in communities or were born
in countries with high prevalence of HIV infection; (5) Pregnant women and women
seeking family planning services in neighborhoods with high incidence of AIDS
infection among young women; (6) As part of prenatal screening for all pregnant
women in order to take advantage of all current medical treatments for both mothers
and infants; (7) Persons who received blood transfusions or blood components from
1978 to mid-1985; (8) Persons undergoing medical evaluation or treatment with
selected clinical signs and symptoms; i.e., generalized lymphadenopathy; unexplained
dementia; chronic, unexplained fever or diarrhea; unexplained weight loss; or diseases
such as tuberculosis as well as sexually transmitted diseases, generalized herpes, and
chronic candidiasis; (9) Persons who consider themselves at risk, and whose history
or clinical status warrant this measure; (10) Persons planning marriage; (11) Persons
admitted to hospitals in age groups deemed to have a high prevalence of HIV
infection; and those requiring surgical or other invasive procedures from areas with
high incidence of AIDS or who engage in high risk behavior; (12) All victims of
rape. Victims are to be encouraged to be re-tested in six months if the initial test is
negative and strict confidentiality of test results are to be maintained.
(Council 4/23/87; Council 6/11/87; Reaffirmed HOD 95-152)
15.994
Needles and Syringes (Sterile), Providing to Drug Abusers: MSSNY opposes the
concept of making sterile needles and syringes available to known drug abusers, but
approved support for a hypodermic needle and syringe exchange program trial in New
York State which includes a controlled evaluation and drug user education program,
strongly encouraging drug treatment and rehabilitation as part of the ultimate goal in
this process. (HOD 86-61; Council 12/18/86)
15.995
Public Reservoirs of Sexually Transmitted Diseases, Control of: MSSNY endorses
the efforts of federal, state and local health authorities to close down or control public
reservoirs of infection represented by commercial sex establishments, as these may be
defined by state and local statutes. (Council 4/10/86)
15.996
Notifying Sexual Partners of HIV Status: MSSNY supports legislative statutes
which, while protecting to the greatest extent possible the confidentiality of patient
information: (1) Provide a method of warning unsuspecting sexual partners;
14
(2) Protect physicians from liability for failure to warn the unsuspecting third party,
(3) Establish clear standards for when a physician should inform the public health
authorities who need to trace the unsuspecting sexual partner of the infected person.
Ideally, a physician should attempt to persuade the infected party to cease endangering
the third party; if persuasion fails, the authorities should be notified, and if the
authorities take no action, the physician should notify and counsel the endangered
third party. (Council 9/10/87)
15.997
Contact Tracing: Serious consideration should be given to implementing contact
tracing programs. Provisions must be made for adequate safeguards to protect
confidentiality of seropositive persons and their contacts, and for the counseling of
parties involved. (Council 9/10/87)
15.998
Counseling: Physician should counsel patients before tests for AIDS to educate them
about effective behaviors to avoid the risk of AIDS to themselves and others. Patients
who are found to be seropositive should be counseled by physicians regarding: (1)
Strategies for health protection with a compromised immune system; (2) The
necessity of alerting sexual contacts, past (5-10 years) and present. (Council 9/10/87)
15.999
Heroin Addicted Population: To contain the spread of HIV infection in the heroin
addicted population, MSSNY is supporting the development of low cost interim
methadone maintenance clinics as a public health measure to control the spread of
HIV infection. (Council 9/10/87)
20.000
ALCOHOL AND ALCOHOLISM:
(See also Accident Prevention, 10.000; Drug Abuse, 65.000; Health Insurance Coverage, 120.000;
Reimbursement, 265.000; Tobacco Use and Smoking, 300.000)
20.898
Blood Alcohol Level and Driving: MSSNY supports proposals to lower the current
drinking level standard for 0.10% alcohol content to 0.08% and will continue to
encourage state officials in the future to lower successively the legally permissible
standard to the more desirable alcohol level of 0.05%. (HOD 97-182)
20.899
Continuation of the Hospital Intervention Services Program for Alcoholism
Screening: MSSNY will recommend that all hospital currently offering the Hospital
Intervention Services program continue to do so; and that those hospitals that have not
yet established an HIS system consider doing so.
MSSNY will communicate this position to the New York State Department of Health,
the NYS Office of Alcoholism and Substance Abuse Services (OASAS), the Greater
New York Hospital Association (GNYHA), the Hospital Association of New York
State (HANYS), the eighteen hospital which are already involved in the HIS program,
and the Chairperson of the NYS Senate and Assembly Health Committees.
(Council 10/24/96)
20.900
Sales Tax Increase on Alcohol and Cigarettes: MSSNY is supporting an increase in
the tax on alcohol and cigarettes in order to discourage alcohol and cigarettes use.
(HOD 93-124)
20.991
Advertising Ban: In the interest of promoting better health in our communities, the
Medical Society of the State of New York takes the position towards banning alcohol
15
advertising on billboards near all schools and public housing and at sporting events.
Billboard advertisements should not be placed less than five city blocks or 1,500 feet
from all schools and public housing. (HOD 92-100 & 92-101)
20.992
Blood Alcohol Levels in Automobile Accident Cases: MSSNY supports
legislation that would mandate implementation of Section 1194.1.(b) of the New
York State Vehicle and Traffic Law in all motor vehicle accidents where a
police officer is at the scene. Section 1194.1.(b) provides: “Every person
operating a motor vehicle which has been involved in an accident or which is
operated in violation of any of the provisions of this chapter shall, at the request
of a police officer, submit to a breath test to be administered by the police
officer. If such test indicates that such operator has consumed alcohol, the
police officer may request such operator to submit to a chemical test in the
manner set forth in subdivision two of this section.” (HOD 92-73)
20.993
Admissibility of Blood Alcohol Samples as Legal Evidence: MSSNY supports the
principle of permitting a blood alcohol sample drawn in the course of medical
treatment of an injured driver to be admissible as legal evidence in any criminal or
civil proceeding against such individual, provided that an appropriate chain of custody
and quality of analytical results is maintained. (Council 5/14/92)
20.994
Classification of Disease: The International Classification of Diseases includes
alcoholism, alcohol abuse, and alcohol dependence in the section described as mental
disorders. MSSNY believes that alcoholism should be listed as both a mental disorder
and a medical disorder for these reasons: (1) Clinical and investigative work of the
past three decades has led many workers in the field of alcoholism to the conclusion
that it may well be a medical condition with concomitant emotional and psychiatric
components. (2) Listing of the disease as purely mental disorder adds an unnecessary
and undesired stigma to an already overly stigmatized illness. (3) Adequate medical
education as well as research concerning alcoholism might be significantly broadened
and advanced by its inclusion within a classification of illness. (4) Such
reclassification might also result in significant improvement in the accuracy with
which alcoholism is reported in documents dealing with public health. (5) As long as
alcoholism remains classified as a psychiatric disease, insurance payments for health
care are limited to amounts ordinarily offered for psychiatric conditions. These
amounts are often less than adequate for medical treatment. (Council 12/17/92)
20.995
Deleterious Effects of Alcohol Consumption: MSSNY supports the adoption of
comprehensive legislation which warns the public about the risk associated with the
consumption of alcohol as it affects both men and women. (HOD 91-120)
20.996
Detoxification Coverage in Minimum Benefits Package of Uninsured: MSSNY
endorsed the position that coverage for detoxification be included in any minimum
benefits package for the uninsured. (Council 6/13/91)
20.997
Alcoholism Prevention/Control: MSSNY supports prevention policies and programs
that include, but are not limited to, the following: (1) Control of the quality,
availability, advertising and promotion of alcoholic beverages. Such Controls include:
(a) Establishment of a national legal age of purchase of 21 years for all alcoholic
Beverages. (b) Curbs on advertising of all alcoholic beverages, including the
voluntary elimination of radio and TV advertising, and intermediate measures, such as
16
the establishment and enforcement of national standards for radio, TV and print
advertising which eliminate use of young people, athletes, persons engaging in risky
activity and sexual innuendo. (c) Counter advertising, through paid and public
advertising, including health warnings about alcoholism and alcohol-related problems.
(d) Requirements that alcoholic beverage containers display all ingredients and
alcoholic content by volume, in addition to a rotating series of health warnings on
drinking and driving, drinking and pregnancy interactions between alcohol and other
drugs, links of excessive alcohol use to health-related disorders, including alcoholism
cirrhosis, heart disease and cancer. (e) Adjusting taxes on beer and wine to equate
with those for distilled spirits, and adjusting taxes on all alcoholic beverages for
inflation experienced since 1951. (f) Devoting significant additional funds derived
from increased taxes to the support of prevention and research. (2) Control of the
quality, distribution and availability of psychoactive drugs, including: (a) Measures
to prevent the manufacture, importation and sale of illicit drugs. (b) Programs to
prevent diversion of licit drugs for illicit sale and use. (c) Discouraging the inclusion
of alcohol as an ingredient in the formulation of medicines beyond the minimum
required as a solvent. (d) Promotion of safe and appropriate prescribing practices for
drugs which may produce dependency. (e) Warning labels on prescription and overthe-counter drugs describing possible adverse interactions with alcohol and other
drugs. (f) Warning labels indicating the potential of a drug to produce dependence.
(g) Programs to educate health professionals about identification of drug abusing,
manipulative patients seeking psychoactive drugs for inappropriate use. (3)
Scientifically sound education for all segments of society including: (a) Ageappropriate education about the nature and effects of alcohol and drug use, including
alternatives to such use, throughout the school curriculum. (b) Public education about
the nature and causes of alcoholism and other drug dependence, the interaction of
alcohol and other drugs, alternative techniques of managing stress, and the effects of
alcohol and drugs on health and safety. (c) Adequate professional education about
alcohol and drug problems in all programs which prepare students for careers in
health, human services, teaching, the clergy, police, public administration and law.
(d) Programs to keep practicing health professionals abreast of new knowledge and of
current law and regulation relating to alcohol and drugs. (e) Avoidance of
glamorization of alcohol and drug use and abuse by the media. (f) Accurate reporting
of the adverse societal consequences of alcohol and drug use in the print and broadcast
news. (g) Special programs aimed at populations known to be at high risk, including
children of alcoholic and drug-dependent parents, pregnant women, medical, dental,
nursing, pharmacy and veterinary students, health professionals, persons recovering
from alcohol or drug dependence, persons undergoing stressful life situations and
others. (h) Education for bartenders and other servers of alcoholic beverages about
safe serving practices and prevention of harm to a person who is alcohol-impaired. (i)
Inclusion of accurate information on alcohol and drug use in all health prevention
programs. (j) Measures to discourage or deter the manufacture, sale and promotion of
drug paraphernalia (products designed to process, prepare and administer illegal
substances). (Council 9/12/85)
20.998
Driving While Intoxicated (DWI): MSSNY has taken the following position in
regard to alcohol abuse on New York State highways: (1) Early identification of
alcohol-abusing drivers should be facilitated by more widespread use in the field of
chemical testing devices. Portable breathalyzers which are now available should be
provided for use by officers at the time of initial investigation of accidents or
violations because of impaired driving behavior; (2) It is recommended that an
17
educational program on alcohol abuse and driving be developed by MSSNY for law
enforcement and judiciary personnel, and that such a program be supported by the
New York State Department of Motor Vehicles. The importance of early
identification of alcohol-abusing drivers to achieve earlier treatment and rehabilitation
should be explained. The acute and chronic effects of alcohol, plus a definition and
description of alcoholism and methods of intervention and treatment should be
described as part of the program. MSSNY should devise the medical and professional
elements of the program, but support from the NYS Department of Motor Vehicles
and the State would be necessary for implementation; (3) Local alcohol control
programs in New York State which have successfully increased apprehension,
conviction, and rehabilitation rates of alcohol-abusing drivers should be supported.
MSSNY offers its services as a liaison between the medical profession and citizens
groups to help coordinate a comprehensive program against alcoholism; (4) An
advertising campaign to educate the public, particularly young drivers, on the effects
of alcohol should be undertaken. The public should also be made aware of the fact
that violations and accidents due to alcohol abuse are early warning signs of
alcoholism. The use of warning signs in pubic drinking places, retail liquor stores, and
on the containers of alcoholic beverages should also be supported; (5) MSSNY
favors the passage of legislation supporting anti-drunk driving measures such as the
removal of intoxicated drivers from the road by either an immediate temporary
suspension of a driver’s license or an immediate revocation of a driver’s license based
on the blood alcohol content of the driver sufficient to convict of “Driving While
Intoxicated” rather than “Driving While Impaired.” The Medical Society of the State
of New York encouraged the New York State Department of Motor Vehicles to lower
its level of measuring “driving while intoxicated” (DWI) to 0.05% blood alcohol
content (BAC); (6) MSSNY also is in support of legislative and administrative
actions by State and local governments which will increase the realization on the part
of drunk drivers that they may be arrested, prosecuted, convicted and punished.
(HOD 81-37; Council 9/10/81; HOD 82-20 & 82-75; Council 6/13/91)
20.999
Alcoholism Health Insurance Coverage: In order to receive MSSNY’s endorsement
as a member benefit, any medical insurance plan shall cover not only in-hospital
treatment when acute detoxification is necessary, but also inpatient treatment in goodquality rehabilitation settings. MSSNY also suggests similar provisions be included in
any group medical insurance offered to MSSNY membership by a county or national
medical society with which MSSNY is affiliated. (Council 12/16/76)
25.000
ALTERNATIVE HEALTH CARE:
(See also Reimbursement, 265.000)
25.999
Practice Standards: MSSNY has adopted policy that maintains that all physicians,
including practitioners of alternative medicine, should be held to the same standards of
practice and that this policy be utilized in educating our legislators and the general
public regarding the problem. (HOD 95-66)
30.000
CHILDREN AND YOUTH:
(See also Acquired Immunodeficiency Syndrome – [AIDS], 15.000; Drug Dispensing, 70.000;
Reimbursement, 265.000; Sports and and Physical Fitness; Tobacco Use and Smoking, 300.000;
Vaccines, 312.000; Violence and Abuse, 315.000)
18
30.992
Graduated Drivers’ Licensing: MSSNY will add to its current legislative agenda,
support for a graduated driver licensing program in New York and lobby the
legislature for a reasonable compromise to be enacted into law. (HOD 02-79)
30.993
Classification for Video Games: (Sunsetted HOD 2011)
30.994
Confidentiality of Adoption Records: MSSNY will continue to advise all state
legislative and regulatory agencies that, without mutual consent of the birth mother,
birth father, if known, and child given for adoption, records which would identify
either party remain sealed.
MSSNY affirms that the current system of handling requests for medical information,
through a third party who is under oath to maintain the confidentiality of both parties,
is adequate and sufficient to provide needed medical information to the child given for
adoption. (HOD 01-63; Reaffirmed HOD 2011)
30.995
Immunization of Adolescents: MSSNY endorses the immunization
recommendations for adolescents as set forth by the Advisory Committee on
Immunization Practices of the Centers for Disease Control and Prevention and will
urge NYS to adopt ACIP immunization requirements for adolescents as a condition for
school attendance so that the State will be able to participate in the movement toward
universal protection. (HOD 96-157)
30.996
Students with Complicated Medical Conditions: MSSNY has adopted the
following:
Guidelines to Schools for the Management, Staffing and Program Development for
Student with Complicated Medical Conditions: (1) That the NYSED and the
NYSDOH offer guidelines to schools which outline specific ways to manage, staff,
and develop programs for students with complicated medical conditions, while
awaiting final determinations of laws and regulations; and (2) That the NYSED and
NYSDOH use physicians, as well as mid-level providers involved in school health
matters, and educators with experience with students with complicated medical
conditions as consultants in matters pertaining to such students, before proposals for
guideline bulletins, Commissioner Regulation and changes to Education Law are
made; MSSNY also recommends that the following considerations be taken into
account in developing the above: (1) That the NYSED and NYSDOH develop a
useful definition of the term “Student with Complicated Medical Condition.” (See
NOTE) (2) That the NYSED and NYSDOH include school nurses as individuals who
can honor a valid “Do Not Resuscitate Order.” (3) That the NYSED and NYDOH
mandate all districts to employ registered nurses in all buildings where a child has
been designated by a physician as having a severely complicated medical condition, or
an LPN with an RN or MD directly available within five minutes response time. (4)
That any student with a complicated medical condition have an Individual Health Plan
(IHP) developed by the Committee on Students with Complicated Medical Conditions.
This committee should consist of the district physician, the private physician, the
school nurse, an educator, a district administrator, and the parent. The IHP must be
reviewed at least annually, and more frequently as a child’s medical status changes.
The IHP must include a medical emergency plan for management of the life
threatening condition, including a plan for implementing a valid DNR order, if one
exists, and which outlines the role for every individual who may care for the student.
19
(5) That there be an understanding that the increased care rendered to students with
complicated medical conditions may include care by a school nurse that goes beyond
the present routine guidelines which state that nursing care must be limited to first aid.
(6) That educational training and support groups be provided to all staff involved with
students with complicated medical conditions, especially nurses who may not have
rendered the kind of necessary care required in more than one year. (7) That schools
provide comprehensive programs that address and measure the progress of students
with complicated medical conditions socially, psychologically, and medically. (8)
That care and attention be given to students without complicated medical conditions in
the same class to ensure that they understand what may be happening to their
classmate and to evaluate the impact, both positive and negative, a student with a
complicated medical condition may be having on their educational experience.
* NOTE: “A STUDENT WITH A COMPLICATED MEDICAL CONDITION”
is any child in a school building who has a physical condition which may be
considered by the treating physician to require increased nursing support and/or to be
life threatening. Designations include: (1) Severe: high risk for loss of life due to
unstable, tenuous health status. This may include, but is not limited to, physical
disability affecting swallowing and breathing, cardiac disease, severe anaphylaxis to
food or insect bites, poorly controlled seizures resulting in frequent apneic episodes
longer than 20 seconds. This shall include any students with a valid Do Not
Resuscitate Order. (2) Moderate: high risk for loss of life due to usually stable, but
infrequently unstable medical condition. This may include, but is not limited to, life
threatening conditions generally well controlled on medicines or mechanical devices.
Seizures that are frequent, but mild, or rarely result in cessation of breathing, cardiac
arrhythmias well-controlled on medications or pacemakers, tube feedings that
generally do not cause problems with breathing are examples of moderate
complications. (3) Mild: stable condition that may require increased nursing support,
but would not be expected to be life threatening. This may include but is not limited
to, urethra catheterizations, intravenous drug administration, and well controlled
seizures that have few breakthroughs or breathing cessation during school hours.
(Council 6/1/95)
30.997
School Health Policy, Notification to Physicians of Changes to: MSSNY has
adopted the position that the New York State Department of Education, Health and
Labor should include school district physicians on their mailing lists for any matters
pertaining to school health. (Council 12/15/94)
30.998
AIDS, School Health Education to Prevent the Spread of AIDS: MSSNY
endorsed CDC guidelines for effective school education to prevent the spread of
AIDS. The specific scope and content of AIDS education in schools should be
consistent with parental and community values. The program should: (1) Be
included as an important part of a more comprehensive school health education
program; (2) Be taught by regular classroom teachers in elementary grades and by
qualified health education teachers or other similarly trained personnel in secondary
grades; (3) Be designed to help students acquire essential knowledge to prevent HIV
infection at each appropriate grade; (4) Describe the benefits of abstinence for young
people and mutually monogamous relationships within the context of marriage for
adults; (5) Be designed to help teenage students avoid specific types of behavior that
increase the risks of becoming infected with HIV; (6) Provide adequate training
about AIDS for school administrators, teachers, nurses, and counselors, especially
20
those who teach about AIDS; (7) Provide for sufficient program development time,
classroom time, and educational material for education about AIDS; (8) Monitor and
periodically assess the processes and outcomes of AIDS education. (Council 3/10/88)
30.999
Handicapped Newborns: MSSNY has taken the position that government should not
be involved in cases concerning the medical treatment of severely handicapped
newborns. The medical care of these newborns should be the responsibility of the
parents in consultation with their physician and other professionals on the medical
treatment team. (HOD 84-64)
35.000
CHIROPRACTIC:
35.996
Holistic Medicine: MSSNY will inform the Board of Regents of the State of New
York it has adopted the position that the practice of holistic medicine by Chiropractors
is not part of the authorized practice of Chiropractic, and request that it issue an Order
for such Chiropractors to desist and refrain from such practice of medicine. (The
Council directed that the word “not” be highlighted by boldface type to indicate
stronger emphasis of the intent of the resolution). (Council 3/27/97)
35.997
Limited License Practitioner - Physician Relationship: Whether a physician should
have professional relations with chiropractors must be the individual choice of the
physician, based on what the physician believes is in the best interest of the patient.
As with any limited license practitioner, a physician should be mindful of state laws
which prohibit a physician from aiding and abetting a person with limited license in
providing services beyond the scope of his license. (Council 1/26/89)
35.998
Hospital Privileges for Chiropractors - Opposition to: MSSNY vigorously opposes
the enactment of legislation which would permit the practice of chiropractic by
chiropractors in hospitals. (HOD 88-72)
35.999
Spinal Manipulation: MSSNY knows of no scientific evidence to condone spinal
manipulation as appropriate treatment for the majority of human diseases. MSSNY
will continue to warn the public of the dangers to health in relying on the theory that
most disease is caused by misalignment of the spine which can be cured by manual
manipulation and adjustment. (HOD 1979)
40.000
CLINICAL JUDGMENT:
(See also Hospitals, 150.000)
40.998
Communication in the Physician-Patient Relationship: MSSNY holds that
effective patient care requires the free and unfettered exchange of information on
treatment alternatives and that discussion of these alternatives between physicians and
patients should not subject either party to criminal sanctions; and will communicate
this position to the membership. (HOD 98-153)
40.999
Protection from Criminal Prosecution for Good Faith Clinical Judgment:
MSSNY has adopted the position that physicians, acting in good faith while exercising
clinical judgment in the delivery of medical care, should be exempt from criminal
prosecution as a result of untoward outcomes as a result of said judgment, and intends
to initiate appropriate legislation to assure such protection. (HOD 95-64)
21
45.000
COMPUTER MAILING LISTS:
45.999
Guidelines For Mailing Lists and Computer Printouts:
(1) Requests from Members: All requests from members for lists of physicians will
generally be referred to MSSNY’s Division of Management Information Services.
County Medical Societies will be informed when MSSNY receives a request from a
member for a list of local County Medical Society physicians and will be asked to
reply within 10 days if the County Medical Society objects to MSSNY furnishing the
computer mailing list. (2) Requests from Nonmembers: (a) Requests from
nonmembers will be considered on an individual basis. Factors bearing on acceptance
involve commercial aspects. (b) Lists are usually available to MSSNY membership
organizations which have been approved by the Council. (3) General Considerations:
(a) MSSNY’s policy will be quite circumspect in making mailing lists available.
MSSNY’s general policy will be to protect the confidentiality of these lists. (b) The
Executive Vice-President shall be empowered to decide each case. The Council will
have the ultimate authority to decide if the Executive Vice-President is in doubt.
(Council 2/16/84)
50.000
CONTINUING MEDICAL EDUCATION:
(See also Education, 85.000)
50.989
Continuing Medical Education for Maintenance of Certification (CME for
MOC): MSSNY is to support:
ƒ
the current Continuing Medical Education (CME) accrediting system which
provides high quality CME activities, thus ensuring continuous professional
development as well as educational and practice improvement tools and
resources;
ƒ
the position of the Alliance, which opposes the American Board of Medical
Specialties (ABMS) plan as stated because it would undermine the existing
interdisciplinary approach to education and would also redirect important
resources away from existing educational programs;
ƒ
the position of the Accreditation Council for Continuing Medical Education
(ACCME), which opposes the creation of new systems that would impose
unnecessary burdens upon ACCME-accredited providers, Recognized
Accreditors, intrastate providers and physician learners. (HOD 11-168)
50.990
CME Accreditation: Programs offered by the Medical Society of the State of New
York are to be considered, when appropriate, for American Medical Association
(AMA) Category 1 credit for all physician participants when applicable under AMA
Guidelines. (HOD 11-167)
50.991
CME Credits for Attending MSSNY House of Delegates: MSSNY to provide to
physician delegates who attend the MSSNY House of Delegates the appropriate
number of Continuing Medical Education Credits for participating in the reference
committees and the full House; and MSSNY’s Office of Continuing Medical
Education to convene a group of individuals, comprised of various county medical
society executives and physicians, to discuss the implementation of such a program, in
accordance with the process as outlined by Accreditation Council of Continuing
22
Medical Education (ACCME) for implementation at the 2011 House of Delegates.
(HOD 09-154) (MSSNY’s Continuing Medical Education Committee reviewed this
resolution and, subsequently, determined that the House of Delegates was not an
appropriate CME activity, recommended that it not be adopted and that the
Committee’s report be filed for information.)
50.992
Continuing Medical Education Application Forms: MSSNY approved revised
Continuing Medical Education application forms to be consistent with new standards
and accreditation criteria mandated by the Accreditation Council for Continuing
Medical Education (ACCME). (Forms are available from MSSNY’s Office of
Continuing Medical Education.) (Council 12/13/07)
50.993
Continuing Medical Education Mission Statement: MSSNY adopted the following
revised Mission Statement:
CME Purpose and Goal:
The Office of Continuing Education of the Medical Society of The State of New York
(MSSNY) is committed to support a statewide system of effective continuing medical
education which provides offers all physicians with broad learning opportunities to
increase their skills.
The goal of this system is to upgrade medical care throughout the state by maintaining,
augmenting, and updating physicians’ medical knowledge, skills and attitudes in order
to facilitate delivery of optimal medical care to their patients. This is done by
providing educational programming and accreditation of providers of Continuing
Medical Education (CME) throughout the state.
Content Areas:
The Continuing Medical Education Program of MSSNY strives to provide educational
activities relevant to the practice of all recognized medical disciplines and include
forums for public health, socio-economic, ethical and legal issues related to the
provision of quality healthcare.
To implement this most effectively, MSSNY, in addition to the educational offerings it
provides and sponsors directly, shall also interact and cooperate as an accredited joint
sponsor with non-accredited providers of continuing medical education. In this way,
MSSNY is able to promote public health goals and an awareness of the public health
resources available to physicians and their patients throughout New York State.
Target Audience:
Target audiences include physicians residing or practicing in New York State, with
programs offered to physicians practicing in other states. MSSNY plays an important
role in sharing education with other healthcare professionals.
Type of Activities:
MSSNY‘s continuing medical education offerings will promote high quality
educational programs delivered in a cost effective and accessible manner. This will be
accomplished by using innovative and conventional formats including:
ƒ
Didactic presentations, seminars, symposia, workshops, grand rounds
23
ƒ
ƒ
Enduring material in a print, audio, video or internet format
Interactive, live audio and video conferencing and web casting activities that
encourage physician self assessment and self learning
Expected Outcomes of the Program:
Improvements to MSSNY’s CME Program shall be made by evaluation of CME
activities and self-assessment of the overall program. Measurable outcomes of our
CME efforts include:
ƒ
ƒ
ƒ
ƒ
Assessment of the achievement of MSSNY’s overall CME Mission
Participant satisfaction
Measure practice performance through follow up surveys and evaluation
Acknowledgement of our achievements by others. (Council 1/25/07)
50.994
MSSNY’s Task Force on Quality Medical Care: That the Medical Society of the
State of New York support regulatory or legislative efforts to require physicians to
complete a certain number of continuing medical education credits periodically as
evidence of competence and diligence in medical practice. (Council 11/17/05)
50.995
ACCME’s Standards for Commercial Support: MSSNY approved the following
standards:
STANDARD 1: Independence
1.1 A CME provider must ensure that the following decisions were made free of the
control of a commercial interest. The ACCME defines a “commercial interest” as any
proprietary entity producing health care goods or services, with the exemption of nonprofit or government organizations and non-health care related companies.
(a) Identification of CME needs;
(b) Determination of educational objectives;
(c) Selection and presentation of content;
(d) Selection of all persons and organizations that will be in a position to control the
content of the CME;
(e) Selection of educational methods;
(f) Evaluation of the activity.
1.2 A commercial interest cannot take the role of non-accredited partner in a joint
sponsorship relationship.
STANDARD 2: Resolution of Personal Conflicts of Interest
2.1 The provider must be able to show that everyone who is in a position to control the
content of an education activity has disclosed all relevant financial relationships with
any commercial interest to the provider. The ACCME defines “’relevant’ financial
relationships” as financial relationships in any amount occurring within the past 12
months that create a conflict of interest.
2.2 An individual who refuses to disclose relevant financial relationships will be
disqualified from being a planning committee member, a teacher, or an author of
CME, and cannot have control of, or responsibility for, the development, management,
presentation or evaluation of the CME activity.
24
2.3 The provider must have implemented a mechanism to identify and resolve all
conflicts of interest prior to the education activity being delivered to learners.
STANDARD 3: Appropriate Use of Commercial Support
3.1 The provider must make all decisions regarding the disposition and disbursement
of commercial support.
3.2 A provider cannot be required by a commercial interest to accept advice or
services concerning teachers, authors, or participants or other education matters,
including content, from a commercial interest as conditions of contributing funds or
services.
3.3 All commercial support associated with a CME activity must be given with the full
knowledge and approval of the provider.
Written agreement documenting terms of support
3.4 The terms, conditions, and purposes of the commercial support must be
documented in a written agreement between the commercial supporter that includes
the provider and its educational partner(s). The agreement must include the provider,
even if the support is given directly to the provider’s educational partner or a joint
sponsor.
3.5 The written agreement must specify the commercial interest that is the source of
commercial support.
3.6 Both the commercial supporter and the provider must sign the written agreement
between the commercial supporter and the provider.
Expenditures for an individual providing CME
3.7 The provider must have written policies and procedures governing honoraria and
reimbursement of out-of-pocket expenses for planners, teachers and authors.
3.8 The provider, the joint sponsor, or designated educational partner must pay directly
any teacher or author honoraria or reimbursement of out-of–pocket expenses in
compliance with the provider’s written policies and procedures.
3.9 No other payment shall be given to the director of the activity, planning committee
members, teachers or authors, joint sponsor, or any others involved with the supported
activity.
3.10 If teachers or authors are listed on the agenda as facilitating or conducting a
presentation or session, but participate in the remainder of an educational event as a
learner, their expenses can be reimbursed and honoraria can be paid for their teacher or
author role only.
Expenditures for learners
3.11 Social events or meals at CME activities cannot compete with or take precedence
over the educational events.
3.12 The provider may not use commercial support to pay for travel, lodging,
honoraria, or personal expenses for non-teacher or non-author participants of a CME
25
activity. The provider may use commercial support to pay for travel, lodging,
honoraria, or personal expenses for bona fide employees and volunteers of the
provider, joint sponsor or educational partner.
Accountability
3.13 The provider must be able to produce accurate documentation detailing the
receipt and expenditure of the commercial support.
STANDARD 4: Appropriate Management of Associated Commercial Promotion
4.1 Arrangements for commercial exhibits or advertisements cannot influence
planning or interfere with the presentation, nor can they be a condition of the provision
of commercial support for CME activities.
4.2 Product-promotion material or product-specific advertisement of any type is
prohibited in or during CME activities. The juxtaposition of editorial and advertising
material on the same products or subjects must be avoided. Live (staffed exhibits,
presentations) or enduring (printed or electronic advertisements) promotional activities
must be kept separate from CME.
• For print, advertisements and promotional materials will not be interleafed within
the pages of the CME content. Advertisements and promotional materials may face
the first or last pages of printed CME content as long as these materials are not related
to the CME content they face and are not paid for by the commercial supporters of the
CME activity.
• For computer based, advertisements and promotional materials will not be visible
on the screen at the same time as the CME content and not interleafed between
computer windows’ or screens of the CME content as long as these materials are not
related to the CME content they face and are not paid for by the commercial
supporters of the CME activity.
• For audio and video recording, advertisements and promotional materials will not
be included within the CME. There will be no ‘commercial breaks.’ • For live, faceto-face CME, advertisements and promotional materials cannot be displayed or
distributed in the educational space immediately before, during, or after a CME
activity. Providers cannot allow representatives of Commercial Interests to engage in
sales or promotional activities while in the space or place of the CME activity.
4.3 Educational materials that are part of a CME activity, such as slides, abstracts and
handouts, cannot contain any advertising, trade name or a product-group message.
4.4 Print or electronic information distributed about the non-CME elements of a CME
activity that are not directly related to the transfer of education to the learner, such as
schedules and content descriptions, may include product promotion material or
product-specific advertisement.
4.5 A provider cannot use a commercial interest as the agent providing a CME activity
to learners, e.g., distribution of self-study CME activities or arranging for electronic
access to CME activities.
STANDARD 5: Content and Format without Commercial Bias
26
5.1 The content or format of a CME activity or its related materials must promote
improvements or quality in healthcare and not a specific proprietary business interest
of a commercial interest.
5.2 Presentations must give a balanced view of therapeutic options. Use of generic
names will contribute to this impartiality. If the CME educational material or content
includes trade names, where available trade names from several companies should be
used, not just trade names from a single company.
STANDARD 6: Disclosures Relevant to Potential Commercial Bias Relevant
financial relationships of those with control over CME content
6.1 An individual must disclose to learners any relevant financial relationship(s), to
include the following information:
• The name of the individual;
• The name of the commercial interest(s);
• The nature of the relationship the person has with each commercial interest.
6.2 For an individual with no relevant financial relationship(s) the learners must be
informed that no relevant financial relationship(s) exist.
Commercial support for the CME activity.
6.3 The source of all support from commercial interests must be disclosed to learners.
When commercial support is ‘in-kind’ the nature of the support must be disclosed to
learners.
6.4 ‘Disclosure’ must never include the use of a trade name or a product-group
message.
Timing of disclosure
6.5 A provider must disclose the above information to learners prior to the beginning
of the educational activity. (Council 3/14/05)
50.996
CME Mission Statement: MSSNY, in order to provide the physicians of the State
with the means to enhance their competence to deliver high quality medical care,
affirms it obligation to support a statewide system of effective continuing medical
education. The goal of this system is to upgrade medical care throughout the State by
maintaining, augmenting and updating physicians’ medical knowledge, skills and
attitudes in order to facilitate their delivery of medical care to their patients. This
CME system shall include educational activities relevant to the practice of all
recognized medical disciplines. To implement this most effectively, MSSNY, in
addition to the educational offerings it provides and sponsors directly, shall also
interact and cooperate with other creditable sponsors and providers of continuing
medical education. It shall be the policy of MSSNY that its continuing medical
education offerings be reasonably accessible at reasonable cost to all physicians.
MSSNY shall utilize all conventional formats and modes to provide and deliver
continuing medical education. (Council 9/20/84; Reaffirmed Council 12/19/91;
Revised Council 1/25/07..See Policy 50.993)
50.997
Mandated CME: MSSNY opposes the concept of legislatively mandating specific
kinds of continuing medical education. (Council 10/26/89)
27
50.998
Hardship or Disability: If for any reason, such as sickness, disability, or hardship, a
physician feels that he should not be obliged to fulfill CME requirements, he should
present his case to his county medical society. If the county medical society
recommends that he be relieved of his CME obligation, the recommendation will be
accepted by MSSNY for the period of time designated by the county society.
(Council 9/28/78)
50.999
Retired and Semi-retired Physicians: Retired physicians who have no connection
with medical practice, medical education, or medical administration, and who do not
earn a living from any of these activities need not fulfill the membership requirement
for continuing medical education of the Medical Society of the State of New York.
Semi-retired physicians, if they in any way treat patients or teach or administer to
other physicians who treat patients, must fulfill the continuing medical education
requirement in order to retain membership in MSSNY. (Council 4/28/77)
55.000
COUNTY MEDICAL SOCIETIES:
55.996
Guidelines for Funding County Medical Society Meetings with Legislators:
MSSNY’s Board of Trustees developed the following guidelines in response to
requests by county medical societies to be reimbursed for monies expended at county
medical society sponsored meetings with their local legislators to discuss socioeconomic and/or political issues of concern to the medical profession and issues
affecting health care delivery in New York State:
(1)
Before any reimbursement is made from the Society’s funds, the county
medical society must write the Medical Society of the State of New York for
prior approval of the anticipated project and include a fiscal note with the
request.
(2)
After the function takes place, the county medical society is requested to
inform MSSNY of the amount of actual expenses incurred, the nature of the
meeting, and the number of physicians and legislators in attendance. The
Trustees will determine the amount of reimbursement on the basis of this
information.”
(3)
The Board also recommended that MSSNY be identified as a co-sponsor
and be consulted in the development of a county medical society program,
since MSSNY will be reimbursing the county medical societies for part of
their expenses in these legislative activities. (Board of Trustees 10/25/89)
55.997
Health Care Coalitions for the Needy: The House of Delegates of the Medical
Society of the State of New York reaffirmed the society’s policy of encouraging
county medical societies and medical specialty societies to develop voluntary Health
Care Coalitions for the Needy. (HOD 87-59)
55.998
Litigation - Legal Fee Aid Plan: The following policies shall govern the
administration of the MSSNY legal fee aid plan:
Guidelines to be Followed by County Medical Societies in Requesting Financial
Assistance from the Medical Society of the State of New York in Connection with
Legal Fees for Litigation or Administrative Hearings Concerning the County
28
Medical Society or its Members (1) The County Medical Society shall promptly
advise the Executive Vice-President of the contemplated litigation or administrative
hearing giving full details of the matter involved. The County Medical Society shall
give an estimate of the amount of legal fees involved and a specific request for the
financial assistance requested. (2) Aid will be provided for legal fees only in matters
clearly redounding to the benefit of the Medical Society of the State of New York and
its membership at large. (3) The final decision as to whether legal fee aid will be
granted will be made by the Council of MSSNY with the concurrence of the Board of
Trustees. (4) In the event that MSSNY wishes to participate in legal action initiated
by a county medical society, it shall be understood that there may be a requirement for
county medical societies to participate financially.
(Council 11/20/80; Amended Council 4/16/81)
55.999
Patients’ Complaints Against Physician Members - Guidelines for Handling:
Complaints against physician members are handled at the county medical society
level. Any violation of the Medical Practice Act, the Constitution and Bylaws of the
County Medical Society, the Bylaws of the Medical Society of the State of New York,
or the Principles of Professional Conduct of the Medical Society of the State of New
York can lead to licensure suspension, or expulsion from membership. Charges
against a member physician must be submitted in writing to the county medical society
secretary who will, at once, furnish a copy to the accused and the chairman of the
proper committee. The Committee will investigate the charges on the merits, and the
accused physician will be given a reasonable time to file a written answer to the
charges. The Committee will then hold a hearing, at which the complainant, the
accused, witnesses, and counsel may all be present and submit evidence, enter
objections to evidence submitted by the other party, and call and cross-examine
witnesses. The Committee may question the complainant, the accused physician, and
witnesses. The Committee may accept any evidence deemed appropriate and
pertinent. A report of the hearing will be submitted by the Committee to the Medical
Society. It should include a determination by the Committee that the charges be either
sustained or not sustained, and a recommendation that the accused be (a) censured, (b)
suspended, or (c) expelled. A copy of this report shall be mailed to the accused
physician, who may submit written objections to the report to the Medical Society,
The report, and the accused physician’s objections, if any, shall be on file at the
Secretary’s office and available to the membership. The report and objections will be
considered at a properly announced meeting of the membership. The accused may
also request permission to present oral arguments. The granting of permission is
discretionary with the President of MSSNY. The membership shall vote to determine
the decision of the county medical society. Censure or suspension shall require a twothirds vote of the members present and voting. A three-fourths vote of the members
present and voting shall be required to expel a member. The accused may request to
be furnished, at his own expense, a copy of the recording or transcript which must be
made of the Committee hearing and the meeting of the membership. The accused
physician has the right to appeal the decision of the county medical society to the
Judicial Council of MSSNY and to the Judicial Council of the AMA (if the accused is
a member of the AMA) under such rules as these two bodies may adopt. However, the
disciplinary actions voted by the county medical society shall remain in full force and
effect during the pendency of such appeal or appeals. (Council 1/27/77; Amended
2/16/84)
60.000
DEATH:
29
60.997
New York State Department of Health’s Task Force on Life and the Law:
MSSNY to seek to have more representation on the New York State Department of
Health’s existing Task Force on Life and the Law; and MSSNY’s representatives to:
(1) make an effort to set guidelines on discontinuing or not initiating treatment, which
might then be used to aid treating physicians on a voluntary basis in discussion with a
patient and/or his/her family; and (2) advocate that an appropriate mechanism for
adjudication in end-of-life questions in the hospital setting be available for treating
physicians. (HOD 07-261)
60.998
Determination of Death: MSSNY supports enactment into law of the “Uniform
Determination of Death Act” (UDDA) model statute. The model statute reads as
follows: SECTION I. (Determination of Death) An individual who has sustained
either (1) irreversible cessation of circulatory and respiratory functions, or
(2) irreversible cessation of all functions of the entire brain, including the brain stem,
is dead. A determination of death must be made in accordance with accepted medical
standards. SECTION II. (Uniformity of Construction and Application) This act shall
be applied and construed to effectuate its general purpose to make uniform the law
with respect to the subject of this act among states enacting it. SECTION III (Short
Title) This act may be cited as the Uniform Determination of Death Act.
(HOD 83-28)
60.999
Pronouncement of Death: MSSNY is opposed to any legislation which would
designate individuals other than physicians to pronounce death. (HOD 1979)
65.000
DRUG ABUSE:
65.992
Preventing Overdose Deaths - Community-based Naloxone Programs: MSSNY
and its respective specialty societies will continue to work with the New York State
Department of Health to reduce overdose deaths and to expand Naloxone programs as
part of its comprehensive overdose prevention programs. (HOD 11-155)
65.993
Preventing Overdose Deaths - “911 Good Samaritan”: MSSNY to support efforts
that would enact a “911 Good Samaritan” law that would provide immunity from
arrest, charge, prosecution and conviction for drug and drug paraphernalia possession
and for certain alcohol-related offenses for individuals or victims of a health-related
emergency which resulted due to consumption or use of a controlled substance or
alcohol and who have contacted 911 in good faith to receive emergency medical
treatment for themselves or another individual. (HOD 11-154)
65.994
Dextromethorphan Abuse in Adolescents: MSSNY to support regulation and/or
legislation which would mandate that dextromethorphan-containing products be
placed behind pharmacy counters to prevent abuse in adolescents. (HOD 07-150)
65.995
Methadone Maintenance: Changes in Treatment Venue of Stable Patients:
MSSNY will seek approval from the necessary federal and state agencies to permit
properly trained and qualified practicing physicians to engage in the independent
treatment of opioid dependent patients who have attained behavioral and social
stability under standard treatment. (Council 9/7/00)
30
65.996
Marijuana Alert 2000: MSSNY has approved the following statement, Marijuana
Alert 2000, originally issued by the National Academy of Pediatrics, and agreed to
explore the best method of distributing it to physicians.
“Marijuana today is a high potency addictive, mind altering drug. It is five times
stronger than it was 25 years ago, and users are 104 times more likely to go on to use
cocaine! Some kids think it’s all natural because it comes from a plant and is safer
than tobacco. Surprise - Tobacco is a plant, too. And pot has some of the same cancer
causing compounds as tobacco, sometimes in higher concentrations.
Marijuana’s Many Harmful Effects Include:
Legal:
Marijuana use is a criminal act.
Arrest will affect your future.
Social:
Heavy users become fearful, even paranoid,
and lose sight of goals.
Academic:
Short term memory loss, shorter attention span,
poor learning ability.
Neurological:
Poor coordination and longer reflex time,
inability to track objects.
Cardiovascular:
Increased heart rate and blood pressure.
Pulmonary:
Like tobacco, airway obstruction cough and
even lung cancer.
Reproductive:
Lower sperm count, irregular periods, smaller
babies with smaller heads.
Immunological: Lower ability to fight infection.” (Council 1/20/00)
65.997
Hypodermic Needle and Syringe Exchange Program: MSSNY supports a
hypodermic needle and syringe exchange program trial in New York State which
includes a controlled evaluation and drug user education program strongly
encouraging drug treatment and rehabilitation as part of the ultimate goal in this
process. (Council 5/14/92)
65.998
Drug Dependency as a Clinical Illness: It is the policy of MSSNY that drug
dependency should be treated as a clinical illness. (HOD 98-90; Reaffirmed
Council 9/11/03)
65.999
Testing in the Work Place for Drug and Alcohol Abuse: MSSNY recognizes the
right of employers to require drug and alcohol testing within certain limitations, as
follows: (1) Drug and alcohol testing of applicants for employment in order to
prevent drug and alcohol abusers from entering the work place. Patients taking
medication which artificially triggers a positive test should have due process to be
retested to exclude illegal drug or alcohol. (2) Drug and alcohol testing of employees
for cause, provided that such testing is done under qualified medical supervision and
that economic and other assistance is given in the rehabilitative process. (3) Random
drug and alcohol testing of employees whose jobs may have an impact on public
safety, under conditions as in number 2 above. (4) Drug and alcohol tests must be
31
performed by New York State certified laboratories where adequate quality control
processes are in effect and where a full chain of custody procedure is maintained on
each specimen. In addition, each positive test result must be confirmed by means of
gas chromatography/mass spectrometry or an equally accurate test. (5) Confidentiality
must be maintained at all stages of the process. (6) Drug testing is appropriate when
implemented in conjunction with a program for rehabilitation and treatment of
employees who are psychologically or physically dependent. (Council 12/21/89)
70.000
DRUG DISPENSING:
(See also Children and Youth, 30.000)
70.953
Inappropriate Export of Pharmaceutical Services: MSSNY to work with the
pharmacists of New York and their Professional Organizations to maintain the option
of patients to have their prescriptions dispensed at a local pharmacy and be counseled
face-to-face by their pharmacist. (HOD 11-211)
70.954
Electronic Submission of All Prescriptions: MSSNY to proactively work with the
Department of Health to implement regulations that will permit the electronic
submission of all prescriptions in New York State. (HOD 11-101)
70.955
Unused Prescription Drug Drop-off Programs: MSSNY to work with government,
the pharmacy and pharmaceutical industry as well as the hospital associations to
advocate for the creation of a statewide program to facilitate the installation of
appropriately secured “unused prescription return” boxes in various locations across
the State. (HOD 11-67)
70.956
Return of Unused Medications in Long Term Care Facilities: MSSNY adopted as
policy the existing AMA Policy H-280.959, “Recycling of Nursing Home Drugs.”
Recycling of Nursing Home Drugs
Our AMA supports the return and reuse of medications to the dispensing pharmacy to
reduce waste associated with unused medications in long-term care facilities (LTCFs)
and to offer substantial savings to the health care system, provided the following
conditions are satisfied: (1) The returned medications are not controlled substances.
(2) The medications are dispensed in tamper-evident packaging and returned with
packaging intact (e.g., unit dose, unused injectable vials and ampules). (3) In the
professional judgment of the pharmacist, the medications meet all federal and state
standards for product integrity. (4) Policies and procedures are followed for the
appropriate storage and handling of medications at the LTCF and for the transfer,
receipt, and security of medications returned to the dispensing pharmacy. (5) A
system is in place to track re-stocking and reuse to allow medications to be recalled if
required. (6) A mechanism (reasonable for both the payer and the dispensing LTC
pharmacy) is in place for billing only the number of doses used or crediting the
number of doses returned, regardless of payer source.
Also, MSSNY is to communicate this policy to appropriate Federal and State
governmental agencies to urge its immediate adoption. (HOD 10-250)
70.957
List of Patients’ Medications Provided by Pharmacists: MSSNY to encourage all
pharmacies licensed in New York State to provide individuals with a complete listing
of all their medications each time a prescription is filled. This list of medications
32
provided by the pharmacist to a patient would include the name of the drug (brand and
generic, if appropriate), dosage and any other identifying information which will assist
the individual in recognizing and understanding the medications they are taking.
(HOD 10-103)
70.958
Use and Acceptance of E-Prescription: MSSNY to [1] encourage all physicians to
adopt E-Prescription and make the information about E-Prescription including
incentive payment from Medicare and Medicaid available to all physicians; and [2]
urge all pharmacies, including mail order pharmacies, to accept E-Prescription from
physicians. (HOD 10-101)
70.959
Pharmacy Benefit Managers’ or Payors’Interference with the Course of Good
Treatment and Requiring the Provision of Dangerous Quantities of Medicine:
MSSNY to:
a) seek legislation and/or regulation prohibiting a payor or Pharmacy Benefit
Manager (PBM) from either requiring a prescription to be filled with a quantity
greater than that which is prescribed by a patient’s treating physician, or imposing
significant additional cost-sharing responsibilities on patients for filling
prescriptions with smaller quantities;
b) work with the State Insurance, Health and Education Departments to assure that
patients can obtain prescription drugs consistent with the dosage, frequency and
duration as prescribed by the physician;
c) continue to seek legislation and/or regulation that permits a patient to obtain a
denied prescription drug pending an internal or external appeal of a denial by a
health insurance company at the insurer’s expense;
d) continue to advocate for legislation that would prevent insurance companies from
coercing patients through financial disincentives to change a medication upon
which a patient is stabilized, simply due to a change in formulary, change in plan
or change in insurer. (HOD 10-61)
70.960
Cancellation or Rescission of Renewals after the Prescriptions Have Been
Delivered to the Pharmacy: MSSNY to seek appropriate measures including, if
necessary, legislation to assure the ability of a physician to cancel or rescind a
prescription for a patient if deemed warranted by the patient’s treating physician.
(HOD 10-60)
70.961
NYS Prescription Pads: MSSNY oppose any effort present or future to require
physicians to pay a fee for the official prescription forms supplied by the state; and
work to assure that an adequate supply of prescription forms are provided to each
physician or licensed allied medical practitioner. (HOD 05-97)
70.962
Two-Part Official Prescriptions: MSSNY advocate that two-part official
prescription forms be made available to prescribers requesting them. (HOD 05-89)
70.963
Electronic Prescription System: MSSNY supports working with the New York
State Department of Health, the pharmacists, the insurance companies, the third party
administrators, and the pharmacy benefits management plans of New York State to
plan, advocate, develop, and participate in an Electronic Prescription System as a
voluntary pilot project, and if worthwhile, then offered to all prescribers in New York
State at no charge. (HOD 04-159)
33
70.964
Pharmacies Should Be Required to Accept Faxed Prescriptions for Noncontrolled Substances: MSSNY will work for legislation requiring all New York
State pharmacies to accept faxed or electronically-transmitted prescriptions for noncontrolled substances, when in the pharmacist’s professional judgment that faxed or
electronically-transmitted prescription is legible and valid. (HOD 02-76)
70.965
Coverage for Brand Name Medications as Prescribed by Physicians: MSSNY
must aggressively pursue enactment of MSSNY Policies 70.974 (Restrictive
Formulary Medication Benefit Plans); 70.976 (Continued Coverage for Prescription
Medications from Health Plan Drug Formularies); 70.977 (Restrictive Formulary Drug
Prescription Sanction Through Managed Care); and 165.941 (Coordination of
Pharmacy Benefit Into Existing Health Plans).
Enactment of the aforementioned MSSNY Policies should become a top priority
during the upcoming legislative session in Albany.
Legislation will be sought to ensure that patients are not financially penalized for the
prescription of a “non-preferred” drug by either: (a) seeking legislation to mandate that
any “non-preferred” agent for which no bio-equivalent “preferred” agent exists in that
plan be covered as a “preferred” agent; or (b) seeking legislation to mandate that the
insurer provide a credit towards the cost of the “non-preferred” agent in the amount
equal to that which would have been paid had a similar “preferred” agent been
prescribed. (HOD 02-57)
70.966
Mandatory Acceptance of the Currently Utilized Physician Prescription Form by
Pharmacy Benefit Plan Administration: MSSNY will seek legislation or regulation
that would require pharmacy benefits plans which provide pharmacy benefit coverage
to New York State residents to be licensed, certified or registered to do business in
New York State and to accept the currently utilized physician prescription forms, for
all initial prescriptions and renewals.
It is the position of MSSNY that the provision of a written, oral or electronically
transmitted prescription in keeping with law and tradition constitutes the entirety of
the physician’s responsibility in providing patient prescriptions.
The sentiments articulated in this resolution will be forwarded to the Pharmacists
Society of the State of New York for their consideration and support. (HOD 02-56)
70.967
Public Notification of Expired Pharmaceuticals: MSSNY will aggressively pursue
legislation which would mandate the placement of expiration dates on prescription
drug labels as stipulated in Resolution 95-62, 96-60, reaffirmed in Resolution 99-63
and as currently provided for in the MSSNY 2002 Legislative Agenda.
MSSNY will remind all physicians through their usual publications, i.e. News of New
York, EVPgram, that all prescribed medications are to be utilized within a reasonable
period of time so as to avoid the possibility of patients having unsafe or ineffective
medications.
MSSNY will call upon the American Medical Association to encourage the Food and
Drug Administration and/or other appropriate agencies to undertake a comprehensive
study to determine how certain factors, including but not limited to time, storage and
handling will affect the efficacy and safety of prescription drugs. (HOD 02-53)
34
70.968
Single Dose Labeling of Medication in a School Setting by Registered
Professional School Nurses: (Sunsetted HOD 2011)
70.969
Removing DEA Documentation from Uncontrolled Prescription Pad: MSSNY
adopted as policy the existing AMA Policy H-100.972 “Misuse of the DEA License
Number.”
Misuse of the DEA License Number
MSSNY affirms its opposition to use of the Drug Enforcement Administration (DEA)
license number for any purpose other than for verification to the dispenser that the
prescriber is authorized by federal law to prescribe the substance; and will explore
measures to discourage or eliminate the use of physicians’ DEA license numbers as
numerical identifiers in insurance processing and other data bases, either through
legislation, regulation or accommodation with organizations which currently insist on
collection of this sensitive data.
MSSNY will seek through legislation or regulation limitation of the use of DEA
numbers to those federal and state entities that use the number to oversee and enforce
the law regarding the manufacture, distribution, and dispensing of controlled
substances.
MSSNY will advocate for adoption of the AMA’s Medical Education number as the
unique identifier for physicians. (HOD 01-154; Reaffirmed HOD 2011)
70.970
Drugs with Narrow Therapeutic Index: MSSNY supports the passage of State
legislation requiring third party carriers to cover patient’s costs for brand name drugs
contained on the list of narrow therapeutic index drugs at the same cost as if generic
substitution were permitted. (HOD 01-56; Reaffirmed HOD 2011)
70.971
Administration of Prescription Drug Programs Insuring Patient Access to
Necessary Medication: MSSNY will:
70.972
(1)
express its concern to the New York Department of Health and the
Department of Health and Human Services that the programs concerning
prescription drugs be administered in such a way that patients will not be
denied access to necessary medication; and
(2)
oppose any third party payer reducing reimbursement beyond or below a
physician’s and/or other health care practitioner’s cost; and
(3)
support activity to ensure that all fair administrative costs be considered for
reimbursement; and
(4)
coordinate with the Pharmacists Society of the State of New York in a
concerted effort to insure proper access to pharmaceutical drugs for all
patients in New York State. (Council 1/25/01; Reaffirmed Council 1/22/04)
(5)
vigorously advocate for fair and reasonable reimbursement for
chemotherapy and other vaccines. (Council 1/22/04 addition)
Require Pharmacies to Print the Expiration Dates of Medications On All
Prescription Labels: MSSNY will support legislation to require that expiration dates
35
of prescribed drugs be listed on the package for consumers, and to provide for
enforcement of such provisions by the New York State Attorney General, and MSSNY
will ask its delegation to propose a similar resolution to the American Medical
Association. (HOD 00-162)
70.973
Insurance Companies, Pharmacies and Pharmaceutical Benefits Management
Companies (PBMs) Should Not Require a Diagnosis in Order for the Patients
Prescription to be Filled: MSSNY will advocate for legislative/regulatory relief,
requiring pharmacies, any health plan and pharmaceutical benefits managers to fill
prescriptions even if their patient’s diagnosis is not divulged to them.
(HOD 00-83)
70.974
Restrictive Formulary Medication Benefits Plans: MSSNY supports enactment in
the State of New York of a pharmacy benefits management law that will regulate
managed pharmacy benefit plans to prohibit interference in the doctor-patient
relationship, to prevent interruption of ongoing medical care treatment and to promote
access to medication that is consistent with accepted standards of appropriate medical
care and treatment, to provide patients with advance notice of benefit limits and the
right to pursue external review of medications denied due to formulary restrictions.
MSSNY supports legislation that requires that where a prescription is denied due to
formulary restrictions the prescription drug must be dispensed to the patient for the
pendency of the internal or external appeal process.
MSSNY will educate physicians and patients regarding the right to pursue external
review when patients are denied or provided unequal access to medications because of
formulary restrictions. (HOD 00-78; Reaffirmed HOD 01-53; Reaffirmed HOD 2011)
70.975
Continued Coverage for Prescription Medications From Health Plan Drug
Formularies: MSSNY will seek appropriate legislation that would allow a patient
suffering from a chronic condition to continue to be reimbursed for medically necessary
prescription drugs subsequently removed at the discretion of a health plan from its drug
formularies provided that the patient’s physician believes that there is no appropriate
alternate drug on the formulary. (HOD 98-74; Reaffirmed HOD 01-53; Reaffirmed
HOD 2011)
70.976
Restrictive Formulary Drug Prescription Sanction Through Managed Care:
MSSNY will develop and propose legislation or regulation requiring (a) pharmacists
to contact the prescribing physician if a prescription written by the physician violates
the managed care formulary under which the patient is covered, so that the physician
has an opportunity to prescribe an alternative drug, which may be on the formulary;
(b) which prohibits managed care entities, and other insurers, from disciplining, or
withholding payment from physicians because they have prescribed drugs to patients
which are not on the insurer's formulary or have appealed a plan’s denial of coverage
for the prescribed drug; (c) which ensures that all pharmacy benefit management
companies and insurers which use restrictive drug formularies be required to impanel
an independent group of physicians to determine the composition of the drug
formulary; (d) will request the American Medical Association to examine the
feasibility of establishing a standardized process for formulary development applicable
to all managed care plans. (HOD 98-55; Reaffirmed HOD 01-53; Reaffirmed
HOD 2011)
36
70.977
Sanctioning More Than One Non-Controlled Substance To Be Prescribed On
The Same Prescription Blank: MSSNY will urge, as a matter of priority, revision of
New York State legislation to give the patient the option of requesting that two or
more drugs prescribed at the same time be written on the same blank; and that the
prescribing physician will state in writing, above his signature, the number of items
prescribed. (HOD 97-111)
70.978
Contact Lens Prescription, Expiration Date for: MSSNY has adopted the position
that there is danger to the public health and safety by allowing prescriptions for
contact lenses to be filled without time limitation and without any requirement for
proper ophthalmic follow-up care and that the same strict standards that regulate the
dispensing of oral and topical medications, medical devices and appliances also apply
to the dispensing of contact lenses to the residents of New York, and that contact lens
prescriptions have an expiration date of one year after the date they are written.
(HOD 96-180)
70.979
Expiration Date on Medicine Containers: MSSNY will request the State Board of
Pharmacy to require pharmacies to include the manufacturer’s expiration date on each
medication container. (HOD 96-60)
70.980
Generic Drug, Use of ‘A’ Rated: MSSNY will petition the NYS Department of
Health, and/or appropriate agencies, and/or seek legislation to develop and implement
a system that would allow physicians who permit generic substitutions to designate
substitution only by ‘A’ rated generic drugs. (Council 12/14/95)
70.981
Generic Substitutions: MSSNY will seek legislation to provide that where there is
generic substitution because the physician has not designated “DAW” the pharmacist
filling the prescription include on the label the words “Substituted for (brand name).”
(HOD 94-152; Reaffirmed 10-97)
70.982
Optometrists Prescribing Drugs: MSSNY opposes legislation which would permit
optometrists to administer or prescribe drugs for treatment of patients. (HOD 92-39)
70.983
Triplicate Prescription Program: MSSNY is seeking legislation to rescind the New
York State triplicate prescription program and is working closely with the Legislature
to develop and adopt an ideal drug diversion control program. (HOD 91-89)
70.984
Expiration Date and Control Number on Prescription Drugs: MSSNY will seek
changes in New York State laws and/or regulations to require that expiration dates and
control numbers be included by the issuing pharmacy on the label of each prescription
drug received by patients. (HOD 91-26; Reaffirmed HOD 95-62 & HOD 99-63)
70.985
Opposition to Legalization of Non-Prescriptive Drugs Such as Heroin and
Cocaine: Physicians must oppose the legalization of the use of non-prescriptive,
potentially dangerous drugs such as heroin and cocaine. Use of such drugs poses a
serious threat to the health of the individual and society. In countries where such
drugs have been legalized, their use has increased. Use of potentially dangerous drugs
frequently leads to limited reasoning ability, unproductive and antisocial behavior, an
increase in the development of neurologic, psychiatric, infectious and other medical
diseases and fetal health problems. Maternal narcotism causes damage to the embryo
37
and/or fetus which not only increases fetal mortality but also increases fetal morbidity
which may last the lifetime of the individual. These health considerations outweigh
any potential reduction in crime or reduction in the transmission of infection which
might be anticipated from the legalization of such drugs. (Council 12/13/90)
70.986
New Medications - Testing: MSSNY is urging the pharmaceutical industry to
commence scientific testing of RU-486 in the United States. (HOD 90-83)
70.987
Generic Drug Prescription: MSSNY petitioned the Superintendent of Insurance
and/or the Commissioner of Health of the State of New York, as well as third party
carriers, to cease the practice of requiring and/or encouraging the use of generic drugs
until such time that the bio-equivalency of generic drugs can be assured. (HOD 90-8)
70.988
Opposition to Legalization of Drugs for Non-Medically Indicated Uses: MSSNY
is opposed to the legalization for non-medically indicated uses of the following
substances: hallucinogenics, narcotics, and cocaine and its derivatives.
(Council 1/25/90)
70.989
FDA ‘A’ Generic Drug Prescribing: If a generic drug is appropriate, MSSNY urges
that an FDA ‘A’ generic drug be prescribed. FDA ‘B’ drugs are not pharmaceutically
equivalent and drastic changes in clinical outcome could occur if they are taken as a
plain generic. (Council 12/21/89)
70.990
Political Pressure and Release of New Medications: MSSNY believes that testing
and release of RU-486, and other medications, should be based upon scientific
evidence and should be free of influence of political pressure groups. (HOD 89-26)
70.991
Physician’s Right to Dispense Drugs and Devices: MSSNY supports the position
taken by the AMA House of Delegates in June, 1986 to support the physician’s right
to dispense drugs and devices when it is in the best interest of the patient and
consistent with the AMA’s Ethical Guidelines. (Council 4/23/87)
70.992
Marijuana: MSSNY recognizes that there are laws pertinent to individual use and
possession of small amounts of marijuana, that the sales and/or importation of
marijuana be continued to be regarded a felony, that driving under the influence of
marijuana should be prohibited by motor vehicle law, that State and Federal Health
Departments should be encouraged to develop means of quickly testing the potency of
confiscated marijuana and be encouraged to develop rapid test methods for
determining the presence of marijuana in body secretions. MSSNY believes that, to
prevent people from thinking there is no risk attached to the use of marijuana, an
adequate education and drug information program to disseminate the latest
information on the drug should be encouraged. MSSNY urges that more serious
research be done at the Federal and State levels on the effects of long-term and shortterm use of marijuana. MSSNY encourages the use of drug screening of those persons
who appear to be impaired, in addition to breathalyzer. (Council 6/26/86)
70.993
“Look-Alike” Drugs: MSSNY encourages federal legislation prohibiting the
manufacture, sale, distribution or gift of substances which look like controlled
substances (“Look-alikes”). MSSNY supports stricter legislation controlling the
advertising and sale of “Look-Alike” medications. (Council 12/13/84)
38
70.994
Qualitative Labeling of All Drugs: MSSNY strongly supports efforts to promote
qualitative drug labeling of all drugs, requiring the active and inactive ingredients of
all drugs (over-the-counter as well as prescription) to be listed on the label or package
insert for the drug. (Council 12/13/84)
70.995
Generic Drug Labeling: All generic medications should have an identifying number
or symbol. (Council 12/13/84)
70.996
Heroin for Pain Relief: MSSNY continues to oppose any legislation which would
legalize the use of heroin for pain relief. (HOD 84-57)
MSSNY opposes the use of heroin for pain relief in the terminally ill patient because
there are as yet no data which show its superiority over other drugs currently being
used. The increased availability of heroin could also open up avenues permitting its
divergence to street and other abuses. (Council 6/21/79; Reaffirmed HOD 84-57)
70.997
Generic Drug Substitution Statement on “Physician” Prescription Blanks:
MSSNY supports the position that Doctors of Medicine and Doctors of Osteopathy be
permitted to use the word “Physician” on their own personal prescription blanks and
that those with D.D.S. degrees be permitted to use the word “Dentist,” those with
D.V.M. degrees use the word “Veterinarian,” etc. (HOD 83-8)
70.998
Generic Drug Substitution: The members of the Medical Society of the State of
New York are as interested as any other group of citizens in the State, if not more so,
in eliminating unnecessary costs in the delivery of health care and are actively engaged
in developing measures that will lead to the most effective use of the dollars expended
on health care, provided that none of these measures results in a lowering of the
quality of medical care available to and afforded the public. Two measures that could
lead to a wider use of generic drugs should be considered: (1) The first is to conduct
controlled, scientifically valid studies to conclusively establish that generic drug
substitutes are equivalent in bio-availability and therapeutic equivalence. Disturbing
reports have appeared in scientific medical literature that seriously question whether
generic drugs approved by the FDA do, in fact, satisfy these criteria. In the face of
such doubts, it is understandable that physicians will be reluctant to authorize drug
substitutes for medications with which they are familiar by experience. The necessary
studies do entail expenditure of money and delays, but these are small prices to pay
when one is primarily concerned with providing the very best available drug to an ill
patient. (2) A second major deterrent to physicians readily agreeing to generic drug
substitution is the question of their liability if a substitute, of which they have
insufficient knowledge and no control in choice, should prove to be ineffective for the
purpose intended and the patient suffers thereby. Our Society has had correspondence
with both the State and Federal governments to determine the limitations of a
physician’s liability and the responses have been equivocal. It is our interpretation, as
the Law now stands, that the physician may still be liable. An unequivocal statement
of acceptance, of complete liability, by either the Federal or State government, in the
event of untoward effects developing solely from the use of a generic drug substitute
such as was promulgated for the swine flu immunization program, would remove this
anxiety from the physician’s mind and encourage wider use of generic substitution.
There is a basic principle to be stressed in the consideration of this subject, namely,
that no law should curb the professional judgment of a physician in the treatment of
his patient. Years of intensive schooling and training mark the education of a
39
physician and his licensure. It is such training that establishes the physician as the one
best able to determine the most effective means of therapy for the individual problems
of a particular patient. It is most earnestly hoped that no inadequate substitute for this
professional judgment, based solely on cost, will ever be enacted. (HOD 1983)
70.999
Generic Drug Prescription Forms: MSSNY is in favor, whenever possible, of
reducing the cost of care to the patient. Understanding that the freedom of the
physician to specify a brand name remains inviolable and accepting the value of the
freedom from liability incorporated in a 1982 generic drug substitution legislative
proposal, The MSSNY adopted the position of not opposing a bill so long as the
method of specifying brand name drugs on prescription forms remains simple, such as
D.A.W. (in place of “Dispense as Written”) or checking one of two boxes.
(HOD 1982)
75.000
DRUGS AND MEDICATIONS:
(See also Abortion and Reproductive Rights, 5.000; Drug Dispensing, 70.000; Home Health Care,
135.000; Pharmaceutical Advertising, 227.000; Public Health & Safety, 260.000; Reimbursement,
265.000; Sports and Physical Fitness, 290.000)
75.979
Medical Marijuana: MSSNY to take a leadership role in the development of any
regulations resulting from the passage of state legislation pertaining to medical
marijuana and also request the American Medical Association’s assistance in seeking a
reversal of the Executive Order pertaining to the prosecution of physicians who
prescribe or advise medical marijuana, legally under state statute. Also, a copy of this
resolution is to be transmitted to the American Medical Association for its
consideration. (HOD 09-173)
75.980
Inappropriate Incentives for Recommending Generic Drugs over Brand Name
Drugs: MSSNY to introduce a resolution at the June 2009 Annual Meeting of the
American Medical Association (AMA) calling upon the Centers for Medicare &
Medicaid Services to abolish the provision of providing incentives for pharmacists to
“push” generic drugs over brand name drugs; and, through the AMA, to urge the
Centers for Medicare & Medicaid Services to assure that there be greater transparency
between the use of generics vs. brand name medications so as to enable patients to
make informed and intelligent decision. Also, MSSNY to seek passage of legislation
similar to that passed in Maine in 2003 and, subsequently, in other states, that would
allow for the regulation of Pharmacy Benefit Management plans by imposing contract
transparency and conflict of interest requirements and would require that savings
based on drug volume discounts be passed on to client health plans and consumers.
(HOD 09-103)
75.981
“Pay for Delay” Arrangements by Pharmaceutical Companies: MSSNY to
forward a resolution to the American Medical Association exhorting that organization
to support the Federal Trade Commission in its efforts to stop these “pay for delay”
arrangements. (HOD 08-207)
75.982
Extend Phase-out Period for Proven CFC Inhalers: MSSNY to work with the
American Medical Association to encourage the Food and Drug Administration to
allow the availability of the Chlorofluorocarbon (CFC) delivery system until the
present stock runs out. (HOD 08-170)
40
75.983
Limiting Coverage for Psychiatric Drugs: MSSNY to urge the appropriate state
agency and/or State Legislature to prohibit the practice of health insurance companies
restricting access to psychiatric drugs by (1) requiring failure of a generic drug prior to
permitting coverage for a non-generic drug; (2) limiting doses by number of pills per
day; or (3) limiting coverage to certain formulations.
MSSNY also to seek legislation or other appropriate remedies to assure that patients
who switch insurance companies be able to continue on their existing chronic drug
therapies. (HOD 08-54)
75.984
Medical Use of Marijuana/Synthetic Cannobinoids: MSSNY to encourage
additional research on the use of cannabinoid products in the treatment of illness and
the relief of human suffering without penalty and acknowledge the AMA Report,
Medical Marijuana (A-01), as updated February 2007. (HOD 07-151)
75.985
Availability of Nicotine Replacement: MSSNY advocate for the sale of nicotine
replacement products in the same settings where cigarettes are sold, and in daily units,
as part of a comprehensive program to reduce the sale of the more toxic cigarettes to
New York citizens who are nicotine-addicted; and work with the NYS Department of
Health to make free nicotine replacement products available in physicians’ offices.
(HOD 06-161)
75.986
Herbal Supplements: (1) MSSNY work with the American Medical Association to
educate physicians and the public about FDA’s MedWatch program and to strongly
encourage physicians and the public to report potential adverse events associated with
dietary supplements and herbal remedies to help support FDA’s efforts to create a
database of adverse event information on these forms of alternative/complementary
therapies; (2) MSSNY, in conjunction with the AMA, continue to urge Congress to
modify the Dietary Supplement Health and Education Act to require that (a) dietary
supplements and herbal remedies including the products already in the marketplace
undergo FDA approval for evidence of safety and efficacy; (b) meet standards
established by the United States Pharmacopeia for identity, strength, quality, purity,
packaging, and labeling; (c) meet FDA post-marketing requirements to report adverse
events, including drug interactions; and (d) pursue the development and enactment of
legislation that declares metabolites and precursors of anabolic steroids to be drug
substances that may not be used in a dietary supplement; (3) MSSNY work with the
AMA to support enforcement efforts based on the FTC Act and current FTC policy on
expert endorsements; (4) That the product labeling of dietary supplements and herbal
remedies contain the following disclaimer as a minimum requirement: “This product
has not been evaluated by the Food and Drug Administration and is not intended to
diagnose, mitigate, treat, cure, or prevent disease.” This product may have significant
adverse side effects and/or interactions with medications and other dietary
supplements; therefore it is important that you inform your doctor that you are using
this product; (5) That in order to protect the public, manufacturers be required to
investigate and obtain data under conditions of normal use on adverse effects,
contraindications, and possible drug interactions, and that such information be
included on the label; and (6) That MSSNY continue its efforts to educate patients
and physicians about the possible ramifications associated with the use of dietary
supplements and herbal remedies. (HOD 04-151)
41
75.987
Medical Marijuana: MSSNY adopts as policy that the use of marijuana may be
appropriate when prescribed or certified by a licensed physician solely for use in
alleviating pain and/or nausea in patients who have been diagnosed as chronically ill
with life threatening disease when all other treatments have failed, that the physicians
who prescribe marijuana for patient use, subject to the conditions set forth above, shall
not be held criminally, civilly or professionally liable and that it supports continued
clinical trials on the use of marijuana for medical purposes. Also, MSSNY to (1)
recommend to sponsors of legislation that the use of medical marijuana should not be
utilized in patients who suffer solely from psychiatric conditions; and (2) continue to
work with members of the State Legislature and the New York State Department of
Health to ensure that any legislation that is passed contains limits on certification time
frames and provides a sunset to the law. (HOD 04-169) (Council 11/4/04 considered
an editorial change but tabled action until the 2005 HOD at which time the resolution
would be introduced as Old Business.) (Reaffirmed HOD 09-173) (Council 12/9/10
Reaffirmed as Amended)
75.988
Medicare and ‘Off Label’ Uses of Drugs: MSSNY confirms its strong support for
the autonomous clinical decision-making authority of physicians to prescribe
medications for ‘off-label” use when such physician believes that it is clinically
indicated for the patient. (HOD 04-67)
75.989
Unregulated Sympathomimetic Amines: MSSNY work closely with the AMA to
urge the FDA to formulate a definitive policy regarding the under-regulated sale of
over-the-counter (OTC) Sympathomimetic Amines (SMAs) in medications (with
particular emphasis on weight control supplements that contain SMAs) as a means of
preventing morbidity and mortality. That MSSNY encourage the FDA to reconsider
the appropriateness of providing SMAs OTC, or as a prescription medication, while
also investigating the onslaught of excessive advertising by companies that market and
promote these products to the general public. That MSSNY recommend the FDA, and
other appropriate governmental agencies, perform clinical studies as to the potential
parallel adverse effects of pseudoephedrine and ephedrine to the PPA experience with
central nervous system events in women, as well as the potential effects all of the
products have on hypertension in our population. Also, that MSSNY work towards
educating physicians and the public on the potential adverse events to the use of
supplements through its website, news articles, and other avenues. (HOD 03-164)
75.990
Opposition to Bill Mandating Electronic Submission of Prescriptions: MSSNY
opposes any bill that would mandate physicians type or electronically submit
prescriptions and that instead, MSSNY supports legislation that encourages that
prescriptions be legible and supports a state funded pilot program that studies the
efficacy of the use of electronic prescribing technology in hospitals and physicians’
offices as a means to reduce medical errors involving prescriptions.
(Council 11/8/01; Reaffirmed 2011 HOD)
75.991
Herbal Substances: MSSNY will support Federal legislative and regulatory efforts
to ensure that herbal substances are free from known carcinogens, pesticides or any
other chemicals known to cause human illness and meet standards established by the
United States Pharmacopoeia for identity, strength, quality, purity, packaging, and
labeling; and meet FDA post-marketing requirements to report adverse events,
including drug interactions. (HOD 00-61)
42
75.992
Prohibition of Inappropriate Pill Splitting: It is the position of MSSNY that the
New York State Insurance Department and all other appropriated state agencies
prohibit insurance companies from requiring pill splitting. (HOD 00-160)
75.993
Schedule I Drug Butyrolactone (GBL or 2G3H)-furanone dihydro): MSSNY will
support a federal bill to include gamma Butyrolactone (GBL) or2(3H)-furanone
dihydro, which is a precursor of gamma hydroxy butyrate (GHB) as a Schedule I drug;
and b) that MSSNY will support legislation asking that out-of-state pharmacies be
licensed in New York State, if shipping prescriptions to New York State.
(Council 1/20/00)
75.994
Enhanced Funding for ADAP (Aids Drug Assistance Program), including Drug
Availability and Post Exposure Prophylaxis): MSSNY will advocate its support for
ADAP (Aids Drug Assistance Program) through the appropriate legislative channels.
(Council 2/4/99)
75.995
Payment for Medications Containing Estrogen and Progesterone: MSSNY will
seek legislation that any insurance carrier or HMO that has a prescription medication
benefit be required to cover medications containing estrogen and progesterone alone or
in combination, as long as the medication is being prescribed according to accepted
medical standards. (HOD 99-171)
75.996
Use Of Marijuana For Treatment of Glaucoma: MSSNY opposes any current
legislative initiative which would legalize the use of marijuana for the treatment of
glaucoma. (HOD 97-179)
75.997
Serialized Prescriptions: MSSNY unequivocally takes the position that serialized
prescriptions shall not be another subtle means of open-ended taxation of the physician
community. (HOD 94-175)
75.998
Diet Pills: MSSNY endorsed the banning of over-the-counter diet pills entirely until
such times as there is sufficient proof of their safety and effectiveness.
(Council 12/13/84)
75.999
Amphetamines: It is the position of the Medical Society of the State of New York
that amphetamines should not be used in the management of weight control problems;
however, it recognizes that there are legitimate reasons for prescribing amphetamines
(e.g., narcolepsy, minimal brain damage, and in conjunction with narcotics in control
intractable pain). (Council 1/22/81)
80.000
DUE PROCESS FOR PHYSICIANS:
(See also Reimbursement, 265.000)
80.992
Proposal for a “Two-Tier” Pain and Suffering System in Medical Liability Cases:
MSSNY to seek legislation creating a two-tier pain and suffering award system for
medical liability cases whereby
a.
the jury’s award for pain and suffering would be capped at $250,000;
b.
if the plaintiff’s attorney considered the award insufficient, he/she would be
permitted to file a motion with the judge for a post-verdict modification;
c.
the judge would be permitted, in the interests of justice, to adjust all aspects of
the award, including pain and suffering; and
43
d.
80.993
the judge’s decision regarding any pain and suffering award would not be
limited to the $250,000 cap. (HOD 10-63)
Collaboration with the Bar Association on Apology Legislation: MSSNY will:
−
support collaborative efforts with the American Bar Association (ABA) and the
New York Bar Association to pursue legislation to protect statements of
apology, confessions of regret, or admission of errors to patients and/or their
families regarding less than anticipated clinical outcomes from being admissible
as admission of liability;
−
ask the American Medical Association to support collaborative efforts with the
American Bar Association and its affiliates to pursue legislation to protect
statements of apology, confessions of regret, or admission of errors to patients
and their families regarding less than anticipated clinical outcomes from being
admissible as admission of liability;
−
utilize this collaboration and the American Bar Association policy that supports
enactment of apology legislation to facilitate movement toward medical liability
reform. (HOD 09-55)
80.994
Expungement of Record of Liability: MSSNY to seek legislative, regulatory or
other appropriate means to eliminate the requirement for a physician to report any
information regarding a medical liability claim brought against him or her that has
been concluded without monetary or other pecuniary relief being paid on behalf of that
physician. (Council 11/20/08)
80.995
Support the “Sorry Works” Program: MSSNY to support the “Sorry Works”
Program which also protects against the use of the physician’s admission against
interest in a subsequent lawsuit as long as it is accompanied with meaningful tort
reform and also urge the American Medical Association to support the Program.
(HOD 08-97)
80.996
Bifurcation of Trial: MSSNY to seek legislation to require bifurcation of trial in all
medical liability cases. (HOD 07-53)
80.997
Use of Expert Testimony: MSSNY continues to advocate for meaningful reform
regarding the use of expert testimony, including but not limited to: (1) requiring pretrial disclosure of the identity of experts; (2) requiring the deposing of experts; (3)
requirements that experts have a similar specialty, clinical background, and be in
active practice similar to that of the physician whose care is the subject of the action;
or (4) through the establishment of programs where expert testimony can be preapproved by appropriate medical experts. (HOD 07-52)
80.998
Medical Courts for Medical Liability Cases: MSSNY seeks the creation of medical
courts which are composed of judges who have undergone specialty training and have
been certified to hear medical liability cases. (HOD 07-51; Reaffirmed HOD 10-64)
80.999
Professional Conduct Review: The basic principles of a fair and objective hearing
should be accorded to the physician whose professional conduct is being reviewed.
These basic guarantees are: a specific charge, adequate notice of hearing, and
44
opportunity to be present and to hear the evidence, and to present a defense. These
principles apply whether the hearing body is a medical society tribunal or a hospital
committee composed of physicians. (Council 12/16/76)
85.000
EDUCATION:
(See also Emergency Care, 87.000; Managed Care, 165.000; Tobacco Use and Smoking, 300.000;
Vaccines, 312.000; Weight Management & Promotion of Healthy Lifestyles, 320.000)
85.959
Increasing Funding for Graduate Medical Education: MSSNY to:
1) encourage both public and private payers to contribute to Graduate Medical
Education (GME) funding, through, for example, expansion of government grant
opportunities similar to the Primary Care Residency Expansion Program;
2) encourage adjusting GME funding to account for the need of an expanded
workforce;
3) advocate for transparency in the funding of residency programs and for how those
programs in turn use allotted funding;
4) urge the American Medical Association to work toward the removal of caps on the
number of Medicare funded residency programs and physicians therein.
(HOD 11-166)
85.960
Securing Quality Clinical Education Sites for US-Accredited Schools: MSSNY to
support preference being given to students from LCME/COCA accredited medical
schools over international and dual campus students for clinical clerkship rotations in
hospital or affiliated clinics. (HOD 11-165)
85.961
AMA Encouragement of State Medical Societies to Form Committees to
Eliminate Health Care Disparities: MSSNY’s Delegation to the American Medical
Association to introduce a resolution at its next meeting requesting that the AMA (1)
urge that the state medical societies that are not yet members of the AMA Commission
to Eliminate Health Care Disparities join and participate in this important public health
initiative and (2) strongly encourage all state medical societies to form a Standing
Committee to Eliminate Health Care Disparities and that those committees share ideas
and work together as a coalition. (HOD 11-163)
85.962
Specialty Exams: MSSNY to request of the American Medical Association that:
(1) it recommend to the American Board of Specialties that a physician in private
practice be required to take only one proctored board exam within that physician’s
specialty every ten years, and that within the maintenance of certification at the same
exam other optional sections should be devoted to the added qualifications; and (2) it
request that its component specialty societies restrain from dividing every aspect of
their specialist physician practice into numerous added qualification exams and that,
whenever possible, alternate methods be sought to ensure adequate qualifications and
make the process less onerous for physicians in private practice. (HOD 11-115)
85.963
Promotion of Financial Aid Opportunities for New York Medical Students:
MSSNY to: (a) advocate for the expansion of the Doctors Across New York Physician
Loan Repayment Program by increasing the number of available positions, and
directing any unused funds in the Loan Repayment Program toward the Practice
45
Support Program; (b) support the development of State funded loan forgiveness and
repayment programs for physicians; and (3) advocate for the development of
scholarships and/or grants for medical students who plan to work in the state.
(HOD 11-108)
85.964
Non-Alcohol Fatty Liver Disease: Through its website and numerous publications,
MSSNY to educate the public and physicians about the emerging entity, NonAlcoholic Fatty Liver Disease (NAFLD), its link to Metabolic Syndrome, the possible
dire consequences which may lead to cirrhosis and hepatocellular carcinoma, and that
this disease is preventable by lifestyle changes, including proper diet, diabetes
prevention and control and weight loss. (HOD 10-156)
85.965
Use of Prefilled Insulin Syringes: MSSNY to create and highlight, through its
various news outlets and website, educational articles for physicians and patients on
the safe use of pre-filled insulin syringes and storage of these devices. (HOD 10-155)
85.966
Use of Waiting Room Educational DVDs: MSSNY to assist in the distribution of
available educational videos to members, as needed, on appropriate topics (i.e. medical
liability reform) for use in physicians’ waiting rooms and also collaborate with the
Medical Liability Mutual Insurance Company (MLMIC) and other entities, as
appropriate, to produce and make available, at no cost to MSSNY, educational videos
to be shown to patients on topics determined by MSSNY. (HOD 10-154)
85.967
The Importance of the Theory of Evolution in Science Education: MSSNY
endorses the teaching of the theory of evolution as an integral part of science
curriculum throughout the continuum of the educational experience and will forward a
resolution to the American Medical Association House of Delegates on this subject.
(HOD 09-165)
85.968
Reform the Methodology for Calculating Direct Graduate Medical Education
Payments: MSSNY to urge that (1) the current methodology for calculating direct
Graduate Medical Education (GME) payments be updated to reflect the actual costs
that a hospital incurs for training residents, rather than a hospital-specific per resident
amount determined by the Centers for Medicare & Medicaid Service (CMS) for all
teaching hospitals; (2) caps on Medicare’s support for GME residency positions be
eliminated which would enable teaching hospitals to cover their costs and
subsequently train more physicians. Also, MSSNY to introduce a similar resolutions
at the American Medical Association’s June 2009 Annual Meeting. (HOD 09-153)
85.969
Increasing Matriculation of Medical Students: MSSNY to seek either legislation or
regulation to provide financial support for increasing the number of medical students,
provided that such expansion would not jeopardize the quality of medical education in
New York State. (HOD 08-102)
85.970
Physician Education to Address Malpractice Insurance Crisis: All physicians in
the State of New York will be urged to participate in a series of malpractice
educational seminars in their respective communities. The urgency for such an
educational program, to highlight the malpractice crisis and the prospective loss of
available medical care, will be communicated to the general public via the media with
citizens being directed to demand action by their State legislators for medical liability
tort reform. (HOD 08-99)
46
85.971
Health Promotion Visits: MSSNY should seek to assist in the education of members
on the appropriate coding for clinical prevention services. (HOD 07-152)
85.972
Broad-based Education Campaign for New Yorkers on the Medical Liability
Crisis: Because of the medical liability crisis which exists in New York State and
which is worsening, MSSNY shall undertake and be prepared to expand a broad-based
education campaign utilizing every New York State physician, the public, the media,
and government leaders. The campaign’s objective would be to fully inform all New
Yorkers of the fact that unless fundamental reform of the liability system is enacted a
health care service delivery crisis will be unavoidable; and, as a result, loss of patient
access to necessary care will be extensive, immediate and devastating. (HOD 07-96)
85.973
Medical School and Graduate Medical Education: That MSSNY work with the
Associated Medical Schools of New York, to develop a program that would
encompass: 1) Recruitment of interested community-based physicians to serve as
preceptors/mentors for undergraduate medical students assigned to ambulatory clinical
learning experiences; 2) Training for the role of preceptor/mentor for such volunteers,
with appropriate CME credits for the training; 3) Appointment to the clinical faculty
rolls of a medical school for such volunteers, who satisfy agreed-upon standards of
performance as preceptors/mentors; 4) Assignment of medical students to the practice
offices of such volunteer physicians for purposes of ambulatory clinical learning
experiences, with appropriate access to the patients of the practice for educational
purposes; and 5) Evaluation at intervals of the experiences of the students and the
community-based physicians to determine the effectiveness of the program.
(Council 6/22/06)
85.974
Need to Expose and Counter Nurse Doctoral Programs (NDP)
Misrepresentation: Institutions offering advanced education in the healing arts and
professions shall fully and accurately inform applicants and students of the educational
programs and degrees offered by an institution and the limitations, if any, on the scope
of practice under applicable state law for which the program prepares the student; that
MSSNY work jointly with the State Education Department to identify and prosecute
those individuals who misrepresent themselves as physicians to their patients and
mislead program applicants as to their future scope of practice; and that MSSNY
encourage hospital staff organizations, to counter misrepresentation by Nurse Doctoral
Programs and their students and graduates, particularly in clinical settings.
(HOD 06-91)
85.975
Federation Credentials Verification Service (FCVS): That the Medical Society of
the State of New York supports beginning the process, by the Federation Credentials
Verification Service (FCVS), of compiling documents needed for medical licensure of
International Medical Graduates, after 2 ½ years of medical residency, upon receiving
certification by the Residency Program Director that the IMG will be competent to be
licensed, pending satisfactory completion of the final 6 months of training; and that
one month before the end of the Residency Program, FCVS send all necessary
documentation for licensure of an International Medical Graduate to the New York
State Education Department in order that the license be ready immediately upon the
completion of the 3 year Residency Program. (Council 1/26/06)
47
85.976
Task Force to Eliminate Ethnic and Racial Health Care Disparities
Recommendations: That the MSSNY Task Force to Eliminate Racial and Ethnic
Health Care Disparities enter into a partnership with The New York State Area Health
Education Center System to create a program modeled after the American Association
of Family Physicians’ Tar Wars Program to train MSSNY members and other
physicians on how to be effective role models to enhance awareness among minority
students in grades K-12 about health career options, especially those from underserved
areas in New York State, provided that funding to support such a program can be
obtained; and that the Council of the Medical Society of the State of New York
support the efforts by its physician members to act as role models for middle school,
high school and college students who seek medicine as a career choice.
(Council 11/17/05)
85.977
Oppose Tuition Increase for Medical Students: MSSNY develop policy and take
action to oppose any proposed legislation that would require students and graduates of
the State University of New York (SUNY) medical schools to agree to practice in a
particular locale as a condition of matriculating or paying New York State resident
tuition. (HOD 05-68)
85.978
Preventing Excessive and Retroactive Tuition Increases: That MSSNY and the
Medical Student Section officially oppose implementation of retroactive tuition
increases, that MSSNY encourage all medical schools in New York State to
implement a “truth-in-tuition” policy, that would freeze the tuition charged for the four
years, at the same amount a student was charged at the time of enrollment into medical
school (with adjustments made for increases in the Consumer Price Index) to allow
students to do financial and career choice planning, and that the MSSNY encourage all
medical schools in New York State to implement a “timely disclosure” policy that
discloses the tuition for the schools, prior to May 15, so that students can have this
information before choosing which medical school to attend.
(Council 11/4/04; Reaffirmed HOD 05-68)
85.979
Academic Medical Centers Resident/Fellow Recruitment: That MSSNY
encourage a program whereby MSSNY coordinate with Graduate Medical Education
directors in order to be included as part of new resident/fellow orientation programs.
(HOD 04-203)
85.980
Nutrition and Weight Management Curriculum in Medical Schools: MSSNY
encourage all New York State medical schools to develop a nutrition and weight
management curriculum at both the basic science level and the clinical level; (2) that
MSSNY also encourage New York State medical schools to integrate nutrition
education into their residency programs and encourage the development of bariatric
medicine fellowship programs; and (3) that a copy of this resolution be transmitted to
the American Medical Association for its consideration. (HOD 04-161)
85.981
State Mandated Training Programs: That MSSNY seek legislative remedies to
make infection control training a one-time requirement analogous to other state
mandated training programs for health care providers. That MSSNY encourage the
DOH to evaluate the effectiveness of the existing program to determine its value and
that MSSNY support voluntary educational and training programs intended to promote
the public health in the State of New York. (HOD 03-215)
48
85.982
Resident Work Hours: MSSNY supports reasonable regulations on resident work
hours/conditions that include, but are not limited to, restrictions on the total number of
hours, restrictions on hours consecutively on call, provisions for adequate ancillary
services so as to minimize the reliance on residents to provide patient care services of
limited or no educational value, and a minimum percentage of protected educational
time.
MSSNY strongly endorses the position that organized medicine must take a leadership
role in crafting regulations on resident hours/conditions so as not to adversely impact
the educational mission of the residency programs or patient care.
(HOD 02-173)
85.983
Web-Based System for Registering CME Credits: MSSNY will request the
American Medical Association to pursue development of an internet Web-based
reporting system for continuing medical education (CME), thereby allowing the
physician to store his/her name and other demographic information in the database and
then enter data on each specific CME activity as he/she completes that activity.
(HOD 02-167)
85.984
Impact of Changes to Section 405 of Title 10 of the New York Code of Rules and
Regulations: (Sunsetted HOD 2011)
85.985
Full Reimbursement for Training Costs of PGY V and VI of Child Psychiatry
Training: It is MSSNY’s policy that there should be full reimbursement for training
costs of PGY V and VI years of child psychiatric training. (HOD 01-74; Reaffirmed
HOD 2011)
85.986
Funding for Graduate Medical Education: (Rescinded HOD 11-166; Replaced by
85.959)
85.987
Adjusting Medical School Curricula: MSSNY will recommend that the American
Medical Association propose to our Medical Schools that they adjust their curricula to
add medical socio-economics and practice management. (HOD 99-157)
85.988
Placement of Resident Physicians From Disbanded Residency Training
Programs: MSSNY reaffirms its support for AMA Policy H-310.943 on closing
residency programs to strongly encourage residency programs to offer placement of
their resident physicians in comparable positions before disbanding a training
program. (Council 3/19/98)
85.989
Advocacy Policy to Increase Number of Minority Physicians: MSSNY recognizes
the threat to minority physician training incident to downsizing of training programs in
the state; and will develop an advocacy policy and resources directed toward
maintaining and increasing relative numbers of minority physicians. (HOD 98-160)
85.990
The HCFA Demonstration Project’s Potential for Abuse: MSSNY affirms and
will study the implementation of the use of incentive payments under HCFAs New
York Graduate Medical Education Demonstration Project to relieve the burdens that
may be imposed on remaining residents as a result of the reduction in the number of
residency slots. (HOD 98-129)
49
85.991
Preservation of Opportunities for US Graduates and IMGs Already Legally
Present in This Country: In the event of reductions in the resident workforce in the
State of New York, the Medical Society of the State of New York will advocate for a
mechanism of resident selection which promotes the maintenance of resident
physician training opportunities for all qualified graduates of United States Liaison
Committee on Medical Education and American Osteopathic Association accredited
institutions.
MSSNY adopts and will publicize the position that if hospitals reduce the number of
residency positions they offer, MSSNY will continue to advocate for equal
consideration in the candidate selection process of IMGs who are already legally
present in this country.
MSSNY will ask the AMA to urge the Educational Commission for Foreign Medical
Graduates (ECFMG) to reduce the number of examinations it offers abroad, in the
light of decreased availability of residency position; and make it clear to graduates of
international medical schools that the opportunity for residency training and practice in
the United States are becoming extremely limited.
This information should be included in the initial application materials given to the
candidates prior to the examination. (HOD 97-228; Reaffirmed Council 3/19/98)
85.992
Residents’ Ability to Write Restraint Orders: MSSNY will urge the Joint
Commission for Accreditation of Healthcare Organizations to acknowledge that
residents in ACGME and American Osteopathy Association approved postgraduate
training programs may appropriately write orders for physical restraints, with timely
notification to the attending physician. (HOD 97-153)
85.993
Opposition to Medical Resident Education Fee: MSSNY will continue to strongly
oppose any legislation that includes an annual fee for medical residents. The Division
of Governmental Affairs of MSSNY will continue to strongly oppose any New York
State budget that includes an annual fee for medical residents; and will report to the
MSSNY-RPS any further action attempted by the State of New York regarding this
issue as soon as possible. (HOD 97-86)
85.994
Hepatitis Vaccinations for all Medical Students: MSSNY will seek legislation
and/or regulation which will require all medical students to be vaccinated for Hepatitis
A and B unless they have already been vaccinated; and will also require everyone
entering a US residency training program to be vaccinated for Hepatitis A and B if
they have not yet received vaccination. (Council 3/27/97)
85.995
Infection Control Course, Mandated: MSSNY will seek legislation to eliminate the
statutory requirement that physicians complete course work or training in infection
control practices every four years. (HOD 95-67)
85.996
Funding for Medical Schools and Teaching Hospitals: MSSNY supports the
positions on medical school and teaching hospital funding as adopted by the
Association of American Medical Colleges (AAMC) Executive Committee.
MSSNY supports such funding through legislation that creates all payer fund to
financially assist the Medical Schools in order to ensure the continuation of high
quality and responsive education and research. MSSNY supports such funding
50
through legislation that creates an all payer fund to financially assist teaching hospitals
to support their higher cost relative to non-teaching hospitals and urges that these
funding proposals be incorporated in any legislative vehicles to be considered as a part
of health care reform proposals. (Council 6/2/94)
NB:
A copy of the Recommendations of the AAMC Summary is on file at MSSNY
headquarters.
85.997
Animals in Biomedical Research: MSSNY supports the AMA’s position on the use
of animals in biomedical research which recognizes the importance of biomedical
research, supports the humane use of animals for this purpose and advocates support
of regulatory policies to protect animals from unnecessary uses in biomedical research.
MSSNY joins the efforts of the Health, Safety and Research Alliance of New York
State, a coalition composed of medical schools, voluntary health agencies and
pharmaceutical companies in New York State, whose aim is to increase the public’s
understanding about the appropriate use of laboratory animals in medical research.
(HOD 91-49)
85.998
Graduate Medical Education: MSSNY adopted positions on the First and Second
Annual Reports of the New York State Council on Graduate Medical Education.
Copies of these positions are on file at MSSNY Headquarters. (Council 5/10/90)
85.999
Manpower Assistance for Medical Students: MSSNY supports the concept of
continuing some form of federal manpower financial assistance and support, including
general institutional grants, special project grants for medical schools and the
continuation of the National Health Service Corps and other support mechanisms such
as long term, low interest loans for medical students. (Council 6/26/80)
87.000
EMERGENCY CARE:
(See also Drug Dispensing, 70.000; Managed Care, 165.000; Medicaid, 175.000; Reimbursement,
265.000)
87.993
Concussion and Traumatic Brain Injuries in Youth: MSSNY to advocate for the
immediate removal from play/practice of any youth suspected of having a
concussion or Traumatic Brain Injury (TBI) and also that any youth suspected of
sustaining a concussion or traumatic brain injury need written approval by a physician before
they can return to play or practice. In addition, MSSNY will promote adoption of
this policy within school settings and organized youth sports programs and
support educational efforts to improve understanding of concussion and traumatic
brain injuries in youth among coaches, trainers, athletes, school officials, parents
and legal guardians. (HOD 11-153)
87.994
CPR Traning as a High School Requirement: MSSNY to advocate for legislation
requiring that high school students attend a training course in cardiopulmonary
resuscitation (CPR) and the use of the automated external defibrillator (AED), using
the course guidelines recommended by the American Heart Association and endorsed
by the American Academy of Pediatrics. (HOD 11-152)
87.995
Government Funding of Care Given by US Healthcare Providers to Haitian
Evacuees: MSSNY to urge the American Medical Association to encourage the US
51
government to cover the costs of the medical care required by Haitian medical
evacuees receiving care in the US. (HOD 10-264)
87.996
Emergency Care Data Collection: MSSNY to collaborate with the Department of
Health and the American College of Emergency Physicians-New York Chapter to
determine what data should be collected in Emergency Departments to address the
problems of Emergency Department overcrowding, gridlock and diversion and be used
for the strategic planning of the health care needs of communities. (HOD 08-110)
87.997
New York State Parking Placard for Physicians on Medical Call: MSSNY and
county medical societies to work with New York State and local agencies in designing
and implementing a dashboard parking placard, similar to those used by police and
Boards of Education, to function in lieu of MD plates for member physicians for
parking in restricted areas in the course of rendering medical care. (HOD 07-158)
87.998
Automated External Defibrillators: MSSNY educate physicians on Public Access
to Defibrillators (PAD) guidelines and the Good Samaritan protections afforded
physicians who follow them outside of the hospital or office-based setting.
(HOD 05-154)
87.999
Cardiopulmonary Resuscitation Training: MSSNY support the passage of state
legislation increasing funding for the cardiopulmonary resuscitation and defibrillation
training of personnel at community organizations. (HOD 05-152)
90.000
ENVIRONMENTAL HEALTH:
90.992
High Volume Hydraulic Fracturing in the Marcellus Shale Area: MSSNY
supports a moratorium of natural gas extraction using high volume hydraulic
fracturing in New York State until valid scientific information is available to evaluate
the process for its potential effects on human health and the environment.
(Council 12/9/10)
90.993
Latex Gloves: MSSNY to support legislation to ban the commercial use of latex
gloves in New York State. (HOD 10-152)
90.994
Global Climate Change and Public Health Implications: MSSNY to agree with the
Centers for Disease Control and Prevention (CDC) and the World Health Organization
(WHO) position that global climate change is occurring and that there exists the
potential for abrupt climate change resulting in significant public health consequences.
Also, MSSNY to continue to explore low-cost opportunities to address this matter,
such as: (a) sessions at educational conferences and the development of a policy
position statement as well as other modes of communicating this issue to the MSSNY
membership; (b) inviting qualified members to serve where appropriate on
workgroups, coalitions and committees to advance climate change research,
interventions, policies and legislation that are consistent with MSSNY’s mission and
objectives; and (c) supporting policies and legislation that address measures to prevent
or mitigate public health effects of climate change. (HOD 08-151)
90.995
Safe Disposal of Toxic Materials in Consumer Products: MSSNY to seek clearer
and more effective laws regarding the disposal of consumer products containing toxic
52
substances sold in New York State to effectively deal with the future public health and
financial impacts. (HOD 08-166)
90.996
PCB Contamination of the Hudson River: MSSNY supports the current U.S.
Environmental Protection Agency (EPA) recommendations for remediation of
polychlorinated biphenyl (PCB) contamination of the Hudson River.
(Council 3/19/01; Reaffirmed and Modified HOD 2011)
90.997
Polystyrene and Polyvinyl Chloride Products for Packaging: MSSNY opposes the
use of polystyrene and polyvinyl chloride products for all retail food packaging in
New York State. (HOD 89-40)
90.998
Toxic/Hazardous Substances: MSSNY corresponded with appropriate governmental
agencies including the Department of Health, the Department of Transportation, the
Office of Fire Prevention and Control, and the Attorney General and requested that:
(1) Any toxic hazardous substances be clearly labeled and that proper storage and
handling procedures be included. (2) A vehicle transporting a toxic/hazardous
substance have information available, naming the substance and the proper protective
measures to be taken if exposed. (Council 6/11/87)
90.999
Radioactive Waste, Disposal of Low Level: MSSNY supports legislation regarding
low-level radioactive waste disposal providing it contains the following principles:
(1) A disposal site must be promptly identified; (2) Low level wastes should be
segregated from high level wastes; (3) Long term monitoring of such disposal must be
included in the bill; (4) The costs of such disposal must be borne by those disposing
of the wastes; (5) The environment and the health, safety and welfare of those
inhabiting nearby areas must be protected. (HOD 1985)
95.000
ETHICS:
95.972
Organ Donation: MSSNY to: (1) support efforts to increase education to New York
State residents about organ donation; (2) promote physicians’ awareness of the need to
discuss organ donation with their patients; and (3) continue its support of the New
York State Department of Health’s Organ Donation Registry as a means of increasing
organ donation in the state. (Council 1/20/11)
95.973
Physician Involvement in Interrogation and in Torture: The following definitions
are for purposes of this statement:
Torture is defined as the intentional infliction of physical or mental harm for the
purpose of gathering information, or to secure control or cooperation of a detainee, or
for disciplinary or retaliatory purposes.
Interrogation is defined as questioning related to law enforcement or to military and
national security intelligence gathering, designed to prevent harm or danger to
individuals, the public or national security. Interrogations are distinct from
questioning used by physicians to assess the physical or mental condition of an
individual.
Coercive is defined as threatening to cause harm through physical injury or mental
suffering.
53
Detainee is defined as a criminal suspect, prisoner of war, enemy combatant, or any
other individual who is being held involuntarily.
Physicians who engage in any activity that relies on their medical knowledge and
skills, regardless of jurisdiction or location, must continue to uphold principles of
medical ethics. Physicians must not engage, directly or indirectly, in torture or in
interrogations. Questions about the propriety of physician participation in
interrogations and in the development of interrogation strategies may be addressed by
balancing obligations to individuals with obligations to protect the public interest, e.g.
from terrorist attack. Precedent for this may be found in public health ethics in which
physicians’ expertise inform guidelines, policies, and procedure that lead to the
imposition of relatively minor hardships on individuals for public welfare. However,
when a physician is directly and clinically involved with an individual, the physician’s
obligations to the individual take precedent over public interests.
Physician involvement with interrogations during law enforcement or intelligence
gathering should be guided by the following:
(1) Physicians must not directly or indirectly participate in torture or in the
development of techniques of torture.
(2) Physicians may perform physical and mental assessments of detainees to determine
the need for and to provide medical care. When so doing, physicians must disclose to
the detainee the extent to which others has access to information included in medical
record. Treatment must never be conditional on a patient’s participation in an
interrogation.
(3) Physicians must neither conduct nor directly participate in an interrogation,
because a role as physician-interrogator undermines the physician’s role as healer and
thereby erodes trust in the individual physician-interrogator and in the medical
profession.
(4) Physicians must not monitor an interrogation with the intention of intervening in
the interrogation, because this constitutes direct participation in interrogation.
(5) Physicians may participate in developing effective interrogation strategies for
general training purposes. These strategies must be humane, respect the rights of
individuals, and must not be coercive, for example, threaten or cause physical injury or
mental suffering.
(6) When a physician has sound reason to believe that an interrogation constitutes
torture, he or she must report this concern to the appropriate authorities. If the
authorities are aware of the inappropriate interrogation but have not intervened to
either stop the interrogation or prevent further inappropriate interrogations, physicians
are ethically obligated to report such interrogations to independent authorities that
have the power to investigate and/or adjudicate such allegations. (Council 11/19/09)
95.974
Discourage Gifts from Pharmaceutical and Device Companies: MSSNY to affirm
its support for American Medical Association Council on Ethical and Judicial Affairs
(CEJA) Opinion No. 8.061 and disseminate this opinion to the membership so that it
guides them in their contacts with industry. (HOD 09-203)
54
95.975
Politics Should Not Overule FDA Scientific Findings: That MSSNY urge the
American Medical Association (AMA) to encourage the FDA Commissioner to accept
the scientifically based research of the agency’s panels unless there is more
compelling scientific evidence to the contrary and that a copy of this resolution be
transmitted to the AMA for action at the 2006 HOD. (HOD 06-167)
95.976
No Place for Vicarious Liability: That MSSNY seek legislation, regulation or other
appropriate means to assure that settlements or judgments vicarious in nature, as
determined by the liability carrier, NOT be posted, listed or utilized by the Department
of Health for any physician public Website profile. (HOD 06-62)
95.977
Health Care Proxies: MSSNY urges all physicians to complete their own Health
Care Proxies and encourage their families and their patients to do the same.
(Council 3/14/05)
95.978
Moratorium on Capital Punishment: (Sunsetted HOD 2011)
95.979
Testimony in Professional Liability Cases: MSSNY takes the position that a
physician who provides expert medical testimony in bad faith and/or who provides
expert medical testimony that has no recognized scientific validity, is guilty of
professional misconduct, and should be reported to the appropriate Office of
Professional Medical Conduct.
MSSNY shall encourage all national specialty organizations to enact rules and
disciplinary methods, utilizing the American Association of Neurological Surgeons as
a model, to promote fair and honest expert testimony. (HOD 00-82)
95.980
Use of Percentage-of-Fee Based Compensation Arrangements: The Medical
Society reaffirms its support for the underlying principle that a physician’s dedication
to providing competent medical service for his or her patient is paramount. Moreover,
we also support the opinion that the physician’s control over clinical decision-making
must remain unencumbered and independent from non-clinical influence. The
Medical Society recognizes that the continuation of the corporate practice of medicine
doctrine’s prohibition against an unlicensed person or entity’s influence in the practice
of medicine is necessary to uphold these principles and to protect against potential
abuses and fraudulent activity. Physicians must remain knowledgeable of and in
control of the business aspects of their practice and should not relinquish such
authority to non-physician business entities. In our opinion, the following “business”
decisions and activities involving control over the physician’s individual practice of
medicine should be made by a physician and not by a non-physician or entity:
•
•
•
•
•
ownership and control of a patient’s medical records, including determining the
contents thereof;
selection (hiring/firing as it relates to clinical competency or proficiency) of
professional, physician extender and allied health staff;
set the parameters under which the physician will enter into contractual
relationships with third party payors
decisions regarding coding and billing procedures for patient care services; and
approval of the selection of medical equipment.
Moreover, the following health care decisions should be made by a physician only and
55
would constitute the unlicensed practice of medicine if performed by an unlicensed
person:
•
•
•
•
determining what diagnostic tests are appropriate for a particular condition;
determining the need for referrals to or consultation with another
physician/specialist;
responsibility for the ultimate over-all care of the patient including
treatment options available to the patient; and
determining how much attention to devote to address a patient’s needs.
As a result of the foregoing, the Medical Society supports the continuation of the
corporate practice of medicine doctrine.
Additional information on this position is on file at MSSNY Headquarters, Office of
the Executive Vice-President, ext. 304, E-mail: [email protected]. This
information addresses the following topics:
1) Use of credit cards to pay medical bills (percentage commission to bank or credit
card company).
2) Use of collection agencies for a percentage of the medical fee collected.
3) Use of a practice management company on a percentage-of-fee basis, under any
circumstances, including practice enhancement or marketing of the practice.
4) Use of a practice management company on a percentage-of-fee basis for nonclinical services where no patient referral or practice enhancement is involved,
compared with use of “fair market value” as the basis for determining charges and
maintaining the same restrictions.
5) Use of a billing service on a percentage-of- fee basis, compared to charges based
on “fair market value,” with periodic negotiation of the charges. What would be
the effect of not permitting certain activities, such as referral of patients by the
billing company to the practice?
6) Leasing/renting space, services or equipment to a physician (by another physician,
for example) on a percentage-of-fee basis without restriction, compared to a
situation where cost of the lease/rent is based on fair market value and there are
restrictions, such as not allowing cross-referrals between the landlord and tenant
physicians.
7) Sale of a practice for a percentage of future income by the widow(er) of a
physician, or by him or herself, without restriction, compared to a sale where the
seller severs all connections with the practice, including referrals.
8) Accepting or paying a fee for a patient referral to or from any source.
9) Receiving payment in return for ordering lab tests, prescription drugs, medical
appliances etc. (Council 3/18/99)
95.981
Cloning: It is the policy of MSSNY that there should be a voluntary five-year
moratorium by the medical and research communities on cloning a human being.
Congress should permit human, animal or cellular cloning related research that is not
directed at producing a human being. (Council 5/21/98)
95.982
Gerald Einaugler, MD Full Pardon by Governor Pataki: MSSNY will urgently
request Governor Pataki issue a full and prompt pardon for Dr. Einaugler.
56
MSSNY will request all medical professionals and groups to urgently organize fundraising events on behalf of Dr. Einaugler and remit the proceeds of the fund-raising
efforts to the Physicians’ Home. (HOD 98-91; Reaffirmed 99-78 & HOD 00-51)
95.983
Physician-Assisted Suicide: It is MSSNY’s policy that a physician may not be
mandated to assist a patient’s suicide or to override a patient’s refusal of therapy,
including nutrition and dehydration, and that a terminally ill patient’s appropriate
medical care includes adequate analgesics even when the medication dosage is such
that it may prove fatal. (Council 12/18/97)
95.984
Health Care Proxy Identifier: MSSNY supports the position that the New York
State Department of Motor Vehicles should designate an area on the back of drivers
licenses to identify health care proxy similar to the area already identified for organ
donation. (Council 7/18/97)
95.985
Capital Punishment - Execution by Lethal Injection: MSSNY has adopted the
following policy statement relative to Physician Participation in Capital Punishment:
(1) An individual’s opinion on capital punishment is the personal moral decision of the
individual. A physician, as a member of a profession dedicated to preserving life,
when there is hope of doing so, should not be a participant in a state execution.
“Physician participation in execution” is defined generally as actions which would fall
into one or more of the following categories: (a) An action which could automatically
cause an execution to be carried out on a condemned prisoner; (b) An action which
would assist, supervise, or contribute to the ability of another individual to directly
cause the death of the condemned; (c) An action which could automatically cause an
execution to be carried out on a condemned prisoner. (2) Physician participation in an
execution includes but is no limited to the following actions: prescribing or
administering tranquilizers and other psychotropic agents and medications which are
part of the execution procedure; monitoring vital signs on site or remotely (including
monitoring electrocardiograms); attending or observing an execution as a physician;
and rendering of technical advice regarding execution. (3) In the case where the
method of execution is lethal injection the following actions by the physicians would
also constitute physician participation in execution: selecting injection sites; starting
intravenous lines as a port for a lethal injection device; prescribing, preparing,
administering, or supervising injection drugs or their doses or types; inspecting,
testing, or maintaining lethal injection devices; consulting with or supervising lethal
injection personnel. (4) The following actions do not constitute physician
participation in execution:
(a) Testifying as to competence to stand trial testifying as to relevant medical
evidence during trial, or testifying as to medical aspects of aggravating or mitigating
circumstances during the penalty phase of a capital case; (b) Certifying death
provided that the condemned has been declared dead by another person; (c)
Witnessing an execution in a totally non-professional capacity; (d) Witnessing an
execution at the specific voluntary request of the condemned person, providing that the
physician observes the execution in a non-physician capacity and takes no action
which would constitute physician participation in an execution; and (e) Relieving the
acute suffering of a condemned person while awaiting execution, including providing
tranquilizers at the specific voluntary request of the condemned person to relieve pain
or anxiety in anticipation of the execution. (HOD 95-71)
57
95.986
DNR Within New York State Correctional Facilities: MSSNY supports the
passage of legislation to further amend New York State Public Health Law, Article
29B, Orders Not to Resuscitate, to include inmates incarcerated in correctional
facilities of the New York State Department of Corrections thus making them eligible
for DNR decisions. (HOD 93-107)
95.987
Expert Medical Witness - Ethical Guidelines of MSSNY Members: MSSNY
declares as an “Ethical Consideration” that physicians should aspire to the following
objectives in providing expert medical testimony: (1) In order to have the requisite
skill, knowledge and expertise to offer expert medical testimony, medical experts
should devote the greater part of their professional activities to practicing their
specialties rather that testifying in litigation cases; (2) That when medical experts do
offer testimony in litigation cases, their testimony should be objective, represent
generally accepted facts reflecting the consensus of the scientific community, consist
of verifiable scientific truths and be limited to testimony in his/her sphere of
professional medical expertise.
MSSNY defines an “Ethical Consideration” as a principle intended to be aspirational
in character and which represents objectives toward which every member of the
profession should strive. An Ethical Consideration is intended to provide principles
upon which a physician can rely for guidance in specific situations. Being aspirational
in character, while every member of the profession should strive toward the attainment
of the objective, the failure to attain the objectives of the Ethical Consideration does
not subject the individual to disciplinary action. MSSNY will seek appropriate
legislation that would require individuals to satisfy the requirements of paragraphs 1
and 2 above in order to be qualified to provide expert medical testimony.
(Council 9/22/94; Reaffirmed HOD 00-82)
95.988
Ownership of Medical Facilities and Self-Referral: MSSNY adopted as its position
on physician ownership of medical facilities and self-referral the Guidelines of the
American Medical Association’s Council on Ethical and Judicial Affairs which were
adopted by the AMA’s House of Delegates in December 1992, and which are set forth
in the 1992 AMA Policy Compendium, Section 140.961 entitled “Conflict of Interest Physician Ownership of Medical Facilities,” and read as follows:
(1) Physician investment in health care facilities can provide important benefits for
patient care. However, when physicians refer patients to facilities in which they have
an ownership interest, a potential conflict of interest exists. In general, physicians
should not refer patients to a health care facility outside their office practice at which
they do not directly provide care or services when they have an investment interest in
the facility. (2) Physicians may invest in and refer to an outside facility, whether or
not they provide direct care or services at the facility, if there is a demonstrated need in
the community for the facility and alternative financing is not available. There may be
situations in which a needed facility would not be built if referring physicians were
prohibited from investing in the facility. Need might exist when there is no facility of
reasonable quality in the community or when use of existing facilities is onerous for
patients. In such cases, the following requirements should also be met:
(a) Individuals who are not in a position to refer patients to the facility must be given
a bona fide opportunity to invest in the facility, and they must be able to invest on the
same terms that are offered to referring physicians. The terms on which investment
interests are offered to physicians must not be related to the past or expected volume
of referrals or other business from the physicians. (b) There is no requirement that any
58
physician investor make referrals to the entity or otherwise generate business as a
condition for remaining an investor. (c) The entity must not market or furnish its
items or services to referring physician investors differently than to other invest-ors.
(d) The entity must not loan funds or guarantee a loan for physicians in a position to
refer to the entity. (e) The return on the physician’s investment must be tied to the
physician’s equity in the facility rather than to the volume of referral. (f) Investment
contracts should not include “non-competition clauses” that prevent physicians from
investing in other facilities. (g) Physicians must disclose their investment interest to
their patients when making a referral. Patients must be given a list of effective
alternative facilities if any such facilities become reasonably available, informed that
they have the option to use one of the alternative facilities, and assured that they will
not be treated differently by the physician if they do not choose the physician-owned
facility. These disclosure requirements also apply to physician investors who directly
provide care or services for their patients in facilities outside their office practice. (h)
The physician’s ownership interest should be disclosed, when requested, to third party
payors. (i) An internal utilization review program must be established to ensure that
investing physicians do not exploit their patients in any way, as by inappropriate or
unnecessary utilization. (j) When a physician’s financial interest conflicts so greatly
with the patient’s interest as to be incompatible, the physician must make alternative
arrangements for the care of the patient. (3) With regard to physicians who invested in
facilities under the Council’s prior opinion, it is recommended that they reevaluate
their activity in accordance with this report and comply with the guidelines in this
report to the fullest extent possible. If compliance with the need and alternative
investor criteria is not practical, it is essential that the identification of reasonably
available alternative facilities be provided.
(AMA Council on Ethical and Judicial Affairs Report C., I-1991) (HOD 93-30)
NB:
Per General Counsel, because of developing federal and state law, it is strongly
recommended that physicians consult legal counsel prior to acquiring ownership
interests in health facilities.
95.989
Physician-Assisted Suicide: The principle of patient autonomy requires that
physicians respect the decision of a patient who possesses decision-making capacity to
forego life-sustaining treatment. Life-sustaining treatment is defined as any medical
treatment that serves to prolong life without reversing the underlying medical
condition. Life-sustaining treatment includes, but is not limited to, mechanical
ventilation, renal dialysis, blood transfusions, chemotherapy, antibiotics and artificial
nutrition and hydration. Physicians are obligated to relieve pain and suffering and to
promote the dignity and autonomy of dying patients in their care. This obligation
includes providing effective palliative treatment even though it may occasionally
hasten death. However, physicians should not perform euthanasia or participate in
assisted suicide. Support, comfort, respect for patient autonomy, good
communication, and adequate pain control may decrease dramatically the demand for
euthanasia and assisted suicide. In certain carefully defined circumstances, it is
humane to recognize that death is certain and suffering is great. However, the societal
risks of involving physicians in medical interventions to cause patients’ deaths is too
great to condone active euthanasia or physician-assisted suicide.
(Council 5/14/92; Reaffirmed HOD 95-80)
MSSNY will include in its annual legislative agenda its expressed opposition to any
attempt to legalize physician-assisted suicide and supports efforts to ensure that dying
59
patients are provided optimal treatment for their pain and discomfort. MSSNY
supports the use of more aggressive comfort care measures, including greater reliance
on hospice care and the evaluation and treatment of the psychiatric aspects of terminal
illness which can often alleviate the suffering that leads a patient to desire assisted
suicide. (HOD 95-80)
95.990
Futile Cardio-Pulmonary (CPR) Resuscitation Therapy: MSSNY supports
legislation or regulatory efforts that will absolve physicians of the requirement to offer
futile cardio-pulmonary resuscitation (CPR) therapy to patients in their care.
(HOD 91-43)
95.991
Gender Disparities in Medical Care and Research: MSSNY adopted and supports
the recommendations of the AMA Council on Ethical and Judicial Affairs, Report B
(1-90) as adopted by the House of Delegates on December 4, 1990 as follows: (1)
Attitudes and Practices: Physicians should examine their practices and attitudes for
influence of social or cultural biases which could be inadvertently affecting delivery of
medical care. Further research and education should be conducted to increase
awareness of the possible influences that social perceptions of gender roles may have
on health care. (2) Research: More medical research on women’s health and
women’s health problems should be pursued. Results of medical testing done solely
on males should not be generalized to females without evidence that results apply
equally to both genders. Research on health problems that affect both genders should
include male and female subjects. Sound medical and scientific reasons be required
for excluding females from medical tests and studies such as that the proposed
research does not or would not affect the health of females. An example would be
research on prostatic cancer. (3) Removing Gender Bias: Physicians must ensure that
gender is not used inappropriately as a consideration in clinical decision making. The
development and implementation of procedures and techniques which preclude or
minimize the possibility of gender bias should be developed. For instance, a genderneutral determination for kidney transplant eligibility should be used. (4) Medical
Staff Assessment: Medical staffs should develop programs to determine whether
treatment decisions are influenced by gender bias and whether either gender is being
disadvantaged by treatment decisions generally. (5) Remedial Action: Instances in
which a physician’s treatment decision appears to turn inappropriately on the patient’s
gender deserve further scrutiny. If evidence of systematic gender bias in clinical
decision making is found, then appropriate review or corrective proceedings should be
undertaken. (6) Increasing Numbers of Female Physicians in Leadership Positions:
Awareness of and responsiveness to socio-cultural factors which could lead to gender
disparities may be enhanced by increasing the number of female physicians in
leadership roles and other positions of authority in teaching, research and the practice
of medicine. The AMA should continue its efforts to insure access to higher level
positions in medicine for female physicians. (7) Further Study to Determine Causes of
Disparities: Further research into the possible causes of gender disparities should be
conducted. It is important to ascertain to what extent gender disparities in medical
care are a result of biological differences between the genders and to what extent
utilization practices and physician/patient interactions are influenced by cultural and
social conceptions of gender. (HOD 91-30)
95.992
Capital Punishment - Physician Participation: A physician, as a healer and
member of a profession dedication to the preservation of life, should not be a
participant in a legally authorized execution but may certify the death of the executed
60
person on the grounds that this does not constitute active participation in the
execution. Participation in an execution is deemed to include, among other things:
(1) The determination of mental and physical fitness for execution; (2) The rendering
of technical advice regarding execution; (3) The prescription, preparation,
administration or supervision of doses of drugs in jurisdictions where lethal injection
is used as a method of execution; (4) The performance of medical examinations
during the execution to determine whether or not the prisoner is dead.
Participation in a legally authorized execution is not deemed to include the following
actions and, accordingly, a physician may act in any of the following ways: (1) Serve
as a witness in a criminal trial prior to the rendering of a verdict to determine guilt or
innocence of an accused person; (2) Relieve acute suffering of a convicted prisoner
while he is awaiting execution; (3) Certify death, provided that the prisoner has been
declared dead by someone else1 and; (4) Perform an autopsy following an execution.
This statement is firmly rooted in the principle that a physician’s first consideration is
to do no harm; primum non nocere. (Council 5/10/90; Reaffirmed HOD 96-219)
95.993
Living Wills - Health Care Agents - Advance Directives2: MSSNY endorses the
right of an individual to make an informed decision in advance of incapacity in order
to guide surrogates and providers with treatment decisions. The Society endorses the
concept embodied in the proposed “Health Care Agent Legislation” and has
communicated its support of this legislation to the Legislature. In addition, MSSNY
informed the Governor’s Task Force on Life and the Law and the Legislature that
there is a need for statutory recognition of “living wills,” “durable power of attorney,”
or equivalent documents, as well as a need for statutory recognition of the right of
individuals to designate an agent empowered to make health care decisions on their
behalf. (HOD 88-40)
95.994
Pharmaceutical Companies - Compensation for Specified Prescribing Practices:
MSSNY condemns the practice of financial payment in return for specified prescribing
performances, be it in currency, goods or services. The Society has asked
pharmaceutical companies making such offerings to discontinue such objectionable
practices. (HOD 87-94)
95.995
Terminal Care - Directives For: (1) MSSNY recognizes that patients have the legal
right to refuse medical and/or surgical treatment that would keep them alive. (2) It is
desirable that patients communicate to their physicians(s) their wishes concerning
treatment for an incurable and terminal illness in case of the patients’ incapacity to
decide. (3) Such communications can be oral. It seems preferable, however, for the
patients to incorporate their wishes in a written document either in the form of a
directive to their physician (s) or in the form of a durable power of attorney. In the
latter circumstance, the spouse or other relative, or the patient’s physician or attorney,
or other designee, should be authorized to provide substituted judgment and decisionmaking on behalf of the patient if he/she becomes incapacitated and unable to
participate in the decision-making process. (4) Certain hazards and drawbacks of
1
This proviso assures that the physician will not be in the position of determining whether death
occurred, since a determination that death has not occurred would make the physician a participant in the
execution - for example, by establishing that addition electric voltage is necessary to assure death.
2
Note by General Counsel - Article 29C of the Public Health Law, which became law on July 27, 1990,
establishes a procedure for individuals to appoint health care agents to make health care decisions in the event
the individual loses capacity to make such decisions.
61
such written directives are recognized such as the possible negative impact of a rigid
and arbitrary agreement on the doctor-patient relationship, the irreversibility of a prior
decision because of the patient’s incapacity of informed recission; the difficulty in
defining terms such as “terminal illness,” “irreversible condition,” “extraordinary
measures,” “imminently dying” and the possibility, however remote, of the premature
activation of the provisions of the written directive because of the lack of specificity
and the uncertainty of prognosis. Nevertheless, a written directive from the patient to
the physician(s) seems preferable to an oral declaration, or no directive at all, to make
known the patient’s wishes concerning treatment for a terminal illness if the patient is
incapacitated. (5) MSSNY has no objection to legislation which might facilitate the
above-described goal of enhancing patient-physician communication.
(Council 9/10/87)
95.996
Life Sustaining Apparatus, Withholding and Terminating: In the care of the
terminally ill and in the service of human dignity the physician’s ethical role includes
the provision of comfort as well as healing. Traditionally, hydration by mouth or vein
and oral or tube feeding have been considered to be part of overall supportive care not
different from skin care, bowel and bladder care, grooming and psycho-social support.
It thus follows that the withholding or withdrawal of fluids and nutrition from a
terminally ill patient is ethically wrong. An alternate view is that tube feeding and
intravenous hydration are medical treatments not different from antibiotics, respirators,
oxygen, or hemodialysis. According to this view, when medical treatment is no longer
considered appropriate, it is morally justified to withdraw or withhold intravenous
fluids and tube feeding. Since this issue is complex and difficult and entails not only
medical and legal aspects, but moral and religious sensitivities, it seems prudent that
each case be evaluated, discussed, and decisions made on the individual merits of each
case. It is suggested that, where necessary and appropriate, hospital medical ethics
committees be consulted for guidance and advice.
(Council 5/15/86 in lieu of HOD 84-35)
95.997
DNR - Do Not Resuscitate - Guidelines for Physicians, Hospitals, and Nursing
Homes: The following are intended only to be guidelines for physicians, hospitals,
and nursing homes. Hospital medical staffs and governing bodies are encouraged to
develop policies consistent with their respective bylaws and rules and regulations.
DEFINITION: DNR (Do Not Resuscitate) means that, in the event of a cardiac or
respiratory arrest, cardiopulmonary resuscitative measures will not be initiated or
carried out. (1) An appropriate knowledge of the serious nature of the patient’s
medical condition is necessary. (2) The attending physician should determine the
appropriateness of a DNR order for any given patient. (3) DNR orders are compatible
with maximal therapeutic care. A patient may receive vigorous support in all other
therapeutic modalities and yet a DNR order may be justified. (4) When a patient is
capable of making his own judgment. the DNR decision should be reached
consensually by the patient and physician. When the patient is not capable of making
his own decision, the decision should be reached after consultation between the
appropriate family member(s) and the physician. If a patient disagrees, or, in the case
of a patient incapable of making an appropriate decision, the family member(s)
disagree, a DNR order should not be written.
IMPLEMENTATION: (1) Once the DNR decision has been made, this directive shall
be written as a formal order by the attending physician. A verbal or telephone order
for DNR cannot be justified as a sound medical or legal practice. (2) It is the
62
responsibility of the attending physician to insure that this order and its meaning are
discussed with appropriate members of the hospital staff. (3) The facts and
considerations relevant to this decision shall be recorded by the attending physician in
the progress notes. (4) THE DNR order shall be subject to review on a regular basis
and may be rescinded at any time. (Council 9/9/82; Amended Council 11/14/85)
NB:
Article 29B of the Public Health Law, which became effective on April 1, 1988,
provides that in certain circumstances, it is appropriate for an attending physician to
issue an order not to attempt cardiopulmonary resuscitation of a patient where
appropriate consent has been obtained. Many of the general principles that appear in
the Medical Society’s Position on “Do Not Resuscitate” orders are included in Article
29B. Physicians who require more specific information regarding Article 29B are
advised to consult an attorney, including the hospital attorney and/or the Office of
General Counsel of the Medical Society of the State of New York.
95.998
Neonates - Decision Making for Treatment of Disabled: A neonate born with a
major malformation, or who is critically ill for other reasons, presents parents and
physicians with agonizing decisions concerning the treatment of that infant. Parents or
physicians might request the withholding or withdrawing of life sustaining care. The
withholding of any type of treatment from a neonate because of disability is ethically
justified only when medical or surgical procedures are clearly futile and will only
prolong the act of dying. In cases where it is uncertain whether treatment will be
beneficial, treatment should not be withheld. At the present time, it is difficult to
identify a consensus on which infants with a broad range congenital or acquired
malformations should be treated. However, infants with conditions such as
meningomyelocele and trisomy 21 should receive the benefit of medical and surgical
treatment. Attempts at simple solutions by the insistence that all infants be treated
may not serve the interests of profoundly impaired neonates. The traditional method
of a single physician making life-death judgments, without the involvement of other
persons possessing additional facts, experience and points of view, may lead to
decisions that cannot be justified ethically. The establishment of Infant Bioethics
Review Committees to help the process of decision-making for disabled neonates has
been proposed by the American Academy of Pediatrics and the President’s
Commission for the Study of Ethical Problems in Medicine and Biomedical and
Behavioral Research. MSSNY believes that a well functioning and organized Review
Committee is helpful in addressing such difficult ethical problems. Infant Bioethics
Committees should have broad representation, and their recommendations should be
based primarily on ethical rather than legal, economical, or political considerations.
Infant Bioethics Review Committees should not establish guilt or innocence, but
should serve a positive function for neonates, families, and professionals to make the
decision-making process more careful and critical and most likely to be justified
ethically. (HOD 84-37; Council 8/20/86)
95.999
Euthanasia: The use of Euthanasia is not in the province of the physician.
(Council 12/16/76)
100.000
FAMILY AND MEDICAL LEAVE:
(See also Hospitals, 150.000)
100.999
Family and Medical Leave: MSSNY supports the passage of a minimum statewide
standard Family Medical Leave Act which establishes standards for companies
63
employing over a certain number of persons to allow men and women unpaid leave for
a defined period when the birth or adoption of a child or serious illness of a family
member occurs. (HOD 91-83)
105.000
GENETICS:
105.998
Discrimination, Prevention of Selective in Insurance Plans: MSSNY will
introduce or support legislation to forbid insurance companies from using as criteria
for issuance of coverage or premium rating for health, life and disability policies
information derived from genetic screening. (HOD 96-172)
105.999
Counseling: The physician has a responsibility to inform the patient/couple of the
risk of possible genetic defects when the patient is at risk because of age, previous
obstetrical history, maternal/paternal family history, or exposure to predisposing
factors; to advise the patient/couple of the availability of genetic counseling types of
diagnostic procedures, and the related risks involved. The patient/couple has a
responsibility to seek counseling when the possibility of genetic defects exist, as
evidenced in their personal or family history, and to secure information that will
enhance the patient/couple’s accountability in productive decision-making. Physician
responsibility should be based on the standard of medical practice and the methods of
procedures prevailing at the time of counseling. Only a small percentage of birth
defects have specific diagnostic tests. The great majority of defects are not able to be
diagnosed prenatally. (Council 5/17/79)
110.000
HEALTH CARE DELIVERY SYSTEMS:
(See also Health System Reform, 130.000; Managed Care, 165.000)
110.993
Ionizing Radiation from Fluoroscopy Concerns: MSSNY in collaboration with The
College of Radiology and with advice of legal counsel to clarify the scope of practice
and delineation of privileges regarding the performance of fluoroscopy by physician
extenders under direct physician supervision. (HOD 09-150)
110.994
Health Care Reform Based Upon Evidence Not Ideology: In recognition that the
current health care delivery system model has proven ineffective at the goals of cost
containment, improved access, and improved outcomes, MSSNY should actively
engage in pursuit of a new health care delivery system model that is primarily based
upon evidence which supports these stated objectives, and not reforms based just upon
political or economic ideology. (HOD 07-103)
110.995
Appropriate Disclosure by Nurse Practitioners of Collaborating and Coverage
Agreement & Scope of Practice: MSSNY should advocate for:
(1) the enforcement of Nursing Education Law 139 stipulating that the collaborating
physician(s) be prominently posted;
(2) extension of this ordinance to include the posting of collaborating physician(s) in
all advertising, stationery, business cards, etc.;
(3) the inclusion of not only the collaborating physician(s) but also all coverage
agreements including off hours and emergency in patient areas;
(4) al Society of the State of New York advocate for the principle that, regardless of
any previous specialty training or expertise on the part of the extender(s), the
64
scope of their practice be limited to and be congruent with that of their current
collaborating physician(s); and
(5) assurances that any off hours and emergent covering arrangements be consistent
with the extender(s) current scope of practice and expertise so as to ensure no
gaps in care are incurred by the patient. (HOD 07-99)
110.996
Oral Maxillofacial Surgery Scope of Practice: MSSNY should oppose any and all
legislation to expand the dental scope of practice to allow non-physicians to perform
plastic facial rejuvenation and reconstructive surgery of the oral and maxillofacial area
that is not directly related to restoring and maintaining dental health. (HOD 07-98)
110.997
The Need for Patients to be Informed as to the Difference Between Physicians
and other Types of Health Care Providers so as to Allow the Patient to Make a
Choice of a Physician or Other Health Care Provider Based on Informed
Consent: MSSNY will seek State and Federal legislation mandating that patients be
notified whenever a health care provider other than a physician will provide care to a
patient. (HOD 98-57; Reaffirmed HOD 99-83)
110.998
Nonphysician Practitioners in Today’s Health Care Delivery Systems:
(A) Scope of Practice: While the Medical Society is certainly concerned about
system costs, our primary focus is and must be on quality. We believe, therefore, that
non-physician professionals should be used in a manner commensurate with their
training. It is clear, furthermore, that how we pay non-physician practitioners will
directly affect how they practice. The medical community firmly believes that nonphysician practitioners lack the education and training necessary to practice
independently of physicians. A serious danger to the well-being of the citizens of this
state will result if health care professionals, competent within their own fields, are
permitted to work in areas beyond their competence and training and/or without an
appropriate relationship with a physician. Moreover, to the extent that some advocate
the expansion of the services performed by non-physician practitioners in the pursuit
of system economies, but without an adequate educational base, costs will inevitably
increase, not decrease. Therefore, while the Medical Society is committed to ensuring
the efficient and responsible integration of these professionals into health care delivery
teams, we should be moving toward an integrated system, not reversing statutorily
created interrelationships which foster cohesion in our health delivery processes rather
than fragmentation. Consequently, MSSNY strongly opposes any expansion of the
scope of practice of non-physician practitioners which would undermine the quality of
health care and compromise public safety. (B) Practice Setting and Distribution:
Certain interests recommend increasing the number of non-physician practitioners to
address perceived provider shortages in underserved areas of the state. MSSNY, for a
variety of reasons, questions the reasonableness of this conclusion. Generally, it is
difficult to entice physicians to practice in such locations where they must be on call
constantly, have few professional colleagues with whom to interact and where their
spouses may not be able to find suitable jobs in such settings. Non-physician
practitioners face similar, If not the same disadvantages. Furthermore, government
should always be alert to initiatives which could result in the establishment of a twotiered system of health care and, in effect, deny physician services to the elderly, poor
and chronically ill. In light of the efforts of managed care organizations to
significantly constrict staffing levels, and in view of the persuasiveness of managed
care in New York State, we submit that government should carefully examine future
work force requirements generally. (C) Manner and Extent of Compensation: In
65
certain government forums, non-physician practitioners are advocating that they
should receive the same amount of compensation paid to physicians for certain
services. MSSNY specifically opposes any policy which would implement “parity” of
payment between physician and non-physician providers. MSSNY supports the
implementation of a differential payment structure based upon the provider’s level of
training, skill, expertise, responsibility and practice costs. Such a payment structure
must necessarily recognize the inherent distinctions which exist between the extent of
physician education and training as compared to that of non-physicians. Such
distinctions in education, training, legal recognition and scope of practice demonstrate
beyond argument the lack of any “equivalency” of service despite the claims by some
non-physician practitioners. As noted above, the education of a nurse practitioner can
be completed in as few as thirty-one months consisting of two years of junior college
and nine months of advanced nurse practitioner certification program, or in as much as
six years including four years of college and two years in a combined masters and
certificate training program. By contrast, generalist physicians have at least eleven
years of education and training, including four years of college, four years of medical
school, three years of residency and often, additional years of fellowship training. A
differential payment structure which recognizes and compensates those with greater
skill, knowledge and training is absolutely necessary to assure that dedicated, talented
and intelligent individuals are attracted to the profession of medicine. Obviously,
young women and men are motivated to pursue the long and arduous work of medical
licensure for a variety of reasons, not the least of which is the unique opportunities
which the profession offers to serve society in a very direct and personal way.
However, we must also recognize the necessity of fair and adequate compensation for
those who pursue this course. Without such a structure, there would be inadequate
training required of physicians today.
MSSNY strongly supports the provision of payment to a physician for all services
provided by non-physician practitioners under the physician’s supervision and
direction regardless of whether such services are performed when the physician is
physically present, so long as the ultimate responsibility for such services rests with
the physician. Such a payment relationship is completely consistent with the
functional relationships required by NY law which clearly prescribe that the physician
is ultimately responsible for services provided by nurse practitioners and certified
nurse midwives with whom the physician is collaborating, and physician assistants
who the physician is supervising. As a result, MSSNY opposes direct reimbursement
to non-physician practitioners. (Council 1/19/95)
110.999
115.000
Primary Care Services, Access to: It is the position of MSSNY that a patient’s
access to primary care services provided by a physician should not be limited by the
specialty or subspecialty designation of the physician, but should be determined by the
training, competence, and experience of the physician to provide primary care
services, and that health plans should allow physicians with the appropriate
qualifications to elect to provide primary, specialty and subspecialty care services.
(Council 12/15/94)
HEALTH CARE PROFESSIONALS/PROVIDERS:
(See also Acquired Immunodeficiency Syndrome [AIDS], 15.000)
115.988
Physician Surrogates: MSSNY to urge the American Medical Association to
examine programs developed by government or managed care organizations where
66
physician extenders practice independently and insist that there be Level 1 evidence to
demonstrate that there is no diminution in the quality of patient care by programs that
use non-physician providers. (HOD 11-114)
115.989
Radiology Personnel and Safety: MSSNY to:
−
lobby the NYS Legislature and the NYS Department of Health for legislation
and/or regulation which would mandate those radiology technicians and other
related personnel to participate in continuing education which would keep them
abreast of technological changes and thus certification and licensure would no
longer be a one-time event;
−
urge the Food and Drug Administration in addition to continued monitoring of
safety standards radiological instrumentation and devices, to require that all
mistakes, equipment failures and any incidence which involves faulty radiology
instrumentation be reported to a national database;
−
lobby Congress for new legislation or regulation which would mandate that all
medical radiology units, as proposed by the American College of Radiology, be
professionally accredited. (HOD 11-106)
115.990
Simplifying the Credentialing of Teleradiologists: MSSNY to work with the
Healthcare Association of New York State (HANYS) to devise and implement a
method to expedite the hospital credentialing of physicians providing teleradiology
services, including if necessary legislation or regulation, to reduce the unnecessary
duplication of having to meet credentialing requirements for multiple hospitals.
(Council 11/19/09)
115.991
Limiting the Scope of Practice of Specialists Assistants in Radiology: That
MSSNY support the efforts of the NYS Radiological Society and the American
College of Radiology to obtain regulation which would preclude a Specialist Assistant
in Radiology from rendering an official report of any image produced by any
diagnostic imaging technique and that a similar resolution be forwarded to the
American Medical Association at the 2006 Annual Meeting. (HOD 06-87)
115.992
To Mandate Registered Professional Nurses in Schools: MSSNY encourage the
availability of nurses so that every public and private school has a registered
professional nurse with the appropriate skills, education, and training, in every school
in a ratio consistent with the National School Nurse Association recommendation, but
not less than one registered nurse immediately accessible in person for an emergency.
(HOD 06-165)
115.993
Scopes of Practice of Physician Extenders: MSSNY supports the formulation of
more clear definitions of scopes of practice of physician extenders to include more
direct physician responsibility in their supervision and limits of numbers of visits by
physician extenders allowed between cooperating physician visits with their patients.
MSSNY will embark on a campaign to remind physicians of the importance and
responsibility of maintaining regular contact with all of their patients particularly when
physician extenders are involved. (HOD 02-66)
67
115.994
Certified Medical Assistants/Medical Assistants - Preservation of Physician
Autonomy in Employment and Assignment of Duties: MSSNY will develop and
promote regulation and/or legislation that allows Certified Medical Assistants and
Medical Assistants to continue to perform the usual duties of their position under the
direct supervision of their physician employers if the physician has evaluated and
approved their ability to do so, making this a part of the Annual Legislative Agenda
until this goal has been attained. (HOD 96-68)
115.995
Education Programs for Nurses: MSSNY continues to strongly support programs
that will assist and encourage persons to enter the field or nursing. These programs
should be integrated to allow transfer of credits toward higher levels of education.
Recruitment efforts should begin at the high school level and shall specifically include
orientation of guidance counselors. (HOD 89-31)
115.996
Shortages of Nursing and Other Health Care Personnel: MSSNY is working with
the Legislature to implement short and long range measures to address nursing and
other health care personnel shortages such as: (1) Using New York State funds
earmarked for hospital implementation of the revised minimum hospital code to
provide labor rate relief for nursing and other health care personnel; (2) Providing
hospital reimbursement sufficient to allow hospitals to provide adequate salaries for
nursing and other health care personnel; (3) Encouraging development of salary and
career ladders in nursing that relate experience and increased responsibility to salary;
(4) Developing and increasing efforts to educate and retain professional health care
workers; (5) Developing efforts to increase and retain personnel beginning with
junior and senior high students, and that include scholarship programs and expansion
of loan forgiveness programs.
MSSNY is identifying additional measures that it can support to address these
problems surrounding health care personnel shortages. (HOD 89-7)
MSSNY has strongly encouraged the New York State Department of Health to
establish a Hepatitis B Vaccination program for high risk health care workers in New
York State and is seeking support from the Hospital Association of New York State
(HANYS) for a joint effort to achieve changes in State regulation and/or legislation to
obtain State funding so that such vaccinations can be provided free of charge to any
health care worker at high risk. (HOD 88-51)
115.997
Hepatitis B Immunization: MSSNY takes the position that all health care workers in
New York State who are at risk of infection with Hepatitis B virus should be fully
immunized with HBV vaccine, and that all students entering medical school or dental
school in New York State should be immunized as well.
MSSNY recommends that physicians in proposing prophylaxis with either the plasmaderived or the recombinant DNA Hepatitis B vaccine include in their consideration
persons in the following susceptible pre-exposure categories: health care personnel,
homosexually active men, intravenous drug abusers, heterosexual men and women
with multiple sex partners, household and sexual contacts of Hepatitis B carriers,
clients and staff of some institutions for the mentally retarded, hemophiliacs, hemodialysis patients, inmates of long-term correctional facilities, immigrants and refugees
from countries with high rates of endemic Hepatitis B virus infection, and certain
international travelers at increased risk of acquiring Hepatitis B. virus infection.
(Council 10/9/86; Council 1/30/92)
68
115.998
Nurse Practitioners - Independent Practitioners: MSSNY opposes the concept of
any legislation which would legally permit nurse practitioners to set up an independent
practice of medicine as defined by diagnosis, treatment and prescription writing.
(Council 4/22/82)
115.999
Nursing and Medical Practice, Distinction Between: MSSNY opposes legislation
which would increase the scope of nursing practice so as to blur the distinction
between nursing and medical practice. (Council 3/23/78)
117.000
HEALTH INFORMATION TECHNOLOGY:
(See Managed Care, 165.000; Medicare, 195.000)
117.988
Role of Organized Medicine in Cyberspace Evaluations of Physicians: MSSNY to
work with legislators to secure legislation that would require that (1) the Websites
purporting to offer evaluations of physicians state prominently on their Websites that
they are not officially endorsed, approved or sanctioned by any medical regulatory
agency or authority or organized medical association including a state medical
licensing agency, state Department of Health or Medical Board but that they are a forprofit independent business and have not substantiated the authenticity of individuals
completing their surveys; and (2) organized medicine have an input into the
parameters used in the ratings of physicians on these Websites. Also, MSSNY is to
bring this resolution to the 2010 American Medical Association House of Delegates
Meeting. (Council 1/28/10)
117.989
Anonymous Cyberspace Evaluations of Physicians: MSSNY to:
•
work with legislators to secure legislation to 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;
•
work with legislators to secure legislation that would 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;
•
work with legislators to secure legislation that would 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;
•
work with legislators to secure legislation that would make it a crime for a
company or an individual that does business or resides in New York State to violate
Internet user agreements.
In addition, MSSNY to bring a resolution on this subject to the American Medical
Association. (Council 9/17/09)
69
117.990
AMA Masterfile and AMA Physician Profile: MSSNY to bring resolutions to the
American Medical Association’s 2009 Annual House of Delegates Meeting requesting
that:
−
the American Medical Association (AMA) ensure that the AMA Physician
Profile and AMA Masterfile include the complete name of the training program
[i.e. “Program Name” as listed on the Accreditation Council for Graduate
Medical Education (ACGME) website)];
−
the AMA ensure that the AMA Physician Profile and AMA Masterfile stop
deleting from Physician Profiles and the Masterfile the name of the medical
school or training program that is already listed and verified in the Physician
Profile as it corresponds to the name of the institution at the time of the
Physician’s graduation;
−
if the AMA Physician Profile and AMA Masterfile includes the new updated
name of a medical school or training program, this information be in addition to
but not in place of the name of the medical school or training program at the
time of the physician’s graduation; and
−
when the American Medical Association Physician Profile does its routine
standard primary source verification confirming residency graduation, it states
on the Profile “Completed Training” for the program from which a resident was
graduated. (HOD 09-216)
117.991
Waivers - Mutual Privacy Agreements: MSSNY to examine the use of “mutual
privacy agreements” which are utilized by some physicians as a mechanism to prevent
patients from posting unfavorable comments on blogs, and recently developed rating
websites, as well as other such devices that pre-condition the provision of medical
services upon the waiver of individual patient rights. (HOD 09-212)
117.992
Update nydoctorprofile.com: MSSNY to:
ƒ
work with the New York State Department of Health to ensure that the New
York State Physician Profile includes the complete name of the training program
[i.e. “Program Name” as listed on the Accreditation Council for Graduate
Medical Education (ACGME) Website];
ƒ
work with the New York State Department of Health to ensure that the New
York State Physician Profile stop deleting from the database the name of the
medical school or training program that is already listed and verified in the
Physician Profile as it corresponds to the name of the institution at the time of
the physician’s graduation;
ƒ
work with the New York State Department of Health so that the New York State
Physician Profile stops automatically overriding correct, accurate information
contained in a physician’s profile with inaccurate or incomplete information
contained in the AMA Masterfile and AMA Physician Profile;
ƒ
pursue efforts to assure that data on public physician profiles contain only
correct and appropriate data and that a physician be notified of any changes
made by the profiler to allow corrections. (HOD 09-156)
70
117.993
Information Technology and Stimulus Money: MSSNY to (1) caution health care
policy makers that the Health Care Information Technology stimulus money, as
outlined in the American Reinvestment and Recovering Act, will cause a sudden rise
in the demand for health care IT products and services which may result in inflated
prices for physicians; (2) advise physicians and health care policy makers that the
ongoing maintenance of health care IT can be costly, and that this ongoing expense
will fall to physicians long after the stimulus money is exhausted; and (3) introduce a
similar resolution at the upcoming American Medical Association A 2009 Annual
Meeting. (HOD 09-93)
117.994
Medical Smart Cards: MSSNY to urge the American Medical Association to study and
develop a “white paper” on the issue of medical smart cards and aligned technology,
including the role of organized medicine in smart card development, the emergence of
regional health information organizations (RHIOs), the opportunity for State and Specialty
Societies to obtain grants to educate and inform members of opportunities in this and
similar emerging technology and to enumerate the implications which these technologies
have for physicians, patients and healthcare, in general. (HOD 09-92)
117.995
Fully Functional Universal Health Information Network: MSSNY to continue
working collaboratively with all appropriately recognized entities on the state and
federal levels and other healthcare stakeholders to ensure that the standards developed
to make health information technology operational in communities across New York
State will, in an affordable and user friendly manner, improve efficiency and accuracy
in the delivery of healthcare. (HOD 09-91; Reaffirmed HOD 10-100)
117.996
EHR Interfaces: MSSNY to encourage the State of New York to (1) require electronic
medical records sold in the state of New York to include, at no extra charge, interfaces that
communicate with state-wide databases and local Region Health Information Organizations
(RHIOs); and (2) set clear standards for electronic interfaces. (HOD 09-90)
117.997
Medical Smart Cards: MSSNY to:
1. educate its members through News of New York, the MSSNY website and other
appropriate means of communication, regarding the benefits, technology and
availability of medical smart cards, and keep members informed of developments
and opportunities in this emerging technology.
2. communicate with health care organizations and health insurance plans throughout
New York State to urge the development and use of medical smart cards for the
purposes of:
a.
b.
c.
making patients’ information readily available;
simplifying the task of eligibility verification in physician offices, and
enhancing and ensuring HIPAA compliance with conversion of paper-based
health care information to electronic systems that guarantee the privacy and
security of patient information gathered as part of providing health care.
3. work with health care insurers and agencies to ensure that physicians do not incur
any added expenses to incorporate the use of a health insurer’s / agency’s
generated medical smart card into their practice. In addition MSSNY urge those
entities, including vendors, which currently charge physicians a fee for smart card
readers to provide these free or at a steep discount for MSSNY members.
71
4. develop a collaborative working relationship with the HANYS’ newly created
Office of Health Information Technology Transformation, which is studying the
development of sustainable health information exchanges on community, regional,
and state levels (Regional Health information Organizations or RHIOs). In
addition, MSSNY strive to become an active participant in the GNYHA newly
created New York Clinical Information Exchange (NYCLIX) whose goal is to
“increase patient safety and the efficiency of care by creating a virtual network for
sharing of patient data among health care entities for the purpose of treatment.”
NYCLIX is now embarking on the planning phase in order to create
implementation of patient data sharing. Both of these initiatives (HANYS and
GNYHA) are unique opportunities for MSSNY to provide physician input and
expertise at the early stages of these projects.
5. to prepare a resolution to be forwarded to the AMA House of Delegates to study
and develop a “white paper” on the issue of medical smart cards, including the
role of organized medicine and specific implications for physicians, patients and
healthcare, in general. (Council 1/25/09)
117.998
Information Technology: That MSSNY encourage insurance companies to develop
economic incentives, including increased reimbursement rates, for physicians and
hospitals that use information technology in the care of their patients. (HOD 06-92)
117.999
Putting Economics in Health Information Technology: That MSSNY continue to
work jointly, with the American Medical Association and other organizations, to
develop standards and protocols towards affordable and user friendly health
information and payment systems. (HOD 06-81)
120.000
HEALTH INSURANCE COVERAGE:
(See also Abortion and Reproductive Rights, 5.000; Alcohol and Alcoholism, 20.000;
Reimbursement, 265.000)
120.953
Transparency in Insurance Contracts: MSSNY to seek legislation and/or
regulation that would enforce health insurance plans to clearly and transparently
declare what exactly is covered and not covered in each of their plans in a plain,
simple and concise summary, with carefully documented exclusions to coverage, in a
standardized format to be approved by the New York State Superintendent of
Insurance. Also such legislation and/or regulation should state that once these
limitations of coverage are outlined they cannot be changed without first notifying the
insured of these changes in a timely manner, sufficient enough to allow an insured the
ability to change policies without disruption to healthcare coverage. (HOD 10-260)
120.954
Child Health Plus Program Funding: MSSNY will continue to work with New
York’s Congressional Delegation and the AMA to assure that federal funding for care
provided to beneficiaries of the Child Health Plus and Medicaid programs in New
York is not diminished in the future. (HOD 10-91)
120.955
Truth in Out-of-Network Healthcare Benefits Act: MSSNY to seek legislation
and/or regulation to require insurance companies to provide to potential purchasers the
true expected out-of-pocket costs if patients to out of network. Also, MSSNY to
72
endorse the AMA draft legislation, Truth in Out-of-Network Healthcare Benefits Act,
and seek adoption of similar legislation in the State of New York. (HOD 10-58)
120.956
Out-of-Network Care by Health Plan Providers: MSSNY to petition health plans
as well as the New York State Insurance Department to allow the health plan’s
physician to charge a subscriber as an out-of-network provider when the subscriber is
not an enrolled member of the physician’s specifically contracted health plan product.
(HOD 09-262)
120.957
Outsourcing of Claims: MSSNY to take all appropriate steps including, if necessary,
the passage of legislation to assure that health insurance companies which subcontract
with third party vendor(s) located in a foreign country for claims processing,
utilization review or for any other service adhere to all appropriate federal and state
legal requirements for the prompt adjudication of claims for payment, utilization
review and patient information privacy. (HOD 09-105)
120.958
Eligibility for Enrollment in Family Health Plus: MSSNY to seek a change to the
current eligibility requirements for enrollment in Family Health Plus to allow for small
businesses, including physicians’ offices, with less than 10 full time employees to be
able to offer Family Health Plus as an additional insurance option. (HOD 09-102)
120.959
Revision of the Federal Tort Claims Act: MSSNY to endorse the proposal that all
patients whose care is funded in all or in part by federal funds, and/or whose care is
delivered in facilities funded in all or in part by federal funds, such as those patients
covered by Medicare, Medicaid, Railroad retirement benefits, SCHIP, insurance
purchased with pre-tax dollars, treated in not-for-profit facilities, etc., be brought
under the jurisdiction of the Federal Tort Claims Act. Also, the MSSNY delegation to
the American Medical Association is requested to take this issue to the 2009 AMA
House of Delegates for action on the federal level. (HOD 09-75)
120.960
Assuring Seamless Coverage for Patients Changed from HMO Products into
PPO Products: MSSNY to seek federal and state legislation to eliminate the 12month awaiting period for health insurance coverage for patients with pre-existing
medical conditions and request that the American Medical Association’s 2009 House
of Delegates consider this action as well. (HOD 09-68)
120.961
Impediments to Obtaining Pre-authorizations for Medically Indicated Diagnostic
Tests: MSSNY to 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-authorization. (Council 3/3/08)
120.962
United States Health Care and Gratuitous Privatization: MSSNY to support those
health care policies that favor insurance products to achieve the health care goals of
quality, cost containment and interoperability, only when the evidence in support of
the superiority of such insurance products is composed of unbiased, scientifically
rigorous and medically sound studies. (HOD 08-93)
120.963
Retail Clinics: MSSNY to pursue legislation, regulation, or other appropriate means
to (a) assure that a retail clinic that receives insurer reimbursement be required to
comply with existing standards for the operation of medical practices; and (b) prohibit
73
health plans from incentivizing the utilization of health care in retail stores through
techniques including but not limited to the charging of less expensive co-pays.
(HOD 08-68)
120.964
Universal Bill: MSSNY to seek legislation or other appropriate means to assure that
all durable medical equipment (DME) vendors have a universal bill that is consumerfriendly and clearly states what was paid by the health plan, secondary insurer and
what is owed by the patient and that these bills are received in a timely fashion.
(HOD 08-61)
120.965
Medically Necessary Procedures and Pre-certification & Pre-authorization
Protocols: MSSNY to 1. Seek the enactment of legislation, regulation or other appropriate means to
eliminate the need to obtain pre-authorization for certain procedures and tests that
are clearly indicated, including for urgent and emergency care, based upon a
patient’s particular health condition as defined by relevant physician specialty
society guidelines;
2. Take appropriate steps to assure that health plans obtain meaningful clinical input
from New York physicians representative of all specialties, through practicing
physician liaison committees, in determining which services should require preauthorization or pre-certification;
3. Take appropriate steps to assure that health plans promptly respond to required
pre-authorization requests for tests within 24 hours, including the imposition of
meaningful penalties on health plans, and requiring payment for the requested
services when such authorization is not received in a timely manner;
4. Advocate for a statutory definition of “medical necessity” which gives appropriate
discretion to a physician requesting the health care service or treatment for the
patient, provided the care is consistent with generally accepted standards of
medical practice, and clinically appropriate to the patient’s condition.
(HOD 08-50)
120.966
Coverage by Carriers for Annual Physical Examination in Healthy NY Program:
MSSNY to encourage the Healthy NY Program to negotiate a benefit package that
allows for an annual health maintenance visit. (HOD 08-264)
120.967
Hearing Aids: MSSNY to work with the American Medical Association to
encourage all insurers, including Medicare, to provide coverage for hearing aids for
individuals determined by professionals to be hearing impaired. (HOD 08-263)
120.968
Waiver of Primary Care Referral Requirements for Skilled Nursing Facilities
and Sub-Acute Rehabilitation Facilities: MSSNY will pursue legislation and/or
regulation to simplify and make transparent the health coverage of Skilled Nursing
Facilities/Sub-Acute Rehabilitation Facility residents, by waiving the primary care
referral requirement so that patients receive timely and appropriate treatment and
appropriate reimbursement is provided for these services. (HOD 08-262)
120.969
Removing Barriers to Care for Transgender Patients: MSSNY to support the
resolution being presented at the American Medical Association’s A’08 Meeting by
the AMA-Medical Student Section and AMA-Resident and Fellow Section which asks
74
that the AMA (1) support public and private health insurance coverage for treatment of
gender identity disorder, and (2) oppose categorical exclusions of coverage for
treatment of gender identity disorder when prescribed by a physician. (HOD 08-171)
120.970
Health Coverage Coalition for the Uninsured: MSSNY approves the conclusions
of the Health Coverage Coalition for the Uninsured and express its concern that
additional issues of significance should be also addressed by HCCU including but not
limited to the burdensome cost associated with the administration of current health
care coverage, the need for redress of the medical liability problem, and the need to
obtain leverage in the health care market through collective negotiation.
(Council 3/5/07)
120.971
Medical Outsourcing: MSSNY to request legislation to prevent insurance companies
from incentivizing subscribers in this state to have to go overseas for medical
treatment that could be provided locally and, through the American Medical
Association, request federal legislation to prevent insurance companies from
incentivizing subscribers to go overseas for medical treatment that could be provided
locally. (HOD 07-263)
120.972
Association Health Insurance: MSSNY to seek legislation or regulation to enable
insurers to provide association-specific health insurance alternatives for 501(c)(6) notfor-profit associations in the State of New York. (HOD 07-211)
120.973
Health Promotion Visits: MSSNY should seek legislation and/or regulation
exempting the cost of an annual physician clinical preventive services visit, as defined
in current MSSNY policy 120.983, from inclusion as deductible expenses.
(HOD 07-156)
120.974
Access to Health Insurance for Domestic Partners: That MSSNY seek legal or
regulatory action to require that insurance carriers be mandated to offer domestic
partner coverage to all groups, regardless of group size. (HOD 06-267)
120.975
Home Visits: That MSSNY work to assure appropriate reimbursement for rendering
care to homebound individuals. (HOD 04-64)
120.976
Geriatric Care: That MSSNY work to assure appropriate reimbursement by all
payors for care provided to the elderly. (HOD 04-62)
120.977
Patients’ Out of Pocket Financial Responsibility for Emergency Room Services
Provided: MSSNY takes the position that when an out of network physician provides
care in an emergency room, no patient out of network deductible/co-pay should apply.
(HOD 04-74)
120.978
Public Access to Health Insurance Policy Options Available to Government
Employees: MSSNY will take appropriate steps to assure that health insurance
policies, currently restricted to employees of the New York State government, be
made available for purchase by the general public. (Council 11/l3/03)
120.979
Patient Responsibility for Notification of Change in Insurance Coverage:
MSSNY will encourage physicians to prominently display signs in their offices
instructing patients to immediately identify any recent change in health insurance
75
coverage; and will seek legislation which would deem any contractual provision which
precludes a physician from billing patients, over and above the applicable deductible
and co-insurance amounts, unenforceable in situations where the patient has neglected
to identify a change in health insurance coverage, within a reasonable period of time
and such failure resulted in the denial of all or part of a physician’s claim.
(HOD 02-52)
120.980
Clean Claim: (Sunsetted HOD 2011)
120.981
Standardized Referral Form: MSSNY will work with the appropriate state agencies
to develop a standardized specialist referral form (similar to the HCFA 1500, which
has been accepted as a universal medical claim form); and will seek legislation to
require that Managed Care Organizations doing business in New York State use such
as a uniform referral form. (HOD 00-274)
120.982
“Bare Bones” Health Insurance Policies: MSSNY will urge the New York State
Insurance Department to refuse to permit minimalist health insurance policies,
commonly known as “bare bones” policies to be offered for sale in New York.
(HOD 00-74)
120.983
Payment for Clinical Preventive Services: MSSNY will seek the introduction of
state legislation, as well as federal legislation through the AMA, requiring all
insurance companies (Indemnity and ERISA Health Plans) to pay for at least one visit
a year for clinical prevention services, and that no other diagnosis be required for
payment to the physician. (HOD 99-264; Reaffirmed HOD 07-156)
120.984
Parity in Reimbursement for Mental Health Services: MSSNY will seek the
introduction of legislation requiring insurers to provide coverage for mental illness and
substance abuse in their basic contracts on a parity level with all other medical
services and that reimbursement for such services be made on a parity level for all
physicians at rates normally paid for all other medical care. MSSNY will urge the
AMA to support The Mental Health Equitable Treatment Act of 1999 which would
provide full insurance parity for adults and children with the most severe mental
illness. (HOD 99-263)
120.985
Call for the Closure of Wellcare of New York: MSSNY will take immediate steps
calling for the New York State Insurance Commissioner to close down Wellcare of
NY the most insolvent HMO in New York, and guarantee transfer of subscribers to
equitable health care plans, and MSSNY will work to ensure that the New York State
Insurance Superintendent: (a) regularly evaluates the financial viability of health care
plans operating in New York State, (b) intervene when it is determined that fiscal
insolvency of a plan is imminent to protect and to ensure that all providers are
reimbursed for outstanding claims prior to any action taken to sell, rehabilitate or
dissolve the plan and its assets, and (c) when insolvency is imminent to take actions to
assure the insurability and continuation of coverage for all beneficiary/covered lives in
the plan prior to any action taken to sell, rehabilitate or dissolve the plan or its assets.
(HOD 99-99)
120.986
Non-Assignability Clauses in Health Insurance Contracts: MSSNY supports the
patients’ right to assign their health insurance benefits to their physician, and shall
76
seek legislation that would prohibit non-assignability of benefits clauses from all
health insurance contracts. (HOD 99-61; Reaffirmed HOD 01-66; HOD 08-56;
Reaffirmed HOD 09-63)
120.987
Multiple Product Lines: MSSNY through the American Medical Association will
seek Federal Legislative action to challenge health insurers who mandate the
commitment of physicians to all (or multiple) product lines under a single contractual
agreement as a condition for their participation with such organizations.
(Council 12/18/97)
120.988
MSSNY Position on Child Health Plus Program (CHPlus):
•
•
•
•
•
•
•
•
•
•
120.989
The Medical Society supports using the Child Health Plus program as the platform
for expanding children’s health insurance coverage under the new federal
program.
We support an enhanced benefit package that includes coverage for dental,
eyeglasses and hearing aids.
We support parity for mental illness, alcoholism and substance abuse services in
the CHPlus program.
The Medical Society supports a 60-day presumptive eligibility period beginning
with the initial visit and support a one year enrollment “lock in.”
MSSNY is supportive of the Department of Health efforts to create a “seamless”
application process for Medicaid, CHPlus and WIC.
Legislative efforts to remove the face to face Medicaid enrollment requirement is
supported by MSSNY.
We support targeting the majority of the $25 million annually allocated for
administration including enrollment and marketing to efforts targeted at the most
needy -- low-income, minority and urban and rural residents.
The Medical Society is supportive of developing a program that allows physicians
to sign up children during an office visit.
To the extent funds are available or unexpended, MSSNY would support raising,
on an incremental basis, the eligibility for CHPlus above 220% of the federal
poverty level.
We urge the state to consider, at an appropriate time, subsidies for family
coverage. (Council 2/5/98)
Routine and Refractive Eye Examination: It is MSSNY’s position that third-party
payors make it abundantly clear to patients that eyeglass riders, routine eye
examinations, vision care services, vision benefits, vision aid benefits, vision care
benefits, eyeglass benefits and any such benefits, as desirable as they may be, do not
substitute for a full medical eye examination on a regular basis by a qualified
ophthalmologist, and that when eyeglass benefits are provided, that such benefits
provide coverage for a refractive examination and prescription of eyeglasses by an
ophthalmologist or optometrist of the patient’s choice. MSSNY will coordinate efforts
with medical specialty societies to introduce legislation requiring third-party payors to
use uniform and precise language to describe benefits provided in eyeglass benefits
and riders, and make it clear to patients that such examinations do not substitute for a
full medical eye examination on a regular basis. (HOD 98-78)
77
120.990
Physician Notification of Insurance Payments Made Directly to Patients:
MSSNY will seek legal or regulatory action to require that insurance carriers be
mandated to notify physicians of the amount and date of insurance claim payments
made directly to their subscribers, regardless of the physician’s participation status in
the plan. (HOD 98-52)
120.991
Certain Types Of Well Examinations To Be Covered By All Insurers: It is
MSSNY’s position that: (a) age appropriate well examinations should be covered
services by all insurers; and (b) age appropriate preoperative consultative evaluations
in patients who are undergoing surgery should be covered by all insurers.
In support of this position, MSSNY will petition the State Department of Insurance to
require payment for these examinations by all insurers. (HOD 97-259)
120.992
Insurance Companies To Cover Screening Mammography: MSSNY will work
with appropriate regulatory bodies to mandate that all insurance programs, indemnity
programs, HMOs and Federal Insurance Programs, such as Medicare and Medicaid,
doing business in New York State be required to cover mammography whenever the
patient’s physician deems it medically appropriate. (HOD 97-255)
120.993
Smoking Cessation Reimbursement: MSSNY strongly supports the introduction of
appropriate legislation requiring all health insurers in this state, including HMOs, to
provide coverage for smoking cessation counseling of patients, and that such coverage
encompass physician office visits. (HOD 97-253)
120.994
Insurers To Cover Hepatitis B Immunization: It is the position of MSSNY that all
insurers should cover Hepatitis B immunization; MSSNY will petition the New York
State Commissioner of Insurance to make the Hepatitis B immunization coverage
mandatory for all government, private and commercial insurers who operate in the
State of New York. (HOD 97-252)
120.995
Parity of Coverage for Mental Illness, Alcoholism and Substance Abuse in
Medical Benefits Programs endorsed by MSSNY: MSSNY supports parity of
coverage for mental illness, alcoholism and substance abuse and will seek legislation,
based on language within the Americans With Disabilities Act, that will mandate that
all Third Party Insurance Carriers, including ERISA exempt entities, provide coverage
for mental illness, alcoholism and substance abuse on a parity basis with other medical
conditions. (HOD 96-251)
120.996
Standardized Insurance Claim Forms: MSSNY is seeking appropriate legislative
or regulatory reform to require third party carriers to adopt and use a standardized
health insurance claim format. (HOD 93-67)
120.997
Truth in Health Insurance: MSSNY takes the position that all health insurance
literature and contracts should be mandated to use a standardized form, written in
laymen’s terms (easy to understand language), wherein excluded diseases, diagnoses,
and medical procedures are appropriately identified in policies of contract holders. As
a means of allowing subscribers to make informed decisions concerning their health
insurance choices, the Medical Society of the State of New York is urging the New
York State Insurance Department to support legislation which would amend the
insurance law in relation to the adoption of current procedural terminology for use by
78
health insurers, as well as requiring insurers to release information on the mode of
payment in addition to the actual reimbursement for services rendered to enrolled
subscribers. (HOD 92-37)
120.998
Reimbursement When Patients Refuse to Sign Health Insurance Forms: MSSNY
is urgently requesting the New York State Department of Insurance to draft measures
which would ensure that health insurance companies be obliged to reimburse
physicians for documented medical services performed in accordance with the
patient’s insurance plan whether or not the patient agrees to sign the insurance forms.
(Council 7/23/92)
120.999
Health Insurer Abuses: MSSNY has urged the Superintendent of Insurance to
enhance the means by which consumer and physician complaints regarding health
insurance programs are addressed in a timely, informed and effective manner, through:
(1) Development and identification of clearly defined complaint and review
procedures; (2) Imposition of penalties designed to deal with insurance carrier
abuses; (3) Provisions of 1-800 number enabling consumer and physician access to
appropriate personnel associated with established appeals and grievance processes.
MSSNY is vigorously pursuing legislation or regulation to limit health insurance
abuses which would include specific requirements with respect to the responsibility of
the Superintendent of Insurance to more adequately monitor the activities of health
insurers in the State. (HOD 91-34)
125.000
HEALTH SCREENING PROGRAMS:
125.996
Screening Programs and Interventions Most Beneficial in Improving the Overall
Health of the Public: MSSNY has found that the following screening programs and
interventions are most beneficial in improving the overall health of the public:
Essential Behavioral Changes
1) Smoking Cessation and Counseling – Tobacco cessation counseling on a regular
basis is recommended for all persons who use tobacco products. Pregnant women and
parents with children living at home also should be counseled on the potentially
harmful effects of smoking on fetal and child health. (US Preventive Services Task
Force).
2) Healthy Diet Counseling and Nutritional Intervention – Counseling adults and
children over age 2 to limit dietary intake of fat (especially saturated fat) and
cholesterol, maintain caloric balance in their diet, and emphasize foods containing
fiber (i.e., fruits, vegetables, grain products) is recommended. A variety of groups
have recommended nutritional counseling or dietary advice for patients at average risk
for chronic disease, including the American College of Preventive Medicine (ACPM),
American Academy of Family Physicians (AAFP), American Academy of Pediatrics
(AAP), and the American College of Obstetricians and Gynecologists (ACOG).
Recommendations on nutritional counseling for patients at risk (e.g., those who have
hypertension or hyperlipidemia) have been issued by the American Dietetic
Association (ADA) and two panels sponsored by the National Institutes of Health
(NIH) National Heart, Lung, and Blood Institute. The ADA recommends that primary
care providers screen for nutrition-related illnesses, prescribe diets, provide
79
preliminary counseling on specific nutritional needs, follow up with patients, and refer
patients to appropriate dietetic professionals when necessary.
(http://www.ahrq.gov/clinic/3rduspstf/diet/dietrr2.htm - ref52)
3) Exercise Promotion – Counseling patients to incorporate regular physical activity
into their daily routines is recommended to prevent coronary heart disease,
hypertension, obesity, and diabetes. This recommendation is based on the proven
benefits of regular physical activity (Department of Health and Human Services
(Healthy People 2010) Centers for Disease Control and Prevention, National Center
for Education in Maternal and Child Health (Bright Futures), American Academy of
Family Physicians, American Academy of Pediatrics, The American Heart
Association, and The American College of Obstetricians and Gynecologists).
Essential Preventive Screening
1) Hypertension Screening and Treatment – Screening for hypertension in adults in
adults aged 18 and older. (US Preventive Services Task Force).
2) Diabetes Screening and Treatment – Screening for type 2 diabetes in
asymptomatic adults with sustained blood pressure (either treated or untreated) greater
than 135/80 mm Hg is recommended. (US Preventive Services Task Force). The
USPSTF concludes that the current evidence is insufficient to assess the balance of
benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood
pressure of 135/80 mm Hg or lower.
3) Primary Prevention of CVD in Adult – Frequency of Screening In general, a
comprehensive assessment of risk factors should be performed at least every 5 years
starting at 18 years of age, and a global risk score should be calculated at least every 5
years starting at the age of 35 years for men and 45 years for women. Those with
increased cardiovascular risk, for example, those with diabetes, cigarette smokers, or
those with obesity, should have their risk factors and cardiovascular risk assessed more
frequently. (J Am Coll Cardiol, 2009; 54:1364-1405, doi:10.1016/j.jacc.2009.08.005
© 2009 by the American College of Cardiology Foundation).
4) Primary Prevention of Stroke – Guidelines include well-known prevention
measures such as controlling high blood pressure, not smoking, avoiding exposure to
secondhand smoke, being physically active and treating disorders that increase the risk
of stroke such as atrial fibrillation (a type of irregular heartbeat), carotid artery disease
and heart failure. The guidelines suggest physicians consider using a risk assessment
tool such as the Framingham Stroke Profile to assess patients’ risk. (American Heart
Association/American Stroke Association; US National Institute of Neurological
Disorders and Stroke).
5) Breast Cancer Screening Mammography and Appropriate Treatment – Women
age 40 and older should have a screening mammogram every year and should continue
to do so for as long as they are in good health. Breast self exam (BSE) is an option for
women starting in their 20s. Women should be told about the benefits and limitations
of BSE. Women should report any breast changes to their health professional right
away. Women in their 20s and 30s should have a clinical breast exam (CBE) as part
of a periodic (regular) health exam by a health professional, at least every 3 years.
After age 40, women should have a breast exam by a health professional every year.
(Screening Guidelines for the Early Detection of Cancer in Average-risk
Asymptomatic People—American Cancer Society). Criteria for the use of breast MRI
80
screening as an adjunct to mammography for high risk women include: having a
BRCA 1 or 2 mutation; having a first-degree relative with a BRCA 1 or 2 mutation
and are untested; having a lifetime risk of breast cancer of 20-25 percent or more as
defined by models that are largely dependent on family history; received radiation
treatment to the chest between ages 10-30 such as Hodgkin’s Disease; carry or have a
first-degree relative who carries a genetic mutation in the TP53 or PTEN genes.
(Saslow D, Boetes C, Burk W, et. al. American Cancer Society Guidelines for Breast
Screening with MRI as an Adjunct to Mammography. CA Cancer J Clin 2007:57:7589).
6) Colon Cancer Screening and Appropriate Treatment – Annual, starting at age 50
for all asymptomatic persons at average risk--Fecal occult blood test (FOBT) with at
least 50% test sensitivity for cancer or fecal immunochemical test (FIT) with at least
50%test sensitivity for cancer or stool DNA test. Flexible sigmoidoscopy every 5
years starting at 50 years of age or colonoscopy starting at age 50 every 10 years.
High risks patients should be screened based on their individual medical or family
history. (Screening Guidelines for the Early Detection of Cancer in Average-risk
Asymptomatic People—American Cancer Society).
7) Cervical Cancer Screening and Appropriate Treatment – Cervical cytology
screening is recommended every two years for women aged 21-29 with either
conventional or liquid based cytology. Women aged 30 years of age and older who
have had three consecutive negative cervical cytology screening test results and who
have no history of CIN 2 or CIN 3, are not HIV infected, are not immuncompormised,
and were not exposed to diethylstilbestrol in utero may extend the interval between
cervical cytology examinations to every three years. Co-testing using the combination
of cytology plus HPV DNA testing is an appropriate screening test for women older
than 30 years. Any low-risk woman aged 30 years or older who receives negative test
results on both cervical cytology screening and HPV DNA testing should be
rescreened no sooner than three years subsequently. American College of
Obstetricians and Gynecologists Clinical Management Guidelines for ObstetricianGynecologists, Number 109, December 2009).
8) Prostate Cancer Screening and Treatment in high risk individuals and populations
(African-Americans and Men with a first degree affected relative) – For men, age
50+, digital rectal examination [(DRE and prostate-specific antigen test (PSA)].
Health care providers should discuss the potential benefits and limitations of prostate
cancer early detection testing with men and offer the PSA blood test and the digital
rectal examination annually, beginning at age 50, to men who are of average risk of
prostate cancer, and who have a life expectancy of at least 10 years. (Screening
Guidelines for the Early Detection of Cancer in Average-risk Asymptomatic People—
American Cancer Society).
9) Immunizations – The best way to reduce vaccine preventable diseases is to have a
highly immune population. Appropriate vaccinations should be available for all adults
including the following: Seasonal influenza, pneumococcal polysaccharide, Zoster
(shingles), Hepatitis B and A, Tetanus, diphtheria, pertussis, polio (for adults who
never received or completed the primary series of polio vaccine), varicella for adults
who are without evidence of immunity, meningococcal, MMR (measles, mumps and
rubella for persons born in 1957 or later or born outside the US), HPV for women
through age 26 years of age. (From the recommendations of the Advisory Committee
on Immunization Practices).
81
Further, MSSNY recommends that physicians concentrate on these interventions for
all of their patients and that New York State policy makers devote its limited public
resources to these screening and treatment interventions on behalf of those adults
unable to afford health care. Also, for each intervention, physician and patient should
discuss the positive and negative aspects. (Council 3/8/10; Reaffirmed by Council
1/20/11)
125.997
Barriers to Colorectal Cancer Screening: With regard to Colorectal Screening,
MSSNY is to:
−
stress to the physician community the importance of counseling patients on the
issue of Colorectal Cancer and the availability of a readily available screening
test and procedure to detect this entity early in its course;
−
take an active role through media, press, communication with senior groups and
other community organizations to educate the public on the importance of
routine colorectal screening tests and the importance of discussing with their
Primary Care Physician any fears or concerns they may have, which are
potential barriers to undergoing this procedure;
−
support state financial mechanisms that allow uninsured patients to receive
colorectal screening. (HOD 10-164)
125.998
Use of CT Scans for Early Detection of Lung Cancer: MSSNY to place on its
website the white paper, Use of CT Scans for Early Detection of Lung Cancer, drafted
by its Heart, Lung and Cancer Committee. (HOD 07-164)
125.999
Test Results of Multiphasic Screening Programs: It is the position of MSSNY that
organizations, agencies or other entities that operate or sponsor multiphasic health
screening programs should be urged to include in their promotional and explanatory
materials on the availability of the program, a definitive statement that reports on the
screening test results will be furnished to the individual participants only, and that
each participant is responsible for obtaining any needed medical evaluation or followup should the results of the tests deviate from the normal range. Those operating or
sponsoring multiphasic health screening programs should also be urged to utilize
report forms that state, in bold-face type, that the report does not constitute a medical
diagnosis or evaluation and that the participant should consult a physician of his or her
choice if the screening test results are not within the normal limits indicated on the
report. (Council 12/16/82)
130.000
HEALTH SYSTEM REFORM:
(See also Education, 85.000; Health Care Delivery Systems, 110.000; Managed Care, 165.000;
Reimbursement, 265.000)
130.951
Repeal of the Patient Protection and Affordable Care Act (PPACA): MSSNY
will continue to work with the Federation of Medicine and the American Medical
Association to advocate and achieve needed reforms of the many defects of the federal
PPACA law so as to protect the primacy of the physician-patient relationship. These
needed changes include but are not limited to:
o
o
o
repeal of the Independent Payment Advisory Board (IPAB);
repeal of the Medicare Cost/Quality Index;
repeal of the non-physician provider non-discrimination provision;
82
o
o
o
o
enactment of comprehensive medical liability reform;
enactment of long term Medicare physician payment reform including
permitting patients to privately contract with physicians not participating in
the Medicare program;
enactment of antitrust reform to permit independently practicing physicians
to collectively negotiate with health insurance companies; and
expanding the use of health savings accounts as a means to provide health
insurance coverage. (HOD 11-68)
130.952
Medical Malpractice Research: MSSNY, together with the American Medical
Association, continue advocacy efforts to include the documented failures of the civil
justice system; work to achieve enactment of proven reforms; and obtain funding for
specific demonstration projects that hold promise to reduce medical liability claims
and transitional costs. (HOD 11-52)
130.953
Medical Liability Reform: MSSNY to support legislation which would allow
physicians to carry 1st tier insurance of $500,000/$1.5 million funded by physicians
and that there would be a 2nd tier insurance of $1.0 million/$3.0 million funded by an
insurance pool - said pool to be funded by a fee on every health insurance policy sold
in New York State. To insure the survivability of such a fund, the reforms to include:
1) Cap on non-economic damages of $250,000 per defendant with a total of
$750,000.
2) Medical Courts.
3) A No-fault system for claims involving neurologically-impaired infants.
4) Medical expert witness reform.
5) Certificate of merit reform. (HOD 11-51)
130.954
Tort Reform as a Major Priority: MSSNY to continue (1) seeking the enactment of
medical liability reform as one of its major priorities and (2) urging the AMA to
continue strongly advocating for the enactment of medical liability. (HOD 10-66)
130.955
National Medical Liability Reform: MSSNY’s position is that effective medical
liability reform that will significantly lower health care costs by reducing defensive
medicine and eliminating unnecessary litigation from the system should be part of any
national health system reform. (Council 11/19/09)
130.956
MSSNY Position on Health System Reform: MSSNY to identify and distribute for
the benefit of its members:
• Provisions in proposed HSR legislation that are consistent with AMA/MSSNY
policy, and are therefore supportable
• Provisions in proposed HSR legislation that would render it inconsistent with
MSSNY/AMA policy and therefore unsupportable.
In the event that HR 3961 fails to garner the necessary support in Congress and/or that
the U.S. Senate fails to support a permanent fix to the SGR, MSSNY should convene
its Council or the Council Executive Committee to consider a statement in opposition
of this failure, and, should a statement be developed in response to either the U.S.
House of Representatives or the U.S. Senate’s failure to support a permanent fix to the
SGR, that MSSNY promulgate an agenda which includes opposition to those HSR
efforts that are inconsistent with the following seven AMA principles:
• Health insurance coverage for all Americans
83
•
•
•
•
•
•
130.957
Insurance market reforms that expand choice of affordable coverage and eliminate
denials for pre-existing conditions
Assurance that health care decisions will remain in the hands of patients and their
physicians, not insurance companies or government officials
Investments and incentives for quality improvement and prevention and wellness
initiatives
Repeal of the Medicare physician payment formula that triggers steep cuts and
threaten seniors’ access to care
Implementation of medical liability reforms to reduce the cost of defensive
medicine
Streamline and standardize insurance claims processing requirements to eliminate
unnecessary costs and administrative burdens.
(Council 11/19/09)
MSSNY Position on Medical Liability Reform: MSSNY’s current position on
Medical Liability Reform is to be amended to also include the following:
ƒ
ƒ
An “Early Disclosure” pathway consisting of: early disclosure of medical errors
with non-discoverability of statements of remorse; an administrative
compensatory reimbursement system for error induced damages; and
development of an accurate means of data collection to facilitate learning and
quality enhancement; and
A Medical Court pathway to be used to adjudicate medical liability claims
where an early disclosure pathway is not used; with an administrative
compensatory method of reimbursement for error induced damages; and
development of an accurate means of data collection so as to facilitate learning
and quality enhancement.
In addition, MSSNY to work with:
ƒ
New York State licensed medical liability carriers and, as necessary, the
Governor and the State Legislature, to establish a pilot program for early
disclosure programs and medical courts.
ƒ
New York State licensed medical liability carriers to determine if the early
disclosure and medical court programs can be established in such a way as to
assure the resolution or adjudication of claims within one year.
(Council 11/19/09)
130.958
Government Officials, Proactive Policy and Retrospective Data: MSSNY will (a)
continue its advocacy efforts on various health policies, as articulated by the MSSNY
Council and House of Delegates; and (b) continue to have ongoing discussions with
state and federal officials about proactive ways to address immediate health issues,
such as physician shortages and access to health care. (HOD 09-158)
130.959
Excess Liability Insurance: MSSNY to ask medical liability insurance carriers to
determine the cost of providing Excess medical malpractice insurance coverage to
physicians in non-hospital settings. (HOD 09-72)
130.960
“Consent to Settle” Clause and Frivolous Lawsuits: MSSNY will:
84
a.
seek to protect the ability of a physician to choose at the time of purchasing a medical
liability insurance policy whether they want to retain the right to consent to a
proposed settlement;
b.
work with the American Medical Association and other organizations to
determine the impact of “consent” clauses, and non-New York State licensed
carriers including Risk Retention Groups on the frequency of the initiation of
non-meritorious medical liability claims;
c.
work to encourage medical liability carriers to be explicitly transparent in their
pricing policies, including specifying costs for consent vs. non-consent policies;
d.
collect, collate, compare and publish up-to-date data regarding costs, clauses,
and features of malpractice insurers doing business in New York State.
(HOD 09-51)
130.961
Compensation for Frivolous Lawsuits: MSSNY to continue advocating for
legislation to reduce the bringing of non-meritorious medical liability claims,
including but not limited to revised Certificate of Merit rules, expert witness reform,
and legislation to permit the creation of medical courts. (HOD 09-50)
130.962
Health Care as Economic Stimulus: MSSNY advocate for increased health care
spending (and oppose health care cuts) as an economic stimulus package, owing to its
substantial impact on local, regional economies and Gross Domestic Product (GDP) in
addition to the legacy of better health. (HOD 08-211)
130.963
Mandated Clinical Practice Guidelines: MSSNY policy to be established against
any legislation mandating strict compliance with Clinical Practice Guidelines.
(HODS 08-104)
130.964
Re-institution of the Property and Casualty Insurers’ Contribution to the Excess:
MSSNY will continue to vigorously support medical liability reform, including
premium relief, and support Assembly A08991 and Senate S6131 which would create
a medical malpractice underwriting association to remedy the existing unbalanced
situation by bringing in much needed financial resources to help shoulder the fiscal
burden of supporting this vitally important medical malpractice insurance market of
last resort. (HOD 08-95)
130.965
The High Cost of Medical Liability Insurance: MSSNY is directed to:
a) Place premium relief from the high cost of medical liability insurance as a top
priority for the Legislative Program for next year;
b) Seek legislation to reduce the amount of medical liability insurance required to be
eligible for excess insurance coverage at no cost from $1.3 million to $1.0 million;
c) Seek legislation for New York State to subsidize a percentage of the premium
cost;
d) Make every effort to reduce the cost of medical liability insurance for physicians
in New York State before the number of physicians practicing in New York State
is reduced to a level that may cause delays in accessing and/or an inability to
access health care, especially in high-risk specialties and/or rural areas currently
near or at a crisis; and
85
e) Work to assure that the Legislature appropriates sufficient funds to support the
Excess Insurance Program. (HOD 08-94)
130.966
Universal Access to Healthcare: MSSNY to await the final recommendations of the
Task Force on Health System Reform and take action on those recommendations at the
2009 House of Delegates by directing its delegates to advocate and vote for a platform
embodying those recommendations.
Also, MSSNY will direct its delegates to the American Medical Association Annual
Meeting in 2009 to advocate and vote for a platform which embodies the
recommendations approved by the MSSNY 2009 House of Delegates. (HOD 08-91)
130.967
Reform of the Civil Litigation and Medical Liability Insurance Systems in New
York State: MSSNY approved the comprehensive plan to reform the Civil Litigation
and Medical Liability Insurance Systems in New York developed by:
American College of Obstetricians and Gynecologists - District II
Greater New York Hospital Association
Healthcare Association of New York State
Medical Society of the State of New York
New York Chapter, American College of Physicians
New York Chapter of the American College of Surgeons
The major components of the plan are as follows
1.
Medical Malpractice Civil Litigation Process Reform
Systemic Remedies
Immediate Remedies
2. Financial Relief
3. Quality and Outcome Improvement Measures
(More detailed information about the plan is available from MSSNY’s Division of
Governmental Affairs.) (Council 9/20/07)
130.968
The Role of Physicians in Health Care Reform in New York State: MSSNY
should seek practicing member physician involvement in health care policy and reform
in the state, offering policies formulated by its Task Force on Health Care Reform, by
vigorously petitioning, lobbying and conferencing with the Governor’s office and the
Department of Health to be included as a key partner in any state-mandated health care
reform program. (HOD 07-106)
130.969
Universal Health Care: MSSNY to oppose funding universal health insurance
through decreased reimbursement, or any tax on physicians. (HOD 07-105)
130.970
Unfair Billing of the Uninsured: That MSSNY monitor the impact of newly enacted
legislation designed to constrain what uninsured low income individuals must pay for
services provided in a general hospital. (HOD 06-89)
130.971
Long Term Care – Quality Initiatives: MSSNY adopt as policy that all medical
directors in long term care/skilled nursing facilities be encouraged to take training
which provides recognized education in medical direction and may lead to certification
in medical direction. (Council 9/21/05)
130.972
MSSNY Openness to Health Care System Reform: MSSNY policy on health care
system reform be that of consideration and study of all and any new proposals in the
86
health care arena likely to benefit the general public and the medical profession.
(HOD 05-202)
130.973
Method of Financing Long Term Care: MSSNY supports a change in the financing
of long term care to remove it from the County Medicaid budget and turn it over to the
state budget as it is with most other states. (HOD 04-259)
130.974
MSSNY’s #1 Legislative Priority: MSSNY continue to notify the respective
legislative bodies in Albany, as well as all licensed physicians in New York State, that
changing the present medical malpractice situation and enacting meaningful tort
reform is its number one legislative priority, and that it will devote whatever resources
are necessary to accomplish this important endeavor. That MSSNY be on record as
supporting the statements concerning medical liability reform as articulated by
President George W. Bush in his 2003 State of the Union address. (HOD 03-88)
130.975
MSSNY’s Actions Toward Tort Reform: MSSNY continue to: 1) strongly support
the efforts of New York physicians to communicate their outrage with the failure of
the legislature to take meaningful action to resolve the medical liability crisis; 2)
devote all necessary resources to assist physicians, hospital medical staffs and other
physician organizations in advocating this position to all elected officials and key staff
and 3) provide appropriate assistance to the various grassroots groups protesting the
current system by providing legislative and legal information, distributing
communications among the groups, coordinating public relations and rallying public
opinion. The goal of these activities to solidify legislative support for medical liability
reform to include caps on awards for non-economic damages, limit the time for filing a
medical liability claim and allocate damages fairly in proportion to a party’s degree of
fault. Physicians exercising their legal rights to demonstrate their political opinions be
aware at all times of their professional responsibility to their patients, and continue to
treat emergencies and provide urgent and continuing care for those under active
management. (HOD 03-97)
130.976
Recent Increase in Medical Liability Insurance Coverage: MSSNY will seek
legislative relief from the recent increase in the amount of medical liability coverage
needed for acquiring the excess medical liability coverage, and that the amount of
medical liability insurance required of a physician remain at $1 million/$3 million to
be eligible for excess medical liability coverage at no cost to the physician.
(HOD 02-67)
130.977
Organize Task Force for Health Care in America: MSSNY will encourage the
American Medical Association to work with the federal government to organize a
multi-disciplinary task force for health care in America which includes appropriate
physician representation.
The purpose of the task force shall be to study the current health care system, and
consider design of a stable, enduring health care system that will meet the needs of
physicians, hospitals and people of the United States for many years into the future.
(HOD 02-63)
130.978
Tort Reform: MSSNY will provide its physicians with educational materials, model
letters, including letters to government officials and the newspapers, and strategies to
implement at the local level, including methods to bring about patient advocacy, to
87
assist its physicians in persuading the public and the Legislature about the need to
bring about meaningful tort reform, including caps on awards, in New York State.
(HOD 02-60)
130.979
Equal Fees for Panel Physicians and Non-Panel Physicians: (Sunsetted HOD 2011)
130.980
Federal Laws Controlling Medical Savings Accounts Should be Revisited:
(Sunsetted HOD 2011)
130.981
Education of Public Regarding MCOs and MSAs: MSSNY will educate its
members and the public to: (a) understand that managed care organizations (MCOs)
must function primarily as business entities, and as such, make decisions based on cost
and not necessarily based on the patient’s best interest in the eyes of the treating
physician; (b) educate the public that through the minimization of the role of third
party payors patients and physicians can have the professional relationship desired by
both in which quality will be maximized and costs will be controlled; and (c) educate
its members and the public that this result can be approached at present through
Medical Savings Accounts (MSAs) and ultimately through tax equity for all buyers of
medical care and medical coverage. (HOD 97-277)
130.982
Administration of MSAs: MSSNY will encourage consumers to obtain their MSAs
from providers such as banks, brokerage houses, and other fiduciaries, and not form
insurers. (HOD 97-276)
130.983
Point of Service Plans For Group Insurance Policies: MSSNY strongly supports
legislation to require HMOs to offer patients enrolled under group health insurance
policies the option of selecting affordable comprehensive point of service plans.
(HOD 97-77)
130.984
Malpractice Reform To Reduce The Number Of Frivolous Suits: Medical Society
of the State of New York will seek legislation amending the New York State Civil
Practice law and Rules to require that the Certificate of Merit currently required in a
malpractice action be signed by a physician actively practicing in the same specialty of
medicine or surgery of a defendant who is the subject of the lawsuit and that the
identity of such physician be provided to the defendant at the time such Certificate of
Merit is executed. (HOD 96-61; Reaffirmed HOD 97-62 & HOD 00-76)
130.985
All Self-Insured Programs To Have Same Standards As Other Insurers: Medical
Society of the State of New York will petition the appropriated legislative bodies and
regulatory agencies to mandate that all self-insured programs be held to the same
requirements, coverages and other standards as those to which HMOs, commercial
insurers and governmental insurers are held; and will petition the American Medical
Association to urge appropriate legislative bodies and regulatory agencies to pursue
similar legislation/regulation at the Federal level. (HOD 97-61)
130.986
Timely Return of Properly Endorsed This Party Payor Contracts to Participating
Physicians: The Medical Society of the State of New York will seek appropriate
legislative or regulatory action to require that upon receipt of physician-signed
contracts by the health maintenance organization or insurance plan for participation in
such plans, the HMO or insurance plan must be required to return a fully executed
contract to the physician within 30 days of completion of such organization’s
88
credentialing of the physician. Such legislation shall require the HMO or insurer to
provide notice to the physician within 120 days of submission of the physician’s
signed contract of any additional information necessary to the completion of the
physician credentialing process; and shall require that HMOs or insurers shall have no
more than 30 days from receipt of all necessary credentialing information to complete
the credentialing process. (HOD 97-59)
130.987
Health System Reform - MSSNY Principles: MSSNY is sensitive to the compelling
circumstances generating the movement towards health care system reform in New
York State and nationally. The Society is cognizant of the need to control health care
costs while advocating the provision of health insurance coverage to the entire
population of this state, including our 2.5 million citizens who are currently uninsured.
While cost controls are the primary factor influencing the reform process, MSSNY
believes that access and quality are equally essential objectives which must not be
compromised by any planned system restructuring. In fact, cost control cannot be
achieved if either access or quality is not satisfactorily addressed.
MSSNY believes that eventual stability of the state health care delivery system must
be fundamentally predicated upon: (1) Universal access to high quality care for all
New Yorkers; (2) Redirection of economies derived from renovation of a flawed
system with its significant inefficiencies and frequent misallocation of resources to a
more cost-effective service delivery structure; (3) Finance reform in conjunction with
a price competitive market-based pluralistic system; (4) Meaningful physician input
concerning relevant key aspects of any system reform. Consequently, MSSNY
believes that the following principles should be embodied in any reform of the state
health care delivery system: (1) All New Yorkers regardless of health and income
status should have access to high quality, affordable and basic health care; (2)
Comprehensive health care reform should be achieved through a collective partnership
encompassing the consumer, business, labor, health provider, health insurance and
government sectors which would build on the positive elements of our current
pluralistic health care system; (3) An independent health care access oversight
authority comprised of pertinent private and public sector representatives should be
established to monitor and assess the quality of care provided under the reform; (4)
Health system reform should provide sufficient tax and financial incentives to create
an environment of consumer cost consciousness which would compel vigorous price
competition among health care insurers; (5) Competition among insurers should be
predicated on required offering of the standard benefits program developed under the
auspices of the proposed independent health care access oversight authority; (6)
Individuals should have the right and responsibility to obtain, at minimum a standard
benefits package, and finance a portion of cost of their care according to their means.
State government and employer contributions should supplement the purchase of such
insurance as appropriate, with tax incentives provided to employees and employers for
the purchase of the lowest priced comparable coverage among insurers (as identified
by the independent authority). Coverage beyond the standard package may be
procured at additional cost, but without tax relief for the purchaser; (7) State
financing, coupled with the necessary federal Medicaid/Medicare waivers, should be
provided for the purchase of a standard benefits package by the indigent, elderly,
uninsured and unemployed; (8) Health insurance system reform should be designed
to: (a) Aid small business in the provision of health insurance to their employees; (b)
Promote community rating; (c) Eliminate preexisting condition exclusions; (d)
Guarantee renewability and portability; (e) Control premium increases; (f)
89
Guarantee consumer choice of insurer, inclusive of programs providing freedom of
choice of physicians; (9) Medical liability tort reform, including limitations on noneconomic damages, should be enacted in concert with health care system restructuring
to mitigate the costly practice of defensive medicine, while continuing to protect the
legitimate interests of the patient community; (10) Practice parameters should be
developed by physicians experts as useful educational tools for assuring the delivery
of quality care and providing an affirmative defense in legal actions premised upon
physician negligence; (11) Electronic claims processing (unrelated to a single payor
authority) in conjunction with the development of a uniform claim form should be
achieved in an effort to mitigate the current high administrative costs of health
insurance operations; (12) Reimbursements for a defined service should be the same
regardless of the site of that service (office, home, hospital settings, etc.) thereby
establishing ambulatory care payment parity; (13) The residents of New York State
should assume greater responsibility for their health by the imposition of financial
sanctions directed toward mitigating unhealthy behaviors, taking appropriate
preventive measures, and making conscientious cost effective determinations
concerning the utilization of health care services; (14) The system must be structured
to induce all insurers to function in the most cost-effective manner possible so as to
ensure the mitigation of administrative costs, and application of the maximum amount
possible of the premium dollar to health care benefits; (15) All providers of health
care should be committed to adhering to the highest standards in the provision of
patient care and interaction with health insurers. (16) Organized medicine, as
represented by MSSNY, should be authorized to represent physician interests in
negotiating the establishment of fees with insurers and other payors. (17) MSSNY is
committed to organize physicians into an integrated risk-sharing entity in order to
offer an alternative to capitated plans and to permit private practicing physicians to
compete effectively in the managed care/managed competition arena in both the public
and private payor market. (Council 6/3/93; Reaffirmed HOD 01-256; Reaffirmed
HOD 2011 and also Reaffirmed AMA Substitute Resolution 203, Health System
Reform Legislation (below):
RESOLVED, That our American Medical Association is committed to working with
Congress, the Administration, and other stakeholders to achieve enactment of health
system reforms that include the following seven critical components of AMA policy:
Health insurance coverage for all Americans;
Insurance market reforms that expand choice of affordable coverage and
eliminate denials for pre-existing conditions or due to arbitrary caps;
Assurance that health care decisions will remain in the hands of
patients and their physicians, not insurance companies or government
officials;
Investments and incentives for quality improvement and prevention
and wellness initiatives;
Repeal of the Medicare physician payment formula that triggers steep
cuts and threaten seniors’ access to care;
Implementation of medical liability reforms to reduce the cost of
defensive medicine; and
Streamline and standardize insurance claims processing requirements
to eliminate unnecessary costs and administrative burdens; and be it
further
90
RESOLVED, That our American Medical Association advocate that elimination of
denials due to pre-existing conditions is understood to include rescission of insurance
coverage for reasons not related to fraudulent representation; and be it further
RESOLVED, That our American Medical Association House of Delegates supports
AMA leadership in their unwavering and bold efforts to promote AMA policies for
health system reform in the United States; and be it further
RESOLVED, That our American Medical Association support health system reform
alternatives that are consistent with AMA policies concerning pluralism, freedom of
choice, freedom of practice, and universal access for patients; and be it further
RESOLVED, That it is American Medical Association policy that insurance coverage
options offered in a health insurance exchange be self-supporting, have uniform
solvency requirements; not receive special advantages from government subsidies;
include payment rates established through meaningful negotiations and contracts; not
require provider participation; and not restrict enrollees’ access to out-of-network
physicians; and be it further
RESOLVED, That our AMA actively and publicly support the inclusion in health
system reform legislation the right of patients and physicians to privately contract,
without penalty to patient or physician; and be it further
RESOLVED, That our AMA actively and publicly oppose the Independent Medicare
Commission (or other similar construct), which would take Medicare payment policy
out of the hands of Congress and place it under the control of a group of unelected
individuals; and be it further
RESOLVED, That our AMA actively and publicly oppose, in accordance with AMA
policy, inclusion of the following provisions in health system reform legislation: 2
Reduced payments to physicians for failing to report quality data when
there is evidence that widespread operational problems still have not been
corrected by the Centers for Medicare and Medicaid Services;
Medicare payment rate cuts mandated by a commission that would create a
double-jeopardy situation for physicians who are already subject to an
expenditure target and potential payment reductions under the Medicare
physician payment system;
Medicare payments cuts for higher utilization with no operational
mechanism to assure that the Centers for Medicare and Medicaid Services
can report accurate information that is properly attributed and risk
adjusted;
Redistributed Medicare payments among providers based on outcomes,
quality, and risk-adjustment measurements that are not scientifically valid,
verifiable and accurate;
Medicare payment cuts for all physician services to partially offset
bonuses from one specialty to another; and
Arbitrary restrictions on physicians who refer Medicare patients to high
quality facilities in which they have an ownership interest; and be it further
RESOLVED, That our American Medical Association continue to actively engage
grassroots physicians and physicians in training in collaboration with the state medical
and national specialty societies to contact their Members of Congress, and that the
91
grassroots message communicate our AMA’s position based on AMA policy; and be it
further
RESOLVED, That our American Medical Association use the most effective media
event or campaign to outline what physicians and patients need from health system
reform; and be it further
RESOLVED, That national health system reform must include replacing the
sustainable growth rate (SGR) with a Medicare physician payment system that
automatically keeps pace with the cost of running a practice and is backed by a fair,
stable funding formula, and that the AMA initiate a “call to action” with the
Federation to advance this goal; and be it further
RESOLVED, That creation of a new single payer, government-run health care system
is not in the best interest of the country and must not be part of national health system
reform; and be it further
RESOLVED, That effective medical liability reform that will significantly lower
health care costs by reducing defensive medicine and eliminating unnecessary
litigation from the system should be part of any national health system reform; and be
it further
RESOLVED, That our American Medical Association reaffirm AMA policy H460.909 Comparative Effectiveness Research.
(Please Note: Also Filed for Information is the Final Report of MSSNY’s
Subcommittee on Health System Reform, chaired by Dr. Robert Scher, which was
adopted by the MSSNY House of Delegates.)
130.988
Medical Savings Accounts: MSSNY vigorously supports the introductions of
Medical Savings Accounts (MSAs) in New York State and will support legislation
such as that embodied in State Assembly Bill 6249A and its companion Senate Bill
69A calling for the establishment of tax-favored Supplemental Insurance Accounts
(which essentially embody the MSA concept), subject to subcommittee interaction
with State legislators for an opportunity to: (a) provide additional MSSNY input and
possible suggested modifications to the aforementioned Assembly/State bills; (b)
exchange views with hopeful enlistment of legislative support.
MSSNY supports expansion of the subcommittee charge to timely interact with
representatives of the insurance, banking and business sectors as well as the Council
on Affordable Health Insurance for educational purposes and for an in-depth
investigation and assessment of: (a) the economic ramifications of MSAs; (b) the
level of insurer/consumer interest in MSAs; (c) alternatives or modifications to the
basic MSA concept as may be appropriate, necessary and feasible.
MSSNY vigorously supports the right of individuals to select their own health
insurance plan and to receive the same tax-exempt treatment for individually
purchased insurance as for employer-purchased coverage. (Council 12/19/96)
MSSNY will seek state and federal legislation that would enable individuals to create
medical savings accounts for health care purposes which would encompass the
concepts of utilization of pretax dollars, tax-free accumulations, and non-penalized
withdrawals for health care and other related purposes. (HOD 95-85)
92
130.989
Funding Academic Medicine and Teaching Hospitals: MSSNY supports the
position on medical school and teaching hospital funding as adopted by the
Association of American Medical Colleges Executive Council on February 24, 1994, a
Summary of which states: “The AAMC strongly supports redrafting of the Academic
Health Center (AHC) section of the Health Security Act (Title III, Subtitle B) to create
a fund for teaching hospitals which is fundamentally similar to the purpose of the
indirect medical education (IME) adjustment in the Medicare prospective payment
system, and to establish a separate all-payer stream of revenue to assist medical
schools in meeting their academic responsibilities, including the education of high
quality physicians, in an era of health care reform.”
MSSNY support such funding of medical schools that creates an all payer fund to
financially assist the medical schools in order to ensure the continuation of high
quality and responsive education and research, and to financially assist teaching
hospitals to support their higher cost relative to non-teaching hospitals. MSSNY
believes that any legislative vehicles to be considered as part of health system reform
proposals should include provisions for such funding. (Council 6/24/94)
130.990
Contracting, Independent Patient-Physician: MSSNY endorses the concept of the
inalienable right of physicians and their patients to privately contract for the provision
of and payment for medical services, and will urge the American Medical Association
not to participate in or endorse any legislation which does not guarantee this right.
(HOD 94-60; Reaffirmed HOD 00-262)
130.991
Financial Disclosure Requirements by Health Maintenance Organizations
(HMOs), Revision of: MSSNY supports legislation and/or regulation to require that
all managed care entities or organizations incorporate into their annual financial
disclosure statements all disbursements made by such entities or organizations for all
administrative purposes, marketing, physician, hospital, pharmacy and ancillary health
care provider services, as well as any surplus funds, profits or dividends declared.
(HOD 94-56)
130.992
Reimbursement for Medically Necessary Emergent Services Provided by Nonparticipating Managed Care Physicians and Hospitals: MSSNY will seek
appropriate legislation which would require all managed care entities operating in the
State of New York to reimburse physicians and hospitals for medically necessary
emergency services provided in good faith to managed care subscribers, without
consideration of participation status. (HOD 94-84)
130.993
Medical Liability Reform: MSSNY reaffirms its support for the inclusion of medical
liability reform within the context of state and/or federal health system reform which
shall include but not be limited to the following: (1) Enactment of a $250,000 cap on
the non-economic component of a medical liability award. (2) Extension of the
excess liability insurance program until fundamental tort reforms is achieved. (3) The
establishment of a no-fault administrative compensation system for impaired
newborns. (4) Legislation which would provide an affirmative defense to any cause of
action for physicians adhering to appropriately established practice guidelines
provided, however, non-adherence to practice guidelines shall not be used as evidence
that the physician failed to meet the accepted standards of care. (HOD 94-86;
Reaffirmed HOD 08-96)
93
130.994
“Willing Provider” Legislation: MSSNY supports Federal and/or State legislation
or regulation modeled after the recommendations contained in Report 25 of the
American Medical Association adopted by the AMA at its 1993 Interim Meeting
which report affirms: (1) The patient’s right to choose his or her physician. (2) The
physician’s primary role as patient advocate. (3) The physician’s right to apply to any
health plan or network and to have that application approved if it comports with
physician-developed objective criteria based on professional qualifications,
competence and quality of care. (4) That managed care entities and organizations and
third party payers be required to disclose to physicians applying to a plan the selection
criteria used to select, retain or exclude a physician from a managed care plan,
including the criteria used to determine the number, geographic distribution and
specialties of physicians needed. (5) That in those cases in which economic issues
may be used for consideration of sanction or dismissal, the physician participating in
the plan should have the right to receive profile information and education and that no
action be taken without due process. (6) That any federal effort to preempt state “any
willing provider” laws be opposed. (7) Support for appropriate changes in relevant
antitrust laws to allow physicians and physician organizations to engage in group
negotiation with managed care plans.
MSSNY supports legislation that would protect physicians from dismissal from health
care plans and/or the imposition of sanctions by health care plan administrators
without due process, and will reach out to and seek the cooperation of ancillary
providers and relevant consumer organizations to elicit their support of legislation and
regulation which prohibits managed care entities and organizations, insurance
companies or other similar organizations from unreasonably inhibiting provider access
to their patients. (HOD 94-57)
130.995
Long Term Care: MSSNY is supporting legislation that would establish a publiclyfunded insurance trust fund for the purpose of providing basic long term care for all
citizens. (HOD 93-78)
130.996
Single Payor Reimbursement System - Opposition To: MSSNY is opposed to
universal health care proposals with single-payor reimbursement systems. It reaffirms
the position reflected in its Universal Health Plan (UHP) Proposal for improving the
U.S. Health Care System which call for: (1) Retention of the present multiple payor
system with tighter oversight mechanisms to enhance administrative controls and cost
efficiencies; (2) Free-market competition as a stabilizing factor in choosing among a
multiplicity of health insurers offering a standard and appropriate benefits package.
(HOD 92-13)
130.997
Maternal and Infant Care: MSSNY supports legislation to achieve universal access
to maternal and infant care; such legislation must guarantee access to family planning,
pre-pregnancy related health care evaluation, pregnancy diagnosis, nutritional support,
substance abuse counseling, full pregnancy related services, labor and delivery,
postpartum evaluation, neonatal care, and infant care for at least one year.
(HOD 92-56)
130.998
Age as Sole Criteria in Determining Allocation of Health Care Resources:
MSSNY supports the position that chronological age should not be the sole criteria in
determining the allocation of health care resources. (Council 7/21/88)
94
130.999
135.000
Capitated Gatekeeper Reimbursement Policy: Since the potential for abuse exists
under capitated reimbursement systems through the withholding of services, the
Medical Society of the State of New York strongly opposes any system of health care
delivery which would limit services based primarily on financial consideration.
(HOD 86-14)
HOME HEALTH CARE:
(See also Reimbursement, 265.000)
135.995
Home Attendant Ability to Instill Eye Drops: MSSNY to petition the appropriate
authorities to allow home attendants to instill eye drops in their patients.
(HOD 08-107)
135.996
Home Health Care Services in New York State: The MSSNY Council adopted a
position statement of Home Health Care Services in New York State which called on
the State to develop a Home Care Policy Plan and to address the critical manpower
shortage in home care. The position statement endorsed the following principles: (1)
Home care enhances the quality of life, promoting independence and the availability of
choice; (2) Home care should be accessible and available to all persons regard-less of
their financial ability to pay; (3) Home care should maintain reasonable standards of
quality care and be fully integrated with all the other components of the health care
delivery system; (4) All orders emanating from home care agencies that pertain to the
care and management of the individual patient should be under the direct supervision
and control of the attending physician. This alludes to all orders for any type of
medical care rendered to patients, particularly to those confined to the home. It is the
responsibility of the individual physician to see that such orders are completely
executed. (Council 7/21/88)
135.997
Tax Deduction for Long Term Home Health Care: MSSNY supports legislation
which would provide a New York State and federal tax deduction for individuals
rendering home care to family members with a long term illness. (HOD 88-79)
135.998
Elderly - Home Health Care: MSSNY supports the concept that reimbursement for
home health care for the elderly be provided on a twenty-four hour a day basis, seven
days a week, if required for the adequate care of the patient and to prevent the
institutionalization of such patient for reasons not requiring institutional care.
(HOD 80-37)
135.999
Home Health Care Services: MSSNY encourages the stimulation of physician
interest in, and acceptance of home care as an integral part of the overall continuum of
medical care. We also emphasize the need for medical schools and internship
programs to educate medical students, interns, residents, and practicing physicians in
the value and proper use of home health care programs. Hospital boards and medical
staffs should encourage community interest in support of home health care programs.
Community health planning agencies should have representation from organizations
concerned with providing home care services; and practicing physicians should
involve themselves in developing home health care programs along with community
health planning agencies.
95
MSSNY supports the concept that all home health agencies, voluntary or proprietary,
should be subject to the same controls, regulations, and standards. MSSNY also
supports the concept that the physician is responsible for monitoring the home health
care of his patients, or for the transferal of this responsibility to another physician.
(Council 9/14/77)
140.000
HOMELESS SHELTERS:
140.999
Armories as Shelters for the Homeless: MSSNY supports federal, state, and city
fiscal funding of shelter programs and services for the homeless, and the mentally ill
homeless in particular. It supports programs for substantial growth in the number of
smaller congregate homes and in structured daytime programs for the mentally ill
homeless, whether operated under public or private auspices or both. MSSNY has
urged public authorities of New York State and New York City to phase out armories
as shelters for the homeless as quickly as possible, and has urged the State of New
York to defer its current plan to further de-institutionalize the chronic mentally ill
because of its consequence of further increase in the numbers of mentally ill homeless.
Selected members of New York’s Congressional Delegation were approached on
possible additional federal resources to assist state and local governments to provide
adequate shelters for the homeless. (HOD 92-22)
145.000
HOSPICE AND PALLIATIVE CARE:
145.997
Palliative Care Services: MSSNY supports public education regarding palliative
care and seeks state legislation/regulation to provide appropriate reimbursement for
evidenced-based palliative care services. (HOD 05-160)
145.998
Medicare Hospice Benefits for Nursing Home Residents: COBRA of 1986
extended Medicare hospice benefits to nursing home residents. A suitable mechanism
exists in New York State whereby a certified hospice program may provide services to
a nursing home resident as if the nursing home were that person’s own home.
MSSNY supports the concept of contracts between nursing homes and certified
hospice programs and urges nursing homes and hospices to enter into such contracts,
subject to federal and state laws and regulation. (Council 5/14/92)
145.999
Concept of Hospice Care: A hospice is a concept of care, home and family centered,
designed to meet the physical, psychological, spiritual, and social needs of terminally
ill patients and their families. This care shall be rendered by a physician-led interdisciplinary team.
MSSNY concurs with the position of the American Medical Association “...approving
the physician-directed hospice concept to enable the terminally ill to die in
surroundings more homelike and congenial than the usual hospital environment and
encouraging extension and third party coverage of this specialized approach for the
provision of terminal care.”
The seven goals of good hospice care are: (1) To keep the patient at home as long as
possible. (2) To help the patient to live as fully as possible. (3) To support the
family as the unit of care. (4) To supplement, not duplicate, existing services.
(5) To keep costs down through adequate peer review. (6) To educate health
professionals and lay people. (7) To limit the use of hospices to clearly defined
96
terminal needs. (Clearly defined terminal needs mean those physical, psychological,
spiritual, and social requirements necessary to ensure the tranquility, fulfillment, and
dignity of the dying patient. A terminal state implies the cessation of heroic, highly
technological treatment and the initiation of palliative comfort-oriented procedures.)
(Council 6/21/79)
150.000
HOSPITALS:
(See also Clinical Judgment 40.000; Ethics, 95.000; Medical Examiner System, 185.000; Nuclear
War, Weapons and Terrorism, 215.000; Practice Management, 240.000; Reimbursement, 265.000;
Vaccines, 312.000; Weight Management & Promotion of Healthy Lifestyles, 320.000)
150.970
Compensation for Emergency Department Coverage: MSSNY recommends that
hospitals utilizing voluntary physicians to provide coverage for emergency
departments provide appropriate compensation for these services in a manner
consistent with Advisory Opinions issued by the Office of the Inspector General (OIG)
and, also, that voluntary physicians should not be required by hospitals to provide
emergency department coverage without compensation. (HOD 11-111)
150.971
HHS and Hospital-Acquired Conditions: MSSNY to ask the American Medical
Association to work with the Centers for Medicare & Medicaid Services to delay the
implementation of Section 5001(c) of the Deficit Reduction Act (DRA) of 2005 in
order to eliminate from the list those conditions that cannot be fully prevented even
with the application of the best evidence-based guidelines. (HOD 08-258)
150.972
Gain-sharing: MSSNY to ask the American Medical Association to study and
prepare a report on gain-sharing programs. (HOD 08-206)
150.973
Unified System for Hospital Re-credentialing in New York State: MSSNY will
work for legislation requiring all New York State hospitals to use the same standard
re-credentialing form, and require the same standard data and/or materials for recredentialing.
MSSNY will work for legislation providing that hospital re-credentialing forms should
require the physician to fill out only information that has changed since the previous
submission. (HOD 02-269)
150.974
Hospital Overcrowding; Developing Statewide Solutions: MSSNY will urge the
New York State Department of Health, with input from MSSNY and other interested
parties, to analyze data on hospital overcrowding, and make this data available for
local initiatives, including public relations and media tactics, and other efforts to
mitigate the hospital overcrowding problem. (HOD 02-78)
150.975
MSSNY to Take All Appropriate Measures to Facilitate Transfers of Non-acute
Patients to Physicians’ Offices: MSSNY should take all appropriate measures to
allow hospital emergency departments to facilitate the transfer of non-acute patients to
physicians’ offices in appropriate situations. (HOD 00-77)
150.976
Opposition to the Criminalization of the Infractions of State Statutes and
Regulations Regarding Post Graduate Supervision and Staffing: MSSNY will
notify all teaching hospitals of the importance of adherence to the requirements of
State Statutes and Regulations regarding Post Graduate Supervision and Staffing.
97
MSSNY shall continue to oppose the Criminalization of good faith medical judgment,
and each teaching institution required to comply with State Statutes and Regulations
Regarding Post Graduate Supervision and Staffing regulations shall provide on a
yearly basis a copy of those regulations to each house officer and each attending
physician. (HOD 99-172)
150.977
Prohibit Institutions from Mandating In-House Testing: MSSNY will seek
measures to prohibit mandatory in-hospital pre-operative testing when those tests,
including but not limited to blood and urine, EKGs, chest X-rays, etc are performed in
a qualified physician’s office or in a state-and/or CLIA-accredited facility.
(HOD 98-126)
150.978
For Profit Hospitals and Nursing Homes: MSSNY will vigorously support current
law prohibiting for-profit businesses from entering the New York hospital and nursing
home market. (Council 12/18/97)
150.979
In-House Testing, Prohibition of Institutions from Mandating: MSSNY believes
that institutions should allow physicians to perform any mandated pre-operative
testing outside the institution and will encourage institutions to adopt this policy.
(HOD 96-126)
150.980
Services, Provision of on a Seven Day A Week Basis: MSSNY supports the
provision of all appropriate services on a seven day a week basis to assure timely
evaluation treatment and safe discharge of patients and will encourage hospitals to
comply with this policy. (HOD 96-127)
150.981
Maternity and Family Leave for Hospital Medical Staff, Including Residency
Programs in New York State: The position of the Medical Society of the State of
New York regarding leave policies for physicians in practice or residency training
includes as follows: (a) MSSNY urges medical schools, residency training programs,
medical specialty boards, the Accreditation Council on Graduate Medical Education
and medical group practices to incorporate and/or encourage development of written
leave policies including parental leave, family leave and medical leave; (b)
Residency program directors and group practice administrators should review federal
and state law for guidance in developing policies for parental, family and medical
leave; (c) Physicians who are unable to work because of disability due to pregnancy,
childbirth and other related medical conditions should be entitled to such leave and
other benefits on the same basis as other physicians who are temporarily disabled for
other medical reasons; (d) Residency programs and group practices should develop
written policies on parental leave, family leave and medical leave for physicians. Such
written policies should include the following elements:
•
leave policy for birth or adoption;
•
duration of leave allowed before and after delivery;
•
category of leave credited (e.g. sick, vacation, parental, unpaid leave, short
term disability);
•
whether leave is paid or unpaid;
•
whether provision is made for continuation of insurance benefits during
leave and who pays for premiums;
•
whether sick leave and vacation time may be accrued from year to year or
used in advance
98
Residency program policies should also include:
•
extended leave for resident physicians with extraordinary and long-term
personal or family medical tragedies for period of up to one year without
loss of previously accepted residency positions, for devastating conditions
such as pregnancy which threaten maternal or fetal life;
•
how time can be made up in order to be considered board eligible;
•
whether make-up time will be paid;
•
what period of leave would result in a resident physician being required to
complete an extra or delayed year of training;
•
whether schedule accommodations are allowed, such as reduced hours, no
night call, modified rotation schedules and permanent part-time scheduling.
(e) Staffing levels and scheduling are encouraged to be flexible enough to allow for
coverage without creating intolerable increases in other physicians’ workloads,
particularly in residence programs; and (f) Physicians should be able to return to their
practices or training programs after taking parental leave, family leave or medical
leave without the loss of status. (Council 3/9/95; Amended HOD 97-180)
150.982
Medical Directors in New York State, Guidelines Regarding the Role of: MSSNY
supports the following Guidelines Regarding the Role of the Hospital Medical
Director: (1) The hospital governing body, management and medical staff should
jointly determine if there is a need to employ a medical director; establish the purpose,
duties, and responsibilities of this position; establish the qualifications for this
position; and provide a mechanism for medical staff input into the selection,
evaluation and termination of the hospital medical director; (2) The organized
medical staff should maintain overall responsibility for the quality of the professional
services provided by individuals with clinical privileges and should have the
responsibility of reporting to the governing body; and (3) Government regulations
which mandate that a hospital medical director has authority over the medical staffs
should be repealed.
MSSNY will seek modification of existing laws and regulations consistent with these
guidelines. (HOD 95-72)
150.983
Faculty/Staff Appointments at Medical Schools: MSSNY is petitioning the New
York State Department of Health to develop regulations or support legislation that
would prevent a hospital from requiring a member of its voluntary staff to resign or
accept a faculty appointment at a medial school as a condition of appointment to the
medical staff, and is petitioning the New York State Department of Education to take
all steps necessary to encourage the development of an adjunct faculty line at each
medical school which would permit physicians to hold more than one medical school
faculty appointment. (HOD 93-131)
MSSNY adopted the policy that it is inappropriate for any hospital to require a
member of its voluntary staff to resign a faculty appointment at a medical school as a
condition of appointment or reappointment. MSSNY supports the development of an
adjunct faculty line at each medical school in New York State that could be used to
permit physicians to hold more than one medical school faculty appointment. It has
adopted as policy that it is inappropriate for a hospital or medical school to deny a
physician an appointment or reappointment to its voluntary staff because that
physician already holds a position at another medical school. (HOD 92-88)
99
150.984
Outpatient Medical Services: MSSNY is seeking legislation to provide that
practitioners whose practices are supported, sponsored by and financially beneficial to
hospital controlled satellite diagnostic and therapeutic facilities be held to the same
self-referral standards to which the community-based practitioners are held.
(HOD 93-77)
150.985
Incident Reports: MSSNY is working with the Hospital Association of New York
State to ensure that a copy of a hospital incident report which has been forwarded to
the New York State Department of Health be sent to any physician whose name is
included in such incident report. MSSNY is seeking to ensure that physician
identifying information included in hospital incident reports submitted to the New
York State Department of Health remain confidential and not be publicly disclosed, as
well as seeking to ensure that all information developed by review of incidents
required to be reported including, but not limited to “Statements of Deficiency” be
covered under existing New York State confidentiality statutes and not be subject to
disclosure through the Freedom of Information Law (FOIL). (HOD 92-40)
150.986
Physical Examination for Physicians (Annual): MSSNY continues to meet with the
Department of Health and other interested parties to clarify existing issues pertaining
to the physical examination requirements under Section 405.(b)(10) of the Health
Department regulations. MSSNY takes the following position with regard to the
physical examination requirements: (1) Physicians should have the option of going to
his/her personal physician for the physical examination; (2) If the physician opts to
have the physical examination performed by the personal physician, the medical
records pertaining to the physical examination should be retained in the office of the
personal physician. (3) The attestation form which the hospital must retain to
document the physical examination should be standardized. MSSNY should be
involved in the development of an attestation form. (HOD 91-91)
150.987
Plan of Correction - Medical Staff Involvement in Development of: MSSNY
adopted the policy that a hospital medical staff must be appropriately involved in the
development of a “Plan of Correction” as it pertains to the medical staff. Such
involvement should be consistent with existing hospital medical staff Bylaws, rules
and regulations. Hospital medical staffs were encouraged to amend their Bylaws, if
necessary, to establish a procedure to ensure appropriate medical staff input into the
development of a “Plan of Correction.” (HOD 91-105)
150.988
Economic Credentialing and Medical Staff Privileges: It is the position of MSSNY
that: (1) No hospital or ambulatory facility shall curtail, restrict, or terminate the
medical staff privileges of any physician without adherence to established procedures
set forth in the medical staff Bylaws, and only after the accordance of due process
rights pursuant to the procedures specified in the Federal Health Care Quality
Improvement Act of 1986, or in accordance with provisions of the hospital or
ambulatory facility medical staff Bylaws; and (2) No hospital or ambulatory facility
shall curtail, restrict, or terminate the medical staff privileges of any physician based
upon economic criteria unrelated to the quality of patient care; and (3) No hospital
ambulatory facility shall solicit, require, or accept any payment as direct or indirect
consideration for the awarding or granting by the hospital or ambulatory facility of the
right to exercise medical staff privileges. This prohibition shall not apply to required
payment of medical staff dues or medical society dues that may be required of all
members of the hospital or ambulatory facility medical staff. (HOD 92-33)
100
MSSNY’s Hospital Medical Staff Section developed a MSSNY Policy Paper on
Economic Credentialing and Exclusive Contracts which was approved by Council on
July 23, 1992. The Policy Paper is available, upon request, at the Society
Headquarters in Lake Success. MSSNY affirmed the concept that the credentialing of
physicians for medical staff appointment or reappointment should be based solely on
issues of competency, training and quality of patient care. The Society is seeking
regulatory or legislative remedies to assure that only those with appropriate medical
training, experience and ongoing clinical expertise will have the ability to establish
standards of care and measure practice by these standards. MSSNY has
communicated to the Hospital Association of the State of New York, its component
associations and all other appropriate and interested parties its concern over the use of
an individual physician’s economic performance data which is being generated by
hospitals in an effort to link charges, cost and clinical outcome as a major parameter,
in and of itself, for the purposes of credentialing and re-appointing physicians.
Hospital medical staff physicians and their leadership were informed by MSSNY to
take precautions against any hospital initiative aimed at restructuring medical staff
Bylaws which would emphasize economics and which could ultimately undermine
quality of care. (HOD 91-67)
150.989
Governing Boards - Medical Staff Physician Representation: In light of recent
changes to revised New York State Hospital Code (Part 405) and the resulting increase
of hospital governing boards’ focus on quality assurance and clinical resource
allocation, the Medical Society of the State of New York reaffirmed its positions and
urged hospitals in New York State to appoint active medical staff members as full
voting staff members of hospital governing boards. (HOD 90-20)
MSSNY is seeking enactment of legislation specifically authorizing physicians who
are members of the medical staffs of municipal hospitals to serve on the governing
body of such municipal hospitals, and is encouraging physicians who are members of
medical staffs of all hospitals to seek to serve on the governing bodies of their
hospitals. (HOD 88-82)
MSSNY recognizes the essential close working relationship that must exist between
hospital governing bodies and medical staffs to ensure the delivery of optimal quality
medical care to all patients served by hospitals. To accomplish this, MSSNY strongly
endorses the concept of practicing physician representatives from the medical staffs
serving on hospital governing boards with voice and vote, to provide expertise and
guidance concerning the development of medical care priorities. (Council 11/14/85)
150.990
Certificate of Need: MSSNY has insisted on the elimination of the technique utilized
by the New York State Department of Health of withholding or delaying Certificates
of Need from hospitals (and other institutions) until compliance with other State
Health Department regulations is obtained. It is the position of MSSNY that the
public be advised of the medical profession’s concern about this abuse of authority.
(HOD 89-15)
150.991
Physician Credentialing: It is the policy of the Medical Society of the State of New
York that physician DRG profiles: (1) Should not be used as a means of determining
physician credentialing or competence; and (2) Should remain confidential. The
Society petitioned the Hospital Association of New York State to prevent the use of
DRG profiles as a means of credentialing and/or sanctioning physicians.
101
(HOD 89-24)
150.992
Bed Reductions: MSSNY vigorously opposes any reduction of hospital beds
throughout New York State unless very specific rationale supports it. (HOD 87-31)
150.993
Newborn - Resuscitation of: Inasmuch as resuscitation and stabilization of the
distressed newborn may be required in any hospital delivering maternity care at any
time, it is incumbent on the hospital administration to provide assurance to its patients
that these services are available. Furthermore, it can no longer be assumed that the
mere presence of an obstetrician, pediatrician, anesthesiologist or midwife guarantees
that appropriate treatment will occur. The Committee on Maternal & Child Health of
the Medical Society of the State of New York suggests that each hospital and free
standing birthing center delivering maternity care be capable of providing skillful
resuscitation procedures to newborns at all times. Hospitals must also assure that
appropriate professional personnel are available who can perform the following
procedures for newborns when indicated: (1) Bag and mask ventilation (2)
Endotrachael intubation (3) Umbilical vessel catheterization (4) Short term
respiratory support (5) Preparation and stabilization for transport. Hospitals must
ensure maintenance of personnel expertise in the above procedures. For level I and II
facilities this training could be provided on an ongoing basis by an affiliated tertiary
perinatal center. (Council 9/11/86)
150.994
Termination of Hospital Privileges Based on Age of Physician: MSSNY opposes
mandatory termination of hospital privileges based solely upon the age of the
physician, and takes the position that age should not be used as a criterion in judging
the character or competency of the physician. (HOD 86-23)
150.995
Preadmission Review: MSSNY is in agreement with the American Medical
Association policy to oppose mandated blanket hospital preadmission review for all
patients, or for specified categories of patients, by government, other payors or
hospitals, while encouraging physician-directed peer review organizations to consider
the implementation of focused preadmission review on a voluntary basis. The
MSSNY promulgated the following sample Guidelines for all third party payors or
insurers in the matter of preadmission certification and review in this State
Preadmission Certification and Review Guidelines: (1) The physician/patient
relationship must remain intact and must not be disturbed by interference from any
entity, including third party insurer. (2) The quality of health care delivered must
remain at the highest level and not be affected by health insurance mandated policies
and procedures. (3) There shall be direct and continuing communications by health
insurers to physicians and insureds regarding prior authorization requirements; it shall
be the responsibility of the insured or insurer to notify physicians when there are any
pre-authorization or other technical contract requirements connected with the
rendering of specific services. (4) In situations where the diagnosis, proposed plan of
treatment, and anticipated length of hospital stay is questioned, it must be discussed
only between the treating physician and a physician representing the third party
carrier. (5) After thorough review of all submitted medical information, if the
insurer’s physician disagrees with the certification request, be it the rule that the
patient’s physician be allowed a consultation with the insurer’s consulting physician
prior to any adverse decision. The attending physician should be given the
opportunity to provide additional medical information to substantiate the request for
hospital admission. If the patient’s physician disagrees with the initial consultation, be
102
it the rule that a request for a second consultation be granted by the health insurer.
(Under these circumstances, further monetary penalties, i.e., reduced benefits, should
not be imposed on the insured because of physician’s request for a second consultant.)
However, it is understood that reduced benefits may be imposed by the insurer if the
patient does not adhere to the preadmission certification requirement to obtain a
second opinion. (6) Physician-to-physician contact be the rule when there is
disagreement between a treating physician’s plan of treatment and insurance company
guidelines. If there is a change of treatment plan, the insurer must give the treating
physician ample time to notify his/her patient of such change. Further, where
disagreement exists between the physician and the insurer as to anticipated length of
stays and preadmission certification, ample time must be allowed for the attending
physician to apprise the patient that his/her contract may or may not provide full
benefits for the prescribed plan of treatment, and any ensuing costs for the services
provided may become the patient’s responsibility. (7) Since patients who
inadvertently do not request required pre-admission and length of stay certification for
services performed may be subject to reduced benefit payments, they must have right
of appeal. (8) When emergency hospitalization is required, up to 48 hours (i.e., two
business days, following the patient’s admission) must be allowed for the purpose of
certification. (9) Health insurers must also be responsive to the desires of the State
and local medical community concerning input into the establishment of criteria for
preadmission certification programs. (10) In view of the significant increase in New
York State health insurance plans requiring Preadmission Certification Programs,
salient features of these programs, such as second surgical opinions, concurrent length
of stays, and confirmation of emergency admissions, be implemented uniformly in
order to mitigate confusion among the patient and physician community in such a way
as to conform to the basic principles outlined in the foregoing Guidelines.
(HOD 86-11; Amended Council 2/12/87; Amended HOD 3/14/87)
150.996
Professional Misconduct, Notification by Hospital to Accused Physician: 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 for 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 Position of MSSNY and HANYS approved
by Council 11/14/85)
150.997
Admitting Privileges: MSSNY supports the policy that hospitals should continue to
offer equal hospital admitting privileges and equal access to beds to qualified
physicians on their staff regardless of the physician’s choice of reimbursement
mechanisms or their financial arrangements with their hospital. (HOD 82-58)
150.998
Attending Physicians and Residents, Guidelines For: MSSNY adopted the
following statement as part of its official position. It is a supplement to the Guidelines
for Attending Physicians and Residents Established by the New York Academy of
Medicine. Because optimum care of hospitalized patients often entails technically
sophisticated treatment modalities, reliance on the expertise of specialists and
consultants, and frequent clinical assessments and judgments by house officers or
other designees of the attending physician, it is imperative to specifically indicate the
authority and responsibility for decisions about treatment and management. Ethically
103
and legally, the patient’s freely selected attending physician possesses this authority
and responsibility. Such action will strengthen the patient-physician relationship
essential to the continuity of a patient’s care. The patient’s own physician clearly
retains ultimate responsibility for patient management but close cooperation between
his/her own physician and the involved house officers and specialist consultants is
essential to provide the highest quality of patient care. Features of this cooperation
should include at least the following: (1) Ongoing discussions and review of the
patient’s course by the attending and other involved physicians. (2) Explicit approval
and/or supervision by the amending of invasive, hazardous, or complex diagnostic or
treatment procedures. (3) Explicit approval by the attending physician of the
indications or requests for consultations, and of the choice of consultant. (4)
Recognition by the attending physician to contribute to the education, training and
learning experience of the house staff. (5) Conscientious efforts by the house staff
and other involved physicians prompted to inform the attending physician of
unexpected changes in the patient’s condition or needs for treatment. (6) Although
there is recognition by both attendees and house officers that they share responsibility
for writing orders, recording observations, or formulating analyses or treatment goals
in the progress notes, the ultimate authority for patient care is the patient’s attending
physician.* These guidelines will best serve the goal of optimum care for the patient
and will enhance the quality training for young physicians. The attending physicians,
hospital administrations, and house officers have the obligation to respect these
guidelines and the attending physician shall candidly inform the patient of the roles of
the various physicians in that patient’s care. In such explanations, the patient’s right
freely to select his/her own physician must be maintained. No assignment of attending
physician shall be made without prior discussion of available options with the patient
and then only with his/her full knowledge and freely given consent.
(HOD 82-51)
The Guidelines of the New York Academy of Medicine are available, upon request, at
the Society Headquarters in Lake Success.
NB:
Per General Counsel, this position statement was cited in the dissenting opinion in
Somoza v. St. Vincent’s Hospital 596 N.Y.S. 2d 789 (App. Div., 1st Dept., April 22,
1993). The majority decision nevertheless held that a hospital and a hospital resident
may be held legally responsible where the hospital resident carries out the order of a
private attending physician but knows, or should know, that the physician’s orders
“are so clearly contraindicated by normal practice that ordinary prudence require
inquiry into correctness of the order.” The ruling, according to the majority decision,
is an exception to the general rule followed by the courts which holds that the hospital
and the hospital staff cannot be held legally responsible for the actions of a private
attending physician as long as the hospital staff properly carries out the attending
physician’s orders.
150.999
Medical Staff Criteria: The policy of the Medical Society of the State of New York
is that admission to a hospital medical staff should be on an individual basis, after an
impartial review of the applicant’s qualifications by the medical staff credentialing
committee. Such impartial review should serve as the basis for the hospital Board of
Trustees’ final determination upon request for appointment to the medical staff, and
that membership in any group affiliated with the hospital shall be a substitute for
review of the individual’s qualifications. (HOD 80-25; Amended Council 1/22/81)
104
155.000
INDEPENDENT PRACTICE OF MEDICINE:
155.999
Independent Practice of Medicine by Nurse Practitioners: MSSNY, in the public
interest, opposes the independent practice of medicine by any individuals who have
not completed the presently prescribed education and the examination for licensure for
the practice of medicine and, furthermore, has taken the position that the independent
practice of medicine remain under the authority and control of the Board of Regents as
assisted by the New York State Board for Medicine. (HOD 82-1)
157.000
INITIATIVES AND REFERENDUMS:
157.999
Initiative to Amend New York State Law to Allow Public Referendums and/or
Ballot Propositions: MSSNY is to begin the process of developing a coalition of
interested groups with the goal of amending New York State law to allow for Public
Referendums, Initiatives, Recalls, Constitutional Conventions and/or Ballot
Propositions. (HOD 11-119)
160.000
LICENSURE:
(See also Managed Care, 165.000; Medicare, 195.000)
160.976
Promoting Physician Retention in New York State: MSSNY to support the
advancement of legislation to retain its trained, qualified physicians, regardless of their
citizenship or green card status and will also transmit a resolution to the American
Medical Association for assistance in expediting citizenship for qualified physicians.
(HOD 09-155)
160.977
Physician Registration Fee: MSSNY will continue to work to assure that the
physician registration fee is used to support only activities related to the Office of
Professional Medical Conduct, the Committee for Physician Health and other activities
related to the physician workforce. (HOD 09-110)
160.978
Laser Vision Correction - Health Care Facility: MSSNY adopted as policy that
laser vision facilities must comply with the corporate practice of medicine prohibition
to ensure patient protection and safety and optimal medical care and that MSSNY is to
seek legislation or regulation to effectuate this change. (Council 1/25/09)
160.979
Physician Registration Fee: MSSSNY to oppose any future increase to the biennial
physician registration fee. (HOD 07-107)
160.980
Opposition to Non-Physicians Performing Laser and Intense Pulsed Light Source
Skin Enhancement Procedures: MSSNY vigorously opposes certification of nonphysicians (including non-medical personnel) to perform laser and intense pulsed light
source skin enhancement procedures. (HOD 01-95; Reaffirmed Council 11/13/03)
160.981
Development of Legislation Regarding Physical Therapists (PTs): MSSNY will
seek through legislation, regulation, or whatever means necessary, the adoption of the
following amendment to the New York Education Law:
(1)
Needle electromyography is the practice of medicine and shall be performed
and interpreted only by physicians licensed in the State of New York who are
105
appropriate to perform and interpret such tests by virtue of specialty and
training; and
(2)
Physical therapists shall be limited in the scope of electrodiagnostic practice to
the role of technicians utilized to perform nerve conduction studies under the
direct supervision of a licensed physician who is appropriate to perform or
interpret such tests by virtue of specialty and training; and
(3)
Non-licensed individuals as defined by the NYS Department of Education may
not perform needle electromyography under any circumstance, whether or not
the individuals are supervised by a licensed provider of any type.
MSSNY will request that the State of New York Insurance Department and the State of
New York Workers’ Compensation Board, as they relate to the care of individuals
sustaining automobile and work related injuries, respectively, adopt these resolutions in
whole into their prevailing and future statutes. (Council 11/2/00)
160.982
Enforcing Licensing Statutes: MSSNY will seek support of the appropriate
regulatory bodies to enforce licensing statutes to ensure that HMOs do not permit nonphysician practitioners to perform services beyond the scope of their licensure.
(Council 3/13/00)
160.983
Licensure of Non-Physician Practitioners: MSSNY will seek support of the
appropriate regulatory bodies to enforce licensing statutes to ensure that HMOs do not
permit non-physician practitioners to perform services beyond the scope of their
licensure. (Council 3/13/00; Reaffirmed Council 11/13/03)
160.984
Citizenship Requirement for Medical Licensure: MSSNY will support legislation
to extend the authority of the Board of Regents to grant an extension of the three-year
waiver of U.S. citizenship or immigration status requirements for a physician with
alien citizenship status who has trained in New York and who works in pubic hospitals
regardless of whether they are located in areas designated as medically under-served.
The extension would continue until the citizenship or permanent residency issue is
resolved. (HOD 00-92)
160.985
Destruction of the Doctor-Patient Relationship and the Practice of Medicine by
Insurers: MSSNY will seek legislation to discourage activities by insurers and other
third parties that weaken or destroy the doctor-patient relationship including, but not
limited to, the profusion of telephone based evaluation and referral by non-physicians.
Where managed care plans and insurers utilize nurses for “on-call” triage purposes,
such nurses shall be licensed in New York State and provide, establish and maintain
appropriate medical documentation of their activities as well as timely follow-up
documentation to the patient’s primary care physician regarding the nurse’s
assessment and recommendation; and that where MCOs provide triage services they
must assume the liability for adverse events which may ensue. (HOD 98-75)
160.986
New York State Licensure Requirements: MSSNY will seek, through regulation or
legislation, a requirement for a full New York State license for all physicians who
provide medical advice, diagnosis or treatment through the technology of
Telemedicine for patients located in New York State. Excluded from this full New
106
York State license requirement would be traditional physician-to-physician
consultations which occur on an infrequent basis. (HOD 98-63)
160.987
Statutory Authority for Licensure: MSSNY supports the statutory transfer of
authority for license restoration from the Education Department to the Board for
Professional Medical Conduct. (Council 2/6/97)
160.988
Licensure Restoration Process: MSSNY supports the following recommendations
of the Office of the Professions, New York State Education Department, to improve
and streamline the license restoration process. An in-depth license restoration
application to be developed with the burden being placed on the physician to explain
why he or she should have the license back. The establishment of a minimum waiting
period of three years between the time a physician’s license is revoked and the time
that a physician may reapply for license restoration. The minimum waiting period is
currently one year. A graduated application fee for restoration to be set so the
physician covers the administrative cost of the restoration. There is currently no fee or
charge. The need for a personal appearance in every case to be eliminated, but to
permit the state board the option of calling for a personal appearance.
(Council 2/6/97)
160.989
Licensure Requirement for Providing Medical Advice Through Telemedicine:
MSSNY will urge the New York State Board of Medicine to require full New York
State licensure for an individual providing medical advice through the technology of
Telemedicine from in or out of state for patients under treatment in New York State.
Such medical advice requiring full licensure would entail the performance of an act
that is part of a patient care service initiated in this state and affecting the diagnosis or
treatment of the patient. Excluded from this full licensure requirement would be
traditional informal physician-to-physician consultations (“curbside consultations”)
that are provided without expectation of compensation. MSSNY will recommend
further monitoring and study of the areas of Telemedicine encompassing
confidentiality of patient information, professional liability, coding and
reimbursement, and will seek the development of legislation and/or regulation
requiring the full New York State licensure of Medical Directors and physicians
employed by managed care systems or other health insurers in or out of state who
make decisions which affect medical care. (Council 10/24/96)
160.990
Laser Surgery: MSSNY has adopted the position that laser treatments should be
prohibited by those not licensed as MD, DO, DMD, DDS, DPM-trained and will
include this as a priority item in its 1997 legislative program. (HOD 96-80)
It is the position of the Medical Society of the State of New York that laser surgery be
performed only by appropriately credentialed and licensed physicians or by those
categories of practitioners specifically licensed by the State to perform surgical
services. (HOD 91-45)
160.991
Self-Incriminating Questions: MSSNY has urged the American Medical
Association to proceed further and revise the second recommendation of its Board of
Trustee’s Report 13 (I-93) to urge that questions as in current illnesses that might
interfere with the competency to practice be applied to all such illnesses, physical as
well as psychiatric and addictive, and not to the past history of such illnesses if those
illnesses do not extend into current impairment, and to amend its Board of Trustee’s
107
Report 13 (I-93) so that it applies to all licensing, board certifying, and credentialing
procedures. MSSNY has urged the AMA to add to its Board of Trustee’s Report 13
(I-93) a strong emphasis on the need for very strict confidentiality legislation and
regulations on state, federal and private levels in regard to any such information
obtained, and to implement recommendations 4 and 5 of said report relating to the
impact of the Americans with Disability Act (ADA) concerning these matters.
(HOD 94-161)
160.992
Mandated CME for Re-registration of Medical Licensure: The Society strongly
reaffirmed its opposition to any linkage between legislatively mandated CME with reregistration of medical licenses. (HOD 93-15)
160.993
Self-Incriminating Questions on Application Forms by Licensing, Certifying and
Credentialing Bodies: MSSNY takes the position that questions regarding past
history of referral and treatment for alcohol and other drug disorders and mental and
emotional illness should not be used on application forms by licensing, certifying, and
credentialing bodies because it is not believed that such questions are pertinent to a
physician’s current ability to practice medicine but merely infringe on privacy matters.
MSSNY is urging that such bodies instead ask a question regarding the applicant’s
current ability to practice medicine, such as: “Is your ability to practice medicine
currently impaired by any physical, mental, emotional, alcohol or substance abuse
disorder?” (Council 7/23/92)
160.994
Therapeutic Ultrasound: It is the position of the Medical Society of the State of
New York that therapeutic ultrasound be performed only by individuals licensed to
practice medicine and surgery or by those who have been specifically authorized by
law to perform these services. (HOD 91-47)
160.995
Cryotherapy: It is the position of the Medical Society of the State of New York that
cryotherapy be performed only by individuals licensed to practice medicine and
surgery or by those who have been specifically authorized by law to perform these
services. (HOD 91-46)
160.996
Diathermy: It is the position of the Medical Society of the State of New York that
diathermy be performed only by individuals licensed to practice medicine and surgery
or by those who have been specifically authorized by law to perform these services.
(HOD 91-48)
160.997
Single National Examination for Medical Licensure: MSSNY affirmed its support
for the concept of a single national examination pathway for medical licensure.
(Council 10/26/89)
160.998
Licensure Based on Professional Standards: It is the position of the Medical
Society of the State of New York that physician licensure be based solely upon
professional standards, including training, education, ability, competence and moral
fitness. The Society vigorously opposes any attempts to establish nonprofessional
standards, such as acceptance of third-party payment, as a condition of medical
licensure. (HOD 89-6)
108
160.999
Licensure as a Prerequisite for Membership in County or State Societies: At the
present time there is no official State Society policy as to the requirement of licensure
as prerequisite for membership in the county or State medical societies.
(Council 12/16/76)
165.000
MANAGED CARE:
(See also Health Care Delivery Systems, 110.000; Health System Reform, 130.000; Health
Information Technology, 117.000; Licensure, 160.000; Medicare, 195.000; Reimbursement,
265.000; Rights and Responsibilities of Physicians, 270.000; Utilization Review, 310.000; Workers’
Compensation, 325.000)
165.855
Identification of Insurance Plans by Payor ID: MSSNY to:
1. Urge the NYS Insurance Department to formulate regulations to require greater
clarity from NYS health plans with respect to patients’ health insurance cards for
identification of the payer’s claim address, product line (Medicare, Medicaid,
PPO, HMO, etc.), primary care physician, co-payment(s), deductible, and/or coinsurance amounts, etc.;
2. Seek to have patients’ health plan cards identify the health plan’s website and
direct link to the webpage access for verifying patient eligibility and financial
responsibility (i.e. co-payment(s), deductible, co-insurance, etc.);
3. Seek the development of swipe-card technology in real-time (24/7) with
verification.
4. Urge the NYS Insurance Department to formulate regulations to require greater
clarity from NYS health plans with respect to patients’ health insurance cards for
identification of the payer’s claim address, product line (Medicare, Medicaid,
PPO, HMO, etc.), primary care physician, co-payment(s), deductible, and/or coinsurance amounts, etc.;
5. Seek to have patients’ health plan cards identify the health plan’s website and
direct link to the webpage access for verifying patient eligibility and financial
responsibility (i.e. co-payment(s), deductible, co-insurance, etc.);
6. Seek the development of swipe-card technology in real-time (24/7) with
verification. (HOD 11-250)
165.856
Restrictive Covenants in Physician Employment Contracts: MSSNY policy
regarding restrictive covenants is that they are unethical if they are excessive in
geographic scope or duration in the circumstances presented, or if they fail to make
reasonable accommodation of patients’ choice of physician. (HOD 11-112)
165.857
Expert Medical Advice by Insurance Companies: MSSNY to take all appropriate
steps necessary to prevent health insurance companies from advertising and providing
medical treatment advice to patients when the patient has not received an in-person
examination or appropriate medical evaluation. (HOD 11-62)
165.858
Options for Physicians When an Insurance Plan Becomes Insolvent: MSSNY will
(1) seek legislation or regulation that would permit physicians to bill plan subscribers
if their insurer became insolvent; and (2) advocate to the State Insurance and Health
109
Departments to assure that health insurance companies remain adequately capitalized
to pay patients’ health insurance claims. (HOD 11-61)
165.859
Deductible Transparency: MSSNY to seek (a) legislation, regulation or other
appropriate means to require health insurance companies to provide a patient’s innetwork and out-of-network deductible information both on the patient’s insurance
card, as well as be available on the health insurance company’s website; and (b)
assurance that the deductible information provided on the company’s web site be
updated immediately when an insured’s deductible and/or policy has changed.
(HOD 11-60)
165.860
Provider Agreements: MSSNY to seek legislation or other appropriate means to
prohibit provisions in physician contracts with health insurers that automatically renew
the contract at the end of the term. (HOD 11-57)
165.861
Violations of State Insurance Laws by Managed Care Organizations and Private
Insurers: MSSNY to take the following action:
1. Seek legislation or other appropriate means to a) prohibit health insurance
companies from demanding refunds from physicians without providing physicians
a detailed audit report which clearly identifies the claims in question and the
methodology utilized to arrive at the alleged overpayment amount; b) eliminate or
establish a more objective definition of the “abusive billing” exception to the two
year current statutory limitation on health plan overpayment recoveries c) permit
physicians a meaningful opportunity to appeal a requested refund demand
including review by an independent body and d) prohibit automatic offset
provisions in physician contracts;
2. Work to assure that the New York State Insurance Department and Attorney
General’s office appropriately investigate and resolve complaints made by
physicians regarding violations of the New York State Insurance Law by health
plans, including violations of: the Prompt Payment law; laws that limit refund
demands and recoveries; and laws which specify a minimum period of time to
submit claims;
3. Educate and encourage physicians to submit suspected violations of these laws to
the New York State Insurance Department and Attorney General. (HOD 11-55)
165.862
Clarification of Chapter 551 Law - Insurance Law Sections 3224-b and 4803(a):
MSSNY to:
A. Initiate a legal review of the provision of the Chapter 551 Law (Insurance Law
Sections 3224-b and 4803(a)) that states that “all accident and health insurers and
Article 43 corporations (“insurers”) and health maintenance organizations are
required to accept and initiate the processing of physicians’ claims utilizing the
American Medical Association’s (AMA’s) current procedural terminology (CPT)
codes, reporting guidelines and conventions and the Centers for Medicare &
Medicaid Services (CMS) Health Care Common Procedure Coding system
(HCPCS)”;
B. Review (1) whether that section of the law specifically requires insurers to use the
AMA CPT coding manual (particularly that manual’s Introductory Section and its
110
narrative policy sections), and (2) whether the law also requires insurers to use all
other standard coding conventions as well;
C. Seek legislation and/or regulatory relief, in regard to the provision in the
Chapter 551 Law (Insurance Law Sections 3224-b and 4803(a)) that contains
the phrase “codes, reporting guidelines and conventions,” mandating that
insurers incorporate all AMA CPT guidelines and conventions, as well as
codes, in their payment policies. (HOD 11-54)
165.863
American Well: MSSNY will: (a) continue to advocate for compensation of care
provided by physicians to their patients via electronic means; (b) work with the NYS
Education Department, the NYS Department of Health and the Office of Professional
Medical Conduct to assure that only NYS-licensed physicians provide care to patients
in NYS; (c) work to ensure that the product offered by American Well follows all
pertinent laws for New York State relative to its business and that any liability
insurance offered by American Well is licensed in New York State. In addition, all
physicians who choose to participate in the provision of online care shall be entitled to
participate in all such programs. (HOD 10-267)
165.864
Pre-Authorized Services by Non-Participating Physicians: MSSNY to seek
legislation/regulation mandating that when an out-of-network physician has obtained
prior authorization (verbal or written) to perform medically necessary
services/procedures, that insurance companies be precluded from utilizing
communications (i.e., letters, EOBs, etc.) which contain language urging/directing
patients to obtain the requested services from an in-network provider with the threat of
being exposed to the imposition of additional out-of-pocket expenses due to their
continued use of out-of-network physicians. (HOD 10-266)
165.865
Support Community Rating for Health Insurance: MSSNY adopted as policy the
existing AMA Policy H-165.856, “Health Insurance Market Regulation”:
Health Insurance Market Regulation
Our AMA supports the following principles for health insurance market regulation:
(1) There should be greater national uniformity of market regulation across health
insurance markets, regardless of type of sub-market (e.g., large group, small group,
individual), geographic location, or type of health plan;
(2) State variation in market regulation is permissible so long as states demonstrate
that departures from national regulations would not drive up the number of uninsured,
and so long as variations do not unduly hamper the development of multi-state group
purchasing alliances, or create adverse selection;
(3) Risk-related subsidies such as subsidies for high-risk pools, reinsurance, and risk
adjustment should be financed through general tax revenues rather than through strict
community rating or premium surcharges;
(4) Strict community rating should be replaced with modified community rating, risk
bands, or risk corridors. Although some degree of age rating is acceptable, an
individual’s genetic information should not be used to determine his or her premium;
(5) Insured individuals should be protected by guaranteed renewability;
(6) Guaranteed renewability regulations and multi-year contracts may include
provisions allowing insurers to single out individuals for rate changes or other
incentives related to changes in controllable lifestyle choices;
(7) Guaranteed issue regulations should be rescinded;
111
(8) Health insurance coverage of pre-existing conditions with guaranteed issue within
the context of an individual mandate, in addition to guaranteed renewability.
(9) Insured individuals wishing to switch plans should be subject to a lesser degree of
risk rating and pre-existing conditions limitations than individuals who are newly
seeking coverage; and
(10) The regulatory environment should enable rather than impede private market
innovation in product development and purchasing arrangements. Specifically:
(a) Legislative and regulatory barriers to the formation and operation of group
purchasing alliances should, in general, be removed; (b) Benefit mandates should be
minimized to allow markets to determine benefit packages and permit a wide choice of
coverage options; and (c) Any legislative and regulatory barriers to the development of
multi-year insurance contracts should be identified and removed. (CMS Rep. 7, A-03;
Reaffirmed: CMS Rep. 6, A-05; Reaffirmation A-07; Reaffirmed: CMS Rep. 2, I-07;
Reaffirmed: BOT Rep. 7, A-09; Res. 129, A-09) (MSSNY HOD 10-263)
165.866
Online Access to Managed Care Organizations’ Professional Relations
Department: MSSNY to:
−
draft a legislative proposal requiring New York State private insurers and
managed care organizations to provide physicians with access to their Professional
or Provider Relations staff, so that the physicians can request assistance from these
representatives;
−
recommend that, in order to accommodate participating physicians’ questions and
requests for assistance, the private insurers and managed care organizations
augment their present Internet and e-mail capabilities by (1) placing their
Professional/Provider Relations representatives’ contact information on-line,
and/or (2) providing lists of representatives’ territories by zip code, including the
phone, fax, and e-mail address of the Professional/Provider Relations
representative responsible for each zip code;
−
recommend punitive measures, applicable to the insurers themselves, that would
apply if an insurer’s Professional/Provider Relations staff fails to respond in a
timely manner to a participating physician’s question or request for assistance;
such punitive measures might include fines, performance reviews and/or a
requirement that the insurer pay the claim. (HOD 10-255)
165.867
Timely Discussion Between Treating Physician and the Insurance Company’s
Medical Director When Services are Denied Based on Medical Necessity:
MSSNY to seek legislation and/or regulation to assure that the Insurance Company’s
Medical Director be directly available, within 2 business days, to discuss a denial
based on medical necessity with the treating physician. (HOD 10-252)
165.868
United Healthcare/Oxford Subscriber Identification Cards: MSSNY to urge the
Superintendent of Insurance, and any other pertinent official or governmental agency
to require United Healthcare/Oxford to issue identification cards to its subscribers
which prominently identifies the primary insurance company name (either United
Healthcare or Oxford) with the appropriate mailing address, so as to avoid any
confusion as to which insurance company is actually responsible for payment. In the
event that a claim is denied for timely filing because of the obfuscation of United
Healthcare in clearly identifying the appropriate entity responsible for payment,
112
United Healthcare should be required to make restitution to the physician for the
denied claim. (HOD 10-251)
165.869
Participating Provider Lists: MSSNY will request that the State Superintendent of
Insurance and the State Legislature (1) establish criteria for insurers to review and
update participating provider lists on a regular basis and (2) establish penalties for
substantial inaccuracies in provider lists. (HOD 10-59)
165.870
Minimum Medical Loss Ratio: MSSNY to support legislation that would (1) require
health insurers to spend a minimum of 85% of their collected premiums on medical
care as a means of ensuring that insurance companies become more efficient while
making health care more affordable and (2) if a health insurance company fails to
maintain an 85% medical loss ratio, any excess be refunded to the premium payers.
(HOD 10-55)
165.871
Healthcare Reform: MSSNY to continue to advocate for the end of abusive
managed care practices that threaten the viability of physician practices and patient
access to care. (HOD 10-54)
165.872
Insurance Industry Antitrust Protection: MSSNY to support repeal of antitrust
exemptions afforded to health insurance companies under federal law that may permit
health insurance companies excessive domination and anti-competitive control over
physicians in any given market. (HOD 10-53)
165.873
Discriminatory Treatment of Psychiatrists’ Use of E/M Codes: MSSNY to call
upon the New York State Department of Insurance and the New York State
Department of Health to enforce New York Insurance Law §3224-b (Chapter 551 of
the Laws of 2006) and to inform all health plans in writing that the provisions of New
York Insurance Law §3224-b mandate that:
165.874
a)
if a health plan covers (i.e., accepts, processes and provides reimbursement for)
Evaluation and Management (E/M) services provided by physicians in their
office or in the hospital, then health plans must accept, process and reimburse
claims submitted by psychiatrists for E/M services in the same manner and to
the same extent as provided for E/M services provided by physicians in other
specialties (subject to any limitations on coverage of the treatment of mental
illness under the health plan and permitted by law);
b)
to the extent that a health plan provides coverage for specific E/M codes, health
plans must accept and process claims for those E/M codes submitted by
physicians without limitation or restriction based upon the physician’s medical
specialty;
c)
health plans cannot restrict psychiatrists to submitting claims only for psychiatry
procedure codes and must permit psychiatrists as well as all other physicians to
use all E/M codes covered under the health plan. (HOD 09-263)
Collaborative Efforts with the Bar Association: MSSNY to:
a.
support collaborative efforts with the bar association to remove the Employee
Retirement Income Security Act of 1974 (‘ERISA’) shield that pre-empts action
113
against health plans for the adverse outcomes that result from their delays or
their medical decision making;
b.
ask the American Medical Association (AMA) to support collaborative efforts
with the bar association to remove the ‘ERISA’ shield that pre-empts action
against health plans for the adverse outcomes that result from their delays or
their medical decision making; and,
c.
together with the AMA, utilize this collaboration and the American Bar
Association (ABA) policy that supports alternative dispute resolution (ADR)
mechanisms to facilitate movement toward medical liability reform.
(HOD 09-69)
165.875
Condemnation and Reporting of Unilateral Physician Fee Reduction by Any
Health Plan: MSSNY to (1) condemn the unilateral reduction of fees paid to
participating physicians by any health plan; (2) present this issue promptly to the
Governor of the State of New York, the Majority and Minority Leaders of the State
Senate, the Speaker and Minority Leader of the State Assembly and the
Superintendent of Insurance; and (3) have the New York Delegation to the American
Medical Association bring this issue to the AMA’s next Annual Meeting for action on
the federal level. (HOD 09-67)
165.876
Ownership of Managed Care Organizations: MSSNY to advocate for legislation or
regulation that would prohibit a health insurance company from having a financial
interest in any subsidiary or other organization which may negatively influence health
care spending, such as restrictions on patient access to care or reductions in physician
reimbursement. (HOD 09-61)
165.877
Increase Medical Loss Ratios: MSSNY to seek legislation or regulation requiring
(1) health insurers to increase their medical loss ratios as well as mandating that they
meet a minimum medical loss ratio; and (2) increased transparency of health insurers’
premium dollars, that they publicly disclose information on their medical loss ratios in
an easily understandable manner, including allocations for salaries and administrative
costs. Also, MSSNY should collect, collate, compare and publish up-to-date data on
health insurers during business in New York State. (HOD 09-60)
165.878
Insurance Company Merger: MSSNY to (a) support the conversion of Emblem to a
not-for-profit mutual company governed by and accountable to those it insures; and
(b) reaffirm the Society’s vehement opposition to Emblem’s for-profit conversion.
(HOD 09-56)
165.879
Medical Smart Cards: Approved the following recommendations:
1.
MSSNY educate its members through News of New York, the MSSNY website
and other appropriate means of communication, regarding the benefits,
technology and availability of medical smart cards, and keep members informed
of developments and opportunities in this emerging technology.
2.
MSSNY communicate with health care organizations and health insurance plans
throughout New York State to urge the development and use of medical smart
cards for the purposes of:
114
a.
b.
c.
making patients’ information readily available;
simplifying the task of eligibility verification in physician offices, and
enhancing and ensuring HIPAA compliance with conversion of paperbased health care information to electronic systems that guarantee the
privacy and security of patient information gathered as part of providing
health care.
3.
MSSNY work with health care insurers and agencies to ensure that physicians
do not incur any added expenses to incorporate the use of a health insurer’s /
agency’s generated medical smart card into their practice. In addition MSSNY
urge those entities, including vendors, which currently charge physicians a fee
for smart card readers to provide these free or at a steep discount for MSSNY
members.
4.
MSSNY develop a collaborative working relationship with the HANYS’ newly
created Office of Health Information Technology Transformation, which is
studying the development of sustainable health information exchanges on
community, regional, and state levels (Regional Health information
Organizations or RHIOs). In addition, MSSNY strive to become an active
participant in the GNYHA newly created New York Clinical Information
Exchange (NYCLIX) whose goal is to “increase patient safety and the efficiency
of care by creating a virtual network for sharing of patient data among health
care entities for the purpose of treatment.” NYCLIX is now embarking on the
planning phase in order to create implementation of patient data sharing. Both of
these initiatives (HANYS and GNYHA) are unique opportunities for MSSNY to
provide physician input and expertise at the early stages of these projects.
5.
MSSNY’s AMA Delegation prepare a Resolution to be forwarded to the AMA
House of Delegates to study and develop a “white paper” on the issue of medical
smart cards, including the role of organized medicine and specific implications
for physicians, patients and healthcare, in general. (Council 1/25/09)
165.890
Guidelines for Executive Compensation in Health Insurance Companies:
MSSNY to urge the enactment of federal legislation or regulation that will establish
guidelines for executive compensation in health insurance companies that assures
appropriate and responsible allocation of resources for health care delivery.
(HOD 08-67)
165.891
Patient-Directed Educational Campaign Regarding Managed Care
Organizations: As part of its ongoing efforts to achieve meaningful reform of
abusive managed care practices, MSSNY will (a) utilize educational materials that
encourage physician and patient grassroots advocacy; and (b) work to educate
physicians, the public and patients regarding the increasing threat to the health care
delivery system caused by excessive health plan market share, profits and executive
compensation. (HOD 08-64)
165.892
Contract and Fee Schedule Disclosure: MSSNY to seek legislation, regulation or
other appropriate means to compel health plans to provide physicians with full written
contracts with all changes highlighted, a full fee schedule applicable to the physician’s
specialty, and a written summary of such changes, each time they renew the contract.
(HOD 08-59)
115
165.893
Changes in the Overpayment Recovery Law: MSSNY to seek legislation,
regulation or other appropriate means to:
1. assure that meaningful fines and penalties are imposed on health plans that violate
the current two-year statutory limitation on health plan refund demands as well as
the requirement that health plans provide 30 days notice before initiating efforts to
recover an alleged overpayment;
2. limit the time that health plans can seek repayment of overpayments to physicians
to the same time that a physician has to submit a claim;
3. require that, in the event a physician has paid a recovery to a Managed Care
Organization due to erroneously billing the MCO rather than the correct insurer
(e.g. no-fault or Workers’ Compensation), the appropriate responsible party be
required to honor a claim for the services rendered for a period of 60 days form the
date of the recovery. (HOD 08-58; Reaffirmed HOD 11-55)
165.894
Tracking Electronic Claims: MSSNY to seek legislation or regulation mandating
health payment plans that require electronic claims submission be required to make
available the means of tracking the claim electronically as it is processed.
(HOD 07-265)
165.895
Requirement for MCOs to Provide Education and Training Initiatives: MSSNY
to legislation that would require: (1) each third-party insurer to develop and
implement a formal Local Provider Education and Training (LPET) Initiative,
designed to give panel physicians all the information they need now and in the future
about the carrier’s policies, procedures, and coverage issues, in order to receive
appropriate reimbursement; and (2) third-party insurers to provide dedicated and
identifiable staff, telephone lines, and e-mail addresses, whereby physicians can
contact the carrier in order to fully understand and abide by the carrier’s policies and
procedures. (HOD 07-256)
165.896
Retraction Letters and Erroneous Termination Letters: MSSNY to work with the
appropriate New York State regulatory agency to draft regulations requiring managed
care organizations (MCOs) to issue letters of retraction when the MCO has
erroneously informed patients that a physician is no longer participating, when the
physician has merely filed a request to change the demographic information in the
plan’s Provider File. (HOD 07-254)
165.897
MCOs Use of Pre-Payment Claim Reviews to Circumvent the New York State
Prompt Payment Law: MSSNY to:
(1) using the Hassle Factor Form, solicit and compile examples of prepayment claim
reviews initiated by managed care organizations where the physician has
received no prior notification of aberrant coding or claim submission practices;
(2) review these examples to determine whether the managed care organizations are
in violation of the New York State Prompt Payment Law or related regulatory
directives, such as the New York State Insurance Department Regulation # 178
(11 NYCRR 217) (Prompt Payment of Health Insurance Claims) or Article 26 of
the Unfair Claim Settlement Practices law (Section 2601); and
(3) urge the New York State Insurance Department to take appropriate action against
these managed care organizations if it is determined that the MCOs are indeed in
116
violation of the relevant statutes or regulations through their use of erroneous
pre-payment reviews. (HOD 07-253)
165.898
Health Care Reinvestment Fund: MSSNY to support legislation to (1) create a
health care reinvestment fund to assure that a portion of health insurer profits are
returned to physicians and hospital within the service area served by each insurer; and
(2) limit an insurer’s medical loss ratio. (HOD 07-110)
165.899
Phlebotomy Services by Physician Offices: MSSNY to oppose penalties on
physicians for referring patients for out-of-network services and work with health
insurance plans to appropriately reimburse the expense for phlebotomy services at
physician offices. (HOD 07-73)
165.900
Bar For-Profit Health Plan Operations: In addition to MSSNY’s seeking
legislation to bar for-profit plan health insurance operations in New York State, it
should also (1) publicize the better claims settlement and quality of care indicators of
non-profit plans over for-profit plans; (2) take all steps necessary to assure that health
insurers seeking to convert to for-profit status are required to rectify frequent
complaints and address other patient and physician concerns as a condition of being
permitted to convert to for-profit status; and (3) continue to seek legislation and
regulation to rectify the abusive claims processing practices of all health plans.
(HOD 07-72; Reaffirmed HOD 08-66; Reaffirmed HOD 09-56; Reaffirmed
HOD 10-56)
165.901
Health Care Providers and Antitrust: In acknowledging that federal antitrust
agencies have consistently placed physicians under a far higher level of scrutiny than
is warranted by their comparative economic strength in today’s health care system,
MSSNY to pursue relaxation or exemption of antitrust laws as applies to physicians in
order to promote greater connectivity, and thus improve health care outcomes and cost
savings that will result from improved outcomes. (HOD 07-71; Reaffirmed
Council 11/20/08; Reaffirmed HOD 09-56; Reaffirmed HOD 10-53 & HOD 10-54)
165.902
Insurance Product Oversight by the Superintendent of Insurance: MSSNY to
seek a change in legislation so that New York State reinstates the rate review authority
of the Superintendent of Insurance and to press for legislative reinstatement of earlier
regulations requiring insurance companies doing business in New York State to
submit to the Commissioner of Insurance all proposed changes in products and
premium rates for prior review and approval. (HOD 07-70; Reaffirmed
HOD 10-54)
165.903
Contract Termination - Merged MCOs: MSSNY will continued its support the
ability of a physician to choose the health plans and the health plan products with
which they will participate, and continue to oppose efforts by health plans to require
physicians to participate with all affiliates of a particular plan or all products offered
by a particular plan; and
Should health plans continue to have the ability to require physicians to participate in
all its affiliates, MSSNY to advocate for legislation to assure that:
a) newly merged health plans are required to follow the termination protocols of the
health plan that provides more beneficial terms to the physician; and
117
b) permits the physician wishing to terminate from the health plan and all its
affiliates to execute such termination by contacting the plan with which the
physician originally contracted. (HOD 07-69)
165.904
Reform of Managed Care Denial Process: MSSNY to: (1) support legislation or
regulation requiring health plans to submit quarterly detailed schedules of
reimbursement denials, including the number of denials, the amount, and the reasons
for denials to deter abusive practices and improve quality of care; (2) continue sharing
with all relevant state agencies the most frequent causes of health plan denials reported
to MSSNY, so that the Superintendent of Insurance and Commissioner of Health may
investigate such denials; and (3) urge the Superintendent of Insurance to investigate
patterns of inappropriate denials by health plans as part of their routine market conduct
audits. (HOD 07-68)
165.905
Reimbursement for Pre-Authorized Services Subsequently Denied by MCOs:
MSSNY to take all appropriate steps to assure that physicians have the ability to seek
payment from patients where a health plan subsequently denies a pre-authorized
service and seek to assure that the insurer notify the patient regarding their financial
responsibility. (HOD 07-67)
165.906
Hard-Coded Personal Computer Dates as Proof of Timely Filing of Paper
Claims: Legislation, regulation, or other appropriate means to be sought by MSSNY
to require all insurers, including workers compensation carriers, to accept hard-codedsystem generated data as proof that a paper claim was timely filed, provided the
physician attests that the claim was mailed on or about the day the claim was
generated. (HOD 07-65)
165.907
Clarification of the New York State Current Procedural Terminology Uniformity
Law: MSSNY should take all the steps, including legislation, necessary to assure that
health plans comply with and abide by the American Medical Association coding
policy statements that are contained in the yearly AMA CPT coding manual.
(HOD 07-61)
165.908
Insurer Practices Oversight by the Appropriate State Agencies: MSSNY to seek
legislation, regulation or other appropriate means to prohibit health insurance
companies from unilaterally changing any material contract provision; and, if unable
to obtain such change to the law, seek to assure that such material contract changes are
reviewed and subject to prior approval by appropriate state agencies, including the
Departments of Health and Insurance, with interested groups being given the
opportunity to provide comment. (HOD 07-58; Reaffirmed HOD 11-57)
165.909
Psychiatric Medication Formulary Exclusion: MSSNY should: (1) promote
passage of legislation that would allow patients who, based upon the judgment of the
treating physician, demonstrate stability on current medication regimens not be
required to be subjected to therapeutic equivalent changes based on formulary
preferences; and (2) work with the Insurance Department and the Health Department
to enable a patient or physician to request an exemption from a health plan when the
required drug is placed on a high-cost tier. (HOD 07-56)
165.910
Codification and Access of All Formularies: MSSNY to: (1) advocate for the
creation of a unified industry-supported website that lists the formularies of all health
118
plans and Part D plans; (2) explore the feasibility of requiring a plan to format their
formularies in a nationally recognized standard that would facilitate physician
Electronic Medical Record interfaces; and (3) seek to assure that health plan prior
authorization rules for prescribing medications be clear and concise. (HOD 07-55)
165.911
Physician’s Ability to Refer to Imaging Center of Choice: That MSSNY - (1) ask
the New York State Department of Health and the New York State Insurance
Department to investigate whether there are adverse health care consequences for
patients as a result of managed care organizations: a) removing the ability of a
physician to refer a patient to the imaging center of their choice and b) scheduling
imaging services without the input of the referring physician; and (2) endeavor to limit
the ability of third parties to intrude into the clinical-decision making authority of
physicians. (Council 11/2/06)
165.912
Electronic Data Interchange (EDI) for Claims Appeals: That MSSNY draft model
legislation requiring each managed care organization to establish an electronic data
interchange (EDI) function through which physician participants can appeal denied
claims, online or via a secure web-based Internet site, and since this EDI claims appeal
project would significantly reduce costs for employee health insurance, MSSNY enlist
the support of the appropriate New York State Employer Association. (HOD 06-254)
165.913
Protection Against Being Assigned: That MSSNY seek legislation, regulation or
other appropriate means to assure that any managed care company or other entity
which assigns its provider network, to promptly notify all entities to which the services
of that provider has been assigned, and that such legislation or regulation specify that a
managed care company or other entity be responsible for any financial loss suffered by
a physician because of a lack of prompt notification by such managed care company or
entity that the physician resigned from such network. (HOD 06-64)
165.914
Standardized Managed Care Participating Agreements: MSSNY seek regulation
requiring managed care organizations licensed to do business in New York, to utilize
standard physician participation agreements containing easily identifiable contract
provisions, with clearly delineated standard disclosures, thereby enabling physicians to
have a clear understanding of their rights and responsibilities as well as the rights and
responsibilities of the contracting entity; and that if an insuring entity elects to
incorporate a provision in a participating physician agreement which may depart from
the norm of a standard contract provision, i.e., allowing that entity to assign/sell their
listing of participating physicians to other entities (a concept referred to as a “silent
PPO”), that these provisions be included in a separate and easily identifiable section of
the contract. (HOD 05-252)
165.915
“Indentured Servitude” with Managed Care Organizations (MCOs) and ThirdParty Administrators (TPAs): MSSNY seek legislation to require MCOs and TPAs
to notify physicians when their contract with the MCO or TPA has been assigned and
the amount of the discount fee schedule associated with the assignment of said
contract. (HOD 05-63; Reaffirmed HOD 06-64)
165.916
Patient Responsibility for Services Denied by Managed Care Organizations due
to Coverage Parameters: MSSNY encourages all managed care organizations
licensed in this state, to adopt a policy allowing participating physicians to bill patients
for those services that have been denied due to the company’s internal coverage
119
parameters, provided that the patient knew in advance that the procedure would not be
covered and still chose to have the procedure performed. (Council 6/3/04)
165.917
Carriers’ Failure to Obey PHL 4406-c (5A) Release of Fee Schedule: MSSNY
work with the NYS DOH to amend appropriate provisions of law to assign monetary
penalties for failure to comply with requests for fee schedules. Failing legislative
relief, MSSNY study the feasibility of bringing appropriate legal action against
carriers in New York who are identified as refusing to provide requested fee schedule
data. (HOD 03-52)
165.918
Time Limit for Retrospective Denials: MSSNY continue in its efforts to seek
legislation, regulation or other appropriate means to prohibit retrospective refund
requests by heath plans in all circumstances except fraud. Short of achieving a
complete ban on retrospective refund requests, MSSNY seek legislation, regulation or
other appropriate means to limit to 90 days the time within which a health plan can
seek such a refund, or other significant restrictions on the ability of health plans to
seek such refunds, such as limiting the time that a health plan can seek a refund to the
same time that a physician has to file a claim with such health plan. (HOD 03-69)
165.919
The Elimination of “Silent PPOs”: MSSNY will seek legislation:
1. to prohibit a health plan from selling, renting or assigning a physician’s agreement
to provide a discount without the physician’s expressed approval;
2. ensuring that a panel or network physician’s services be subjected to a fee discount
only when the patient presents an insurance identification card identifying the plan
that has contracted with the physician; and
3. to make “silent PPOs” unlawful in New York State. (HOD 02-270)
165.920
Adoption of the Use of Unlisted Procedure Code Series in the Referral Process for
Managed Care and Private Insurers: MSSNY will seek modification in managed
care regulation by the appropriate state agency to mandate that all managed care plans
and private insurers doing business in New York adopt as policy in their referral
processes the use of CPT codes for Unlisted Procedures which would permit Primary
Care Providers (PCPs) to refer patients to specialists without requiring the PCP to
specify the exact ancillary procedures to be performed by the specialist.
(HOD 02-262)
165.921
Fee Schedules: MSSNY will seek legislation to assure that physicians have timely
notification of proposed changes in fee schedules and that such notice include clear
representation of fee schedules, and be agreed upon before implementation.
(HOD 02-81)
165.922
Resolution to Allow Complete Treatment: MSSNY will support legislation or
regulation that would prohibit third-party payors from denying payment for services
prescribed by physicians through the application of limits on the number of treatments
or services authorized to treat an illness or condition.
MSSNY will support legislation that would provide that a reduction or modification of
a physician-prescribed treatment plan is an adverse determination pursuant to Article
49 of the Public Health Law and Insurance Law and would require review through the
independent external review process. (HOD 02-75)
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165.923
Approval by Insurance Companies to Providers: MSSNY will seek legislation
assuring that insurance companies remain obligated to pay for all services that have
been pre-authorized, unless such authorization was obtained fraudulently.
(HOD 02-73; Reaffirmed HOD 04-83; HOD 07-67; HOD 08-50)
165.924
Health Plan Fee Schedule Releases: MSSNY will continue to monitor the activities
of health plans as they pertain to the violation of Section 4406-c (5-a) of the New York
State Public Health Law, specifically, the refusal of health plans to release their fee
schedules to physicians; and will continue to encourage members to report to the
MSSNY’s Official Legal Counsel, Kern Augustine Conroy & Schoppmann, PC,
health plans that violate Section 4406-c (5-a) of the New York State Public Health
Law. (HOD 01-259; Updated 2011 HOD)
165.925
Use of Federal Surpluses for Uninsured Americans: MSSNY supports the use of a
portion of the anticipated federal budget surpluses to provide health insurance to some
or all of the more than 40 million uninsured Americans. MSSNY introduced a similar
resolution in June 2001 together with the request that such resolution be communicated
to the Chairs of relevant Congressional Committees and the President. (HOD 01-77)
165.926
Deductible Should Be Prorated to Make Them Equitable for Enrollees: It is
MSSNY’s policy that the New York State Department of Insurance require insurers to
prorate annual deductibles to the date of contract enrollment.
MSSNY introduced a resolution asking the American Medical Association’s House of
Delegates to seek legislation, regulation or other appropriate relief to require insurers
to prorate annual deductibles to the date of contract enrollment. (HOD 01-67;
Reaffirmed HOD 2011)
165.927
Physicians Should Not Be Financially Liable in Retrospective Denials: MSSNY
will seek, by legislation, regulation, or other appropriate means, the following:
(a)
To prohibit retrospective denials caused by the employer’s failure to pay
premiums in a timely fashion, or the employer failing to provide the carrier with
timely and correct eligibility data.
(b)
To prohibit a payor from attempting to retroactively deny or adjust a claim after
payment is made to a physician for care rendered.
(c)
That should obtaining a complete ban on retrospective denials or adjustments
not be able to be enacted, seek to prohibit insurers from making a retroactive
denial and/or adjustment of a reimbursement beyond 90 days after payment is
made to the physician for care rendered.
(d)
In the event that an insurer attempts to issue a retroactive denial or adjustment
after payment is made to the physician, to require such insurer to provide the
physician with a detailed explanation on each patient as to the circumstances
surrounding the retroactive adjustment or reimbursement and/or denial, and
provide the physician with an effective opportunity to counter the reasons for the
adjustment.
121
(e)
In the event that an insurer has already paid the physician for a service, but later
issues a retrospective denial or adjustment, to prohibit such insurer from
attempting to recoup its payments for that service via offsets on payments for
other services.
MSSNY will work regularly with all appropriate regulatory agencies to insure that the
regulators are kept apprised of payment policies employed by plans which do not
comport with the law. (HOD 01-65; Reaffirmed HOD 10-259)
165.928
Rejection of Milliman & Robertson as Standard of Care: MSSNY formally rejects
the Milliman & Robertson guidelines as a standard of care. (HOD 00-273)
165.929
Health Plan’s Improper and Bullying Techniques to Force Physicians to
Inappropriately Downcode E&M Services: MSSNY will contact the New York
State Attorney General, New York State Department of Health, New York State
Insurance Department, and New York State Legislature, making them aware of the
practice of economic intimidation of physicians by means of repayment demands
based solely upon statistical analysis of coding rather than by chart review.
MSSNY will ask the New York State Attorney General to determine whether or not
such tactics violate RICO statutes and, if appropriate, seek judicial relief and penalties.
MSSNY will seek legislation that would prevent third-party payers from demanding
refunds of payments without appropriate chart review and physician due process.
(HOD 00-288)
165.930
Health Insurance Eligibility Electronic Verification System: MSSNY will seek
legislation requiring all health care plans doing business in New York State to issue
health insurance cards containing magnetic strips, which can be used with an
electronic verification system which would be furnished to physicians free of charge
by the health care plans. (HOD 00-272)
165.931
Managed Care Organizations Should Supply Complete Fee Schedules and
Should Include Cost of Living Adjustment (COLA) Guarantees in Contracts:
MSSNY will seek legislative/regulatory relief (a) to require managed care
organizations (MCOs) to provide physicians, as a condition of new or continued
participation, with complete fee schedules, including past fee schedules; (b) to require
managed care organizations (MCOs) to include in physician contracts a Cost of Living
Adjustment (COLA) provision guaranteeing an upward adjustment of fee schedules
when the physician’s overhead increases, similar to a Resource-Based Relative Value
fee schedule. (HOD 00-266)
165.932
Health Care Plans: MSSNY will seek regulation and/or legislation that once a health
care plan has sold its product to a consumer, the health care plan is not permitted to
limit the territory it covers during the policy term. (HOD 00-254)
165.933
Downcoding: MSSNY will seek legislative relief to (a) preclude down-coding and/or
bundling of any medically necessary service by health care plans doing business in
New York State and Computer Sciences Corporation/Medicaid; (b) prevent health care
plans and Computer Sciences Corporation/Medicaid from the down-coding of medical
services without first obtaining, at the expense of the health care plan, copies of
patients’ medical record and justifying the change in reimbursement; (c) prevent health
122
care plans and Computer Sciences Corporation/Medicaid from requiring automatic and
mandatory submission of medical record documentation for Evaluation and
Management (E&M) codes at the time of claim submission. (HOD 00-253)
165.934
AMA Policy on ERISA: (Please note that the original position statement cited policy
H-165.882 which has since been significantly modified and original policy H-165.883
which no longer exists.) MSSNY affirms the following AMA Policy:
H-165.882
Improving Access for the Uninsured and Underinsured
Our AMA: (1) Will assist state medical associations and local medical societies to
work with states and the insurance industry to design value-based private group and
individual health insurance policies. Such policies should cover with low cost-sharing
those services adjudged to have the greatest health benefit, should be affordable, and
should be equivalent to or an improvement over the Medicaid coverage in that state, so
as to provide a continuum of gradually enhanced coverage. (2) Supports federal
legislation to encourage the formation of small employer and other voluntary choice
cooperatives by exempting insurance plans offered by such cooperatives from selected
state regulations regarding mandated benefits, premium taxes, and small group rating
laws, while safeguarding state and federal patient protection laws. Any support for
such small employer and voluntary purchasing cooperatives shall be strictly contingent
upon safeguarding state and federal patient protections. For purposes of such
legislation, small employers should be defined in terms of the number of lives insured,
not the total number employed. (3) Through appropriate channels, encourages unions,
trade associations, health insurance purchasing cooperatives, farm bureaus, fraternal
organizations, chambers of commerce, churches and religious groups, ethnic
coalitions, and similar groups to serve as voluntary choice cooperatives for both
children and the general uninsured population, with emphasis on formation of such
pools by organizations which are national or regional in scope. (4) Supports continued
study of all approaches to providing health services for the uninsured and cooperation
with business groups to develop approaches that are best suited to the needs of small
employers. (5) Encourages physicians, through their local county medical societies, to
explore ways to work within their communities to address the expanding problem of
inadequate access to care for the uninsured and underinsured and openly communicate
with one another to share information about successful programs. (CMS Rep. C, I-86;
BOT Rep. JJ, A-89; Reaffirmed: Sub. Res. 110, A-94; Reaffirmed: CMS Rep. 6, I-96;
CMS Rep. 7, A-97; Amended by CMS Rep. 9, A-98; Reaffirmation I-98;
Reaffirmation A-99; Reaffirmed: CMS Rep. 5, I-99; Reaffirmed: Res. 238 and
Reaffirmation A-00; Modified: BOT Rep. 17, I-00; Reaffirmation A-02; Res. 102, A05; Consolidated: CMS Rep. 7, I-05; Modified: CMS Rep. 8, A-08) ,(Modified
MSSNY HOD 2011)
165.935
HMO Carve-outs: MSSNY will introduce legislation which would provide every
citizen of this state with the ability to access all of the services provided by his
physician when such physician is a member of his health care plan’s panel of
physicians, or in the case of policies which provide for out-of-network coverage, is a
physician licensed in the State of New York. (HOD 00-90)
165.936
Mandated Use of Hospitals by Managed Care Companies: MSSNY will seek
passage of state legislation which would prohibit managed care companies and
hospitals from mandating that physicians participating in their plans use a hospital list
123
instead of being able to follow their own patients when those patients are hospitalized.
(HOD 00-85; Reaffirmed HOD 04-57)
165.937
Full Adoption of the National Specialty Societies’ Practice Parameter Guidelines
by Third-Party Insurers: MSSNY will seek legislative or regulatory relief to require
third-party insurers in New York State to utilize practice guidelines for utilization
review purposes as developed by the appropriate national or state specialty societies.
(HOD 00-72; Reaffirmed HOD 03-268 & 278)
165.938
Patient’s Choice: MSSNY will seek New York and Federal legislation which
requires a health care plan to permit patients to access, without restriction, any and all
providers participating with the plan who provide medical or diagnostic services.
(HOD 00-63)
165.939
Insurance Company Participating Provider Networks: MSSNY will pursue a
legislative remedy to ensure that when any health care plan entity publishes a list of
participating providers as part of an advertising campaign to enroll new members for a
future time period (or upcoming coverage period), that said list accurately reflect the
physicians who will be participating during the time period the insurance will be in
effect and not merely the physicians who are currently participating as of the time of
the advertising campaign. (HOD 00-62)
165.940
Full Disclosure of All Documents Related to Third-Party Insurer Contracts:
MSSNY will seek legislation, regulation and/or enforcement of current laws and
regulations to allow for informed decision-making by physicians, by requiring thirdparty payors to provide all pertinent information prior to the signing of any
participation agreement, including but not limited to (1) medical necessity and
utilization review procedures and guidelines, (2) fee schedules, and (3) the
medical/surgical and administrative claims processing policies and procedures to
which the physician will be subjected. (HOD 00-61; Reaffirmed HOD 01-258;
Reaffirmed HOD 03-268 & 278)
165.941
Coordination of Pharmacy Benefit into Existing Health Plans: MSSNY will seek
legislation which would preclude health care plans from requiring physicians to
deviate from an already established drug regimen (formulary) based solely upon cost
factors associated with less expensive, but possibly less effective drugs. The
aforementioned legislation should include coordination of a pharmacy benefit into
already existing health plans. MSSNY will strongly encourage the development and
utilization of technologies to allow physicians to instantly access the established drug
of any health plan with which the physician maintains a contractual relationship.
(HOD 00-56; Reaffirmed HOD 01-53; Reaffirmed HOD 2011)
165.942
Education About HMOs as Payors for Health Care: MSSNY will urge the
American Medical Association to better educate the lay public, and executive and
legislative branches of the government, about the percentage of premium dollars
expended by Health Maintenance Organizations on health care (i.e. the medical loss
ratio). (HOD 99-204)
165.943
Require Health Insurance Carriers to Report Medical Loss Data that Reflects All
Levels of Managed Care Subcontracting: MSSNY shall take all steps necessary to
ensure that the New York State Department of Health and the New York State
124
Insurance Department promulgate regulations requiring HMOs and health care
insurers to include in their calculation of medical loss data only payments for patient
care and to exclude from the calculation of medical loss data and funds retained by
“carve out” managed care companies under contract with an HMO or health care
insurer for administration and profit. (HOD 99-265)
165.944
HMO Requirements that Physician Providers Use Only Approved Laboratories:
MSSNY will inform HMOs that physicians should be allowed to use laboratories of
their choice for all patients, and MSSNY shall seek legislative action that would
require HMOs to refrain from interfering with the practice of medicine by making it
mandatory to use specific clinical and anatomic pathology laboratories. (HOD 99-95)
165.945
Qualification of Precertification Reviewers: MSSNY will support legislation
requiring MCOs to utilize New York State practicing physicians as pre-certification
reviewers. MSSNY shall support legislation requiring that any pre-certification denial
be reviewed by a physician in active practice in New York State in the same specialty
or subspecialty as the physician performing the procedure, and that such legislation
include provisions which would require managed care organizations to utilize medical
protocol and review criteria approved by New York State practicing physicians who
participate in the plan. (HOD 99-91; Reaffirmed HOD 11-107)
165.946
Information Included on Health Insurance Identification Cards: MSSNY
reaffirms its commitment to the positions embodied in Resolution 97-56, (Policy
165.981) and, in addition, MSSNY will work with payors to encourage the use of
“smart cards” which would encode information, including but not limited to, the
patient’s eligibility data, co-pay, type of policy, effective policy dates, company
address and appropriate phone number, I.D. number, group number, and the name of
any entities with whom the MCO has subcontracted to pay for specific “carved-out”
services. MSSNY will work with payors to encourage the use of a standard
encryption format so that one machine is capable of reading data from all companies,
and that the smart card reader be made available to all physicians at a reasonable price.
MSSNY will seek through legislation or regulation a requirement that payors provide
immediately, upon application for enrollment, a temporary health insurance
identification card providing information including but not limited to notice of
effective date of eligibility. (HOD 99-87; Reaffirmed HOD 00-272)
165.947
HMO Physician Indemnification: MSSNY will seek legislation requiring health
care plans to indemnify and hold harmless a participating physician who acts in good
faith and is sued by an insured patient for outcomes that result when the physician’s
recommended course of action has been denied by the health care plan. (HOD 99-81)
165.948
Community Rating for Medical Coverage: MSSNY will work with the American
Medical Association to secure passage of federal legislation to: (a) replace the current
tax exclusion of employer-provided coverage with a refundable tax credit for each
individual who receives coverage as a benefit of employment, or who purchases health
insurance in the private market; (b) expand the definition of health benefits under
Section 106 of the Internal Revenue Code to include employers’ contributions to their
employees’ purchase of individual health insurance; (c) eliminate the restrictions on
the availability of MSAs; and, (d) enable the creation of risk pooling cooperatives to
foster an environment in which individually owned insurance could be purchased
economically. MSSNY will support all legislative/ regulatory efforts to examine the
125
need to implement effective state insurance reform that would facilitate the purchase
of individual and group coverage for all New Yorkers at an affordable cost.
(HOD 99-68)
165.949
Quarterly Publication of Supplementary Provider Lists for HMO Subscribers:
MSSNY will seek regulatory or legislative action to require that insurance plans and
health maintenance organizations in New York State distribute on a quarterly basis an
updated supplementary list of providers to their subscribers. This regulation or
legislation should also include a requirement that insurance plans and health
maintenance organizations provide to their patients in an annual directory and, in any
update to said directory, a listing of participating physicians in all of the specialties for
which the plan has approved the physician. MSSNY will seek to establish through
legislation an increased penalty for insurance plans and health maintenance
organizations that do not comply with these provisions. (HOD 99-66; Reaffirmed
HOD 00-81)
165.950
Require that HMO Subscribers Select a Primary Care Physician Within 30 Days
or be Assigned One by the Plan, as per the Requirements of the NYS Medicaid
Managed Care Guidelines Issued by the NYS Department of Health: MSSNY
will seek regulatory or legal action to require that if HMO subscribers do not select a
primary care physician within thirty days, they be assigned one by the plan, similar to
the current guidelines utilized by the NYS Department of Health governing Medicaid
Managed Care Plans; and such regulatory or legal action should also require that
HMOs inform each enrollee of the name, address, and telephone number of the
primary care physician to whom the enrollee has been assigned and of the enrollee’s
right to select a different primary care physician. MSSNY will seek regulatory or
legal action to require that payment of the capitated amount to the primary care
physician begin at the time of selection or assignment. (HOD 99-62)
165.951
Quarterly Financial Disclosures: MSSNY will seek the introduction of legislation
and/or regulation to require HMOs and insurance companies to provide quarterly: a
standard financial report, a statement of financial reserves, and a statement of
outstanding debt including “disputed” and “undisputed” claims to the Medical Society
of the State of New York and that MSSNY shall seek the introduction of legislation
and/or regulation to require HMOs and insurance companies to report to the State all
transfers of funds in excess of $250,000 not in the ordinary course of business within
15 days of such transfer and that such legislation and/or regulation should require
HMOs and insurance companies to provide, upon request by MSSNY, an independent
audit of a quarterly report when in the quarter for which the report was issued, such
plan has transferred funds in excess of $250,000 not in the ordinary course of business.
(HOD 99-59)
165.952
Managed Care Organizations’ Restricting Practice of Credentialed Physicians:
MSSNY will seek legislation or regulation barring managed care organizations from
limiting, by internal policy or refusal of payment, qualified physicians from practicing
within the scope of their abilities, license and training. (HOD 99-54)
165.953
Accountability for HMO Termination of a Physician by Mistake: MSSNY will
actively seek legislation or regulation which holds an HMO or managed care plan
accountable for all damages incurred by a physician as the result of termination
notification which was made in error, to the physician’s patients. MSSNY will take all
126
action necessary to assure that physicians are informed of their rights when terminated
by a plan or when patients are inappropriately notified of a physician’s termination
from the plan. (HOD 99-53; Reaffirmed HOD 07-254)
165.954
Prudent Layperson – 911 Calls: MSSNY reaffirms its support of the prudent
layperson standard for emergency medical service and opposes triage by 911 dispatch
which divert 911 (Emergency Dispatch) calls to non-emergency facilities, other than
birthing centers or those facilities identified by the local REMAC (Regional Medical
Advisory Committee) because of geographic constraints. (Council 10/28/98)
165.955
The Need for Patients to be Informed as to the Difference Between Physicians
and Other Types of Health Care Provides so as to Allow the Patient to Make a
Choice of a Physician or Other Health Care Provider Based in Informed
Consent: MSSNY shall seek enactment of State and Federal legislation mandating
that patients be notified whenever a health care provider other than a physician will
provide care to a patient. (HOD 98-57, Reaffirmed HOD 99-83)
165.956
Disclosure of Conversion Options by Medicare Managed Care Organizations to
Prospective Enrollees Previously Covered by Employer-Sponsored Insurance
Contracts: MSSNY will urge the AMA to support federal legislation that would
require Medicare Managed Care Organizations to provide complete, comprehensible
and accurate disclosure of information to prospective enrollees. Such disclosure to
prospective enrollees must include advantages as well as disadvantages, especially the
inability of beneficiaries to return to their former employer group health plan
coverage, and the possible restriction of their access to physicians, hospitals and other
services. MSSNY will also ask the AMA to urge HCFA to develop clear and concise
guidelines concerning the content of the presentations made by agents of MCOs and
other insurers and that such guidelines be monitored by HCFA for strict adherence by
MCOs, subject to penalties for any purposeful misleading or inaccurate information.
(HOD 98-274)
165.957
Recredentialing of Physicians in Merged Managed Care Organizations: The
Medical Society of the State of New York will seek to assure, through whatever means
appropriate, that when a contract between a managed care organization and
credentialed physicians is transferred, merged or consolidated into another
organization, the cost associated with re-credentialing of already credentialed
participating physicians be borne by the new entity. (HOD 98-207)
165.958
Crediting Capitated Payment: MSSNY will advocate for legislation and/or
regulations requiring managed care plans (a) to begin capitated payments to the
physician starting from the date of which the patient enrolls in the managed care plan;
(b) that the enrollee designate a primary care physician in a timely manner and (c) that
the physician be notified of such selection. (HOD 98-83)
165.959
Channeling of Eye Examinations to Optometrists: It is the position of MSSNY that
third-party payors not be permitted to shift patients from ophthalmologists to
optometrists, that third-party payors not designate optometrists as primary eye care
providers; and that MSSNY will issue a letter to all third-party payors operating in
New York State, putting forth organized medicine’s strong opposition to channeling
enrollees to optometrists and other non-physicians and opposing the exclusion of
127
ophthalmologist from refractive eye examinations, routine eye examinations, or
primary eye care.
MSSNY will coordinate efforts with medical specialty societies to introduce
legislation prohibiting third-party payors from mandating or encouraging that routine
and refractive examinations be performed by optometrists rather than by
ophthalmologists. (HOD 98-79)
165.960
Capitation: The Medical Society of the State of New York will seek legislation or
regulation which (a) defines acceptable financial risk arrangements between
physicians and managed care plans to minimize the potential for the reduction or
limitation of appropriate access to medically necessary services; and (b) ensures that
managed care plan enrollees be entitled to know the type of financial risk arrangement
health plans have in place for their providers. (HOD 98-72; Reaffirmed HOD 99-268)
165.961
Enforcement of Disclosure Laws Under Managed Care Bill of Rights: That the
Medical Society of the State of New York petition the state legislature, Attorney
General, and the Governor to (a) strictly enforce the current law and (b) increase the
fine to a sufficient level to encourage compliance and (c) clearly stipulate that such
fines shall not be paid from money budgeted for the provision of health care.
(HOD 98-61)
165.962
State Control Over Changes in Health Insurance Coverage and Reimbursement:
MSSNY will seek the enactment of legislation that (a) requires that physicians receive
specific notice of the compensation terms proffered by managed care plans, including
a detailed statement of the precise terms by which monies will be paid and (b) requires
that physicians be routinely informed of the method by which the amount of a
withhold or a bonus will be calculated, the date upon which payment will be made and
a description of the records relied upon to calculate the withhold or bonus and (c)
requires scrutiny of managed care plans financial statements by appropriate state
agencies when a managed care plan fails to return funds withheld from physicians in a
given year to determine if the retention of funds by the managed care plan is, indeed,
justified and (d) if retention of funds is determined to be unjustified, said agencies
direct the managed care plan to return the withhold with appropriate interest and
penalties, and (e) inform beneficiaries when benefits are changed. (HOD 98-60)
165.963
Public Disclosure of Telephone Triage Protocols by MCOs: MSSNY will actively
seek legislation requiring Managed Care Organizations to publicly disclose the details
of the telephone triage protocols used to determine authorization for access to
emergency medical services by covered enrollees seeking emergency medical care
through utilization of the MCOs’ designated emergency access hotline numbers. Such
legislation shall also require that the protocols be routinely referred to appropriate
designated review panels and/or agencies for the purpose of assessing their
consistency with accepted Emergency Medical Services standards and with the terms
of the New York State law pertaining to “prudent laypersons” seeking access to
emergency medical services. (HOD 98-56)
165.964
Formation of a Special and/or Public Commission to Monitor Managed Care:
MSSNY supports the enhanced operation and funding of the Office of Managed Care
within the New York State Department of Health. (HOD 98-54)
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165.965
Repeal of ERISA Exemption for HMO Tort Liability: MSSNY, both directly and
through its input into its American Medical Association’s policymaking will seek
repeal and/or revision of those provisions of the ERISA law which restrict managed
care plan enrollees’ legal recovery for damages resulting from a managed care plan’s
inappropriate denial of care. (HOD 96-63; Reaffirmed HOD 98-59)
165.966
Uniform Application Form, Uniform Encounter Form: MSSNY supports the
establishment and use of a uniform application and a uniform encounter form to be
used by all HMOs, IPOs, HPOs and IPAs. (HOD 97-273)
165.967
Managed Care Organizations to Standardize Pre-Certification: MSSNY will
encourage managed care organizations to standardize pre-certification procedures and
time limits for HMOs to respond to pre-certification requests for patient care
regardless of the time of day or day of week. (HOD 97-254)
165.968
Liability of Managed Care Entities As Well As Their Employees, Agents,
Ostensible Agents And Representatives: MSSNY will develop or support
legislation or regulation requiring that whenever an employee, agent, ostensible agent
and/or representative of a managed care entity makes a determination that affects a
patient’s health, both the individual and the entity should be held liable for any adverse
outcome to the patient arising directly from the determination or as a consequence of
the determination. (HOD 97-114; Reaffirmed HOD 98-84)
165.969
Managed Care Companies and The Practice Of Medicine Without A License:
MSSNY will support legislation or regulation that will declare that any person making
decisions on the medical necessity or appropriateness of care affecting the diagnosis or
treatment of a patient in New York must have a license to practice medicine in New
York; and that a physician making decisions on the medical necessity or
appropriateness of care affecting the diagnosis or treatment of a patient in New York
without a valid New York license, as well as the company that employs him/her, will
be subject to investigation, criminal prosecution and possible fines. (HOD 97-112;
Reaffirmed HOD 98-62)
165.970
DEA Numbers Should Not Be Used As A Means Of Physician Identification:
MSSNY will advise and encourage New York State physicians not to release their
DEA numbers except where required for prescribing narcotics and other Schedules IIV drugs; and will advise all MCOs of this policy. In the event that MCOs persist in
using the DEA number as a means of physician identification, MSSNY will
vigorously pursue appropriate legislative or regulatory relief and will ask the AMA to
pursue similar legislation or regulatory relief. (HOD 97-107; Reaffirmed HOD 00-60)
165.971
Retrospective Denial of Insurance Claims: MSSNY will seek legislation which
would amend subdivision (4) of section 4903 of the public health law and subdivision
(d) of section 4903 of the insurance law which require health maintenance
organizations and insurers to “make a utilization review determination involving a
health care service which has been delivered within 30 days of receipt of the
‘necessary information’” to further require that in no event shall such determination be
made later than 90 days from the submission of the claim. (HOD 97-97)
165.972
Requiring The Use Of Accepted Medical Guidelines By Insurers And Managed
Care Entities: MSSNY will seek legislative or regulatory relief to ensure that
129
insurers and managed care entities use medical guidelines developed by recognized
medical specialty societies; such legislation should include provisions that insurers and
managed care entities be required to identify and disclose the guidelines being used in
specific areas of practice. (HOD 97-94; Reaffirmed HOD 03-268 & 278)
165.973
Patient Access to Physicians No Longer On Plan: MSSNY will seek legislation
which would enable enrollees to a managed care plan to continue to receive care from
the enrollee’s current physician for up to one year or the balance of their policy period,
whichever is longer, where the physician has left or has been terminated by the plan
provided that the termination is not related to imminent harm to patient care, a
determination of fraud or a final disciplinary action and provided further that the
physician continues to accept reimbursement from the managed care plan at the rates
applicable prior to the termination or departure of such physician from the plan and
adheres to the plan’s quality assurance and utilization review requirements.
(HOD 97-93)
165.974
“Hold Harmless” Protection for Physicians Under Contract: MSSNY will
included in its policies and practices educating the physician on how such “Hold
Harmless” clauses can serve to protect the physician or to increase risk exposure.
(HOD 97-79)
165.975
Retroactive Denials: MSSNY working through the Committee on State Legislation
will strongly support the introduction of appropriate legislation to require all health
insurers in this State, including HMOs, to be precluded from retroactively denying
reimbursement to physicians for patients’ admissions to hospitals. (HOD 97-78)
165.976
Substituting Nurse Practitioners For Licensed Primary Care Physicians:
MSSNY will seek legislation prohibiting the substitution of licensed primary care
physicians with nurse practitioners, and will continue its public opposition to replacing
physicians with physician extenders. In recognition of a patient’s right to receive high
quality medical care from appropriately trained health care professionals, and the lack
of any credible studies which indicate that services provided by nurse practitioners are
equal to those rendered by physicians, MSSNY will communicate to all appropriate
state agencies and state officials its opposition to the Oxford Health Plan agreement
with Columbia University and Presbyterian Medical Center and to similar activities
engaged in by other managed care entities operating in New York State. (HOD 97-71)
165.977
Financial Incentives Based Upon The Non Provision Of Services: MSSNY will
seek legislation which would prohibit the use of any financial incentives which inhibit
the provision of medically necessary care. (HOD 97-68)
165.978
Referrals To Allied Health Providers: It is the position of MSSNY that managed
care organizations in the State of New York should be required to designate only MDs
and DOs as primary care providers for any individual or group of patients. MSSNY
will continue its public opposition to replacing physicians with physician extenders;
and will communicate its opposition to the assignment of primary care status to any
professional provider other than an MD or DO in managed care entities and workers
compensation programs operating in New York State. (HOD 97-64)
165.979
Elimination of the Managed Care Requirement to Obtain a Referral from a
Primary Care Physician Prior to Utilizing the Services of a Specialist: In
130
recognizing an individual’s right to make his/her own decisions on health related
issues, but in also recognizing that in most cases, the individual’s employer arranged
and pays for the individual’s insurance coverage, the Medical Society of the State of
New York, in collaboration with consumer organizations, patient advocacy groups,
business and labor, will work to assure that managed care organizations facilitate
patient access to necessary specialty care by: (a) offering to employers affordable
point of service plans; and (b) allowing enrollees to visit specialists within their
medical group or independent practice association without a referral from the primary
care physician. (HOD 97-51; Reaffirmed HOD 03-261)
165.980
Dismissals for Cause in Managed Care Contracts: The Medical Society of the
State of New York shall seek legislation that no terminations or non-renewals of
physician contracts with managed care plans shall be valid without cause, and will
seek the introduction of legislation which would require managed care plans to
provide all physicians with a fair and equitable due process appeal if they are excluded
from a managed care plan regardless of the reasons for such exclusion and irrespective
of whether such exclusion is considered to be a termination or a non-renewal. Such
due process hearing shall be held before a panel which is composed of three New York
State licensed physicians, one of whom is chosen by the plan, one of whom is chosen
by the physician who is the subject of the hearing, and the third who is chosen by the
other two members of the panel. At this hearing, the physician shall be entitled to be
advised of the reason for his de-selection and shall be provided with: (a) the
opportunity to be represented by counsel, and (b) the right to call witnesses and
present evidence in support of this position. (HOD 97-53)
165.981
Toll-Free Telephone Numbers to be Required for all Health Insurance Carriers
to Provide Access for Participating Physicians: The Medical Society of the State of
New York will seek legislation or regulatory action to require PPOs and self-insured
plans, as well as insurers not engaged in utilization review procedures, to provide
adequate personnel to respond to telephone requests from patients and physicians.
These plans should be required to have procedures that; (a) would require that
adequate personnel to be available at least 40 hours per week during normal business
hours to discuss patient care and allow response to telephone requests; and (b) this
telephone system should be accessible on a toll-free basis for patients and physicians;
and (c) that there be a toll-free telephone system capable of accepting, recording or
providing instruction to incoming telephone calls during other than normal business
hours and to ensure that a response to the accepted or recorded message occurs not
more than one business day after the date on which the call was received; (d) and that
where a plan does not provide for such reasonable and adequate access, the eligibility
of a patient with an identification care from the plan will be deemed valid.
(HOD 97-56; Reaffirmed HOD 00-272; Reaffirmed HOD 09-259)
165.982
Changes in the Bundling of Medical Services by Managed Care Plans: It is
MSSNY’s position that when a patient sees a physician for evaluation and
management of an illness, whether primary care or consultation, and the physician also
performs a procedure which helps in the diagnosis or treatment of that illness, the
physician should be paid for both the evaluation and management code and the
procedure code. When a physician sees a patient to perform a pre-scheduled
procedure, cognitive services are considered part of the performance of the procedure
and the physician should be paid only for the procedure. The supporting rationale for
this policy is embodied in two separate functions; (a) the evaluation of the problem
131
and decision to perform a procedure; and (b) the performance and interpretation of
the procedure. These functions could often be performed on separate days, but, for
reasons of good medicine, expedited care and patient/physician convenience, it is often
preferable to perform the procedure on the same day as the evaluation and
management visit. It would, therefore, be inappropriate under these circumstances to
either unnecessarily require the patient to have the procedure performed on another
day or to deprive the physician of equitable payment for the proper provision of both
services on the same day. (Council 12/19/96; Reaffirmed HOD 00-257 & 268)
165.983
Redefining the Roles, Obligations and Responsibilities of Insurance Companies
which Utilize Capitation as a Means of Physician Reimbursement: MSSNY will
seek legislation requiring managed care organizations to assume appropriate risk while
at the same time: (a) providing an adequate proportion of premium dollars dedicated
to medical care; (b) providing for equitable physician reimbursements; (c) reducing
excessive MCO profit margins. (Council 12/19/96)
165.984
Prior Authorization for Procedures Under Managed Care: Limits on Time
Requirements: MSSNY supports the requirement that managed care organizations
implement and comply with written procedures to assure that entities that conduct
utilization review: (1) provide adequate access to its review staff by a toll-free or
collect call phone line, at a minimum, from 8:00 a.m. of each standard business day;
(2) establishment of written procedures for receiving or redirecting after-hour calls
either in person or by recording; and (3) having a mechanism to receive timely call
backs from providers. (HOD 96-76)
165.985
“Hold Harmless” Clauses in Physicians’ Contracts with Health Care Delivery
Entities: MSSNY supports the immediate removal of unpalatable and controversial
“Hold Harmless” provisions in physician contracts which insulate health care delivery
entities from any culpability or liability for which it should be responsible, while also
shifting full risk to the physician whose medical liability coverage may not provide
sufficient protection under these circumstances. (HOD 96-72)
165.986
Gag Rule in Managed Care Contracts: In signing a managed care contract, the
physician does not abrogate the right to fully disclose all aspects of care, including the
risk of withholding services, that have been denied by a managed care organization.
Legislation or regulation that will prevent managed care companies from including in
any contract a prohibition of discussing any issues with patients that may have a
bearing on their health, including the consequences of payment decisions by managed
care organizations will be sought. (HOD 96-56)
165.987
Administrative Procedures, Standardization of Managed Care: MSSNY will
work with the NYS Health Maintenance Organization (HMO) Conference and other
appropriate authorities to develop a standardized credentialing and re-credentialing
form to be used by all managed care organizations doing business in New York State.
(HOD 96-79)
165.988
Specialty Rosters in Managed Care: All managed care organizations should be
required to maintain full rosters of medical specialists, representing all the specialties
approved by the American Board of Medical Specialties and the American
Osteopathic Board of Medical Specialties or otherwise provide access outside the
managed care organizations to the full range of medical specialists as needed.
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(HOD 96-78)
165.989
Retrospective Denial of Pre-Certified Services by Managed Care: The practice of
retrospective denial of payment for care which has bee pre-certified by an insurer,
except when false or fraudulent information has knowingly been given to the insurer
by the physician, hospital or ancillary service provider to obtain pre-certification
should be banned. (HOD 96-90)
165.990
Profits and Administrative Costs of Managed Care Organizations: MSSNY
supports legislation which would require public disclosure by managed care
organizations of the percentage of premium dollars expended on health services,
administrative services and plan marketing, and takes the position that such
organizations be required to disclose the percentage of premium dollars retained as
profit. (HOD 95-94)
165.991
Responsibility To Patients in Managed Care Plans: MSSNY will seek legislation
requiring that any health plan using managed care techniques should be subject to
legal action for any harm incurred by the patient resulting from application of such
techniques; health plans shall also be subject to legal action for any harm to enrollees
resulting from failure to disclose, prior to enrollment, any coverage provisions, review
requirements, financial arrangements, or other restrictions that may limit services,
referrals or treatment options, or negatively affect the physician’s fiduciary
responsibility to his or her patient. (HOD 95-59)
165.992
Utilization Review Management: MSSNY affirms the following position with
regard to Utilization Review Management applicable to managed care entities who
utilize down-coding, site of service payment reductions, and restrictive patient referral
policies as a means of economic disincentives as follows: Physicians who are trained
and/or Board Certified in their practice should be allowed to perform and be
reimbursed for services if they are medically indicated. Any managed care plan
implementing utilization review or management programs should establish an appeals
process whereby physicians, other health care providers and patients may challenge
policies restricting access to specific services and decisions to deny coverage for
services. Such individuals must have the right to have reviewed any coverage denial
based on medical necessity by a physician who is of the same specialty and has
appropriate expertise and experience in the field. Any physician who makes
judgments or recommendations regarding the necessity or appropriateness of services,
or site of services, should be licensed to practice medicine and actively practicing in
New York State and should be professionally and individually accountable for his or
her decisions. The medical protocols and review criteria used by managed care plans
in any utilization review or management program must be developed by practicing
physicians. Managed care plans should be required to disclose to physicians, on
request, the screening and review criteria, weighing elements, and computer
algorithms used in the review process, as well as how they were developed. A
physician of the same specialty must be involved in any decision by a utilization
review or management program to deny or reduce coverage for services based on
questions of medical necessity. A physician whose services are being reviewed for
medical necessity should be provided the identity and credentials of the reviewing
physician on request. The reviewed physician should also have the opportunity to
speak with a reviewer. (Council 9/22/95; Reaffirmed HOD 00-79 & 80)
133
165.993
Emergency Services at Specialty Centers - Equity Coverage by Managed Care
Entities: It is the position of MSSNY that those managed medical care organizations
that limit or restrict fiscal coverage to certain hospitals and physicians make an
exception for emergent critical care case situations (such as extensive burns, neonatal
spinal injuries, multi-organ/extensive trauma) that are sent to the appropriate specialty
centers pursuant to guidelines established by organized medicine, and State or Federal
policy, rules and regulations. MSSNY strongly opposes any attempt by a managed
care entity or third party payer to delay, to deny payments, or to reduce payments
when a patient is sent, on an emergent basis, to a designated specialty center and will
disseminate this position to the membership and the New York State Health
Maintenance Organization Council. (HOD 94-274)
165.994
Policy on Managed Care: MSSNY affirms the following policy as adopted by the
Council on January 23, 1986, and amended by the Committee on Interspecialty on
January 13, 1994: (1) No single pattern of health care delivery is necessarily suited to
all patients or to all physicians; and that (2) The traditional fee-for-service, the HMO,
the HMO-IPA, and PPO concepts are valid and acceptable health care delivery
systems; but (3) There must be available multiple delivery mechanisms among which
both the patient and the physician can truly exercise the right of free choice of how
they will receive and disburse quality medical care; and that (4) Any managed care
plan is urged to cover in its basic policy all medically necessary procedures for all
ICD-9 illnesses; medical, surgical, psychiatric and addictive. In the presence of such
parity, cost factors may be dealt with by practice parameters, by utilization criteria and
review, and by sliding scales of co-insurance and deductibles, not by limiting areas or
specialties of care; and that (5) Employers should contribute equitable amounts for
each employee’s health benefit plan, regardless of the plan selected; and that (6) Fair
market competition among all systems of health care delivery shall continue to be
MSSNY policy (similar to AMA policy) with the potential growth of health care
delivery systems being determined not by governmental intercession or entrepreneurial
considerations, but by the number of people who prefer this mode of delivery. In
addition, MSSNY recognizes both closed panel plans and open panel plans as valid
and acceptable health care delivery modalities, consistent with the foregoing MSSNY
policy statement.
MSSNY affirms the following AMA policy statements on managed care
encompassing: (1) Case Management; (2) Financial Incentives and Disincentives; (3)
Selective Contracting; (4) Physician Governance of Managed Care Program Policies:
1) Case Management (a) Case Management Health plans using the preferred
provider concept should not use coverage arrangements which impair the continuity of
patient’s care across different treatment settings. (b) With the increased specialization
of modern health care, it is advantageous to have one individual with overall
responsibility for coordinating the medical care of the patient. The physician is best
suited by professional preparation to assume this leadership role. (c) The Primary
goal of high-cost management or benefits management programs should be to help to
arrange for the services most appropriate to the patient’s needs; cost containment is a
legitimate but secondary objective. In developing an alternative treatment plan, the
benefits manager should work closely with the patient, attending physician, and other
relevant health professionals involved in the patient’s care. (d) Any health plan which
makes available a benefits management program for individual patients should not
134
make payment for services contingent upon a patient’s participation in the program or
upon adherence to treatment recommendations. (AMA Policy 285.998)
2) Financial Incentives and Disincentives (a) Any financial arrangements that may
tend to limit the services offered to patients, or contractual provisions that may restrict
referral or treatment options, should be fully disclosed to prospective enrollees by
plans utilizing such arrangements. (b) Physicians must disclose any financial
inducements or contractual agreements that may tend to limit the diagnostic and
therapeutic alternatives that are offered to patients or restrict referral or treatment
options. Physicians may satisfy their disclosure obligations by assuring that the
managed care plan makes adequate disclosure to patients enrolled in the plan.
Physicians must also inform their patients of medically appropriate treatment options
regardless of cost or the extent of their coverage. (c) Physicians should have the right
to enter into whatever contractual arrangements with health care systems they deem
desirable and necessary, but should be aware of the potential for some types of
systems to create conflicts of interest because of financial incentives to withhold
medically indicated services. Physicians must not allow such financial incentives to
influence their judgment of appropriate therapeutic alternatives or deny their patients
access to appropriate services based on such inducements. (d) Physician payments
that provide an incentive to limit the utilization of services should not link financial
rewards with individual treatment decisions over periods of time insufficient to
identify patterns of care or expose the physicians to excessive financial risk for
services provided by physicians or institutions to whom he or she refers patients for
diagnosis or treatment. When risk-sharing arrangements are relied upon to deter
excess utilization, physician incentive payments should be based on performance of
groups of physicians rather than individual physicians, and should be based over short
periods of time. (e) Alternative private health benefit plans, with different schedules
of deductibles, coinsurance and premiums, should be available to enrollees so that they
are aware of the financial trade-offs associated with different plans. Both private and
public third party payment systems should use deductibles and coinsurance as
financial incentives for health care recipients to use health care resources in an
appropriate manner. However, cost-sharing should not result in an undue financial
burden for the health care recipient , and should not act to prevent access to needed
care. (f) Physicians, other health professionals, and third party payors through their
reimbursement policies, should continue to encourage use of the least expensive care
setting in which medical and surgical services can be provided safely and effectively
with no detriment to quality. (AMA Policy 285.998)
3) Selective Contracting (a) Health plans or networks should provide public notice
within their geographic service areas when applications for participation are being
accepted. (AMA 285.998) (b) Physicians should have the right to apply to any health
care plan or network in which they desire to participate and to have that application
judged on the basis of objective criteria that are available to both applicants and
enrollees. (AMA CMS Report B, A-93) (c) Those managed care plans that contract
with selected physicians to furnish care should utilize selection criteria based primarily
on professional competence and quality of care. Any economic criteria used in such
selective contracting should have a demonstrated positive relationship to the quality
and appropriateness of care and to professional competency. (AMA Policy 285.997)
(d) Managed care plans that contract with selected providers should have an
established appeals mechanism by which any provider willing to abide by terms of the
plan contract could challenge a decision to deny the provider’s application for
135
participation in the plan. (AMA Policy 285.997) (e) All managed contracts should
expressly require the managed care plan to provide meaningful due process
protections, in order to prevent wrongful and arbitrary contract terminations that leave
the physicians without means of redress. (AMA Policy 285.996) (f) Prior to
initiation of actions leading to termination or non-renewal of a physician’s
participation contract for any reason, the physician shall be given notice specifying the
grounds for termination or non-renewal, a defined process for appeal, and an
opportunity to initiate and complete remedial activities except in cases where harm to
patients is imminent or an action by a state medical board or other government agency
effectively limits the physician’s ability to practice medicine. (AMA CMS Report B,
A-43) (g) All “hold harmless” clauses in managed care contracts should be explicitly
identified as such. Physicians should consider consulting with legal counsel prior to
contracting with a managed care entity to prevent the imposition of unfair liability
upon the physician. (AMA Policy 285.995) (h) Physicians should have the right to
enter into whatever contractual arrangements with managed care plans they deem
desirable and necessary, but should be aware of the potential for some types of plans
to create conflicts of interest because of financial incentives to withhold medically
indicated services. (AMA Policy 285.998)
4) Physician Governance of Managed Care Programs’ Policies (a) The medical
protocols and review criteria used in any utilization review or utilization management
programs must be developed by physicians. (AMA Policy 285.998)
In addition it is the position of MSSNY that quality assurance policies and any
medical protocols be governed by practicing physicians. Credentialing of physicians is
directly related to utilization review and quality assurance, and should, therefore, be
operated in accordance with policies determined by physicians. (Council 3/10/94)
165.995
Organized Medical Staffs in Managed Care Entities: It is MSSNY policy that
managed care entities establish self-governing medical staffs similar, if not identical,
to those in hospitals. The principles of self-governance should include, but not be
limited to:
• the development of medical Staff Bylaws which cannot be unilaterally changed by
the governing of managed care entity;
• physician selection representatives to the governing board and other appropriate
committees of managed care entities including credentialing, privileging, quality
assurance and utilization review committees;
• due process protections for physicians credentialed by a managed care entity; and
full indemnification by managed care entities of physicians who, in good faith,
serve as members of credentialing, quality assurance and utilization review
committees of managed care entities. (HOD 94-102)
165.996
Personal Financial Gain Should Not Influence Medical Decisions: It is MSSNY
policy that decisions involving medical care should be based upon the medical needs
of the patient and independent of physician financial incentives and disincentives.
(Council 9/22/94)
165.997
Physician Participation in Managed Care Plan: MSSNY reaffirms current policy
on managed care adopted by the Council on March 10, 1994 which is consistent with
AMA policy and addresses the right of any physician to seek participation in any
health care system. The relevant provisions of this policy read as follows:
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(1) Physicians should have the right to join any health care plan or network in which
they desire to participate and to have that application judged on the basis of objective
criteria that are available to both applicants and enrollees. (2) Those managed care
plans that contract with selected physicians to furnish care should utilize selection
criteria based primarily on professional competence and quality of care. Any
economic criteria used in such selective contracting should have a demonstrated
positive relationship to the quality and appropriateness of care and to professional
competency. (3) Selective contracting decisions made by any health delivery or
financing system should be based on an evaluation of multiple criteria related to
professional competency, quality of care, and the appropriateness by which medical
services are provided. In general, no single criterion should provide the sole basis for
selecting, retaining, or excluding a physician from a health delivery or financing
system.
MSSNY further espouses the policy that no managed care entity may discriminate
against the application of any properly credentialed physician licensed to practice in
New York State regardless of board certification status. MSSNY will urge the New
York State Department of Health and the New York State Health Maintenance
Organization Council to support the MSSNY Managed Care Policy provision which
are advanced in the interest of: (1) Continued quality patient care through sustained
physician/patient relationships; (2) Equity through the elimination of demeaning,
discriminatory, and prejudicial physician enrollment practices and will communicate
these principles to all managed care systems doing business in New York State.
(HOD 94-259; Reaffirmed HOD 96-270, HOD 97-222 & HOD 03-100)
165.998
Point of Service Provision in Managed Care Programs: MSSNY supports
legislation to require all managed care organizations to offer enrollees the option of
purchasing coverage for medical care and services provided out-of-network or out-ofplan, and that such option be affordable and provide reasonable payment in order to
allow enrollees to seek care outside managed care organization if so desired.
(HOD 94-64; Reaffirmed HOD 96-58)
165.999
Regionalized Emergency Care Exemption: MSSNY takes the position that
managed care organizations should make an exception for emergency medical
situations covered under the regional system of emergency care and strongly opposes
any attempt to delay or deny payment for medically necessary emergency services in a
regionalized facility that may not be part of the managed care network of approved
hospitals. (Council 6/2/94)
170.000
MANDATORY MEDICAID MANAGED CARE:
170.998
Medicaid Reform: MSSNY is strongly supportive of fundamental reform of the
Medicaid program and shares the Pataki administration’s conviction that fundamental
Medicaid reform is necessary. MSSNY opposes the administration’s Medicaid
managed care proposal and waiver application in its current form. MSSNY’s concerns
involve the following three key components of the proposal:
(1) Program Structure: MSSNY believes it is both shortsighted and unnecessary to
cede the Medicaid population to the fully capitated model primarily reflected by the
for-profit HMO industry. MSSNY believes that government has a appropriate role in
articulating the broad parameters within which managed care should operate, but
137
strongly disagrees with an initiative in which government actually creates a monopoly
for one particular type of managed care model. The state is the buyer of Medicaid
services.
MSSNY is at a loss to understand how the “buyer-state” saves money by creating a
statutory monopoly for a single type of “seller.” Moreover, MSSNY believes that
such a policy direction is completely inconsistent with data presented in the
Department of Social Services Annual Managed Care Report released in October 1994
which demonstrates that the state savings achieved by enrolling recipients into
physician case management programs are more than three times greater than the
savings in the fully capitated plans. The higher level of savings is attributed to the fact
that all of the savings in these programs accrue directly to the state and not to HMO
profits. Such a policy, furthermore, ignores the experience of other states…where the
physician case management program has proven to be extremely successful, costeffective has shown that a case management program has led to more patient visits to
primary care physicians and less patient use of emergency rooms. It has also resulted
in a decrease in in-patient hospital care. As a result, initial estimates show that the
physician case management program’s cost savings will at least match those produced
by fully capitated plans to date. MSSNY favors a pluralistic system with multiple
managed care models to ensure a competitive environment which will inevitably
maximize potential savings to the state while at the same time enhancing the state’s
capacity to absorb the influx of new enrollees. Moreover, MSSNY has been given no
satisfactory explanation of why local county government should be denied the right to
pursue the physician case management program approach if such a model is the
responsible structure for their community. This is particularly true since the fully
capitated plans do not have adequate capacity to reach enrollment objectives.
(2) Exempt Populations: MSSNY and its constituent physicians are acutely aware
of the pain and human suffering which would be caused by mandating the enrollment
of special needs populations in Medicaid managed care before developing a managed
care system capacity which adequately and cost efficiently meets the needs of these
populations. MSSNY believes no mandatory inclusion of special needs populations in
Medicaid managed care can be supported until all questions of managed care adequacy
to their special needs are answered specifically and fully. Until that time, full
treatment options outside of fully capitated managed care for these particularly
vulnerable population must be maintained as an option. Moreover, the access to
services in the non-managed care sector must be fully maintained and protected in
order to assure that this option is meaningful.
(3) Quality of Care: MSSNY believes a minimalist approach which includes a
requirement that plans report encounter data which will be used to monitor and
evaluate health care delivery, an assessment of client satisfaction and access to
services, and collection of key clinical information to compare plans, inclusive of the
measures utilized by the national HEDIS Program is not sufficient to assure that the
quality of care provided is not diminished by the financial incentives of a health care
delivery system dominated by capitated health care networks, many of which are forprofit entities. MSSNY strongly urges the incorporation of a series of protections in
this initiative which assure:
•
enrollee access to a sufficient number of primary care and other medical service
providers, including emergency medical services;
138
•
•
•
•
disclosure to enrollees of: the list of covered and excluded services; any
requirement for prior authorization of post-treatment review requirements that
may lead the patient to be denied coverage for a particular service; any financial
arrangements between the plan and its panel of providers that would limit the
services offered; and financial information on the amount of premium dollars the
plan actually spent on patient care;
that providers are afforded the right to apply to any plan and to have that
application approved if it comports with provider developed objective criteria
based upon professional qualifications, competence and quality of care, and if not
approved, that plans disclose to the provider the reason for such denial;
the establishment of appeals mechanisms and procedures by which credential
denials or provider terminations can be challenged, including notice of the
underlying complaint, an opportunity to be heard and where the plan seeks to
terminate a provider, an opportunity to complete a corrective action plan;
the adequacy of grievance procedures to address enrollee concerns; the
establishment of safeguards to protect the patient against inappropriate access
limitations including, at a minimum, a requirement that the clinical protocols and
review criteria used by managed care plans in utilization review be developed by
qualified providers and be consistent with recognized professional standards of
care.
NB:
(Excerpts from Report of the Division of Governmental Affairs entitled “Medical
Society of the State of New York Position Paper on Mandatory Medicaid Managed
Care Proposal [S.1805/A.3105] and DOH/DSS Waiver Concept Paper,”; Full Report
on file at MSSNY Headquarters - Council March 9, 1995.)
170.999
HIV Care in Mandatory Medicaid Managed Care: It is MSSNY’s position that the
provision of HIV care must be accessible, cost effective and of high quality. Managed
care plans should include health care delivery that is fair, appropriate, and encompass
negotiable payment modalities and rates inclusive of capitation, partial capitation, and
fee-for-service. Flexibility is important as New York State moves to a new style of
HIV care delivery and finance. Full capitation may not apply to all community
providers of HIV care. There is no question that HIV care can be cost effective
without sacrificing access or quality. The AIDS Institute’s preferred provider network
has laid the necessary infrastructure over the past 10 years to move to a managed care
model for HIV care. The most logical next steps involve maximizing the potential of
this network and developing the model to meet the intent of the State’s managed care
initiative.
This should be achievable by: (a) A transition period to determine appropriate
capitation rates. (b) Studying full, partial and other fee arrangements. (c) Utilizing
the components of the AIDS Institute’s ambulatory HIV provider network to ensure
access, quality, and cost effectiveness.
MSSNY believes that managed care organizations providing HIV care need to be held
to the same standards as the current HIV provider network that has been developed
over the past 10 years by the AIDS Institute. (Excerpts from “Response to Managed
Care Concept Paper” written by William M. Valenti, MD in response to the concept
paper describing NYS Section 1115 Waiver application to restructure the current NYS
Medicaid program.) (Full report on File at MSSNY Headquarters - Council March 9,
1995.)
139
175.000
MEDICAID:
(See also Drugs and Medications, 75.000; Health Insurance Coverage, 120.000, Medicare, 195.000;
Professional Medical Conduct, 250.000; Reimbursement, 265.000)
175.979
Consequences of Involuntary Termination of Medicaid Participation: MSSNY to
work with the New York State Office of Professional Medical Conduct (OPMC), the
New York State Office of Medicaid Inspector General (OMIG), The Joint
Commission, the Healthcare Association of New York State (HANYS) and the
Greater New York Hospital Association (GNYHA) to remedy the situation where
disciplined physicians are allowed by OPMC to retain their medical licenses but are
effectively relieved of any ability to treat their patients because of the regulatory
cascade imposed by OMIG, hospitals and third party payors. (HOD 10-69)
175.980
Physicians as Medicaid Providers While in Supervised Recovery: MSSNY to:
1.
request that the New York State Office of Professional Conduct (OPMC) and
the New York State Office of the Medicaid Inspector General (OMIG) should
work together cooperatively to permit physicians who are participating in a
program of rehabilitation that includes practicing only in a monitored setting to
maintain enrollment as a participating provider in the New York State Medicaid
Program; and
2.
urge the New York State OMIG to recognize the plan of rehabilitation developed by
the OPMC and Committee for Physician Health to permit physicians to return to the
practice of medicine in a monitored setting and reinstate such physicians in the New
York State Medicaid Program. (HOD 09-111)
175.981
Promotion of Cost Savings for New York State: MSSNY to study and explore
ways that physicians can contribute ideas to our elected officials on ways to reduce the
cost of health care to Medicaid without negatively impacting the quality of care or the
physician-patient relationship, and communicate these ideas to its membership and the
State of New York in an effort to help the state reduce its budget deficit. (HOD 09-99)
175.982
Medicaid Utilization Thresholds: MSSNY to draft legislation to eliminate the
necessity for physicians to submit separate utilization threshold requests prior to
billing and attempt to secure sponsors for this legislation in the majority party of each
house of the New York State Legislature and lobby actively to get this legislation
introduced and passed in this legislative session. (HOD 09-98)
175.983
CPT Coding: MSSNY will (a) draft legislation to require that the Medicaid program
limit itself to standard Current Procedural Terminology (CPT) coding and standard
billing forms and will attempt to secure sponsors for this legislation in the majority
party of each house of the New York State Legislature; and (b) actively lobby to get
this legislation introduced and passed in this legislative session. (HOD 09-97)
175.984
Reconsideration of the Current Medicaid Process: MSSNY will contact the newlyelected New York State Governor to: (1) reconsider the hassles associated with the
current process which are impediments to physician participation; and (2) work with
MSSNY in an effort to alleviate these impediments. (Council 1/25/07)
140
175.985
Cost Effective Support for Medicaid Prenatal and Perinatal Services in
Economically Distressed Communities and Hospitals: That the Medical Society of
the State of New York advocate for increased Medicaid rates, including prenatal and
perinatal services that will allow for a sustainable infrastructure in underserved
economically distressed areas. (HOD 06-155)
175.986
Identification of Medicaid Applicants: (Sunsetted HOD 2011)
175.987
Medicaid as a Secondary Payer: MSSNY will work with Medicare and Medicaid to
create an automatic claim crossover system. (HOD 00-284; Reaffirmed HOD 09-101)
175.988
New York State Department of Health Office of Medicaid Management Medicaid
Fee Increase: MSSNY and all of its component county medical societies will work
together to affect ongoing changes in Medicaid fee schedules to make it a program
more attractive to physicians, ultimately improving patient care. (HOD 00-64;
Reaffirmed Council 6/3/04)
175.989
Expanding Scope of Commission on Medicaid: MSSNY will urge widening the
scope of the proposed Commission on Medicaid to include general issues of health
expenses in New York State. (HOD 00-52)
175.990
Standing Orders: Since (a) the Medicaid Program does not currently recognize a
standing orders protocol which is widely accepted by other insurers and (b) it becomes
inefficient and burdensome for physicians to provide original signatures on all
laboratory test requisitions, MSSNY will urge the Office of Medicaid Management of
the NYS Department of Health to:
•
Eliminate the requirement for original physician signatures, except the first
signature, on each laboratory test requisition and allow standing orders for such
tests involving chronic patient conditions (which may include, but not be limited
to, diabetes (Glucose, Hemoglobin A1C/Glycohemoglobin), chemotherapy (CBC,
Platelets), heart conditions (Prothrombin Time, Digoxin) substance abuse
monitoring by a licensed treatment facility, any other condition deemed chronic in
the reasonable judgment of a physician, etc.);
•
Allow the initial standing order containing an original physician signature to be
valid for up to six months, after which time it must be renewed;
•
Enable physicians to designate staff members to sign the laboratory test
requisitions on their behalf so long as the physicians formally acknowledge
ultimate responsibility for the ordered tests;
•
Develop a similar protocol for electronically ordered laboratory tests
•
Interact the MSSNY, the Advisor on Practice Parameters Partnership and the
NYS Clinical Laboratory Association (NYSCLA) to develop a listing of
acceptable chronic conditions for the application of standing orders;
•
Interact with MSSNY and NYSCLA to develop an appropriate mechanism for the
implementation of a standing orders protocol for laboratory test requisitions.
(Council 2/4/98)
141
175.991
Public Health Mandate Funding: Fee schedules for immunizations under public
funding mechanisms such as Medicaid should be modified to include additional
reimbursement to help defray physicians’ expenditures for compliance with State and
City mandates which increase physicians’ operating costs. (HOD 97-268)
175.992
Site of Service Differential Payment Policy: MSSNY reaffirms its position calling
for the elimination of the highly objectionable Medicaid site of service differential
payment policy for similar services provided in physicians’ offices as compared to
hospital settings; particularly as the state-proposed Medicaid Managed Care
Demonstration unfolds. (Council 12/19/96)
175.993
Nine-Tier Reimbursement Structure for HIV Care: MSSNY endorses the NineTier structure for HIV Care under Medicaid which will result in a more consistent and
realistic reimbursement structure for the care needs of patients with HIV/AIDS.
(Council 12/19/96)
175.994
Emergency Care Exemption Under a Regionalized System: MSSNY takes the
position that managed care organizations should make an exception for emergency
medical situations covered under the regional system of emergency care and strongly
opposes any attempt to delay or deny payment for medically necessary emergency
services in a regionalized facility that may not be part of the managed care network of
approved hospitals. (Council 6/2/94)
175.995
Funding for Medicaid Services: MSSNY has urged the Governor of the State of
New York not to impose co-payments on Medicaid services, including nursing and
therapy visits, paraprofessional services, prescriptions, and clinic visits. In addition,
MSSNY has urged the Governor to: (1) Retain the existing Medicaid personal care
program; (2) Retain Medicaid payments to hospitals for patients receiving alternative
level of care services; and (3) Not to freeze Medicaid reimbursement rates for home
health care providers. (HOD 93-106)
175.996
“Pill Mill” Centers: MSSNY is seeking regulatory or statutory reform mandating
that physicians affiliated with Medicaid “Pill Mill” Centers where there is undisputed
evidence of Medicaid abuse be subject to an expedited license review and suspension
as may be required by the appropriate agencies. MSSNY is seeking to ensure that
suspension of any physician’s license be based on direct and verifiable identification
of the clinic(s) in question by the appropriate enforcement and investigative agencies
and established community organizations, and not solely upon indirect and tangential
criteria. Such unacceptable criteria would include, but not be limited to, Medical
Management Information Services (MIS) computerized billing records or superficial
and unreliable “spot check” site visits productive of only anecdotal and ultimately
inadmissible evidence as gathered by the funding agency of the Medical Assistance
Program. (Council 1/19/92)
175.997
Utilization and Audits: MSSNY is working with the New York State Department of
Social Services and the New York State Department of Health to establish protocols
against inappropriate utilization of Medicaid services and commensurate expenditures
and to address the needs for: (1) Clear utilization of services parameters for
dissemination to the physician community to guide physicians in the provision of
health care under the Medical Assistance Program; (2) Development of more
palatable and equitable methodologies to ensure appropriateness in audit investigations
142
through mutually agreeable physician peer review activities and any disputes arising
from such a peer review process. (Council 12/19/92)
175.998
Fraud and Abuse Audit Control Activities: MSSNY is cognizant of the realities
surrounding health insurance audit and utilization review activities to ensure justifiable
expenditures of private or public funds for claimed medical services. The Society is,
nevertheless, deeply concerned by reports of inappropriate and inequitable Medicaid
fraud and abuse investigations in New York State.
MSSNY asserts that any such fraud and abuse investigations motivated by established
recoupment targets and bonus incentives by investigating state and federal entities is
highly unethical, immoral, and contrary to the principles of fairness that are inherent in
the American administrative and judicial system, and that have come to be rightfully
expected by the medical community and the public at large. In acknowledging that not
all individuals seek to fulfill the highest aspirations of their particular professions,
MSSNY believes that any such individuals in medical practice who subscribe to
substandard principles of medicine and ethics in interacting with health insurance
programs should be treated accordingly. However, since MSSNY is confident that
such practitioners comprise a decided minority of the state’s medical community, the
Society logically expects the New York State Department of Social Services
(NYSDSS) Fraud and Abuse/Audit Control Divisions, the New York State Attorney
General’s Office, and the Office of the Inspector General to conduct legitimate
Medicaid fraud and abuse investigation in an ethical and moral manner that ensures:
(1) Equitable and meaningful due process for those medical professionals whose
services are under review or investigation; (2) Appropriate classification of Medicaid
audits so that cases basically involving the following are not unduly labeled as
fraudulent activities and, thus, pursued accordingly: (a) Lack of adequate
documentation of services; (b) Simple billing irregularities; or (c) Other billing
errors (3) Physician safeguards against occurrences of unwarranted prosecutions by
investigating agencies through: (a) Utilization of medical experts to corroborate
substandard medical practices and justify Medicaid investigations; (b) Provision of
pertinent guidelines to physicians for proper conformance with Medicaid
requirements; (4) Retention of sufficient physician participation in the Medicaid
program to guarantee access to quality health care for medically needy recipient (5)
Physician immunity against harassment and victimization by overzealous reviewers to
the detriment of their well-being, community standing, and professional careers; with
such reviewers being answerable for their unwarranted actions; (6) Physician
immunity against undue harassment and pursuit by reviewers on the basis of state
budgetary constraints or bureaucratically devised recoupment targets and bonus plan
incentives; (7) Physician entitlement to reasonable compensation by the investigating
state or federal agencies for legal costs incurred by exonerated practitioners for
compelled involvement in arbitrary fraud and abuse or audit control activities. In
summary, it is the position of the Medical Society of the State of New York that no
medical practitioner in the State of New York be subjected to the traumatic,
intimidating and career-threatening activities of state and federal agencies, or any
other health insurance entities, unless there is absolute and unimpeachable evidence of
serious wrongdoing to warrant such focused pursuit. (Council 1/31/91)
175.999
Medicaid - Title XIX Recipients: The position of the Medical Society of the State of
New York is that all Title XIX (Medicaid) recipients must have equal access to highquality health care along with freedom of choice as to the source from which they
143
receive such care. This quality care should be delivered in an efficient manner by
appropriately recognized and varying alternative mechanisms of medical care delivery.
Reimbursement for medical service rendered to Title XIX (Medicaid) patients must be
based on a realistic fee pattern, in keeping with current economic realities and with the
physician mode of practice. Such fee patterns must be subject to periodic adjustments
in the same manner as are all other recognized alternative mechanisms of medical care
delivery. Further, there should be a: (1) Return of Medicaid patients to the offices of
practicing physicians by revising the New York State Medicaid fee schedule to
provide usual and customary fees, or to implement a realistically higher fixed fee
schedule. (2) Well developed peer review system, administered by physicians at the
local level and providing for an adequate appeals mechanism through physician
ombudsmen. (3) Development of a program that would provide incentives to
physicians for locating in undeserved areas. (4) Unification of administrative and
fiscal Medicaid responsibilities within a single Department at the State level.
(Council 4/22/82; Reaffirmed Council 6/3/04)
180.000
MEDICAL DATA:
(See also Acquired Immunodeficiency Syndrome (AIDS), 15.000)
180.984
Privacy in Electronic Health Records: MSSNY endorses the recommendations of
the Tiger Team of the National Health Information Policy Committee and supports
their implementation by the State Department of Health, the New York
eHealthCollaborative and all health information exchanges operating in the State of
New York. (HOD 11-100)
180.985
Insurance Company Requests for Medical Records: MSSNY will:
A. seek legislation/regulation which requires that when insurance carriers request
copies of medical records:
1)
They allow at least 30 days for physicians to forward the records to the
requestor;
2)
There be a clear identification as to the reason for requesting the medical
records;
3)
Physicians be notified as to the outcome of the medical record review;
4)
A reasonable cap be placed on the number of records an insurance carrier
can request per patient;
5)
They follow the guidelines of the Recovery Audit Contractors (RACs)
Summary of Additional Documentation Limits as listed below:
Sole Practitioner: 10 medical records per 45 days per NPI
Partnership (2-5 individuals): 20 medical records per 45 days per NPI
Group (6-15 individuals): 30 medical records per 45 days per NPI
Large Group (16+ individuals): 50 medical records per 45 days per NPI;
6)
Requiring the managed care organization to render, in advance, a per-page
fee, pursuant to Public Health Law Section 18.
B. reaffirm and actively pursue legislation in accordance with MSSNY Policies
180.988, 180.989, 180.992, 180.995.
C. ensure that the drafted legislation include language that clarifies the physician’s
ability to charge and collect for any/all postage costs. (HOD 10-257)
144
180.986
Methodology for Efficiency/Quality Indicator Data Collection and Analysis:
MSSNY to seek legislation and/or regulation that (1) permits patient data to be
excluded from calculations utilized to develop physician profiles where medical
advice and patient noncompliance are clearly documented, and such noncompliance
has an adverse effect on a physician’s “quality,” “efficiency” and/or other similar
rating; and (2) limits physician profiling data to the time period that the doctor-patient
relationship existed. (HOD 10-94)
180.987
Social Security Form Completion: MSSNY to seek legislation that increases the
cost of completing this form to an inflation adjusted rate. (HOD 08-259)
180.988
Charges for Copies of Medical Records: MSSNY seek changes in state law to allow
physicians to charge $2 per page for the first 15 pages and $1 per page thereafter, for
photocopies of records requested for purposes unrelated to ongoing patient care and to
allow other charges for mailing costs. (HOD 03-59; Reaffirmed HOD 10-257)
180.989
Realistic Time Frame to Comply with Requests for the Release of Medical
Records: In an attempt to minimize any accusations for professional misconduct for
failure to comply within a reasonable period of time, with requests for copies of
medical records, MSSNY will aggressively pursue modification to Section 18 of the
New York State Public Health Law which would redefine the “reasonable period of
time” which physicians have to comply with requests for copies of medical records
from its current definition of 10 days to a more realistic 30 days. (HOD 02-55;
Reaffirmed HOD 10-257)
180.990
FBI Raids: MSSNY will take all necessary steps to ensure that government
investigators not be permitted to remove records of patients from a physician’s office
without copies being made prior to removal.
MSSNY’s position is that if patient records are seized and there is no provision made
for copying of records at Government expense, copies must be made on side and left
for the affected practitioners’ use in ongoing care of their patients.
State and Federal legislation must be sought which would provide immunity for
physicians from any physicians from any suit or administrative proceedings where it
can be shown that absence of the patient records contributed to an alleged negligent
act or where the patient records seized contain information relevant to defending
against an alleged negligent act.
MSSNY will seek passage of State and Federal legislation that would ensure that FBI
investigations regarding physicians should be done in a matter that is sensitive to the
health of patients and the viability of the medical practice under investigation, and that
physicians not be required to pay any fees to receive copies of their patient records
which have been seized by the FBI. (HOD 00-73)
180.991
Privacy and Confidentiality: MSSNY will seek legislative/regulatory relief to
prevent insurance companies and other managed care organizations from selling,
trading, transmitting, or in any way communicating, individually identifiable health
information to third parties. Such legislative/regulatory relief should include a
provision that patients be permitted to opt to provide individually identifiable
information to third parties. (HOD 00-69)
145
180.992
Increase Fees for Medical Records Reproduction: MSSNY will seek legislation to
a) increase the amount annually by the previous year’s Consumer Price Index (CPI)
that physicians can charge to reproduce copies of medical records in order to reflect
inflation and the higher cost of living endured by physicians in New York; and b) to
allow physicians to charge a search and retrieval fee of $15.00 plus $1.00 per page and
that both fees be increased annually by an amount equal to the previous year’s CPI.
(HOD 00-53; Reaffirmed HOD 05-86; Reaffirmed HOD 10-257)
180.993
Privacy of Medical Records: It is MSSNY position that any proposed legislation
should include:
1.
2.
3.
4.
5.
Universal protection against pressuring physicians to re-release patient data to
outside sources (i.e., in order to obtain medical insurance).
Civil and criminal penalties for individuals who violate the universal non-release
policy.
Restrictions on the selling of physician prescription patterns to the
pharmaceutical industry.
Requirements that informed consent be obtained from each individual
participant in a medical insurance plan regarding release of patient information
to third parties.
Universal protection against the release of patient data to any law enforcement
agency unless required by a court order. (Council 3/18/99)
180.994
Confidentiality of Patient and Physician Data: MSSNY will continue to take
whatever measures appropriate to discourage insurance companies and other health
care agencies from publishing social security numbers and tax identification numbers
whether it is stored, transmitted, or disposed of, in paper, electronic, or other media,
and will become a strong proponent in efforts that may be underway to protect the
confidentiality of patient and physician information whether it is stored, transmitted, or
disposed of, in paper, electronic, or other media. (HOD 98-88)
180.995
Compensation for Providing a Patient’s Medical Record: MSSNY will seek
legislation to amend the New York State Public Health Law 17 and 18 to include
language that would call for a charge of $1.00 per page for copies of patient
information requested by a patient for use to facilitate the patient’s health care; and
such legislation should include a provision that when copies are requested by other
parties or for other purposes, the provider may impose a fee of up to $50.00 for search
and retrieval, one dollar per page for paper copies, and two dollars per page for
microfilm copies. (HOD 98-66; Reaffirmed HOD 10-257)
180.996
Access to Medical Records by Insurance Companies: MSSNY strongly supports
the option to allowing physicians to provide insurance companies with medical history
summaries of prospective subscribers instead of actual copies of medical records in
response to request for medical information. (HOD 97-76)
180.997
Privacy of Medical Records: MSSNY supports the enactment of legislation to
preserve patient privacy that includes the following: (1) that HMOs as well as other
financial or insurance organizations obtaining medical information preserve this
information in such a manner that only personnel under the authority of a physician
(MD or DO) have the right to peruse the medical information and that records be kept
of those who do access any medical records indicating the purpose for which it was
146
accessed and the person, time and date when it was accessed. (2) that consent for
release of information be limited to particular purposes. (3) that information used to
determine medical necessity for payment be covered by the rules established above.
This would ensure that decisions regarding such necessity for payment would be
subject only to medical rather than lay review. (4) that penalties established as a
result of these evaluations be assessed in terms of gross revenues to prevent the larger
entities from being able to violate the rules since the penalties might not affect them in
any significant degree. (5) that repeated violations could result in loss of ability to
conduct business in the health care field. (6) that violations by the supervising
medical personnel be subject to professional sanctions and that repeated violations by
personnel being supervised who disregard their organization’s and supervisor’s rules
regarding confidentiality be subject to criminal as well as civil penalties.
(Council 10/24/96)
180.998
Medical Data Confidentiality: MSSNY formally recognizes the importance of
safeguarding the confidentiality of patients’ records and, to this end, strongly supports
appropriate legislation to protect this confidentiality regardless of form (paper,
electronic, etc.) and prevent unauthorized persons from having access to sensitive,
personally identifiable health data. (HOD 96-51; Reaffirmed HOD 10-257)
180.999
Amendment of NYS Public Health Law 17 and 18: In order to adequately
compensate a provider relative to the office time and resources expended for retrieval,
inspection, copying and delivery of a patient’s medical records, MSSNY will seek
legislation to amend Section 18 of the Public Health Law accordingly.
(HOD 96-91; Reaffirmed HOD 97-65; Reaffirmed HOD 10-95; Reaffirmed HOD
11-118)
185.000
MEDICAL EXAMINER SYSTEM:
185.997
Recognition of Autopsies as an Educational Tool: That, because autopsies are
valuable, indicated, necessary and in the public interest, MSNNY take the position that
autopsies be encouraged for use as an educational tool; that treating physicians be
notified of their patients’ autopsy results; and trained in the communication skills
necessary to effectively obtain autopsy consent. (HOD 06-154)
185.998
Autopsies Performed by Medical Examiner: MSSNY will seek appropriate
changes in New York State legislation and/or regulations to mandate the Coroner or
Medical Examiner to release a copy of his autopsy findings to the attending physician
and/or the hospital QA Committee in which the patient has expired. (HOD 95-105;
Reaffirmed HOD 99-82)
185.999
Forensic Medicine: MSSNY believes that the Medical Examiners System should be
extended on a regional basis throughout the State to augment and direct any existing
Coroner Systems and that the Medical Examiner’s Office should be an entirely
independent unit of government with a direct line of responsibility to the chief
executive officer of the jurisdiction who should not delegate his responsibility to the
appointee of another agency. Any funding for Medical Examiners’ Offices available
from the State should be paid to the city or county government and dedicated for the
Medical Examiner’s Office and not diverted to other agencies’ non-related needs.
(HOD 1980; Amended Council 12/19/91)
147
190.000
MEDICAL MALPRACTICE PANELS:
190.883
Lawsuit Against Expert Witness: MSSNY to inform its membership of
developments regarding legal actions brought by physicians against expert witnesses
who have provided scientifically unsupportable testimony. (HOD 10-70)
190.994
Expert Witness Testimony in Medical Liability Cases: That MSSNY develop
educational resources which will assist physicians and specialty societies in learning
about and recognizing the potential professional misconduct ramifications in providing
inaccurate, scientifically unsupportable testimony while acting in the capacity of an
expert witness in medical liability cases; and that MSSNY seek legislation to create a
new category of professional misconduct for physicians who provide scientifically
unsupportable expert witness testimony. (HOD 06-58)
190.995
Certifying Doctors for Malpractice Lawsuits: That MSSNY adopt policy that a
physician who provides certification to a malpractice lawsuit in a certificate of merit
should be board certified in the same specialty in the field called into question and
licensed to practice in New York State; that a physician who provides certification to a
malpractice lawsuit be required to sign a formal certification statement, and that their
identity and credentials be clearly noted on this statement; and that these certifying
statements be provided to the Court and to the physician who is sued so they can be
verified. (HOD 05-95)
190.996
Amendments to the “Certificate of Merit” in Medical Liability Cases: MSSNY
will seek legislation which would provide that physicians who provide consultation to
attorneys for purposes of executing the certificate of merit required in medical
malpractice actions (CPLR, Section 3012-a) and who routinely, arbitrarily and falsely
assert that a basis for such medical malpractice actions exist, shall be guilty of
unprofessional conduct and shall be subject to all appropriate disciplinary penalties
pursuant to the Public Health Law. (HOD 99-86)
190.997
Expert Witness Disclosure: MSSNY supports legislation which would require the
disclosure and pre-trial deposition of expert witnesses in medical liability cases.
(HOD 98-85)
190.998
Certificate of Merit in Liability Cases: It is MSSNY’s position that (a) a plaintiff’s
attorney, when initiating a medial liability action, certify that he or she has consulted
with a physician licensed to practice in New York State who has reviewed the relevant
medical records, and that said physician is of the opinion that there were departures
from good medical practice that caused injury to the patient; (b) that it is solely the
responsibility of the plaintiff’s attorney to select the physician consultant
commensurate with the above requirements; and (c) that the name of the consulting
physician be made available. (HOD 98-73)
190.999
Reinstatement of Panel System: MSSNY will seek the reinstatement of the medical
malpractice panel system which was eliminated in the 1991 legislative session.
(1992 State Legislation Program)
195.000
MEDICARE:
(See also Drug Dispensing, 70.000; Drugs and Medications, 75.000; Health Insurance Coverage,
120.000; Health System Reform, 130.000; Medicaid, 175.000; Peer Review, 225.000)
148
195.942
Procedures Where MACs Notify Physicians: MSSNY will petition the Centers for
Medicare & Medicaid Services to allow and appropriately budget Medicare
Administrative Contractors (MACs) to expand their electronic mail notification
procedures to include personalized e-mail alerts to physician practices that are
candidates for Revalidation of their Enrollment information, so as to substantially
decrease the volume of telephone calls and correspondence to the MAC service areas
and help preclude the unnecessary revocation of physicians’ Medicare billing
privileges. (HOD 11-258)
195.943
The Need for a Resource Explaining Medicare Remittance Denials: MSSNY to
work with National Government Services (NGS) Medicare to compile a user friendly
document that will aid physicians in rectifying disputed claims. (HOD 11-257)
195.944
Reprocessing Claims Affected by the Patient Protection and Affordable Care Act
and by 2010 Medicare Physician Fee Schedule Changes: MSSNY to urge the
Centers for Medicare and Medicaid (CMS) to continue to automatically adjudicate any
and all claims that were inappropriately recompensed due to the significant tweaking
of the Medicare Physician Fee Schedule during the first five (5) months of 2010.
Also, the NY Delegation will ask the American Medical Association at its Annual
Meeting to urge CMS to automatically adjudicate Medicare claims similarly situated
on a nationwide basis. (HOD 11-256)
195.945
NGS Systems Issues: MSSNY to warn the Centers for Medicare & Medicaid Services
(CMS) that in increasing instances, claims processed by the Multi-Carrier System are
being denied, suspended or otherwise not paid due to technical errors by the System (e.g.,
the System may fail to properly read appropriate ICD-9 diagnosis codes, or may fail to
calculate appropriate time frames for frequency screens), which have nothing to do with
the way the physician submitted the claim. Also, MSSNY will petition CMS to set up a
dedicated unit or contact at the Multi-Carrier System site, to respond to reports from the
county and state medical societies and the specialty societies about erroneous claim denials
due to technical errors by the System, and to quickly resolve these error reports.
(HOD 11-255)
195.946
Provider Enrollment Chain Ownership System (PECOS) Penalty Phase: MSSNY
will continue to urge the Centers for Medicare and Medicaid Services (CMS) to
postpone the initiation of any penalty phase regarding PECOS enrollment until such
time as the Medicare contractors no longer have a backlog in their processing of the
enrollment applications. (HOD 11-254)
195.947
National Government Services Should Re-oen Its Local Coverage Determinations
Web Page: MSSNY to urge the Centers for Medicare and Medicaid Services to
reestablish and fund the Local Coverage Determinations (LCDs) web page at the local
Medicare Administrative Contractor (MAC) level and continue to work toward a more
user-friendly and accessible LCD online resource. (HOD 10-254)
195.948
Reform of the Medicare Geographic Practice Cost Index (GPCI) System:
MSSNY to: (1) advocate with the Centers for Medicare and Medicaid Services (CMS)
and with the New York State Congressional Delegation for increases in physician fees
in the Upstate New York Medicare Physician GPCI system that will benefit the
communities and physicians of Upstate New York without adversely impacting other
areas of the state; (2) have its President appoint a committee to study and report on
149
reform options for the Medicare Physician GPCI system that will not have an adverse
impact on other areas of the state; and (3) continue advocating to the New York
Congressional Delegation for elimination of the flawed Sustainable Growth Rate
(SGR) methodology and for a meaningful increase in Medicare reimbursement that is
consistent with increases in practice cost. (HOD 10-50)
195.949
National Government Services: MSSNY to: (1) work with National Government
Services (NGS) to find and identify which physician practices continue to bill NGS via
paper claims; (2) 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 9/17/09)
195.950
National Government Services: MSSNY will:
a) continue to interact with National Government Services (NGS), while continuing
to apprise the Centers for Medicare & Medicaid Services (CMS), the American
Medical Association (AMA) and federal legislative officials regarding intolerable
denials and delays in physician payments;
b) urge CMS to provide fiscal support to NGS enabling NGS to have staff review
paper claims rejected by the optical scanner and make appropriate improvements,
to eliminate many of the denied claims;
c) seek federal legislation to require that interest payment on Medicare physician
claims be based upon 100% of the Medicare allowed amount since delays in
payment adversely impact the collection of coinsurance;
d) seek federal legislation which would impose a monetary penalty upon Medicare
carriers, in addition to the interest payments, for failure to process and pay claims
consistent with the current Medicare payment floors (13 days for electronic
submission and 29 for paper claims);
e) transmit a similar resolution to the American Medical Association seeking passage
of federal regulation and/or legislation to accomplish the sentiments expressed in
this resolution;
f) take any action necessary - legal, regulatory, or litigation - to rectify the intolerable
delays in physician payments due to National Government Services (NGS) denials
and delays;
g) contact other state societies serviced by NGS to explore working jointly with them
to resolve problems with NGS;
h) seek from CMS a requirement that NGS provide a service representative that has
the authority to adjudicate claims and can be contacted by telephone for every
physician that submits claims (either paper or electronically); and
i) request that a person, committee or mechanism be set up to oversee the operation
of the NGS and that the continuation of the NGS contract be reviewed periodically
and predicated upon the quality or effectiveness of NGS operation. (HOD 09-255)
195.951
Medicare Claims Processing Problems Under National Government Services:
150
MSSNY to educate its members about Medicare’s Advance Payment process,
including submission requirements, restrictions and offset procedures that will affect
future Medicare payments made when all corrections have been addressed and will
work with the Centers for Medicare & Medicaid Services to improve patient access
problems created for Medicare beneficiaries by reducing this and many other
operational problems created for Medicare physicians. (HOD 09-254)
195.952
Medicare Physician Payments: MSSNY to ask the American Medical Association
to interact with the Centers for Medicare & Medicaid Services (CMS) to ensure that
any plan that CMS contracts with to provide a Medicare Advantage product be
mandated to adhere to Medicare’s National Coverage Determinations (NCDs) and
Local Coverage Determinations for their service areas. (HOD 09-253)
195.953
Internet-Based Instant Messaging Program for Medicare Customer Care Contact
Centers: MSSNY to:
ƒ
urge the Centers for Medicare & Medicaid Services (CMS) to allocate a
budget item allowing National Government Services (NGS - the Medicare
Administrative Contractor for New York) to provide, through the NGS
Customer Care Contact Center, an Internet-based instant messaging or live
chat feature that would enable physicians to communicate with NGS in real
time;
ƒ
stress to CMS that such a service would help physicians discuss and resolve
critical questions related to claims processing, education, and other pressing
issues;
ƒ
alert CMS and NGS to the existing precedent, namely, the “Live Chat” system
now used by Empire Blue Cross Blue Shield/Wellpoint; and
ƒ
urge NGS to work with Empire to implement a similar system. (HOD 09-252)
195.954
On-Site PC-ACE and Electronic Claims Training for Physicians: MSSNY to
petition the Centers for Medicare & Medicaid Services (CMS) and National
Government Services (NGS) to identify and contact paper-claim submitters who might
benefit from submitting claims electronically, using such software as Medicare’s PCACE Pro-32 package. Also, MSSNY to urge CMS to include in its NGS budget a
separate item for the development and implementation of a PC-ACE Pro-32 training
program, to be provided on-site (in physicians’ offices), whereby physicians and their
staff could learn to submit their claims electronically via the PC-ACE software.
(HOD 09-251)
195.955
Issues Handled by Medicare Telephone Reopening Units: MSSNY to assist
National Government Services (NGS) with the communication to MSSNY’s
membership via the News of New York, the EVPgram, and the MSSNY website about
the formal list of specific issues that can and cannot be reopened via the Medicare
Administrative Contractor’s (MAC) telephone reopening unit (TRU). (HOD 09-250)
195.956
Medicare Contractor-Based PQRI: MSSNY urge the Centers for Medicare &
Medicaid Services (CMS) to (a) intensify its Physician Quality Reporting Initiative
(PQRI) training efforts via sessions at the Medicare Administrative Contractor (MAC)
level, rather than via national conference calls at the CMS level; (b) require the MACs
151
to set up specialty-specific seminars, addressing the PQRI measures that are unique to
each specialty area; and (c) integrate a mechanism to provide timely feedback during
the course of the reporting year to physicians. (HOD 09-96)
195.957
Centers for Medicare and Medicaid Services’ Deadlines for Implementation of
Changes, e.g. National Provider Identifier: MSSNY submit a formal protest to the
Centers for Medicare and Medicaid Services (CMS) urging CMS not to commit to
hard deadlines for changes to be implemented; rather CMS should work toward a
transition that does not adversely impact physician cash flow caused by systems
problems that result in denied/rejected claims. (Council 3/03/08)
195.958
Support for Critical Opposition to the Impending Medicare Fee Reduction:
MSSNY, in partnership with the American Medical Association, to emergently and
aggressively advocate to eliminate the current 10.6% reduction in Medicare scheduled
payments for July 1, 2008, with a remedy similar to that proposed in Senator
Stabenow’s Senate Bill S2785, as well as to lobby Congress for reform of the SGR
formula to reflect the true cost of the delivery of quality patient care. (HOD 08-266)
195.959
Home Infusion of Antibiotics: MSSNY to ask the American Medical Association to
work with the Centers for Medicare and Medicaid Services (CMS) to develop a
coordinated system among the various Medicare plans to ensure an expedited,
seamless process for provision of home infusion of antibiotics to reduce the need of
the patient to remain in the hospital unnecessarily. (HOD 08-254)
195.960
Medicare Private Contracting Opt-Out Renewal Requirement: MSSNY to
request that the American Medical Association draft legislation to amend Section 1802
of the Social Security Act, as amended by Section 4507 of the Balanced Budget Act of
1997 as it relates to Private Contracting under Medicare, to rescind the two-year optout renewal requirement for private contracts between physicians and Medicare
beneficiaries. Also, the language in this proposed amendment would provide that
private contracts will be deemed to remain in effect indefinitely unless and until the
physician rescinds the private contracts and rejoins the Medicare Program.
(HOD 08-253)
195.961
Medicare Carrier Processing of Claims Involving Retired, Archived, or End
Dated Local Coverage Determinations: MSSNY will:
ƒ seek formal written clarification from the Centers for Medicare & Medicaid
Services (CMS) regarding the CMS policy on local coverage determinations
(LCDs) that have been retired, archived or end dated;
ƒ seek clarification of CMS’s routine statement regarding particular LCDs that have
been retired, archived or end dated, in which CMS states, (1) all local policy rules,
requirements and limitations within these LCDs will no longer be applied on a
prepay basis but, as with any billed service, will be subject to post pay review, and
(2) all Centers for Medicare & Medicaid Services national policy rules,
requirements and limitations remain in effect;
ƒ seek CMS’s confirmation that the above statement means that claims involving
already retired LCDs should go through to payment when they are initially
submitted (prepay); and
ƒ request that CMS require Medicare carriers to issue formal instructions to
physicians regarding CMS’s policy regarding the payment of claims involving
LCDs that have been retired, archived or end dated. (HOD 08-252)
152
195.962
Undue and Burdensome Regulations Inflicted by Medicare Part D Pharmacy
Benefit Plans: MSSNY to work with the Medicare Part D pharmacy benefit plans to
(1) devise and expedite a process so that physicians may, in the proper practice of
medicine, prescribe for doses and durations that are in the best interest of their patients
and supported by the medical literature; and (2) allow patients who demonstrate
significant therapeutic benefit and stability on their current therapeutic regimes to
continue such regimes as a covered benefit under their current Medicare Part D carrier
without interference or interruption. (HOD 08-251)
195.963
Difficulty Filing Medicare Claims: MSSNY to urge the American Medical
Association to work with the Centers for Medicare & Medicaid Services (CMS)
toward achieving an orderly transition to the National Provider Identifier number that
does not adversely affect physician cash flow by asking CMS to provide claims
adjudication services that are more physician-friendly and more open to
communication to physicians and carriers. (HOD 08-250)
195.964
Consumer Rights for Durable Medical Equipment: MSSNY to request that the
American Medical Association conduct a study regarding greater transparency and
increased choices to patients in meeting their durable medical equipment needs.
(HOD 08-163)
195.965
Deadlines for Implementation of Changes: MSSNY to submit a formal protest to
the Centers for Medicare and Medicaid Services (CMS) urging CMS not to commit to
hard deadlines for changes to be implemented; rather CMS should work toward a
transition that does not adversely impact physician cash flow caused by systems
problems that result in denied/rejected claims. (Council 3/3/08)
195.966
Interaction by the Medicare Part D Carriers with the Physician Community re
Drug Dosages: MSSNY to:
(1) advise the Regional Office of the Centers for Medicare and Medicaid Services
(CMS) that physicians are very concerned with the manner in which the
Medicare Part D carriers are interacting with the physician community regarding
drug dosages. Physicians find utilization review activities that demand the
completion of cumbersome forms and submission of chart notes unwarranted and
believe that these activities interfere with the practice of medicine; and
(2) urge the CMS Regional Office to re-evaluate the manner in which their Medicare
Part D carriers interact with the physician community and instruct their Medicare
Part D carriers that the dosage levels provided to the geriatric community for a
variety of prescribed drugs often differ from the standard of FDA approved
indications and/or therapeutic dosages. (Council 3/3/08)
195.967
Postponement of National Provider Identifier (NPI) Implementation Date: In
view of the Centers for Medicare & Medicaid Services (CMS) failure to appropriately
address data dissemination concerns relating to the security and protection of
physician issued National Provider Identifier (NPI) numbers, MSSNY to request that
the May 23, 2007 NPI implementation date be postponed, at least until CMS has
appropriately developed and published their Data Dissemination Policy in the Federal
Register. (HOD 07-257)
153
195.968
Medicare Opt Out Physicians and Secondary Insurers: In conjunction with the
New York State Insurance Department, MSSNY to:
(1) draft legislation to develop and implement a mechanism to: a) require secondary
insurers to identify Medicare opt out situations; b) allow physicians and patients
who have executed a Medicare Opt Out agreement (yet still participate with the
secondary private or managed care insurer) to have their claims processed
correctly by making the secondary insurer primary as Medicare is no longer the
primary insurer and no Medicare explanation of benefits exists; and
(2) draft legislation to: a) identify Medicare Opt Out situations; and b) include the
requirement that the secondary insurer access the Medicare fee schedules posted
on the carrier websites in order for the secondary insurer to calculate their
payment responsibility in the event that present insurance law cannot be changed
and the secondary insurer can reduce the benefit paid based on what Medicare
would have covered. (HOD 07-250)
195.969
Herpes Zoster Vaccine and Medicare Payment: MSSNY to encourage Medicare to
pay for the herpes zoster vaccine and the service of providing it. (HOD 07-114)
195.970
Sustainable Growth Rate (SGR): MSSNY continues its aggressive lobbying efforts
to eliminate the flawed Medicare Sustainable Growth Rate (SGR) Formula and replace
it with a system that more appropriately factors the annual increase in practice costs.
(HOD 07-50)
195.971
Holding Medicare Payments: That MSSNY advocate for repeal of Section 5203 of
the Deficit Reduction Act and seek the support of the American Medical Association
to help ensure that our members will not be placed in a financial bind as the result of
this federal provision. (HOD 06-262)
195.972
Recovery Audit Contractor: That MSSNY explore and/or assist its members with
negotiations creating a payment for recognition between themselves and Connolly
Recovery Audit Contractor (RAC) to incentivize the RAC to look for underpayments
whenever a physician is sited for potential overpayment by the RAC throughout the
three years of the CMS demonstration pilot project. (Council 9/22/05)
195.973
Repeal of Section 306 of the Medicare Modernization Act: That MSSNY notify
the three New York State Medicare carriers that it will pursue by any and all means
necessary the repeal of Section 306, which references Medicare’s pilot program
involving Recovery Audit Contractors of the Medicare Modernization Act and that
MSSNY, working with the Florida and California Medical Associations, urge the
American Medical Association to petition Congress to repeal and rescind Section 306
of the Medicare Modernization Act. (Council 3/14/05)
195.974
Medicare MCO’s, CMS Operational Policy Letter #46, and the Proposed
Handover of the Medicare Program to Private and Managed Care Insurers:
MSSNY reaffirm our policy as stated in resolution 2003-272 and gather data to submit
to the Center for Medicare and Medicaid Services (CMS) that documents that
Medicare Managed Care Plans are not following CMS Operational Policy Letter # 46;
and urge that Medicare Managed Care Plans inform their providers and their potential
154
members in writing of any standard Medicare procedures that they will not cover.
(HOD 04-256)
195.975
Medicare and ‘Off-Label’ Uses of Drugs: MSSNY opposes the imposition of any
limitation, including under the new Medicare “Part D” drug benefit, on the “off-label”
prescribing practices of physicians, whether by statute, regulation or operating practice
of any private contractor administering such benefit. (HOD 04-67)
195.976
Low Molecular Weight Heparin: MSSNY will advocate the interpretation of the
BIPA 2000 provision for Medicare coverage of “drugs and biologicals which are not
usually self-administered by the patient” as being inclusive of LMWH used in the
short term outpatient treatment of venous thrombosis.
MSSNY will communicate this request to the New York State Carrier Advisory
Committee.
MSSNY will submit a resolution to the House of Delegates of the American Medical
Association supporting and advocating a directive by the Centers for Medicare and
Medicaid Services to all fiscal intermediaries, mandating the aforementioned
interpretation of BIPA 2000. (HOD 02-272)
195.977
Empire Medicare Services: Physical Medicine and Rehabilitation: MSSNY,
through its Committee on Interspecialty agrees to do the following:
a)
Work with the Medicare Carrier Advisory Committee (CAC) to amend
Medicare’s proposed policy on Physical Medicine and Rehabilitation so that
there is greater practicality to the actual practice of physical therapy and
rehabilitative medicine.
b)
Request that the AMA CPT Editorial Panel revise the direct patient contact
definition so that there is greater practicality to the actual practice of physical
therapy and rehabilitative medicine.
c)
Recommend that the Medicare Carrier Advisory Committee change the Physical
Medicine and Rehabilitation policy to state that all passive procedures (e.g.
manual stretching, etc.) are to be under the direct one to one ratio of care, while
active procedures (e.g. balance training exercises, etc.) may be delivered under
the general supervision guidelines as enumerated in the Federal Register. The
Committee also recommended the use of Procedure Code 97150 in those
instances where the patient is performing active exercises. (Council 7/19/01;
Reaffirmed HOD 2011)
195.978
Removal of Benign Skin Lesions: (Sunsetted HOD 2011)
195.979
The Treatment of Pain: (Sunsetted HOD 2011)
195.980
Prescription Drug Benefit for Seniors: (Sunsetted HOD 2011)
195.981
Expansion of Medicare Coverage for Preventive Services: MSSNY will
recommend to HCFA, Congress and the President that screening for hypertension,
vision and hearing, as well as counseling for tobacco cessation, physical activity and
155
nutrition be included as covered preventive services under Medicare and that
additional federal appropriations be made for these services. (HOD 01-262;
Reaffirmed HOD 2011)
195.982
Elimination of $75.00 Charge for Purchase of Medicare E.D.E.N. Relay/Gold
Software for Electronic Billing: MSSNY will seek legislative or regulatory relief to
ensure that all health plans doing business in the State of New York eliminate any
charges to physicians for software and/or transmission capability in an effort to
encourage electronic claim submissions. (HOD 00-270)
195.983
Medicare “Fraud and Abuse”: MSSNY will urge the appropriate federal and state
agencies to acknowledge that the characterization of any billing errors as “fraud” to be
libelous and offensive.
MSSNY objects to the heavy handed techniques of search and seizure, with guns
drawn and without formal charges levied, as tactics of a totalitarian police state;
MSSNY will demand that Congressional inquiry address these concerns, which give
the perception that the physicians are “GUILTY UNTIL PROVEN INNOCENT,” with
open public hearings at the earliest opportunity.
MSSNY objects to and rejects “statistical analysis” that attempt to claim that a
physician’s billing or practice is aberrant by use of flawed methodologies, and will
advocate to stop the use and extrapolation of this data as “fraud and abuse.
MSSNY will seek legislation, in concert with the AMA, directing the Health Care
Financing Administration (HCFA) to remove the notations of fraud reporting
announcements from all mailings to Medicare beneficiaries in order to prevent erosion
of the physician/patient relationship. (HOD 00-255)
195.984
Proposed CAC Policies: MSSNY will make available on its website for members
only: a) the draft medical policies under consideration by the Medicare Carriers
Advisory Committee (CAC) for review and comments; b) a listing of the CAC
Specialty Society representatives who may be contacted by their colleagues on
proposed CAC medical policies. (Council 5/20/99)
195.985
Repealing Restrictions on Private Medicare Contracting: MSSNY will support
and lobby on behalf of related bills HR 2497 (Representative Archer) and S.1194
(Senator Kyl), which would amend Title XVIII of the Social Security Act to clarify the
right of physicians and other health care providers to enter into private contracts with
Medicare beneficiaries for: a) the provision of health services for which no payment is
sought under the Medicare program; b) the right to privately contract with
beneficiaries without physicians having to opt out of the program for two (2) years.
MSSNY will introduce a resolution to the 1999 Annual Meeting of the AMA House of
Delegates calling for the Association to support and lobby on behalf of related bills
HR 2497 and S.1194. (HOD 99-271)
195.986
System for Checking Eligibility of Patients in Medicare HMOs: MSSNY will urge
HCFA to adopt the procedures of other third-party carriers that do not consider the
release of information that the patient is insured by a particular insurance company as
confidential information and to require Medicare carriers to develop a carrier-level onthe-spot eligibility check system for Medicare beneficiaries. (HOD 98-269)
156
195.987
Opposition To Limitations on Medicare Contracts: MSSNY will support
corrective legislation concerning the Section 4507 of the Balanced Budget Act to
allow Medicare beneficiaries to enter into private contracts for provision of medical
care without any significant preconditions being imposed either on the patient or on
those providing the care. MSSNY will specifically seek to abolish the requirement
that the physicians providing care under a private contract must forego participating in
the Medicare program for two years. (HOD 98-261; Reaffirmed HOD 00-82)
195.988
Comparative Performance Reports (CPRs): MSSNY will urge HCFA Region II,
and call upon the AMA as well, to urge the HCFA Central Office to annually require
the carriers to provide Comparative Performance Reports (CPRs) to all physicians
furnishing Evaluation and Management Services under Medicare. (Council 12/18/97.)
195.989
Physicians’ Appeals of Medicare Hearing: MSSNY will interact with HCFA in
preparing and distributing formal guidelines for carriers and physicians to follow
through the entire Administrative Law Judge Hearing process. These guidelines will
properly identify all the appropriate actions that physicians must take in order to
guarantee their rights of due process and preclude unwarranted and spurious denials of
Administrative Law Judge Hearings based on a physician’s failure to follow
established protocols that have, heretofore, never been formally distributed to the
physicians’ community. (HOD 97-274)
195.990
Patient’s Choice In Continuing a Physician/Patient Relationship: MSSNY will
advocate that all providers of Medicare health care coverage be required to provide
that all Medicare recipients enrolling in an HMO have the name of their physician on
their enrollment form at the time of the enrollment to prevent confusion after the fact;
and that MSSNY similarly advocates that if a patient finds out that his/her physician is
not on the panel of the HMO to which a patient has enrolled that the patient be allowed
to disenroll from the HMO. (HOD 97-272)
195.991
Mandatory Enrollment of Medicare - Medicaid Patients in Managed Care Plans:
MSSNY strongly opposes mandatory enrollment of Medicare-Medicaid patients in
managed care plans, and will actively use any available means to prevent forced
enrollment and will bring this resolution before the next American Medical
Association House of Delegates to be adopted as an official policy of the American
Medical Association. (HOD 97-103)
195.992
Beneficiary Identification System: In view of the current physician inability to
verify beneficiary coverage under a closed-panel physician Medicare Managed Care
Program (MCP), MSSNY takes the position that the Health Care Financing
Administration should be urged to: (1) Establish an expedient beneficiary
identification system via current technological means such as employed by the NYS
Medicaid Program (i.e., the Electronic Medicaid Eligibility Verification System
(EMEVS), featuring “swipe card” technology to verify patients’ Medicaid coverage
under a Managed care system; (2) Require Medicare Managed Care Programs to
provide identification cards designate beneficiary’s coverage under the managed care
plan; (3) Provide a dedicated telephone line to enable physicians to expeditiously
verify beneficiaries’ coverage under a managed care system. (Council 9/7/95;
Reaffirmed HOD 00-272)
157
195.993
Durable Medical Equipment Providers, Prohibition of Solicitation of Patients:
MSSNY reaffirms the concept that physicians are solely responsible for the medical
needs of their patients and should be the initiators of orders for durable medical
equipment supplies. In support of this reaffirmation, MSSNY will seek the
reintroduction, amendment, and enactment of Section 133 of US Senate Bill (S.1668),
to prohibit unsolicited contacts by Durable Medical Equipment suppliers to Medicare
beneficiaries and has sought the support of the American Medical Association for the
enactment of this legislation. (HOD 94-261)
195.994
Electronic Paper Claims: While the Medical Society strongly encourages physician
involvement in the emerging electronic claims transmission initiative, it strongly
supports the prerogative of physicians to choose the most suitable and practical
modality of claims submission for their practices and has urged the AMA to seek
appropriate legislative relief from the unfair and discriminatory federal requirements
mandating Medicare carriers to delay payment of paper claims for at least 27 days.
(HOD 93-2)
195.995
Extrapolation Methodology in Medicare and Medicaid Postpayment Review:
MSSNY is: (1) Petitioning the AMA to urge HCFA to adopt a policy that Medicare
carriers just provide data which justify the statistical validity of their findings when
any extrapolation technique is used in a Medicare post-payment audit and review
process prior to any request for return of monies paid to physicians; (2) Seeking
statutory changes in the Medicare and Medicaid laws to prevent the application of the
extrapolation methodology in order to ensure due process for physicians whose
medical records and billing procedures are under review; (3) Educating physicians in
concert with local county medical societies about the potential abuses by Medicare and
Medicaid administrators in carrying out reviews, and identifying legal resources which
can be called upon by individual physicians for legal assistance and/or defense in cases
of alleged Medicare/Medicaid fraud and abuse or overpayment. (HOD 92-5 & 92-76)
195.996
Medical Necessity Determinations: MSSNY is urging the Health Care Financing
Administration to require Medicare carriers to provide physicians with the name and
phone number of the physician responsible for making a determination as to the
medical necessity in the initial letter of inquiry sent by the carriers.
(Council 9/13/90; Reaffirmed 09-259)
195.997
Fair Hearing: MSSNY is urging the Health Care Financing Administration to
mandate that Medicare carriers utilize as hearing officers only licensed physicians of
the same specialty and in the same geographical area as that of the physician who
requests the Fair Hearing. Prior to the Fair Hearing, the educational and medical
credentials of the Hearing Officers should be made known to the requesting physician.
(Council 9/13/90; Reaffirmed HOD 03-269)
195.998
Mandatory Acceptance of Medicare Assignment as a Condition of
Licensure/Relicensure: MSSNY opposes any legislation that would require, either
directly or indirectly, that a physician accept assignment of Medicare or any other
health care plan benefits as a condition for medical licensure or re-licensure. The
Society opposes as well legislation which calls for any penalties for not accepting
assignment. (HOD 87-67; HOD 89-6)
158
195.999
Mandatory Acceptance of Medicare Assignment: MSSNY opposes mandatory
assignment for payment for Medicare services. (HOD 83-45; HOD 90-46)
200.000
MEMBERSHIP:
200.992
MSSNY Minority Physician Mentor Database: MSSNY to:
200.993
•
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 11-164)
MSSNY Privacy Policy: MSSNY adopted the following policy:
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?
I.
Medical Directory of New York State
The Medical Directory of New York State (“Medical Directory”) is compiled and
published as a reference source of demographic and professional information every
two years. Since its first publication in 1899, it has been a recognized and trusted
source. The biographical data included in the Medical Directory are obtained through
questionnaires completed by physicians. The Medical Society of the State of New
York is not responsible for validating any information published by physicians.
Physicians who have not verified (or indicated changes to) their biographical data for
the current edition of the Medical Directory are so noted by + at the end of their
respective listings. The information listed is extracted from MSSNY’s master
computer database. Additional sources of data are maintained in MSSNY master files
which include data obtained from the American Medical Association, county medical
societies and other organizations/institutions.
159
Since the purpose of the Medical Directory questionnaires is to compile biographical
data for publication purposes, MSSNY does not undertake to maintain the privacy of
biographical data included in completed questionnaires. 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.
II. Demographic, Professional and Contact Data
The MSSNY master file includes information obtained from physicians, the AMA,
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:
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Physician name (first, middle, last)
NY State medical license number
License date
Date of birth
Gender
Medical school
Year of medical school graduation
Resident year & place of residency
Specialty (primary specialty plus 2 sub-specialties)
Board certifications
Other state or national medical society membership
Preferred mailing address, phone, fax, email
Office address (up to 3 office addresses, phone, fax, email)
Languages spoken
Insurance carrier plans accepted by office
Hospital affiliation, title, department
Practice website
Some of the demographic data is used for the Medical Directory of New York State,
see I above. 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 the AMA and county medical societies in order to assure
the highest possible level of accuracy in the AMA-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 in II above as well as
the following
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IMIS identification number
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MSSNY membership category and type
Membership status
Physician’s full name
Preferred mailing address
Phone
Fax
E-mail address
Joined date
Dues payment date and amount
County Medical Society membership
MSSNY committees
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 AMA
members, AMA student outreach, and AMA Life Membership/Dues Waived/
Deceased Physician Information.
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 obtain electoral and personal
demographic data including: residential address, congressional and senatorial districts,
political party affiliation, voter registration, voters in each household, voted (yes or no)
in recent elections and primaries, median household income, per capita income by
geographic area, residential real property tax rates and real property assessed valuation
(herein referred to as “Electoral Data”). The outside consultant has obtained Electoral
Data from public sources. The Electoral Data has been imported to the IMIS system,
see II above.
The Electoral Data is used by MSSNY to conduct demographic studies and to assist
MSSNY to provide advocacy by demonstrating the continued strength that physicians
bring to New York State from an electoral, financial, political contribution and tax
base perspective. MSSNY will not release Electoral Data that will identify any
individual physician or medical practice unless consented by the physician or medical
practice. If a demographic study or document is prepared using Electoral Data, the
data will be aggregated such as by county, district or specialty.
III. Third Parties
MSSNY generally does not rent or sell phone numbers, fax numbers, e-mail addresses
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
161
mailing lists and contact information provided may not be duplicated, and must adhere
to MSSNY Privacy policies.
IV. 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, the AMA and the county medical
societies. 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: [email protected]
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.
V. General Provisions
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 anytime. Amendments will be
posted on the MSSNY website. (Council 9/21/06)
200.994
Communications with Non-members and other Health Care Professionals:
That 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 06-211)
200.995
Innovative Methods to Improve Membership via Periodic Credit Card
Membership Charges: MSSNY 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 06-206)
200.996
Credentials and Election of New Members:
1. MSSNY will make information available to all county medical societies
regarding on-line resources for reviewing credentials of applicants for
membership.
2. MSSNY urges county medical societies to find ways of meeting existing
credentialing requirements that do not place the burden of compliance on the
applicant. (For example, checking an applicant’s registration of the license to
162
practice medicine directly through the State Education Department’s website
rather than requiring the applicant to provide a copy of the registration form.)
3. 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.
4. MSSNY urges county medical societies to review any materials they send to
applicants for language or requirements that might inhibit some from
completing the application process. (“Submit proof of Board Certification”
implies that such certification is a requirement for membership. And while
having photographs of members might be desirable, requiring them makes
applying difficult and can serve as a serious barrier.)
5. MSSNY will offer an on-line application for membership and encourages
county medical societies to do the same. Applicants should not be required to
submit any documents or other materials with their applications (other than
dues payment), as this renders the on-line concept useless.
6. MSSNY encourages county medical societies to accept payment of dues by
credit card.
7. MSSNY will let members and applicants know that MSSNY can accept credit
card payments of dues if their county societies cannot.
8. 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.”
9. 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.
10. 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.
White Paper:
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)
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,
163
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 92-62)
200.998
CME Requirements for Membership: An active member who fails to fulfill the
requirements for continuing medical education established by the Council of the
Medical Society of the State of New York shall not be in good standing. This section
shall become effective on March 1, 1981. An active member, as defined in Article II.
Section 1 of the MSSNY Bylaws, who is found not to be in good standing as of March
1, 1981, or March 1 of any subsequent year for failing to comply with paragraph 1 of
this Section shall receive reasonable notice that he must fulfill continuing medical
education requirements by the last day of December of the year in which he is found
not to be in good standing. An active member who does not fulfill continuing medical
education requirements by the last day of December of the year in which he is found
not to be in good standing shall automatically cease to be a member of the component
county medical society and the State Society, unless, in the view of the Council,
specific mitigating circumstances exist that the physician could not complete the CME
requirements. (Bylaws, Article II, Section 3; HOD Resolution 81-50)
200.999
Discrimination: 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, sex,
ethnic affiliation, or national origin. It calls upon all component county medical
societies, and upon all members of the MSSNY, to exert every effort to end every
instance in which such equal rights are denied. 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)
205.000
MENTAL ILLNESS:
(See also Health Insurance Coverage, 120.000; National Practitioner Data Bank, 210.000; Public
Health & Safety 260.000)
205.992
Health Services Upon Release for Prisoners with Mental Illnesses: MSSNY to
advocate to assure that the New York State Division of Parole afford prisoners with
serious mental illnesses effective discharge planning services to assure that continuity
of care will be provided. (HOD 07-111)
205.993
Increased Funding for School and Pre-School Services for MRDD Children:
MSSNY seek passage of state regulation and/or legislation increasing funding for
services for pre-school and school-aged mentally retarded/developmentally disabled
children in the educational setting. (HOD 05-159)
205.994
Mentally Retarded/Developmentally Disabled (MRDD) and Autism: MSSNY
seek the passage of state and federal legislation increasing the funds available for
research and treatment of autistic and MRDD individuals. (HOD 04-164);
Reaffirmed HOD 06-163)
164
205.995
Increased Funding for Physician Training and Reimbursement for the Health
Care of Mentally Retarded/Developmentally Disabled (MRDD) Individuals:
MSSNY will seek:
(a)
(b)
Seek the passage of legislation increasing the funds available for training
physicians in the care of mentally retarded/developmentally disabled (MRDD)
individuals, and increasing the reimbursement for the health care of these
individuals.
Seek the passage of legislation increasing the insurance industry and
government reimbursement to reflect the true cost of health care of mentally
retarded/developmentally disabled (MRDD) individuals. (HOD 01-91;
Reaffirmed HOD 03-279 & HOD 05-153)
205.996
Integrated Services for Public Mental Health Care: MSSNY will ask that the New
York City Department of Mental Health and the New York State Office of Mental
Health work together to study other systems for providing public mental health care
and develop more integrated services that provide continuity of care.
(HOD 00-163)
205.997
Outpatient Certification: MSSNY will seek Federal legislation to permit out-patient
certification allowing psychiatrists to require patients who are non-compliant to be
brought involuntarily to clinics. (HOD 99-156)
205.998
The Need for Adequate Community Facilities Prior to Discharge of Mentally Ill
from Mental Institutions: MSSNY opposes further rapid deinstitutionalization of the
mentally ill until an adequate community system is in place to accommodate them.
MSSNY will strongly urge the Commissioner of the New York State Office of Mental
Health, Mr. James Stone, to use his existing powers and funds to establish residential
services appropriate in number and location to meet existing and projected needs.
(Council 10/22/98)
205.999
Definition, Mental Illness: MSSNY defines “mental illness” to mean a substantial
disorder of thought, mood, perception, orientation or memory which grossly impairs
judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands
of life. The Society has initiated a mechanism to amend the section of the Criminal
Procedure Law to define mental illness as follows: “Mentally Ill” means that a defendant
currently suffers from a mental illness whose diagnosis has been established by accepted
medical standards, and whose treatment by a psychiatrist is essential to such defendant’s
welfare; and where a defendant is mentally retarded, the term “mentally ill” shall also
mean, for purposes of this section, that the defendant is in need of care and treatment by a
developmental center or other facility for the mentally retarded and developmentally
disabled under the jurisdiction of the State Office of Mental Retardation and Development
Disabilities. (Council 12/85; HOD 85-10)
210.000
NATIONAL PRACTITIONER DATA BANK:
210.994
Length of Time for Storing Medical Malpractice Data: MSSNY to bring a
resolution to the American Medical Association’s 2009 Annual House of Delegates
165
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 09-113)
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 00-70; Reaffirmed HOD 01-87; 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)
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 99-97; Reaffirmed HOD 01-87; 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 99-96)
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 91-10; Reaffirmed
HOD 01-87; 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 to 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 11-117)
215.997
Better Hospital Cooperation During Disasters: MSSNY will work with the State
and New York City Departments of Health and the various hospital associations to
ensure that there is a coordinated and cooperative response between hospitals in the
event of a disaster. (HOD 02-170)
166
215.998
Arms Reduction: MSSNY supports the position of the American Medical
Association on arms reduction, which is to actively encourage the President and
Congress to continue the process of bilateral and verifiable nuclear arms reduction.
(HOD 86-38)
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)
217.000
NURSING HOMES:
(See Reimbursement 265.000; Weight Management & Promotion of Healthy Lifestyles, 320.000)
217.997
Quality of Care - Nursing Homes: MSSNY to 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 07-260)
217.998
Quality of Care in Nursing Homes - Nursing Staffing Level:
That MSSNY support 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 06-252)
217.999
Quality of Care – Nursing Home Mandatory Reporting Serious Injuries:
That MSSNY support 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 06-251)
220.000
OBSTETRICS:
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)
225.000
PEER REVIEW:
167
225.988
Peer Review Protection: MSSNY to 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 08-70)
225.989
Pending Legislation to Make Office Procedure Complications Public
Information: (Sunsetted 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 99-173)
225.991
IPRO Citations, Mandatory Purging of After Specified Time Period: MSSNY
will request the Health Care Financing Administration (HCFA) 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 96-128)
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 94-59)
225.993
Fourth Scope of Work - PRO: MSSNY strongly supports the following principles
of operation of the Fourth Scope of Work of Peer Review Organizations that:
(1) The review process be purely educational; (2) State medical associations and
other appropriate professional societies be involved in the formulation of review
criteria and that comments from state medical associations be included when criteria
are published; (3) The reports and data obtained from the review process be made
available to the AMA, state and specialty medical societies, as well as hospital medical
staffs for comment and that, when published, such comments be included; (4)
Compliance with guidelines be deemed sufficient proof of adequate medical practice.
(HOD 93-10)
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
168
are conducted; (4) Require IPRO to utilize the practice parameters as provided by the
AMA and developed by its recognized specialty societies. (HOD 91-62)
225.995
Physician Specific Data, Release to the New York State Department of Health PRO: The MSSNY expressed deep concern and strong opposition to the routine
release of any confidential physician and provider specific data by the Peer Review
Organization to the New York State Department of Health. (HOD 91-51)
225.996
Review in Private Offices - PRO: MSSNY endorsed the position of the AMA to:
(1) Continue to monitor HCFA’s pilot project on review of physician office care;
(2) Continue to seek enactment of amendments to the PRO law prohibiting such
extension; (3) Insist, should enactment not be obtained, that any such office review
be non-disruptive, be based upon a review by peers only, be logical, and be based on
medically sound measures of process and medical outcomes; and (4) Insist that
physicians be compensated for the administrative cost required to complete such office
review. (HOD 91-50)
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 90-39; Reaffirmed
HOD 91-62 & HOD 96-52)
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 87-30 & 87-36)
169
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)
227.000
PHARMACEUTICAL ADVERTISING:
227.997
Pharmaceutical Advertising: MSSNY 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 05-161; Reaffirmed HOD 10-98)
227.998
Regulation of Media Advertising of Prescription Drugs: MSSNY confirms its
strong support for the autonomous clinical decision-making authority of physicians to
prescribe medications for “off-label” use when such physician believes that it is
clinically indicated for the patient. (HOD 04-67)
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 01-51;
Reaffirmed HOD 03-252)
230.000
PHYSICIAN DISCIPLINE:
230.998
Confidentiality as a Key Element of the Physician Disciplinary Process
in New York State: MSSNY is seeking to prohibit the release of charges of physician
misconduct by the OPMC to the public, pending final adjudication. The only
exception to this intent would be situations in which the Commissioner of the New
York State Department of Health has summarily suspended the license of a medical
professional in the interest of public safety. All professional medical conduct hearings
should be closed to the public consistent with the policy governing the conduct of
hearings as in the case of all other licensed professionals. (HOD 92-12)
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 91-9)
170
235.000
PHYSICIAN CREDENTIALING/RECREDENTIALING:
235.993
Advertising for the Physician’s Performance of Specific Ancillary Services/
Procedures: MSSNY to 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 10-96)
235.994
Repeal of the Fifth Pathway: MSSNY to 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 09-152)
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 99-77)
235.996
Granting of Provisional Credentialing Status to New York Physicians by MCOs:
In view of the time consuming and burdensome credentialing process and its
corresponding affect on new physicians’ efforts to earn a livelihood as they gain
valuable patient care experience, MSSNY will take immediate steps to petition the
New York State Legislature, the Superintendent of Insurance, the Commissioner of
Health and the National Committee on Quality Assurance to require managed care
organizations to grant “provisional” credentialing status to new properly trained and
medically qualified physicians while their actual credentialing processes are
underway. The aforementioned “provisional” status remained in force until the entire
credentialing process has been successfully competed. (Council 2/4/98)
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 97-87)
235.998
Physician Recredentialing: MSSNY supports the concept of the Department of
Education doing a special survey of a small group of physicians licensed in the State
of New York at the time of their next re-registration provided that the Society will
have input into the creation of such a survey. The survey will solicit information on
their education, continuing medical education activities, disciplinary actions, etc.
Results of the survey may be used to expand its future use to include all New York
State physicians.
MSSNY supports: (1) The development of an “indicator system” to identify “problem
physicians”; (2) The development of more sophisticated methods of determining
171
what the problems really are; and; (3) The organization of appropriate remedial
actions.
MSSNY understands that the State Board for Medicine has already started the first
phase. Phases 2 and 3 are more complex and will require collaboration among several
groups. MSSNY recommends the careful development and testing of “practice
parameters” to assist physicians in clinical decision-making but opposes any attempts,
at this time, to use them for “re-credentialing purposes.” MSSNY urges better
recognition and stronger support efforts to bring together under one umbrella, all
parties in the Continuing Medical Education-Quality Assurance fields for better
coordination of efforts, collaboration where appropriate, development of policy, and
instigation of pilot projects including the issue of re-credentialing. The Continuing
Medical Education Council of the State of New York, Inc. is designed to serve this
purpose. MSSNY agrees with the Federation of State Medical Boards (FSMB) that “it
is not possible in practical terms to determine the competence or fitness of the mass of
physicians in any way that will not burden the system with unacceptable costs and
physicians with unacceptable interruptions.” (Council 1/30/92)
235.999
NYS Advisory Committee on Physician Recredentialing Report - MSSNY’s NonSupport of: 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 wellknown 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
172
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 88-25)
240.000
PRACTICE MANAGEMENT:
(See Vaccines, 312.000)
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 nonphysicians pursuant to 29.1(12)(iv) will apply to testimonials by physicians.
(HOD 11-105)
240.987
Truth in Advertising: MSSNY to 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 11-104)
240.988
Patients’ Responsibility for Their Own Care: MSSNY to 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 09-104)
240.989
New Legislation, Regulation or Rule Impacting the Practice of Medicine:
MSSNY to 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 08-109)
240.990
Reimbursement for Use of Interpreters: MSSNY to 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 08-108)
240.991
Translation Services: That further research is necessary on how the use of
interpreters -- both those who are trained and those who are not -- impacts patient care
(2) treating physicians shall respect and assist their patients’ choices whether to
173
involve capable family members or friends to provide language assistance that is
culturally sensitive and competent, with or without an interpreter who is competent
and culturally sensitive (3) physicians continue to be resourceful in their use of other
appropriate means that can help facilitate communication -- including print materials,
digital and other electronic or telecommunication services with the understanding,
however, of these tools’ limitations -- to aid LEP patients’ involvement in meaningful
decisions about their care, and (4) physicians cannot be expected to provide and fund
these translation services for their patients, as the Department of Health and Human
Services’ policy guidance currently requires, and that when trained medical
interpreters are needed, the costs of their services shall be paid directly to the
interpreters by patients and/or third party payers and physicians shall not be required
to participate in payment arrangements. (HOD 04-61)
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; MSSNY
Council 11/2/00)
174
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)
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 96-263; Reaffirmed HOD 04-274)
240.995
COLA (Commission of Office Laboratory Accreditation): MSSNY is taking the
following actions with regard to COLA: (1) Endorsement of the accreditation
program for laboratories of the Commission on Office Laboratory Accreditation
(COLA) ; (2) Publicizing of information about COLA. (3) Encouragement of
physicians to seek clinical laboratory accreditations through COLA as their peer
review alternative to federal certification under CLIA 88. (4) Encouragement of the
New York State Department of Health to grant the Commission on Office Laboratory
Accreditation approval under the state laboratory licensure law and regulations.
(HOD 96-181)
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 91-41)
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)
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)
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 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
175
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)
245.000
PRACTICE PARAMETERS:
245.999
Practice Parameters, Evaluation and Implementation:
MSSNY: (1) Strongly encourages research and demonstration projects to evaluate the
use of practice parameters to enhance patient care. (2) Supports efforts to assure that
physician organizations maintain direct involvement in and oversight of the
development of practice parameters. (3) Takes the position that organized medicine be
responsible for the implementation of practice parameters. (HOD 91-38)
250.000
PROFESSIONAL MISCONDUCT:
(See also Medicaid, 175.000)
250.994
OPMC Administrative Review Board: MSSNY to 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 09-112)
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 07-93)
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 07-92)
250.997
Changes to OPMC Procedures: MSSNY seek legislation and/or regulation which
creates a statute of limitations on all investigations and hearings of the OPMC. That
such legislation provide any accused physician receive within a reasonable period of
time, in advance of any interview, a copy of all documentary evidence (including
expert witness reports) which can be admissible at any hearing of the OPMC. That the
physician be informed of his/her right to bring counsel to an interview along with
receiving a transcript of the interview.
MSSNY support any changes designed to reform the activities of the OPMC which
protect the public against incompetent and impaired physicians while protecting due
process rights of such physicians. (HOD 03-51; Reaffirmed HOD 04-56, HOD 06-77
& HOD 07-92)
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)
176
NB:
Professional misconduct applicable to physicians is defined by Article 131-A of the
Education Law. The Office of General Counsel of 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: (1) Whether to make an investigation.
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. (2a) 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. (2b) 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. (2c) It should be
177
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. (e) Records should be kept
regarding the complaint received and information disseminated by the county medical
society. (Council 6/16/83)
255.000
PROTEST AND DEMONSTRATIONS:
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 90-30)
260.000
PUBLIC HEALTH & SAFETY:
(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)
260.919
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 11-151)
260.920
Restoration of Funding for New York State Poison Control System: MSSNY to
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 10-169)
260.921
Guidelines, Infrastructure and Educational Program re Anal Intraepithelial
Neoplasis: MSSNY to:
178
a.
b.
c.
d.
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 08-168)
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 08-165)
260.924
Expiration Dates: MSSNY to 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 08-164)
260.925
Increase Funding for Lung Cancer Research: MSSNY to support efforts to
increase funding for lung cancer research to aid in prevention, early diagnosis and
treatment methods. (HOD 08-159)
260.926
Impact of the Medical Malpractice Crisis on Women’s Health: MSSNY to
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 08-98)
260.927
Physician Reporting of Patients Who Should Not Drive: MSSNY to 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 to work with
the New York State Department of Motor Vehicles to:
179
(1)
(2)
(3)
produce standard, accessible guidelines that support a medically sound and
administratively efficient process for medical certification of drivers covered by
Article 19-A;
increase the confidentiality of driver medical records by limiting their access to
appropriate personnel; and
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)
260.929
Increasing the Blood Supply: MSSNY 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 07-160)
260.930
Irradiation of Food Products: MSSNY should join in supporting state and federal
legislation urging the use of irradiation for appropriate food products to retard the
spread of foodborne infectious disease and adopt American Medical Association
Policy D-150.996, Irradiation of Foods in the United States which urges the
Department of Agriculture to implement irradiation of appropriate foods in the United
States prior to its distribution to the public. (HOD 07-152)
260.931
Insurance for People Released from Prison: MSSNY to 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 07-111)
260.932
MSSNY as a Patient Safety Organization: MSSNY to explore the possibility of
becoming a Patient Safety Organization (PSO) as defined in House of Representatives
HR.3205 and Senate bill S544; and, if it determined that it is fiscally and practically
prudent to become a PSO, then MSSNY will give each county medical society the
option of participating with MSSNY as a local partner safety organization with
administrative support from MSSNY. (HOD 07-109)
260.933
Manufacturer Labeling of Medical Supplies: MSSNY to 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 07-100)
260.934
Retail Clinics: The Medical Society will monitor the implementation of retail clinics
to assure compliance with all appropriate laws and regulations. (Council 11/2/06)
260.935
Reporting of Non-Communicable Illness: MSSNY support generic surveillance of
health issues and unless there is a public health or environmental justification, such
information should not include individual patient identification, but instead be
demographic (e.g. by zip code); and work with affected county medical societies to
advise them regarding state, city and county policy and any other appropriate
information that will help them convey their concerns to the New York City
Department of Health and Mental Hygiene about treating non-communicable diseases
as if they were communicable diseases and being required to report patients who have
180
non-communicable diseases; and hat MSSNY transmit this position to the New York
City Mayor and the Commissioner of the Health and Mental Hygiene. (HOD 06-160)
260.936
Lead Poisoning: MSSNY support 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 05-164; Reaffirmed
HOD 06-168; Reaffirmed HOD 09-166). See also Policy 260.945.
260.937
Amendment to Bankruptcy Legislation: MSSNY advocate that Congress restore
protections to people devastated by the financial impact of medical illness that will
result from the pending bankruptcy legislation and convey this position to the AMA.
(HOD 05-94)
260.938
Mentally Retarded/Developmentally Disabled (MRDD) and Autism: MSSNY
seek the passage of state and federal legislation increasing the funds available for
research and treatment of autistic and MRDD individuals. (HOD 04-164)
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.
181
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 11-157)
Additional Action on HOD 11-157: MSSNY to support legislation to 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.
260.940
Automated External Defibrillators: MSSNY supports state and federal legislation
to increase funding for the purchase of automated external defibrillator devices so that
they are available in the community and that a similar resolution be referred to the
American Medical Association’s House of Delegates. (HOD 04-166)
260.941
Adequate Cell Phone Service Throughout New York State: MSSNY 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 04-158)
260.942
Free Access to Fresh Water at Food Establishments: MSSNY supports local and
state efforts to assure that all non-mobile venues that sell beverages provide public
drinking fountains or other free sources of fresh drinking water. (HOD 04-154)
260.943
Government to Support Community Exercise Venues: MSSNY encourage towns,
cities and counties across New York State to make recreational exercise 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; and that MSSNY transmit a copy of this
resolution to the American Medical Association House of Delegates for its
consideration. (HOD 04-152)
260.944
Lead Poisoning: That MSSNY advocate for stronger governmental and nongovernmental 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
182
on prevention. (HOD 03-154; Reaffirmed HOD 04-162; Reaffirmed HOD 09-166)
See also Policy 260.936.
260.945
Identification of Slave-Made Products: MSSNY is opposed to slave labor
throughout the United States and the world. (HOD 03-157)
260.946
Potassium Iodide (KI) Distribution: MSSNY will support the New York State
Emergency Management Office in its efforts to request that the Federal Nuclear
Regulatory Commission and the Federal Emergency Management Agency conduct a
comprehensive review of federal standards for emergency plans at nuclear plants and
the surrounding communities within the state and request sufficient quantities of
potassium iodide (KI) for those people within a 50-mile radius of a nuclear reactor site
together with the appropriate guidelines for use.
MSSNY will provide information, through its website, to those physicians and
interested individuals on the particulars of KI. (HOD 02-155)
260.947
Mammography Screening for Breast Cancer: MSSNY strongly endorses the
positions of the American College of Obstetrics and Gynecology, the American
Cancer Society, and the American College of Radiology that all women have
screening mammography as per current guidelines.
MSSNY will seek legislation to mandate an appropriate increase in reimbursement for
mammography which would permit the re-opening of previously closed facilities, as
well as forestall the closure of additional facilities, thereby ensuring timely access for
all patients.
MSSNY will urge the AMA to seek legislation to require the Centers for Medicare and
Medicaid Services (CMS) to change the formula for calculating the practice expense
component of the RBRVS to one which will realistically reflect the costs of providing
services. (HOD 02-260)
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; Reaffirmed Council
1/20/11)
260.949
Post-Traumatic Stress Disorder and Treatment: MSSNY will cooperate with
others providing disaster relief to make available courses to practicing physicians to
help them a) reach out to those potentially harmed by the events of September 11 and
subsequently, b) counsel those in psychological need, c) detect, refer, and treat posttraumatic stress disorder, depression, substance abuse, and other conditions arising
from the events. (HOD 02-165)
183
260.950
Further Integration of Mental Health and General Health: MSSNY will urge that
the position of executive deputy commissioner within the New York City Department
of Public Health be filled by a board-certified psychiatrist. (HOD 02-164)
260.951
Physician Use of Health Provider Network (HPN): MSSNY will work with the
New York State Department of Health in promoting and helping facilitate the use of
the Health Provider Network (HPN) to provide urgent information to physicians
throughout the state. (HOD 02-163)
260.952
Autism: MSSNY to seek the passage of state and federal legislation requiring the
insurance industry to cover all therapy services needed by autistic individuals.
(HOD 01-167; 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 01-159; 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 01-158)
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 01-153; 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 01-89; HOD 2011 - Reevaluation by the Appropriate 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. In addition, in 2001 the Medical Society
will support legislation 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 02-162)
260.958
Herbal Substances: MSSNY will support Federal legislative and regulatory efforts
to ensure that herbal substances are free from known carcinogens, pesticides or any
other chemicals known to cause human illness and meet standards established by the
United States Pharmacopoeia for identity, strength, quality, purity, packaging, and
labeling; and meet FDA post-marketing requirements to report adverse events,
including drug interactions. (HOD 00-161)
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 00-165)
184
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 should provide guidance to the medical community regarding pain
management; (2) that the New York State Department of Health work with the
Medical Society of the State of New York in structuring educational programs for
physicians on pain management; (3) that the New York State Department of Health
should encourage physicians to familiarize themselves with the therapeutic advantages
and risks involved in the use of the newest analgesic agents; and (4) that the New York
Sate Department of Health avoid threatening, punitive measures in dealing with the
question of inadequate pain management. (HOD 00-164)
260.961
Folic Acid and the Prevention of Neural Tube Defects: MSSNY has adopted as its
policy, AMA PolicyH-440.898, “Recommendations on Folic Acid Supplementation”:
Our AMA will: (1) encourage the Centers for Disease Control and Prevention (CDC)
to continue to conduct surveys to monitor nutritional intake and the incidence of neural
tube defects (NTGD); (2) continue to encourage broad-based public educational
programs about the need for women of child-bearing potential to consume adequate
folic acid through nutrition, food fortification, and vitamin supplementation to reduce
the risk of (NTD); (3) encourage the CDC and the National Instates of Health to fund
basic and epidemiological studies and clinical trials to determine casual and metabolic
relationships among homocystein, vitamins B12 and B6, and folic acid, so as to reduce
the risks for and incidence of associated diseases and deficiency states; (4) encourage
research efforts to identify and monitor those populations potentially at risk for
masking vitaminB12 deficiency through routine folic acid supplementation of enriched
food products; (5) urge the Food and Drug Administration to increase folic acid
fortification to 350 mcg per 100 grams of enriched cereal grain; and (6) encourage the
FDA to require food, food supplement, and vitamin labeling to specify milligram
content, as well as RDA levels for critical nutrients, which vary by age, gender, and
hormonal status (including anticipated pregnancy).
(CSA Rep. 8, A-99); (HOD 00-156)
260.962
Irradiated Food: MSSNY affirms its endorsement of the usefulness of food
irradiation, and will urge the New York State Department of Health to publish an
advisory to the public which reflects the addition of meat to the long list of irradiated
products going back to 1963. (HOD 00-151)
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 00-87)
185
260.964
Organ/Tissue Donation Information on Health Insurance Cards: MSSNY will
call for legislation requiring that a) insurers and managed care organizations in New
York State to indicate the subscribers’ wishes on organ donation on the health
insurance card issued to each subscriber; b) requiring that information regarding organ
donation wishes be included on all Health Care Proxy forms. (HOD 00-55)
260.965
Prevention of Pneumococcal Disease: MSSNY has adopted as policy the
recommendations of the Advisory Committee on Immunization Procedures (ACIP) of
the Centers for Disease Control and Prevention on the prevention of pneumococcal
disease published in Morbidity and Mortality Weekly Report vol. 48 8RR S, April 4,
1997. A copy of Morbidity and Mortality Weekly is available in the Office of the
Executive Vice-President. (HOD 99-162)
260.966
Asthma Warning Labels for Yellow Dye Number 5 Food Coloring: MSSNY will
seek legislation that would require clear ingredient labels be placed on all edibles and
drugs which contain yellow dye number five (5). (HOD 99-161)
260.967
FDA Regulation of Nutritional Supplements: MSSNY supports a resolution to the
American Medical Association’s House of Delegates to seek passage of federal
legislation establishing the Food and Drug Administration’s authority to regulate
nutritional supplements. (HOD 99-153)
260.968
Prominent Notice of Product Reformulation on Cosmetic Products: MSSNY
supports a resolution to the American Medical Association’s House of Delegates
seeking passage of federal legislation requiring that any changes in the formulation of
and the date of change of a cosmetic preparation should be prominently displayed on
the container and the outer wrapper. (HOD 99-152)
260.969
Prudent Layperson – 911 Calls: MSSNY supports the prudent layperson standard
for emergency medical service and MSSNY opposes triage by 911 dispatch which
divert 911 (emergency Dispatch) calls to non-emergency facilities, other than birthing
centers or those facilities identified by the local REMAC (Regional Medical Advisory
Committee) because of geographic constraints and opposes the non-transport of
patients calling 911 (Emergency Dispatch) based on telephone triage by 911
emergency dispatch. (Council 10/22/98)
260.970
Improving Asthma Outcomes While Reducing Costs: MSSNY recognizes and will
publicize the availability of the 1997 asthma guidelines as published by the National
Institutes of Health. (HOD 98-156)
260.971
Women’s Health Training: MSSNY will urge the American Medical Association to
explore ways to improve formal training in women’s health issues. (HOD 97-152)
260.972
Needles and Syringes, Over-the-Counter Sale of: MSSNY supports repeal of New
York State Education Law 6811 and the New York State Public Health Law 3381 to
provide for pharmacy-based sale of reasonable quantities of hypodermic needles and
syringes without a physician’s prescription. (HOD 96-75)
260.973
Chlamydia Infection Sexually Transmitted, Screening for In Routine Care:
MSSNY recognizes the public health need for physicians to consider screening for
186
Chlamydia infection as an important part of care in sexually active female adolescents,
high risk pregnant women, and other women at high risk for Chlamydia infection
along with treatment of male partners as well as the patient. While there is insufficient
evidence to recommend for or against routine screening of males, MSSNY
recommends that screening be performed in clinical settings with a high prevalence of
asymptomatic infection (7% or more) as in urban adolescent clinics. (HOD 96-155)
260.974
Calcium, Optimal Intake of: MSSNY has adopted the position that physicians, in
their health advice and dietary prescription, seek to educate both patients and the
public about the need for optimal dietary calcium intake in all age groups in line with
the United States Public Health Service and the American Medical Association advice
to prevent osteoporosis and will recommend its position to physicians. (HOD 96-159)
260.975
Scented Inserts in Magazines and Mailings, Prohibition of: MSSNY will advocate
for legislation to prohibit the unsolicited distribution of scented inserts and other odoremanating materials in magazines and through the mail because of the deleterious
effects it has on the health of many individuals and will take an active leadership role
in educating, promoting awareness of, and disseminating information concerning the
negative health consequences which stem from the unsolicited use of scented products,
not only to the consumer, but to those in close contact with them as well.
(HOD 96-171)
260.976
Mammography Recommendations: MSSNY reaffirms the American Cancer
Society’s recommendation that mammography screening begin by age 40, but not
preclude self-examination, and that this screening be repeated every one to two years
for women 40-49, and every year thereafter. (HOD 95-160)
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 legislation in
the State that will lead to protection of domestic violence victims, and abatement of
domestic violence. (HOD 95-163)
260.978
Maternal And Newborn HIV Testing And Care: MSSNY has adopted the
following Official Position with respect to HIV testing of all pregnant women:
(1) Public Health Law should be amended to make HIV antibody testing routine,
consistent with general informed consent, at the first prenatal visit. The institution
giving intra-partum care shall obtain HIV antibody testing of the infant as part of the
panel of screening tests already Performed. Results of the HIV Antibody testing will
be reported to the patient’s parent or appropriate caregiver. (2) Counseling will be
provided in the course of routine medical care to those HIV-positive individuals. (3)
Adequate resources must be allocated for continued infrastructure expansion and the
costs of ongoing care, including, but not limited to: (a) Enhanced Medicaid and other
third party reimbursement rates reflecting the special costs of services for HIVinfected pregnant women and children. (b) Grants and contracts for expansion and
ongoing support to regional centers of excellence which meet standards for
multidisciplinary care, including outreach, Public education and other nonreimbursable services. (c) Financial protection of programs in the face of competitive
pressures associated with health care reform. (d) Measures to facilitate enrollment of
children and their mothers in clinical treatment trials. (4) MSSNY advocates
continued development and evaluation of better diagnostic tests for HIV infection in
newborns and supports their widespread use in early diagnosis. (5) MSSNY advocates
187
development of optimal programs for HIV-Positive and AIDS-symptomatic infants
and their families. Such programs should include support systems to help parents care
for these infants and simplified foster care arrangements for children whose parents
are unable to provide such care. (HOD 95-169)
260.979
Tuberculosis Screening of Immigrants: MSSNY has adopted the position that the
AMA review with the Centers for Disease and Control and prevention and the U.S.
State Department current policy and procedure for screening applicant immigrants
with abnormal chest films, and advocates a return to the practice of requiring negative
sputum cultures for tuberculosis in suspect cases and completion of a regimen of
therapy before admission to the U.S. (HOD 95-177)
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 95-182; Reaffirmed HOD 11-151)
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 94-85)
260.982
Vitamin K Prophylaxis in Newborn: MSSNY has adopted the position that state
medical societies urge state health departments to amend their health codes to specify
that every neonate should receive a single dose of 0.5 - 1 mg of natural vitamin K
oxide (phytonadione), preferably parenterally, within one hour of birth to prevent
vitamin K dependent hemorrhagic disease and coagulation disorders and has urged the
American Medical Association to become a vigilant advocate, in a continuing way, on
the routine use of vitamin K prophylaxis for the newborn. (HOD 94-159)
260.983
AZT Intervention in Pregnancy: MSSNY has introduced a resolution at the
American Medical Association’s House of Delegates urging that the AMA study AZT
intervention in pregnancy from several aspects, including: (1) The guidelines for HIV
diagnosis and AZT treatment needed to maximize favorable outcomes for mothers and
infants; (2) The cautions to be observed; (3) Re-clarification of the central role of
physicians and nurse-midwives in professional decision-making; (4) Modification of
the circumstances of practice, if any. (HOD 94-163)
260.984
Respirators for Nosocomial TB Control: MSSNY endorses the American Medical
Association’s Board of Trustees Report JJ (A-93) entitled “Update on Tuberculosis”
which states that the routine use of powered air purification respirators for protection
against the transmission of TB is uncalled for in health care facilities where all other
standard professional and governmental protective guidelines are fully implemented,
and takes the position that the High Efficiency Particulate Air (HEPA) respirator is not
a feasible device for use in routine care of tuberculosis patients. (HOD 94-165)
260.985
Brand Certification Process, Opposition to: MSSNY opposes the implementation
of a Brand Certification Process. (HOD 94-168)
260.986
Chlamydial Infection, Screening for In Routine Care: In recognition of the need to
educate physicians and the public in the recent approaches that have become available
for the prevention and control of chlamydial infection, the Medical Society of the State
188
of New York takes the position that physicians and other health care providers be
encouraged to recognize the public health need to include screening for chlamydial
infection as an important part of routine care of sexually active, at-risk individuals, and
recognize the public health key to reaching large numbers of individuals with
asymptomatic infection. MSSNY has asked the AMA to take a similar position and to
urge state medical societies to alert their members to the new diagnostic screening
tests and the therapies available for the management of chlamydial infection.
(HOD 94-169)
260.987
Right Heart Catheterization: The MSSNY Committee on Cardiovascular Diseases
supports the concept that Right Heart Catheterization should only be performed when
there are specific indications. (Council 12/16/93)
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. The Society is
attempting to work with local law enforcement agencies and health departments to
assure that these health rights of prisoners are respected. (HOD 93-71)
260.989
Folic Acid (Dietary) For the Prevention of Neural Tube Defect: In order to reduce
the risk of neural tube defect, the Medical Society of the State of New York has
requested that the AMA call attention in its public education materials and reports to
the recommendations of the United States Public Health Service that all women
capable of becoming pregnant consume 0.4 mg. of folic acid daily and that a larger
amount be consumed under medical supervision if there is a history of this defect.
(HOD 93-82)
260.990
Case Management for TB, Increased Funding for: MSSNY is supporting and
encouraging the New York State Congressional Delegation to seek increased funding
for New York State tuberculosis (TB) case management and programs for directly
observed therapy with patient inducements, if necessary. The Society is urging local
health officers to exercise their statutory authority to isolate, as soon as possible,
infectious TB patients who are not compliant with directly observed therapy, pending
due process hearings. (HOD 93-75)
260.991
Tuberculosis - Directly Observed Therapy: MSSNY called on the AMA to support
the initiative of public health authorities to modernize the health codes of their states
on tuberculosis control, including specific authorization for implementation of a
Commissioner-ordered program of directly observed therapy for tuberculosis when
patient compliance poses a risk to the public. It also requested the AMA to support the
view that directly observed therapy for tuberculosis for newly discharged patients from
hospitals is seen as desirable routine policy for community control against the
evolution of multi-drug resistant strains, as well as supporting the view that, in cases
when coercive examination, evaluation, treatment or detention are seen as necessary
by public health authority, each decision should be based on an individualized decision
and a full due process hearing provided when detention is ordered. (HOD 93-81)
260.992
Breast Feeding: MSSNY is taking the following initiatives in regard to breast
feeding of infants: (1) It is educating its members about the process and benefits of
breast feeding. (2) It is encouraging innovative and educational programs for use in
medical training about the clinical benefits and process of breast feeding. (3) It is
189
cooperating with other professional medical groups to encourage breast feeding education programs at national and regional meetings of pediatricians, obstetricians, and
family physicians. (4) It is encouraging all of its members, regardless of specialty, to
offer professional and emotional support for their patients who are breast feeding
mothers. (5) It is seeking legislation which would provide that women may not be
charged with indecent exposure or lewd behavior as a result of breast feeding in
public. (HOD 93-27)
260.993
Food Labeling: MSSNY supports fat content labeling of food. (HOD 92-82)
260.994
Air Quality Reports: MSSNY has requested that local area media report on a daily
rating of air quality as part of their weather sections, and rate the air quality in relation
to the federally accepted pollution levels. Air quality rating reports should indicate
high risk groups (i.e. children, people with lung disease or heart disease, and the
elderly) and provide standard advice and precautions for these groups when the
pollution levels are high or exceed federal standards. The MSSNY is encouraging its
members to direct high risk patients to comply with precautions as stated in daily air
quality reports. (HOD 91-103)
260.995
Blood Glucose Monitoring: MSSNY endorsed the position paper on Bedside
Capillary Blood Glucose Monitoring, of the American Diabetes Association and
communicated its endorsement to the Commissioner of Health of the State of New
York. (HOD 88-35)
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)
260.997
Fluoridation Statewide: MSSNY has urged the New York State Department of
Health to consider the value of requiring statewide fluoridation, preferably a
comprehensive program of fluoridation of all public water supplies where these are
fluoride deficient and to initiate such action as deemed appropriate. The Society
recommended to the American Medical Association that it communicate its
endorsement of statewide water fluoridation to state medical associations, the
American Dental Association, the American Academy of Pediatrics, the American
Public Health Association and the Association of State and Territorial Health Officer
and urge favorable consideration. (Council 4/23/87)
260.998
Boxing: MSSNY has taken a position in favor of the total prohibition of the sport of
boxing. (HOD 84-59)
260.999
Fluoridation - Fluoride Rinse Program: MSSNY endorses the concept of school
fluoride programs and that members of MSSNY encourage the schools to participate
in fluoride rinse programs in those communities without fluoridation of drinking
water. (HOD 80-12)
262.000
QUALITY ISSUES:
190
262.994
Physicians’ Control of Quality Monitoring: MSSNY to 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 09-95)
262.995
MSSNY Task Force on Quality Medicare Care: MSSNY support regulatory or
legislative efforts to 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)
262.996
Maximum Medical Improvement: MSSNY work with insurers to develop clinical
guidelines and best practices for maintaining therapies for chronic conditions using an
evidence-based model. (HOD 05-263)
262.997
Tracking Improvement of Medical Error Evidence: MSSNY support 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 05-172)
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 05-171)
262.999
Task Force on Quality Medical Care: MSSNY will establish a Task Force (a) to
guide New York State physicians in setting up programs for their offices in order to be
more successful in avoiding medical errors; (b) to work with appropriate hospital and
long term care associations to develop better quality improvement programs for
facilities in New York; (c) to report its findings and recommendations to the members
of the 2001 House of Delegates 30 days prior to the 2001 Annual Meeting; (d) to
request that the American Medical Association study and report underutilized clinical
systems to improve the quality of medical care, and provide recommendations for
fostering their implementation. (HOD 00-212)
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)
265.882
Direct Payments to Physicians by Insurance Carriers: MSSNY to 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 11-252)
191
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 11-65)
265.884
Hospital Readmissions: MSSNY to 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 11-64)
265.885
Out-of-Network Reimbursement: MSSNY to support and advocate for legislation
and/or regulation that:
ƒ
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;
ƒ
Prevents health insurance companies from selling policies that purport to but, in
fact, fail to adequately cover out-of-network health care benefits;
ƒ
Requires health insurance companies to “crosswalk” their out-of-network
reimbursement methodology to true UCR (such as that being developed under
FAIR Health). (HOD 11-58)
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 10-262)
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 10-256)
265.888
Denial of Reimbursement Based on Volume of Procedures Peformed: MSSNY to
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)
192
265.889
Claims Denial Although Accurately Coded: MSSNY to 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 nonphysician 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 09-265)
265.890
Medical Certification Paperwork: MSSNY to 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 09-261)
265.891
Adjustments Made to Relative Value Scale to Include Increased Paperwork for
Physicians: MSSNY to 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 09-258)
265.892
Medical Home Model: MSSNY to study the medical home model through an
existing committee or by establishing a Task Force on Medical Home Models with
these directives:
1. define medical home, including payment models, after considering American
Medical Association Policy H-160.919;
2. research successful medical home pilot projects;
3. monitor the progress of medical home pilot projects in New York State;
4. make policy and legislative agenda recommendations on this subject to the
MSSNY Council; and
5. develop a program to educate physicians in New York State about the
opportunities and threats inherent in medical home pilot projects. (HOD 09-94)
265.893
Assist Physician Practices to Move Toward Electronic Billing: MSSNY to (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 to
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 to 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
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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 09-76)
265.896
Legal Flexibility to Offer Uninsured Patients Structured Pre-Payment Options:
MSSNY to 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 09-65)
265.897
Inappropriately Constrained Provider Reimbursement, Increasing Health
Insurance Premiums and Increased Patient Cost-Sharing: MSSNY should
continued 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 to 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 08-60; Reaffirmed HOD 09-70)
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 08-57)
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 nonparticipating treating physician also preserves the ability of such non-participating
physician to be reimbursed their usual and customary fee. (HOD 08-56; Reaffirmed
HOD 09-63)
265.901
New Federal Legislation re Prompt Payment and Amendment of New York State
Prompt Payment Law: MSSNY to 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:
1)
2)
3)
4)
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
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document that these fees or costs might not have been incurred if the claim had
been paid within the mandated timeframe.
MSSNY also to work with the AMA for a federal law that:
1)
2)
3)
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 to work towards amending New York’s Prompt Payment Law to:
1)
2)
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 08-55)
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 08-53)
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 specialtyspecific 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 08-257)
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 08-255)
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 08-167)
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 08-161)
265.907
Promotion of the Hassle Factor Form: MSSNY to 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)
195
265.908
Impediments Imposed by Health Insurance Companies to Obtaining PreAuthorization: MSSNY to 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 08-50)
265.909
HMOs Decreasing Reimbursement & Patient Co-Payments: MSSNY 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: MSSNY to take whatever steps it can to
maximize use of the Hassle Factor form and disseminate its findings to all concerned.
(HOD 07-264)
265.911
ERISA Plans and the United States Department of Labor: MSSNY to 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 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 07-251)
265.912
Reimbursement for Participation: MSSNY to adopt the American Medical
Association’s Principles for Pay-for-Performance and Guidelines for Pay-forPerformance, 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 evidencebased performance measures to financial incentives. Such PFP programs are in
alignment with the following five AMA principles:
1. 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. 3. Offer
196
voluntary physician participation - Fair and ethical PFP programs offer voluntary
physician participation, and do not undermine the economic viability of nonparticipating physician practices. These programs support participation by physicians
in all practice settings by minimizing potential financial and technological barriers
including costs of start-up. 4. 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. 5. 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. 1. All performance measures used in the program must be prospectively
defined and developed collaboratively across physician specialties. 2. Practicing
physicians with expertise in the area of care in question must be integrally involved in
the design, implementation, and evaluation of any program. 3. 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. 4. Performance measures should be scored
against both absolute values and relative improvement in those values. 5. Performance
measures must be subject to the best-available risk- adjustment for patient
demographics, severity of illness, and co-morbidities. 6. 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. 7. 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.
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- 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 pilottested 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 deselection. 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.
Patient/Physician Relationship
- 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. 1. Programs
must not directly or indirectly disadvantage patients from ethnic, cultural, and socioeconomic groups, as well as those with specific medical conditions, or the physicians
who serve these patients. 2. 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-compliance, and
sponsors of PFP programs should attempt to minimize non-compliance through plan
design.
Physician Participation
- 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.
198
- Programs must not favor physician practices by size (large, small, or solo) or by
capabilities in information technology (IT). 1. Programs should provide physicians
with tools to facilitate participation. 2. 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. 1. Programs
should use accurate administrative data and data abstracted from medical records. 2.
Medical record data should be collected in a manner that is not burdensome and
disruptive to physician practices. 3. 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.
199
- 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.
Program Rewards
- 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, A06; Reaffirmed in lieu of Res. 226, A-06; Reaffirmation I-06; Reaffirmation A-07).
(HOD 07-94)
200
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 07-66)
265.914
Electronic Payment or Funds Transfer Systems: MSSNY to: (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 07-914)
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 06-269; 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 06-65)
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 06-93)
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
201
prudent lay person 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)
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)
265.920
Payments for Urgent and Emergent Health Care Services: 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 Prudential
layperson standards similar to what already is 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.
(HOD 05-69; Council 1/26/06)
265.921
Unreasonable Taxes on Medical Care: MSSNY proactively and vigorously oppose
taxes on physician services including but not limited to cosmetic surgery, physician–
owned facility taxes or “pass-through” taxes on medical services. (HOD 05-88;
Reaffirmed HOD 10-68)
265.922
Supporting Legislation to Promote Telemedicine: MSSNY support legislation that
would establish a statewide telemedicine/telehealth task force to make
recommendations to the governor and the legislature on the development, standards,
changes in licensure/ certification verification necessary and the methodology for
determining payments due for health care services provided by these systems; as well
as legislation that would facilitate the practice of and reimbursement for telemedicine
in accordance with state law applicable to the licensure and practice of medicine.
(HOD 05-53)
265.923
Legal Strategies to Combat Unsubstantiated Third-Party Payer Refund
Demands: MSSNY 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 05-214)
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 04-81)
265.925
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)
265.926
Single Set of Rules for Physician Reimbursement: MSSNY recommends that there
be only one set of rules, policies and regulations relating to quality medical care,
202
physician reimbursement, and coverage issues in any future systems of physician
reimbursement. (HOD 04-253)
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 04-74)
265.928
Preventive Healthcare Reimbursement: MSSNY will seek legislative or regulatory
relief to ensure that the cost of preventive medical services are adequately covered and
that preventive medical services be further defined in state law to include any
procedure or health counseling recommended by appropriate medical specialty
guidelines, which includes but are not limited to, periodic physical exams, pap smears
and appropriate preventive vaccines. (HOD 03-82; Reaffirmed HOD 04-63)
265.929
Elimination of Pre-Surgical Authorizations: MSSNY will seek legislation to
eliminate pre-surgical authorization due to the lack of cost effectiveness and the undue
burden on providers. (HOD 02-252)
265.930
Reimbursement for Well Child Visits: MSSNY will urge the New York State
Legislature to enact legislation making it mandatory for healthcare insurance
companies, through each product offered by such company, including to the extent
allowable by law ERISA-exempt insurance products, to provide coverage for well
child visits (scheduled in accordance with the prevailing clinical standards of a
national association of pediatric physicians designated by the Commissioner of
Health), without additional deductible or co-payment requirements. (HOD 02-65)
265.931
Out-of-Network Rates Should be Applied Only to Specifically Out-of-Network
Providers: 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 02-264)
265.932
Amendment to the Definition of “Covered Service” for Third Party Insurance
Payment: 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 02-261; Reaffirmed HOD 03-268 & 278)
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 02-253;
Reaffirmed HOD 06-259; Reaffirmed HOD 09-101)
203
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 02-251)
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 02-80; Reaffirmed
HOD 03-268 & 278)
265.936
Support the Health Insurance Guarantee Fund: MSSNY will seek identical
(Senate and Assembly) legislation creating the Health Insurance Guarantee Fund.
(HOD 02-74)
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 02-51)
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 01-260; Reaffirmed HOD 09-259)
265.939
Electronic Billing: MSSNY supports the development of a universally acceptable
electronic claims methodology. (HOD 01-253; Reaffirmed HOD 03-268 & 278)
265.940
Aetna/US HealthCare’s Use of a Primary Physician Communication Form:
(Sunsetted HOD 2011)
265.941
Addressing Oxford’s Policy Regarding Modifier 25: MSSNY will recommend that
all third party payers be held to the standards of the AMA-CPT guidelines in
processing physicians’ bills. (Council 1/25/01; Reaffirmed HOD 03-268 & 278)
265.942
Costs to the Private Medical Practitioner of Complying with New Unfunded
Federal Mandate Called the Needlestick Safety and Prevention Act:
(Sunsetted HOD 2011)
265.943
Coverage of Strabismus Surgery: (Sunsetted HOD 2011)
265.944
Multiple Billing Addresses for Submission of Doctors’ Bills to Individual Health
Care Plans: (Sunsetted HOD 2011)
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265.945
Prevnar, Pneumococcal 7-Valent Conjugate Vaccine: (Sunsettted 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 01-254)
265.947
Autism: 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 01-167; Reaffirmed HOD 03-276)
265.948
Vaccination Schedule Should be Accepted by All Insurance Carriers: MSSNY
supported a resolution to the American Medical Association’s House of Delegates
seeking passage of federal legislation requiring insurance companies to adequately and
appropriately cover the cost and administration of vaccines as recommended by the
American Academy of Pediatrics. (HOD 01-155; Reaffirmed HOD 04-167)
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 01-83; Reaffirmed HOD 2011)
265.950
Insurance Company/Managed Care Plan Acceptance of Physicians Submitted
Claims: (Sunsetted HOD 2011)
265.951
Cost of Living Adjustment to Compensate for Rising Overhead Medical
Expenses: 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 01-58; Reaffirmed HOD 2011)
265.952
HCFA Evaluation and Management Codes - Modifier 25: MSSNY will urge
HCFA to revise the new policy on Modifier 25 since the original RBRVS study
calculated the standard Evaluation and Management (E&M) visit of 99213 with a
Work Relative Value of 1.0. Since the original standard E&M visit had a Work
Relative Value of 1.0, a Work Relative Value of 1.0 should be added to every
procedure for which HCFA assumes has an inherent E&M component for proper
compensation to physicians. (Council 3/13/00)
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 00-281)
265.954
Implementation of Carrier Advisory Committee (CAC) Functions by ThirdParty Insurers: MSSNY will seek legislative or regulatory relief to require all thirdparty 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 00-269; Reaffirmed
205
HOD 03-268 & 278)
265.955
Managed Care Organizations Should Disclose Their UCR Calculation
Methodology: MSSNY will seek legislative/regulatory relief to require managed care
organizations (MCOs) to provide physicians and other parties, as a condition of new or
continued participation, with the calculation methodology that they use in establishing
the UCRs (usual, customary and reasonable charges) that make up their fee schedules,
to include the baseline data and other qualifying factors such as carrier-derived or
adjusted geographical adjustments and patient demographic data. (HOD 00-267)
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 00-265; Reaffirmed HOD 10-259)
265.957
Recognition of “Incident To” Services: MSSNY will contact those third-party
payers that do not recognize “incident to” services and petition these payers to develop
and distribute policy outlining their positions on the coverage (or lack of coverage) of
“incident to” services; MSSNY will petition these payers to cover “incident to”
services when supplied, and not to subject these services to “carve outs” or third-party
reviews.
If such petitions to payers do not succeed, MSSNY will seek legislative or regulatory
relief to ensure that payers develop and distribute policy outlining their positions on
the coverage (or lack of coverage) of “incident to” services. (HOD 00-258;
Reaffirmed HOD 03-268 & 278)
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 00-256; Reaffirmed HOD 09-63)
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
206
phone call(s) is a separate service and specify whether the service is a covered or noncovered service.
If telephone management for patients, and the time spent making the phone call(s) is
deemed to be a noncovered 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 to 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 00-252)
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 00-167)
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 00-88)
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 00-71)
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 00-68)
207
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 00-67)
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 00-66)
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 00-65)
265.967
Recognition of Modifier 25: MSSNY will urge HCFA to revise the new policy on
Modifier 25 since the original RBRVS study calculated the standard Evaluation and
Management (E&M) visit of 99213 with a Work Relative Value of 1.0. Since the
original standard E&M visit had a Work Relative Value of 1.0, a Work Relative Value
of 1.0 should be added to every procedure for which HCFA assumes has an inherent
E&M component for proper compensation to physicians. (Council 3/13/00)
265.968
Pre-Authorization Denials: MSSNY has adopted as policy, the following statement
deeming partial approval of requested physician treatment regimens by managed care
organizations and/or other health insurers as constituting denials of care, and to urge
the endorsement and effectuation of this position by the New York State Department
of Health, the New York State Department of Insurance, and the New York State
Office of the Attorney General and, if necessary, seek legislation to implement this
policy.
It is the position of the Medical Society of the State of New York that:
•
physician-requested treatment regimens only partially approved by managed care
plans and/or other health insurers, be deemed as denials of medical care in
conformance with present law, regardless of whether some of the requested care
was authorized by the insurers;
•
the appropriate state agencies charged with regulating and monitoring the
activities of managed care plans and other health insurers, should prohibit these
entities from circumventing the fundamental premise and spirit of the present law
addressing denials of medical care which would (and should) encompass partial
approvals of physician-requested care.
•
Insurers be mandated to provide physicians and patients with timely written
notifications of such adverse determinations so that they may rightly access
internal and external appeals mechanisms on the premise that partially approved
208
medical services are in actuality reductions in physician requested treatment
regimens and, thus, constitute denials of medically necessary care.
(Council 1/20/00)
265.969
Proper Insurance Claim Protocol: MSSNY will seek through legislation,
regulation, or whatever means necessary, the enforcement of the following provisions:
•
That the definition of a late claim by MCOs and other insurers be no less than a
claim submitted after twelve (12) months of the date of service; thus, effectively
eliminating the current restrictive requirement of health insurers for submitting
claims within 90 days, or a similar restrictive time period;
•
That the time limitation for insurer requests for refunds should not exceed twelve
(12) months, similar to the foregoing proposed time limitation for required claims
submissions; thus, effectively precluding the current inequitable ability of insurers
to seek refunds numerous years following physician dates of services and claims
submissions;
•
That insurers be required to notify physicians of the receipt of their submitted
claims within 10 days of filing, whether by written communications (e.g.
postcard), electronic means, e-mail, etc.;
•
That insurers be required to timely and accurately inform physicians of the reasons
for any denials of submitted claims (i.e. within 45 days);
•
That the State Insurance Department be required to meaningfully enforce the
current Prompt Payment Law to pay clean claims, within 45 days, in tandem with
an investigation by the Office of the Attorney General concerning constant insurer
allegations of lost claims and vague or inexplicable reasons for claims denials in
their efforts to circumvent the law. (Council 1/20/00; Reaffirmed HOD 00-265 &
HOD 03-258)
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)
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)
265.972
Responsibility for Carrier Errors on “Explanation of Benefits” Forms: MSSNY
will ask the American Medical Association at A-99 to point out the Health Care
Financing Administration that patient allegations resulting from carrier errors on
explanation of benefits forms neither constitute fraud and abuse nor prove that their
patient “investigator” program is working; and that carriers should be required to
correct and pay the costs for correction of their “keystroke” or “administrative” errors
on these forms as well as to notify the patient of the error. (HOD 99-274)
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
209
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 99-273)
265.974
Support of MSSNY President Ralph Schlossman’s Response to HCFA’s “Fraud
Seminars”: MSSNY will strongly supports opposition to Health Care Financing
Administration launched fraud seminars, because of the chilling effect it will have on
the practice of medicine. (HOD 99-266)
265.975
Inappropriate Usage Of Correct Coding Initiative and HBOC Software By
Medicare: 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 99-256; Reaffirmed HOD 00-268; HOD 03-268 & 278 and
HOD 05-276)
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 99-255)
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 99-261; Reaffirmed
HOD 06-259)
265.978
Reimbursement for Assistance at Surgery: MSSNY shall seek the introduction of
legislation requiring HMO’s and all other third party payers operating in New York
State to reimburse for assistance at surgery based on the guidelines of the American
College of Surgeons and/or when determined by the operating surgeon that one is
required to insure the safety of the patient. (HOD 99-260)
265.979
Insurance Companies Should Reimburse for Telephone Consultations: MSSNY
policy should be that insurance companies and the Health Care Financing
210
Administration should reimburse physicians for telephone management of patients.
(HOD 99-258; Reaffirmed HOD 05-273)
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 99-72)
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 98-87)
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 oneyear moratorium after the announcement of a new fee schedule, thereby precluding the
lowering of reimbursement to participating physicians for this one-year period.
(HOD 98-273)
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 payor
reimburse the physician performing the procedure regardless of the final diagnosis.
(HOD 98-271)
265.984
Amend Managed Care Payment Policy for X-Ray Examinations: MSSNY will
include, as part of its legislative program, a bill to require managed care companies
operating within the State of New York to amend their policies to pay for x-ray
examinations and other ancillary services performed at the site where consultation or
treatment is being rendered, when such examinations and services are indicated and
appropriate in order to prevent hardship to the patient. (HOD 98-270)
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
211
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 98-262)
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)
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 97-285;
Reaffirmed HOD 00-251, HOD 00-257, HOD 00-268, HOD 03-268 & 278 and
HOD 05-254 & 276)
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 Insurance to review health insurers’ reports concerning savings they have accrued
in their roles as secondary payors and to pass on these savings to consumers in the
form of reduced premiums. (HOD 97-279; Reaffirmed HOD 00-264 & HOD 06-259)
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 97-270)
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
212
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 97-263)
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 97-260)
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 97-163)
265.993
Denial of Payments, “No Fault” Insurance Carriers: MSSNY has adopted the
position that: (1) “No fault” carriers may not deny payment for medical services for
injuries arising from operation of a motor vehicle while under the influence of alcohol;
and (2) No fault” carriers shall be permitted to use all possible legal methods to
recover such payments from the intoxicated operator. (Council 12/14/95;
Reaffirmed HOD 99-70)
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 94-262)
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 94-218)
265.996
Reimbursement Based on Outcome: MSSNY, in the best interests of patient care,
adopted as policy that reimbursement should not be based upon the success of
treatment as medicine, being both an art and a science, cannot guarantee the outcome
of care. (HOD 93-48)
265.997
Benefits Denial by HMOs and Third Party Carriers: It is the position of MSSNY
that the New York State Dept. of Insurance should take the necessary steps to ensure,
through the establishment of Guidelines and closer monitoring protocols, that HMOs
and third party carriers be required to use fair and uniform standards for determination
of medical necessity and that if payment is to be denied for a particular procedure, the
treating physician be timely contacted in advance for any corroborative information
that could preclude the possible denial of a claim. (Council 9/22/94; Reaffirmed
213
HOD 03-268 & 278)
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 92-34)
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 83-3 & 83-46)
267.000
RESIDENT PROGRAM CREDENTIALING/
RECREDENTIALING:
267.997
Final Credentialing for Physicians Who Have Preliminary Training or Transfer
Training Programs and Graduate from the Final Residency Program: MSSNY
to 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 to 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 to work with the American Medical Association to:
214
(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 08-213)
267.999
Credentialing Materials: Timely Submission by Residency and Fellow
Programs: MSSNY to encourage: (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 recredentialing verification data requested on behalf of their graduating residents
to the requesting agency within thirty days of the request. (HOD 07-201)
270.000
RIGHTS AND RESPONSIBILITIES OF PHYSICIANS:
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 11-216)
270.977
Physician Respect: MSSNY to: 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 10-209)
270.978
Cyberspace Evaluations of Physicians: MSSNY to 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
215
facilitates on-line slander, libel and misrepresentation of identify or
cyberbullying;
−
270.979
270.980
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)
Right to Privately Contract: MSSNY to:
a.
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;
b.
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;
c.
send a copy of this resolution to the American Medical Associations 2009 House of
Delegates for its consideration. (HOD 09-74)
Physician Prescribing Information: MSSNY to:
(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)
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 06-55).
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 02-82)
270.983
Safeguarding Identity: MSSNY will support legislation to prohibit the printout of
full credit card numbers with other identifying data in cash register credit card
receipts. (HOD 02-62)
216
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 02-59)
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: MSSNY should aggressively pursue
legislation on the state and federal level to allow physicians to collectively negotiate
with managed care plans.
In addition to its ongoing efforts to facilitate collective physician negotiation with
managed care plans, MSSNY will form an Ad Hoc Committee to identify physician
practice(s) with which a managed care plan(s) has sufficient control that could form
the basis upon which to present to the National Labor Relations Board a challenge to
the traditional definition of independent contractor as such definition applies to said
physician practice(s). (HOD 02-58)
270.986
Cost to Physicians to Implement Government Mandated Rules and Regulations:
(Sunsetted HOD 2011)
270.987
Letter to Hospital-Employed Physicians Regarding Collective Bargaining:
(Sunsetted HOD 2011)
270.988
Physicians for Responsible Negotiation: (Sunsetted HOD 2011)
270.989
Rapid Response Mechanism for Situations with the Media: MSSNY will publicize
to the members that mechanisms exist to:
a.
b.
c.
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 will develop a network of local physicians with communication skills and
formal media training to present MSSNY positions on specific issues. (HOD 99-228)
270.990
Protection from Discovery of Information Collected for Performance
Improvement Activities: 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 99-101)
270.991
Collective Bargaining Unit (CBU): MSSNY will bring forward at the A-99 meeting
of the AMA HOD a resolution containing the following points:
217
1. That the AMA, with all due haste, develop and implement a collective bargaining
unit with no affiliation with existing national trade unions and consistent with our
AMA Principles of Medical Ethics), for employed practicing physicians, in order
to retain the physician’s role as the patient advocate.
2. That the AMA continue vigorously to support antitrust relief that permits
collective bargaining between groups of physicians and health plans/insurers
under the National Labor Relations Act.
3. That the AMA develop and implement a CBU specifically for resident and fellow
physicians, with no affiliation with national trade unions and consistent with the
AMA Principles of Medical Ethics. (HOD 99-100; Council 4/25/99)
270.992
MSSNY’s Support for Physicians in their Quest to be Considered Independent
Contractors: 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 99-84)
270.993
Disruptive Visits to Medical Offices by Government Investigators and Agents:
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 99-57)
270.994
Collective Bargaining: The Council of the Medical Society of the State of New York
will create a task force to explore fully all steps which must be taken to enable
physicians, whether employees or independent contractors, to act collectively in
negotiating all terms and conditions of the relationship between such physicians and
insurers, HMOs and/or any other entities with which such physicians have
employment or other economic arrangement. (HOD 98-70)
270.995
Physician Profiling: Among the elements that should be included in any profiling
system are the following: a) medical school and dates of graduation; b) residency or
fellowship training; c) specialty board certification; d) hospitals where physicians
has privileges; e) appointments to medical school facilities; f) primary practice
location and phone number; g) membership in medical societies (AMA, state,
specialty, county); h) foreign languages spoken in the office; i) license status and
registration renewal date; j) final disciplinary actions taken by BPMC; k) felony or
serious misdemeanor. (HOD 97-220; Council 5/21/98)
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
218
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 96-94)
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 93-103; Reaffirmed Council 2/21/02)
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 89-97; Reaffirmed HOD 02-207)
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 420 Lakeville Road, Lake Success, NY 11042.
(Council 2/89)
275.000
SECOND OPINIONS AND CONSULTATIONS:
275.999
Consultation: Physicians should obtain consultation whenever they believe that it
would be helpful in the care of the patient or when requested by the patient or the
patient’s representative. When a patient is referred to a consultant, the referring
physician should provide a history of the case 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 the case. A physician selected by a patient is encouraged to advise the
patient’s regular physician of the findings or recommendations. (HOD 84-62)
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
219
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 87-15)
285.000
SEXUAL HARASSMENT/RACIAL/GENDER/DISABILITY
DISCRIMINATION:
285.993
Discrimination in Child Custody Cases Against Parents with Disabilities:
MSSNY to 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 09-164)
285.994
Eliminating Religious Discrimination from Residency Programs: MSSNY
encourage 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 05-157)
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 05-156)
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 05-155)
220
285.997
Sexual Assault Legislation: (Sunsetted 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 will either seek the establishment of a coalition, or seek to participate in a
currently formulated coalition, of appropriate and concerned stakeholders, to study and
make recommendations for resolving the problem in the availability and the delivery
of quality medical care because of disparities because of race, color, religion, sex,
sexual orientation, ethnic affiliation, national origin, or underlying disease process.
(Council 1/20/00; Reaffirmed HOD 04-174; Reaffirmed Council 9/9/04)
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)
290.000
SPORTS AND PHYSICAL FITNESS:
290.993
Use of Nebulizers on School Athletic Fields: MSSNY to 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 11-161)
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 10-151)
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,
221
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)
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)
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)
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)
290.999
Anabolic Steroids: MSSNY opposes the prescription or distribution of anabolic
steroids for the purpose of enhancing athletic performance. MSSNY participates in
the education of the public on the harmful effects of use of anabolic drugs when used
solely for the purpose of enhancing athletic performance. (HOD 89-22)
222
292.000
STEM CELL RESEARCH:
292.999
Stem Cell Research: MSSNY support biomedical research on multipotent 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 05-151)
295.000
SURGERY:
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 00-93)
295.998
Special Assistant at Surgery: MSSNY approved a new category of Special Assistant
for appropriately trained and qualified surgical technicians acting as first assistant at
surgery pursuant to regulation published in the State Register. (Council 5/20/99)
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 nonphysicians in postoperative medical/surgical patient care. (HOD 88-80; Reaffirmed
Council 11/13/03)
300.000
TOBACCO USE AND SMOKING:
(See also Health Insurance Coverage, 120.000; Health Screening Programs, 125.000
300.943
Electronic Cigarettes: With regard to “e-cigarettes,” MSSNY supports prohibition of
(1) the sale to individuals under the age of 18 years of age; (2) the sale in any facility
where health care is delivered or where prescriptions are filled; and (3) their use in
public places in accordance with New York State’s Clean Indoor Air Act.
(HOD 10-161)
223
300.944
Eliminating Tobacco Products from Pharmacies and Grocery Stores: MSSNY to
publicly commend those pharmacies, grocery and retail chains which do not sell
tobacco products and/or do not accept tobacco product advertising. (HOD 10-158)
300.945
Oppose Sale of Tobacco Where Patients Receive Health Care: MSSNY opposes
the sale of tobacco at any facility where health care is delivered or where prescriptions
are filled. (HOD 08-172; Reaffirmed HOD 10-158)
300.946
Second-Hand Smoke Policies to Apply to the Pediatric Population: MSSNY
supports policies that eliminate exposure to second-hand smoke in the pediatric
population. (HOD 08-158)
300.947
Support Congressional Bills to Regulate Tobacco Products: MSSNY to support
federal legislation establishing the Food and Drug Administration’s authority to
regulate all tobacco products. (HOD 07-163)
309.948
Tobacco Use and Smoking: MSSNY to encourage its members to maintain a
tobacco-free environment and prohibit all forms of tobacco use on their property and,
also, continue to educate physicians in tobacco cessation techniques based on the most
recent treatment guidelines for tobacco use and dependence. (HOD 07-162)
300.949
Amend NYS Clean Indoor Air Act: MSSNY will take a leadership role in seeking
passage of amendments to New York State’s Clean Indoor Air Act which further
limits smoking in public places. (HOD 02-151)
300.950
Funding of the U.S. Tobacco Suit: (Sunsetted HOD 2011)
300.951
New Legislative Proposals Against the Promotion of Tobacco to Children in New
York State: MSSNY will support legislation (a) to limit the promotion of tobacco
products in the State by all tobacco companies; (b) to prohibit the sale of tobacco
products to anyone under 21 years of age; (c) to increase penalties for the sale of
tobacco to persons under 21 years of age.
MSSNY will convey these positions to Health Committees of the State Legislature,
the Governor’s Office, and the State Health Department beginning with the current
legislative session. (HOD 00-169)
300.952
More Nicotine-Replacement Therapy for Hospitalized Smokers: MSSNY will
urge physicians to regularly consider the use of nicotine replacement therapy,
counseling and post-discharge follow-up for hospitalized smokers when appropriate,
both to reduce nicotine withdrawal symptoms and to enhance continuation of
abstinence from tobacco after discharge, and MSSNY will urge the American Medical
Association to adopt a similar resolution. (HOD 00-154)
300.953
Study on the Possible Use of Pneumococcal Vaccine for Chronic Smokers:
MSSNY will recommend that the American Medical Association study the possible
use of polyvalent pneumococcal vaccine for chronic smokers as a high risk population.
(HOD 00-152)
300.954
Tobacco Settlement Funds: MSSNY will work with state legislators, the Attorney
General and other appropriate elected officials to seek passage of legislation that will
224
devote a significant portion of tobacco settlement funds to: a comprehensive tobacco
use prevention and cessation program similar to those now in place in Massachusetts,
California, and Florida; and the expansion of access to medical care for the uninsured.
MSSNY will immediately to monitor and comment on plans emerging within the State
on the proposed uses of the tobacco settlement monies and report back to the House
periodically and not less than at each annual meeting. (HOD 99-58)
300.955
Tobacco Tax Use: MSSNY will support legislation that would increase the state tax
on the sale of tobacco products, with the proceeds to be used for a comprehensive antitobacco campaign, expanded access to clinical care for uninsured New Yorkers,
including care provided by private physicians, and other appropriate purposes.
Included in the anti-tobacco effort would be an anti-tobacco advertising campaign,
similar to those that were implemented as a result of “Question 1” legislation in
Massachusetts. (HOD 99-56)
300.956
Prohibition of Smoking on Hospital Grounds: MSSNY will seek statutory changes
which would prohibit tobacco smoking on all hospital grounds, indoors and outdoors,
near all entrances, exits and ventilating systems. (HOD 98-169)
300.957
Tobacco Ads on New York City Taxi Cabs: MSSNY supports a ban on tobacco
advertising on taxi cabs in New York City. (HOD 98-166)
300.958
Smoking in Bars and Nightclubs: MSSNY will take the lead in seeking to make
smoking restrictions under New York State law include bars and nightclubs.
(HOD 98-165)
300.959
Doubling the New York State Excise Tax on Cigarettes: MSSNY will encourage
State Government to double the excise tax on cigarettes before the year 2000; and will
support an increase in federal excise taxes on tobacco, which would be allocated to
health care needs and health education. (HOD 98-164)
300.960
Smoking Ban in Public Areas: MSSNY will advocate for a non-smoking
environment in public areas for all people, particularly children in New York State.
(HOD 98-161)
300.961
Ban Cigarette Vending Machines: MSSNY will petition the New York State
Legislature and the Department of Health to ban the sale of cigarettes in vending
machines in New York State. (HOD 97-151)
300.962
Increase State Excise Tax On Cigarettes: MSSNY will seek passage of state
legislation to increase the state excise tax on cigarettes. Such legislation should
mandate that all monies raised by the increase in the state excise tax on cigarettes be
used to pay for state funded education and research into the most appropriate steps to
reduce smoking and for other programs designed to reduce smoking-related diseases.
(HOD 97-74)
300.963
Local Tobacco Ordinances, State Preemption of: MSSNY supports the right of
local jurisdictions to enact tobacco control regulations that are stricter than those
contained in state statutes and strongly opposes efforts to preempt this right through
state legislation.
225
MSSNY strongly opposes the proposed legislation (Senate Bill 5902 - Assembly Bill
8433) which would preempt local option from enacting standards more stringent than
those of New York State in protection of their public health. (HOD 96-158)
300.964
Advertising in Mass Transit Systems: MSSNY places the elimination of alcoholic
beverages and tobacco advertisements in mass transit systems high on its 1995
legislative agenda and has resolved that, in the interest of a timely concerted effort, it
will urge district branches to seek elimination of alcoholic beverage and tobacco
advertisements from mass transit systems in their respective areas of the State
beginning early in 1995. (HOD 94-162)
300.965
Advertising as a Business Deduction: MSSNY has urged the New York
Congressional Delegation to support legislation that proposes to reduce in part the
amount that the tobacco industry claims as a business deduction for costs related to
advertising and promotion. (HOD 93-83)
300.966
Tobacco Subsidies: MSSNY has requested the AMA to sponsor federal legislation
which would discontinue the subsidies to tobacco farmers. (HOD 93-86)
300.967
Sales Tax Increase on Alcohol and Cigarettes: MSSNY is supporting an increase in
the tax on alcohol and cigarettes in order to discourage alcohol and cigarette use.
(HOD 93-124)
300.968
Pharmacies - Commendation for Not Selling Tobacco Products: MSSNY called
on the AMA to encourage local medical societies to publicly commend pharmacies
that do not sell tobacco products and to ask its members to encourage patients to seek
out and patronize pharmacies that do not sell tobacco products. (Council 10/29/92)
300.969
Tobacco Industry “Health Education”: MSSNY called on the AMA to publicly
reject the tobacco industry as a credible source of health education material, and asked
the AMA to encourage state and local medical societies to actively advise
municipalities and school districts against use of health education material sponsored
or distributed by the tobacco industry. (Council 10/29/92)
300.970
Advertising on Billboards, at Sporting Events, in Stores and Restaurants:
MSSNY is seeking and encouraging legislation which would prohibit tobacco
advertising on billboards, at sporting events, in stores and restaurants, as well as
prohibiting the tobacco industry from advertising which may promote and maintain
addiction among children. (HOD 92-58)
300.971
Adolescent Tobacco Prevention Act - Support of: MSSNY supports the Adolescent
Tobacco Prevention Act as outlined in Governor Cuomo’s Messages to the Legislature
on January 8, 1992. It supports increased taxes on tobacco products to be used for
educational programs aimed at decreasing tobacco abuse by adolescents.
(HOD 92-31)
300.972
Smoking Ban in Sports Stadia: MSSNY has urged the owners of all sports teams in
New York State to follow the example of the Oakland Athletics, the Detroit Tigers, the
Minnesota Twins and the Atlanta Braves by banning smoking in all stadia in New
York State out of concern for the comfort and good health of their fans. (HOD 92-27)
226
300.973
Warning Labels on Cigarette Packs: MSSNY has requested the AMA to urge
Congress to require that: (1) Warning labels on cigarette packs should appear on the
front and the back and occupy twenty-five percent of the total surface area on each
side; and (2) In the case of cigarette advertisements, labels of cigarette packs should
be moved to the top of the ad and should be enlarged to twenty-five percent of total ad
space; and (3) Warning labels following these specifications should be included on
cigarette packs of U.S. companies being distributed for sale in foreign markets.
(Council 5/14/92)
300.974
Advertising within the Metropolitan Transit Authority System: MSSNY strongly
urged the Metropolitan Transit Authority to eliminate all advertising of tobacco
products within the system. (Council 5/14/92)
300.975
Governor’s Program Bill - 1991: On June 13, 1991, the Council approved support
for the 1991 Governor’s Program Bill on Smoking and Health which prohibits the
distribution of tobacco products without charge, or at less than basic cost, prohibits
vending machines which dispense tobacco products, prohibits advertising of tobacco
products in publicly owned or operated sports facilities, and prohibits tobacco use on
school property. The purpose of this bill is to reduce the number of minors who begin
smoking. (Council 6/13/91)
300.976
Advertising at Sporting Events: MSSNY supports efforts to ensure that sports
promoters stop accepting tobacco companies as sponsors. (HOD 91-116)
300.977
Cigarette Vending Machine Ban: MSSNY supports all efforts to ban cigarette
vending machines from places readily accessible to minors. (HOD 90-29)
300.978
Advertising Near Public Schools and Public Housing: MSSNY, in the interest of
promoting a better health care in minority and other communities, opposes cigarette
advertising on billboards near public schools and public housing and supports the
concept that such billboard advertisements be placed not less than 5 city blocks or
1000 feet from public schools and public housing. (HOD 90-69)
300.979
Marketing Aimed at Women: MSSNY requested the United States Secretary of
Health and Human Services to continue to issue statements denouncing marketing of
tobacco products specifically aimed at woman. (HOD 90-31)
300.980
Smoking on U.S. Domestic Commercial Flights: MSSNY protests the continuance
of smoking on any U.S. Domestic scheduled commercial flight. (HOD 90-36)
300.981
Magazine Advertisements: MSSNY publishes in the New York State Journal of
Medicine a list of magazines that have voluntarily chosen to decline tobacco ads, and
encourages physicians to substitute magazines without tobacco ads in their office
reception areas. (HOD 90-24)
300.982
Tobacco Use As a Contributory Cause of Demise on Death Certificates: MSSNY
requested the Commissioner of Health of New York State to modify the death
certificate form to include a check off box regarding tobacco use as a contributory
factor to cause of death on death certificates in the State of New York. (HOD 89-69)
227
300.983
Anti-Smoking Information in Primary School Curriculum and Restriction of
Sale of Tobacco Products to Minors: MSSNY has urged the New York State
Education Department to implement an anti-tobacco program as part of the already
mandated substance abuse curriculum. It is the Society’s position that the New York
State law which prohibits the sale of tobacco products be more strictly enforced.
(HOD 89-13)
300.984
Advertising Targeting Minorities: MSSNY recognizes that the targeting of
advertisements for cigarette and other tobacco products toward minorities is a health
hazard to the community and should be curtailed. (HOD 89-9)
300.985
“Smokeless” Cigarettes: MSSNY strongly objects to the introduction of
“smokeless” cigarettes in New York State and seeks to amend existing legislation to
place the same restrictions on this product as presently exists on all other tobacco
products. (HOD 88-23)
300.986
Smoking In Public Places: It is the position of MSSNY to encourage municipalities
in New York State to introduce legislation similar to legislation passes in 1987 by the
New York City Council to regulate smoking in enclosed public places. MSSNY
recommended to the Governor of New York State and the Legislature that legislation
approximating the regulation recently proposed by the Public Health Council be
enacted. (HOD 88-41)
300.987
Smoking Ban in Public Places and in Work Places: The House of Delegates of the
Medical Society expressed strong support for strict anti-smoking measures in public
places and in work place. (HOD 87-16; Reaffirmed HOD 95-164)
300.988
Advertising and Distribution, Ban on the Sale of all Tobacco Products: The
House of Delegates of the Medical Society has expressed support for current federal
legislation prohibiting advertising and promotion of all tobacco products.
(HOD 87-69)
300.989
Hospitals’ Smoking Ban: MSSNY has agreed to petition the Hospital Association of
New York State (HANYS) to urge its member hospitals to ban all smoking by
physicians, employees, visitors and patients within their hospitals, and agreed to
encourage its members to take a leadership role in working with the administrators of
their local hospitals to ban all smoking in their institutions. (HOD 87-17)
300.990
Smoking in Airplanes: MSSNY is on record as being opposed to smoking in
airplanes. (HOD 87-51)
300.991
Minimum Allowable Age to Purchase Tobacco Products: MSSNY has agreed to
urge the New York State Legislature to change the minimum allowable age for the
purchase of tobacco products in New York state from age 18 to age 20.
(HOD 87-42)
300.992
Advertising Against Cigarette and Other Tobacco Products: The House of
Delegates of the Medical Society voted support for an allocation in the State budget to
be used specifically to purchase space in the mass media as a means of countering the
current youth-oriented advertising campaigns of cigarettes and tobacco products.
(HOD 85-6)
228
300.993
Advertising in the Leading Prestigious Newspapers and Periodicals: The House
of Delegates directed the President of the Medical Society of the State of New York to
write to the publishers of the leading newspapers and periodicals centered in New
York State to urge them to refuse advertising for cigarettes and tobacco products
because they present a danger to the public health. (HOD 84-6)
300.994
Restaurants, Non-Smoking Areas: MSSNY will seek and support legislation
requiring that non-smoking areas be provided in all restaurants in New York State.
(HOD 83-11)
300.995
“No Smoking” Signs in Physicians’ Offices: MSSNY approved the voluntary use of
“No Smoking” signs in physicians’ offices. (HOD 83-11)
300.996
Hospitals’ Cigarette Vending Machines: MSSNY has urged hospital authorities to
take steps to remove cigarette vending machines and the sale of cigarettes from their
premises since this is totally inconsistent with a hospital’s mission to protect the public
health and is not in keeping with its standing as a symbol thereof. (Council 11/30/78)
300.997
Designated Smoking Areas: MSSNY supports the principle that smoking in public
places be limited to certain designated areas. (Council 11/30/78)
300.998
National Effort to Reduce Smoking, Support of: MSSNY has indicated its support
of current national efforts to reduce the habit of smoking and pledges to charge those
of its committees which have a responsibility in the area to review their potential
contribution to the control of this public health problem, including those with a special
concern for the young. (Council 11/30/78)
300.999
Smoking Clinics: MSSNY approved and supported the concept of smoking clinics,
which are organized and publicized through appropriate voluntary health agencies, and
have public health support and participation of physicians and health professionals.
(Council 5/24/73)
305.000
UNIVERSAL CODE FOR REPORTING MEDICAL SERVICES:
305.998
HCFA Provision of Coding Information Free of Charge: MSSNY will seek federal
legislation requiring the Health Care Financing Administration (HCFA), via the U.S.
Government Printing Office, to provide physicians, free-of-charge, all the coding
information including nomenclature for all procedure codes, diagnosis codes,
laboratory procedure codes and fee schedules, and National Correct Coding Initiative
(CCI) material, necessary to correctly complete HCFA claim forms, and MSSNY will
present this resolution to the American Medical Association House of Delegates for its
consideration and adoption. (HOD 00-263)
305.999
Universal Code for Reporting Medical Services and Procedures Performed
by New York State Physicians: MSSNY has accepted and recommends to its
members “The Physicians’ Current Procedural Terminology” (CPT-4) as currently
revised and published by the AMA. It is initiating appropriate actions necessary to
require all private and governmental third party payors, carriers, and/or contractors
doing business in New York State to adopt the CPT-4, as currently revised, as the only
229
and universally accepted procedural coding system as of December 31, 1983. (HOD
82-26; Reaffirmed HOD 03-268 & 278)
310.000
UTILIZATION REVIEW:
310.993
Low Cost Arbitration: In order to ensure the quick, fair and inexpensive resolution
of billing and fee disputes between physicians and insurers (especially disputes over
fees for out-of network care in emergency settings), MSSNY to seek legislation
requiring the State of New York to set up a low-cost expedited arbitration process,
separate from the arbitration process required by many physician/insurer contracts
today. Included in this legislation should be (1) a provision whereby the State
Insurance Department would be required to serve as the arbiter and (2) a provision
whereby the arbitration process could be initiated by the physician (e.g., if the
physician gets paid less than the agreed-upon rate). (HOD 09-64)
310.994
Use of Binding Arbitration: MSSNY seek a change to the law to permit binding
arbitration clauses in contracts between physicians and patients. (HOD 06-61)
310.995
Independent Medical Examiners: MSSNY will legislation to create a pool of
physicians in each specialty to act as Independent Medical Examiners (IMEs) for all
third party payers doing business in New York State who request such a service in
order to determine the need for further or continued medical treatment.
MSSNY will urge the Office of the Insurance Commissioner assign IMEs from the
pool to conduct physical examinations and review medical records on a purely rotating
basis so there is no bias in the selection of the IMEs; or, alternatively, select an
independent organization, such as the Empire Foundation, to administer such an IME
program with fees to be paid by the insurers. (HOD 00-280)
310.996
Third-Party Payer Use of Unsubstantiated Demand and Refund Letters: MSSNY
will seek amendment to the New York State Insurance Law to address the issue of
payer demand letters, and to reflect the following provisions: 1) the physician should
have the right to due process, should have access to all pertinent carrier documents,
and should have the right to review the post-payment audit sample with appropriate
carrier personnel; 2) in post-payment reviews, carriers should not retroactively apply
new policy to old claims; 3) where the amount in dispute exceeds $1,000, physicians
should have the right to have an independent entity not employed by the third-party
payer (such as a Peer Review Organization or the American Arbitration Association)
review the results of the carrier’s post-payment review; and 4) third-party payers
should not seek repayment through the claims offset process until the physician has
exhausted all appeals, and until an accurate overpayment amount has been established.
(HOD 00-279; Reaffirmed HOD 10-259)
310.997
Arbitration in Cases of Third-Party Audits: MSSNY will seek legislation or
regulation for the development of an independent arbitration panel to handle requests
for refunds by third-party payers arising from audits of physicians’ practices.
(HOD 98-265)
310.998
Third Party Audits of Physicians with Subsequent Billing of Physicians for Tests
Deemed Inappropriate: MSSNY will urge the appropriate state and federal
regulatory agencies to regulate third party payers’ medical practice audits such that
230
these audits focus on providing education and improving the quality of care, and not
be used for financial or punitive activities. MSSNY will work to ensure outcomes of
all medical practice audit processes would be governed by rules of due process which
will be available for all physicians who participate in third party audits.
(HOD 98-255)
310.999
312.000
Medical Director to be Required for all Third Party Payors: The Medical Society
of the State of New York will seek whatever legislative or regulatory action is
necessary to insure that all health insurance companies that are licensed in the State of
New York and performing utilization review have a physician medical director who is
licensed by the State of New York, who is accessible and identifiable to the treating
physician; and will seek regulatory action which assures that plan medical directors
are held accountable for their medical review determinations. (HOD 97-58)
VACCINES:
(See also Medicare, 195.000; Health Screening Programs, 125.000)
312.979
Healthcare Workers and Influenza Vaccination: MSSNY policy states that
influenza vaccination is:
ƒ
ƒ
ƒ
the best protection for public health;
effective at reducing infections with influenza virus and subsequent person-toperson transmission;
an important infection prevention measure to reduce transmission of influenza
from health care workers to patients and vice versa.
In addition, MSSNY is to support educational efforts to ensure that the public
understands the need for influenza immunization. (HOD 10-166)
312.980
Influenza Vaccine: MSSNY to urge the American Medical Association to seek
federal legislative or regulatory action for the Centers for Disease Control and
Prevention to develop and control all future influenza vaccine in the interest of the
nation’s public health. In addition, MSSNY and the American Medical Association
are to advocate for a distribution method of influenza vaccine similar to the method
that was demonstrated for 2009-10 H1N1 vaccine and that such distribution system
give physicians, hospitals, public health departments and health clinics first priority in
receiving the influenza vaccine. (HOD 10-165)
312.981
Insurance Companies and the Advisory Committee on Immunization Practices
(ACIP): MSSNY to support legislation mandating that health insurance companies in
New York State pay for vaccines recommended by the Advisory Committee on
Immunization Practices (ACIP) for every individual. Also, those insurance companies
not reimbursing for ACIP-recommended vaccines should clearly state so in a notice to
patients and businesses; and health insurance companies should reimburse providers
for the vaccines at fees sufficient to cover the procurement and storage cost of the
vaccine. A resolution is to be transmitted to the American Medical Association to
seek similar appropriate reimbursement for all ACIP-recommended vaccines for all
persons through federally funded programs. (HOD 09-167)
312.982
Herpes Zoster Vaccine and Medicare Payment for the Vaccine and for Physician
Administration of the Vaccine: MSSNY to work with the American Medical
231
Association to lobby for Medicare to pay for both the cost of the vaccine and the cost
to administer the herpes zoster vaccine by the physicians. (HOD 08-169)
312.983
Immunization Registry: MSSNY to: (a) support efforts to delay implementation of
the New York State Immunization Information System to allow sufficient time for
physicians and their staff to be educated, trained and obtain the necessary equipment
to use the registry; (b) support procedures that will ease the administrative burden to
physicians such as FAXing and mailing of vaccination records to the New York State
Department of Health; and (3) continue its advocacy for fair and adequate
administrative fees from all payors. (HOD 08-153)
312.984
Immunization Access to Parents of High-Risk Infants Younger Than Six Months
of Age: MSSNY - (1) endorses the use of the neonatal intensive care unit and hospital
newborn nursery as practical and legitimate venues for parents and first-person
contacts of vulnerable infants (those less than six months of age and/or premature) to
obtain vaccines against communicable respiratory pathogens such as influenza and
pertussis; (2) recommends that hospitals with neonatal intensive care units and
newborn nurseries consider making vaccine against these pathogens available; and (3)
supports local and state governments in efforts to make available vaccinations to
parents and first-person contacts of those infants under the hospital’s care.
(HOD 08-152)
312.985
Education as to the Benefits of the Human Papillomavirus (HPV) Vaccine:
MSSNY to: (1) support educational efforts aimed at the general public regarding the
Human Papillomavirus (HPV) vaccine and its benefits; and (2) support and advocate
for appropriate reimbursement rates associated with the administration, storage, and
counseling of families regarding the Human Papillomavirus (HPV) vaccine.
(HOD 07-167)
312.986
Tamiflu Distribution: MSSNY to: (1) collaborate with all parties of interest,
national and local, to assure that supplies of Tamiflu and other appropriate antiviral
medication are sufficient and available; (2) urge state and local regulators to ensure
that adequate anti-flu viral drugs will be available for distribution, not only to
hospitals, health departments, and other such public agencies, but also to private
pharmacies and physicians directly; and (3) through collaboration with the appropriate
organizations and agencies, seek to eliminate barriers to patients receiving appropriate
medications for treatment and/or prevention of potential catastrophic influenza
epidemics. (HOD 07-166)
312.987
Flu Vaccine Distribution: MSSNY to: (1) seek recognition that physicians offices
and/or clinics are the most appropriate sites for vaccinations; (2) support legislation or
regulation that will ensure an adequate and timely supply of vaccines to physician
offices and clinics; and (3) seek legislation or regulation to ensure sufficient
reimbursement to cover the cost of purchase, storage and administration of
vaccinations and a process for addressing the cost for, or return of, unused/outdated
vaccination material. (HOD 07-165)
312.988
Administration of the Human Papillomavirus (HPV) Vaccine as a Means of
Preventing the Transmission of the HPV, Cervical Cancer and HPV-Associated
Diseases in Individuals:
232
MSSNY support the recommendation of the HPV vaccine as a means of preventing
the transmission of the virus and as a means of preventing cervical cancer and other
HPV-associated diseases in individuals. (Council 1/25/07; Reaffirmed HOD 07-167;
Revised with Title Change, Council 1/20/11)
312.989
Assurance that Practicing Physicians Obtain Influenza Vaccine: That physicians,
hospitals, nursing homes and local public health agencies receive first priority in the
distribution of the influenza vaccine to allow for the timely immunization of patients;
thereby allowing patients to maintain their medical home; that MSSNY urge the
American Medical Association (AMA) to seek federal legislation to enact provisions
to ensure that physicians, hospitals, nursing homes and local public health agencies be
the first priority in the distribution of the influenza vaccine and work together to
effectuate this change in national vaccine policy; and that this resolution be
transmitted to the AMA for action at its 2006 House of Delegates. (HOD 06-156)
312.990
Flu Vaccine Distribution: MSSNY urge the New York State Department of Health
to control the disbursement of flu vaccine should another shortage occur and that the
flu vaccine be preferentially routed to physicians’ offices, medical clinics, hospitals
and public health departments for distribution to the stratified population at the
greatest risk first. MSSNY urge the New York State Health Department to take
appropriate action so that in the event of another influenza vaccine shortage that
vaccine lots can be easily located and recovered for redistribution as necessary.
MSSNY support the concept that the high risk population, as defined by the Centers
for Disease Control and Prevention, be immunized first. (HOD 05-158)
312.991
Availability and Distribution of Flu Vaccine: MSSNY will take all means
necessary to ensure that New York State physicians have adequate influenza vaccine
supplies. (HOD 02-159)
312.992
Vaccine Shortages: MSSNY will strongly recommend that the New York State
Department of Health take all means necessary to ensure that New York State
physicians have adequate vaccine supplies. (HOD 02-154)
312.993
Impact of Vaccine Pricing on a Medical Indication: MSSNY will ask the
American Medical Association to study the influence of a very high price in
determining the indications for a new vaccine. (HOD 00-153)
312.994
Drug-Resistant Streptococcus Pneumoniae: MSSNY has requested that the
American Medical Association encourage state medical societies to urge their
members to expand their use of 23 valent pneumococcal vaccines for those at
increased risk for serious pneumococcal infections age two and over, and for all
persons age 65 and over, in light of the accelerating rise in frequency of multiple
resistant strains to penicillin and related drugs. (HOD 94-164)
312.995
National Vaccine Authority, Establishment of: MSSNY supports the creation of a
National Vaccine Authority, along the lines proposed in the Institute of Medicine
report, in order to coordinate efforts to develop new improved vaccines for use
throughout the world. (HOD 94-170)
312.996
Hepatitis B Immunization of Infants: MSSNY is alerting and educating the public,
physicians, other health care providers and legislators to the importance of Hepatitis B
233
vaccine inoculation of all infants and groups at high risk. It is working to have the
New York State Department of Health regulation adopted which would recommend
that all (healthy full term *) infants born in New York State receive the first dose of
Hepatitis B Vaccine before discharge from the newborn nursery, regardless of the
mother’s HBsAg status. MSSNY is also calling for the implementation of a nationally
mandated Hepatitis B vaccination program for all infants.
NB
Wording added by AMA House of Delegates, A-93 (HOD 93-104)
312.997
Vaccines - Bulk Purchase for Medicaid Eligible Children and Free of Charge
Distribution: MSSNY has requested the New York State Department of Health and
the New York State Department of Social Services to arrange for bulk purchase, at
discount rates, of all vaccines required for Medicaid-eligible children and for free-ofcharge distribution to physicians and other authorized health care providers. The
Society has also recommended that the State of New York consider development of a
universal system of distribution of all vaccines for all children in the State and has
called on the AMA to recommend to state health departments the adoption of a policy
of bulk purchase of all vaccines required by children with distribution free-of-charge
to physicians and other authorized health care providers in states where this is not
current practice. (Council 10/29/92)
312.998
Vaccine - CDC Pamphlets: The Society has asked the AMA to confer with the
Centers for Disease Control and the National Vaccine Program on replacing each of
the current CDC vaccine pamphlets (“What You Need to Know”) with two pamphlets:
a longer one containing general information and a much shorter statement to serve as
sole instrument for providing necessary warnings and obtaining signatures for the
patient’s records. The AMA was asked to work with the American Academy of
Pediatrics toward this policy direction. (Council 10/29/92)
312.999
Vaccines: MSSNY is seeking enactment of legislation in New York State to ensure in
an administratively efficient manner ready availability of vaccines to immunize
individuals in the State at reasonable cost, and has petitioned the Legislature to address
the medical liability problems so that manufacturers may be induced to produce these
vaccines. (HOD 92-32)
315.000
VIOLENCE AND ABUSE:
315.989
Elder Mistreatment: MSSNY’s Long-Term Committee to develop a policy paper,
utilizing the policies contained in the American Medical Association National
Advisory Council on Violence and Abuse as a reference and issue a report on their
findings to the 2010 MSSNY House of Delegates. (HOD 09-163)
315.990
Sexually Violent Predators Civil Commitment Law: MSSNY completely
recognizes and supports the state’s obligation to protect the citizens of New York State
from sexually violent predators, and opposes legislation or regulation which attempts
to create new definitions of mental illness to misuse existing psychiatric medical
diagnoses or require psychiatric physicians and/or psychiatric treatment facilities to
accept such diagnostic categories. Any sexually violent predator program should be
placed under the auspices of another, non-medical department, such as the Department
of Corrections, not under the Office of Mental Health and that funding for any
234
sexually violent predator program should not come at the expense of the Office of
Mental Health. (HOD 06-169)
315.991
Troubled Youth and Violence: MSSNY supports legislation that children who take
guns or other weapons to school should receive an evaluation by a psychiatrist and that
those children who are determined by such evaluation to have a mental illness should
receive appropriate treatment.
MSSNY supports teacher and parental educational initiatives to better enable them (a)
to identify children with severe mental illness/emotional disturbance at risk for
psychiatric illness, substance abuse, and potentially dangerous behaviors, and (b) to be
aware of available treatments to assist these children and their families.
MSSNY reaffirms its support for parity of health insurance coverage for mental illness
including children.
MSSNY will encourage the New York State Education Department to develop and
implement a comprehensive unit in every grade, pre-school through grade 12, on anger
management, peer mediation, and non-violent conflict resolution.
MSSNY will encourage the New York State Education Department to support
adequate ratios of supervising adults to students, both during the school day and
during off-school hours, and advocate for increased resources within the school,
including before- and after-school (“wrap-around”) activities and increased personnel
such as school nurse-teachers, counselors, and similar staff, to assist in educating
children and their families about mental illness/emotional problems and to serve as
resources to other school personnel.
MSSNY will support funding for not-for-profit community organizations that work
with normal, troubled and/or addicted youth and their families to develop and promote
safe, enriching, out of school alcohol and drug free activities for families, as well as
parent education classes including, but not limited to, parenting skills, anger
management, identifying early warning signs of substance use, gang involvement,
deviant behavior, and community resources for management of the same.
MSSNY will support the establishment of guidelines by the New York State
Education Department and funding for their implementation to help schools to deal
effectively and safely with children whose violent or potentially-violent behavior
constitutes a risk to self or others, and to find immediate screening, prevention,
alternate programming and treatment in those instances where a bona fide mental
health emergency has been demonstrated.
MSSNY will support funding to school districts, not-for-profit agencies, and
communities to develop high quality, effective alternate programming, emergency
evaluation and intervention, and short-, medium- and long-term treatment for children
across the spectrum of mental illness.
MSSNY will continue to support efforts by the Legislature and the Governor to
address media influence on youth violence. (HOD 5/20/00)
315.992
Violence Against Physicians, Health Care Workers and Others: MSSNY will
work with the New York State Society of Internal Medicine and other recognized
specialty societies, to formulate, within current budgetary constraints, a public and
235
professional awareness campaign in response to the recent trends towards violence
against physicians and other health care workers in the performance of their duties.
MSSNY shall condemn, without exception, the violence or threat of violence to
physicians, health care workers and other individuals who are practicing according to
their conscience, and in compliance with the law. (HOD 99-202; Reaffirmed
Council 11/13/03)
315.993
Development of Programs Focused on Identification and Treatment of Troubled
Youths: MSSNY, while working in conjunction with the New York State Psychiatric
Association, the State Education Department and other interested parties shall develop
programs designed to provide early childhood identification of troubled youths.
Education systems across New York state will incorporate appropriate educational
programs and referral programs to identify, treat or refer troubled youths and their
families. MSSNY will assist physicians, health care professionals, educators and all
others who work with youths on the warning signs of emotional disturbance in young
people, and MSSNY members shall recognize both their professional obligations and
the importance of young people to the future of the State of New York.
(HOD 99-175; Reaffirmed Council 11/2/00)
315.994
Need for Adequate Training of Teachers to Identify Potentially Dangerous
Children and the Provision of Adequate Insurance Coverage to Provide for Their
Treatment: New York State shall provide adequate training for teachers to identify
disturbed and potentially dangerous behaviors in children and that MSSNY will seek
changes in the laws regarding teacher training to provide this. MSSNY will seek
changes in health insurance policies which would eliminate the limitations on
psychiatric benefits so that emotionally disturbed children and their families may have
expanded access to care and coverage for all psychiatrically/emotionally related
disorders of childhood and adolescence. (HOD 99-174; Reaffirmed Council 11/2/00)
315.995
Violence and Abuse - Addition of Anti-Violence Statements to Birth and
Marriage Certificates: MSSNY strongly supports the addition of the following
statements to certificates of birth and marriage in New York State: (1) Birth - “The
laws of this state affirm your right to live free from violence and abuse. Neither you
nor your child is the property of the other. The laws against physical abuse, emotional
or psychological abuse and sexual abuse are applicable to all family members and
violations of these laws are punishable by either fine or imprisonment, or both.” (2)
Marriage - “The laws of this state affirm your right to live within this marriage free
from violence or abuse. Neither you nor your spouse is the property of the other. The
laws against physical abuse, emotional or psychological abuse and sexual abuse are
applicable to spouses and other family members, and violations of these laws are
punishable by either fine or imprisonment, or both.” (HOD 96-98)
315.996
Identification and Reporting - Licensure Mandated CME: MSSNY has reiterated
its opposition to all mandated courses tied to licensure. Inasmuch as there is a
mandated course of identification and reporting of child abuse and maltreatment for
physicians and other medical personnel, it is the Society’s position that all other
professionals and personnel possibly involved in child abuse cases, including all
judges, attorneys, court personnel, social service workers and others be mandated to
complete course work or training in child abuse and family violence as a licensure or
job requirement. (HOD 93-62)
236
315.997
Dissemination of Information on Violence and Abuse: MSSNY is establishing a
mechanism to ensure the proper dissemination of information to all professionals
involved in the handling of cases of school violence, child abuse, and family violence
relating to the causes, problems of the perpetrators, appropriate solutions, and any
other associated factors. (HOD 92-28)
315.998
Educational Programs: In 1985, the House of Delegates of the Medical Society of
the State of New York adopted a resolution to encourage and/or cooperate with the
New York State Bar Association and/or its component branches in developing
educational programs for physicians and attorneys on: (1) Child abuse identification,
treatment, and prevention; (2) Representation strategies for attorneys who are
appointed as law guardians in the State of New York. (HOD 85-16)
315.999
Physicians’ Responsibility to Report Suspected Child Abuse: MSSNY, to combat
the increasing abuse of children, has approached this problem and has notified all
physicians in the State of their moral, medical, and legal responsibility to report all
suspected cases of child abuse.
MSSNY encourages the development of educational programs that would enable a
better coordination at the local level between police, judiciary, social services and
medical resources to provide help for the victims, as well as the perpetrators, of sexual
crimes against children. (HOD 83-38)
317.000
VOLUNTEER SERVICES OF PHYSICIANS:
317.992
Volunteers in Times of Public Health Emergencies: MSSNY to support and
encourage physicians across the state to volunteer in times of a public health
emergency recognizing that providing physicians contact information to various
individuals in local governments may violate a physicians right to privacy and that
MSSNY contact physicians on the MSSNY Volunteer Database to inform them that
the state will now share all physician information, unless physicians “opt out;” and
that MSSNY work with the New York State Department of Health to resolve legal
issues pertaining to deployment on the local and state level. (Council 1/25/07)
317.993
Incentives for Physicians who Volunteer Without Remuneration: MSSNY to
support legislation that will provide physicians who volunteer without remuneration
with a tax credit on their state income tax; urge the American Medical Association to
seek these liability protections and legislation for a federal tax credit for those
physicians who volunteer without remuneration; and that a copy of this resolution be
transmitted to the AMA for its consideration. (HOD 06-164)
317.994
Physician Volunteers: MSSNY support endorsement of a community based free
clinic program, staffed by physician volunteers to provide interim health care on an
out-patient basis, with the appropriate attention to quality of care; and reaffirm Policy
320.996, which calls for liability protections for those physicians who volunteer within
the free clinic setting. (HOD 05-173)
317.995
Amendment to the Good Samaritan Law, Section 6527, Subdivision 2 of the NYS
Education Law: MSSNY pursue legislation which would expand the definition of
the Good Samaritan Law to include physicians in a hospital setting who may
237
voluntarily respond to emergent situations, thereby protecting the physicians from
malpractice suits. (HOD 05-61)
317.996
Volunteer Physicians: MSSNY will develop a roster of retired physicians who
would consider returning to the medical service in case of national or state emergency.
(Council 2/21/02)
317.997
Immunity For Physicians Serving Volunteer Ambulance Corps: MSSNY will
seek passage of state legislation that would extend the “Good Samaritan” protection to
physicians working on volunteer ambulance corps. (HOD 97-116)
317.998
Volunteer Physician Services: MSSNY strongly encourages who wish to use the
services on a voluntary basis to cover the cost of medical liability insurance as a part
of their arrangement with the volunteering physician. (HOD 96-53; Reaffirmed
HOD 98-65 & 98-69)
317.999
Volunteer Services Provided at Community Based Clinics: On behalf of
physicians who volunteer their services at community-based clinics and other
organizations, MSSNY will seek legislation that such physicians be held harmless in a
medical malpractice lawsuit. (HOD 95-83; Reaffirmed HOD 98-65 and HOD 06-164)
320.000
WEIGHT MANAGEMENT & PROMOTION OF HEALTHY
LIFESTYLES:
(See also Education 85.000; Health Screening Programs, 125.000)
320.988
Supporting Efforts to Reduce Sodium Intake: MSSNY to support efforts to reduce
sodium intake by New York State consumers. (HOD 11-150)
320.989
Decreasing the Incidence of Obesity and Negative Sequelae by Reducing the Cost
Disparity Between Calorie-Dense, Nutrition-Poor Foods and Nutrition-Dense
Foods: MSSNY to support:
•
efforts which seek to decrease the price gap between calorie-dense, nutritionpoor (CDNP) foods and naturally nutrition-dense (ND) foods to improve health
in economically disadvantaged populations by encouraging the expansion,
through increased funds and increased enrollment, of existing programs that
seek to improve nutrition and reduce obesity such as the Farmer’s Market
Nutrition Program (FMNP) as a part of the Women, Infants, and Children (WIC)
program;
320.990
•
novel application of FMNP to existing programs such as the Supplemental
Nutrition Assistance Program (SNAP), and apply program models that
incentivize the consumption of ND foods in wider food distribution venues than
solely in farmer’s markets as part of WIC;
•
a similar resolution being submitted to the AMA House of Delegates at the 2010
AMA HOD by notifying the AMA that the New York Delegation wishes to be
listed as a co-sponsor of this resolution. (HOD 10-168)
Financing Obesity Programs in New York State: MSSNY to:
−
support initiatives to reduce the incidence of obesity in New York State;
238
−
−
−
assume a leadership role in collaborating with other interested organizations,
including state medical specialty societies, to discuss ways to finance a
comprehensive state program for the study, prevention and treatment of obesity
in New York State; and
continue monitoring and supporting state and national policies and regulations
that encourage healthy life styles and promote obesity prevention.
(HOD 09-162)
320.991
Promoting Healthy Foods: MSSNY to (1) continue to advocate for a healthy diet for
all; (2) support legislative efforts to establish New York State nutritional standards
within the educational system; (3) recommend to hospitals, schools, nursing homes,
patients and its physician members that foods should meet the accepted nutritional
standards; and, (4) together with the American Medical Association, promote and
advocate legislation that promotes the availability of fruits, vegetables and whole grain
foods. (HOD 08-150)
320.992
Reduction of Trans Fats in Food Preparation in Restaurants on a Statewide
Basis: MSSNY support and encourage the reduction of trans fats in food preparation
in restaurants on a statewide basis. (Council 1/25/07)
320.993
Obesity Reaching Epidemic Proportions in Children and Adolescents: MSSNY
support the development of model programs that incorporate physical activity,
nutrition and patient education concerning obesity as a controllable risk factor for
preventing disease; and efforts by the New York State Department of Health to
publicize its programs, such as ActiveKids! and the BASIC (Being Active Supports
Independence and Control) Program as a means of providing physical activity.
(HOD 05-164)
320.994
2005 USDA Dietary Guidelines: MSSNY supports the wide use of the 2005 USDA
Dietary Guidelines by a broad spectrum of providers and their patients, and see it as a
complement to the MSSNY White Paper on “Weight Management: Promotion of a
Healthy Lifestyle” 2003, and that these guidelines be made available on the MSSNY
website for use by medical and public health education providers in an effort to focus
on weight management and obesity and that MSSNY supports the use of the Body
Mass Index (BMI) because it can be compared with previous visits. (Council 3/14/05)
320.995
Weight Management Guidelines
Physician Education
The Medical Society will work towards educating its physician members and will
work with its various county medical and specialty societies to bring weight
management before them. The Medical Society will educate physicians via its
website, through continuing medical education courses, and through other media
outlets the Medical Society may have available to them. Additionally, the Medical
Society will enter into a discussion with medical schools regarding the training of
medical students with great emphasis on nutrition, weight management and healthy
lifestyles.
Community Awareness
The Medical Society will work with state agencies, particularly the Department of
Health, in creating awareness for the general public on weight issues. The Medical
239
Society will also contact representatives within the business community and will work
with the New York State Community Health Partnership to promote physical activity
and lifestyles within communities. The Medical Society will also attempt to enlist the
support of the fast food industry to “down size” the portions and to increase the
availability of nutrition information for food purchase within a fast food restaurant.
Educational Institutions
The Medical Society recommends that increased physical activity be incorporated into
the daily schedule at all schools in accordance with the recommendations of “Healthy
People 2010”. (34) Additionally, the Medical Society will seek to preserve “recess”
for all schools to help ensure that children receive physical activity. Furthermore, the
Medical Society will work towards the goal of advocating proper nutrition within the
schools and will support legislative efforts to afford good nutritional choices,
especially in vending machines and in the lunchroom or cafeteria.
Legislative Initiatives
While some insurance plans and managed care organizations pay for programs related
to weight, many in New York State do not. Therefore, the Medical Society will seek
legislation requiring insurance and managed care plans for paying for nutritional visits,
bariatric programs, and certain medications. The Medical Society will also seek
coverage for surgical management, including bariatric surgery and reconstructive
surgery, related to weight loss and management. The Medical Society will also
support efforts to require the Medicaid program to pay for medications related to
weight loss. Furthermore, weight management problems have both medical and
psychological disease origins. Serious mental illnesses can exacerbate the obesity
condition and the conditions related to bulimia and anorexia nervosa. Therefore, the
Medical Society of the State of New York will support legislative efforts to assure that
there is coverage for a full continuum of services to treat these illnesses. Additionally,
the Medical Society supports legislation that will eliminate the outpatient and inpatient
limits and equalize co-payments and deductibles for mental health coverage.
Position Paper:
Weight Management: Promotion of Healthy Lifestyles
Public Health and Education Report 1 Presented by Sheila Bushkin, MD and the members of
the Rural and Preventive Medicine Committee
(HOD 03; Reaffirmed HOD 04-170; Reaffirmed HOD 05-165
320.996
Overweight and Obesity Control as a Major Public Health Program: That
MSSNY:
1. urge physicians as well as managed care organizations and other third-party
payors to recognize obesity as a complex disorder involving appetite regulation
and energy metabolism that is associated with a variety of co-morbid conditions;
2. work with appropriate state and federal agencies, medical specialty societies, and
public health organizations to educate physicians about the prevention and
management of overweight and obesity in children and adults, including education
in basic principles and practices of physical activity and nutrition counseling; such
training should be included in undergraduate and graduate medical education and
through accredited continuing medical education programs;
3. urge state and federal support of research to determine: (a) the causes and
mechanisms of overweight and obesity, including biological, social, and
epidemiological influences on weight gain, weight loss, and weight maintenance;
240
(b) the long-term safety and efficacy of voluntary weight maintenance and weight
loss practices and therapies, including surgery; (c) effective interventions to
prevent obesity in children and adults; and (d) the effectiveness of weight loss
counseling by physicians;
4. encourage state and national efforts to educate the public about the health risks of
being overweight, and obese and provide information about how to achieve and
maintain a preferred healthy weight;
5. urge physicians to assess their patients for overweight and obesity during routine
medical examinations and discuss with at-risk patients the health consequences of
further weight gain; if treatment is indicated, physicians should encourage and
facilitate weight maintenance or reduction efforts in their patients or refer them to
a physician with special interest and expertise in the clinical management of
obesity;
6. urge all physicians and patients to maintain a desired weight and prevent
inappropriate weight gain;
7. encourage physicians to become knowledgeable of community resources and
referral services that can assist with the management of overweight and obese
patients; and
8. urge the appropriate state and federal agencies to work with organized medicine
and the health insurance industry to develop coding and payment mechanisms for
the evaluation and management of obesity. (HOD 03-152)
320.997
Promotion of Healthy Lifestyles: MSSNY will create a position paper to support
and encourage individuals, schools, and communities to promote more physically
active, healthier lifestyles. This may include sending a resolution to the American
Medical Association, and developing a liaison with and supporting other organizations
with similar purposes. (HOD 02-160; Reaffirmed HOD 03-155)
320.998
Medical Treatment and Prevention of Obesity: MSSNY will work with the New
York State Department of Health to develop guidelines for the treatment and
prevention of obesity. (HOD 01-269)
320.999
Physical Activity Increase for Most U.S. Adults: MSSNY endorses, in principle,
the movement calling for every adult to accumulate in the course of each day, 30
minutes or more of physical activity of moderate intensity. (HOD 95-172;
Reaffirmed HOD 99-151)
325.000
WORKERS’ COMPENSATION:
(See also Reimbursement, 265.000; Utilization Review 310.000)
329.959
New York State Workers’ Compensation Board Fee Schedule On Line: MSSNY
will petition the New York State Workers’ Compensation Board to study the
feasibility of placing the “Official New York Workers’ Compensation Board –
Medical Fee Schedule” and associated policies in an on-line environment, accessible
to authorized physicians without charge, in order to save costs by helping physicians
submit proper fee schedule amounts, and by reducing the number of claims/physician
fees that are not deemed to be in accordance with the Workers Compensation fee
schedule. (HOD 11-260)
241
325.960
Timely Payment for Workers’ Compensation Depositions: MSSNY will seek
legislation to ensure timely payment for any physician required to provide a deposition
relative to a Workers’ Compensation (WC) case. This timely payment is to be made
within thirty (30) days from the date the deposition is given, regardless of the outcome
or the time needed to conclude the WC case with interest due and owing as
appropriate. (HOD 11-259)
325.961
American College of Occupational and Environmental Medicine Guidelines:
MSSNY’s legislative staff: (1) to contact the Governor, other elected officials and the
Workers’ Compensation Board requesting them to reevaluate the New York State
Workers’ Compensation draft guidelines for the treatment of injured workers that were
formulated using guidelines from the American College of Occupational and
Environmental Medicine (ACOEM); (2)to request the inclusion of local physician
experts and specialty societies, including interventional pain medicine, anesthesiology,
interventional PM&R, neurosurgery, orthopedic spine surgery, interventional
radiology, psychiatry and neurology when redeveloping the proposed guidelines; (3)
suggest to the Governor’s staff, other elected officials and the Workers’ Compensation
Board that consideration should be given to utilizing existing guidelines from
California, Colorado, and the American Society of Pain Physicians and the evidencebased review committee of the American Academy of Orthopaedic Surgeons.
The redeveloped guidelines will better reflect the most recent high-level evidencebased guidelines, as well as the most widely accepted commercial insurance coverage
policies throughout the United States. (HOD 09-270)
325.962
Definition of Insurance Network: MSSNY to urge the New York State Workers’
Compensation Board to provide a clear definition of an insurance network relative to
the Use of Diagnostic Test Networks. (HOD 09-267)
325.963
Elimination of the Workers’ Compensation Fee Schedule: MSSNY to (a) strongly
urge the Workers’ Compensation Board (WCB), in conjunction with all its current WC
reform initiatives, to look toward increasing the current medical fee schedule in an
effort to maintain its current roster of WC authorized physicians; and (2) encourage
the Workers’ Compensation Board to investigate the feasibility of using the Current
Procedural Terminology (CPT) manual for Workers’ Compensation coding purposes.
(HOD 09-266)
325.964
Workers’ Compensatin Claims Reviews by Qualified Physicians: MSSNY to seek
regulation and/or legislation requiring that claims review for Workers’ Compensation
claims be performed only by physicians licensed in the State of New York and
engaged in the active practice of medicine in a similar scope of practice in the State of
New York. (HOD 08-261)
325.965
Arbitration Fees: MSSNY to seek a change in legislation or regulation requiring the
carrier to pay for the cost of each arbitration in cases where the arbitration committee
increases the reimbursement fees paid to the physician. (HOD 08-260)
325.966
Workers’ Compensation Coding Manual: MSSNY seek to encourage the Workers’
Compensation and No-Fault Administrations to standardize and use the CPT Coding
Manual. (HOD 05-271)
242
325.967
Increase to Workers’ Compensation Fee Schedule: In recognizing Workers’
Compensation regional conversion factors have not been increased for at least 10
years, that the Medical Society of the State of New York aggressively pursue the
newly appointed Chairman of the Workers’ Compensation Board to grant an increase
of the conversion factors to compensate for the increase in the costs associated with
medical practice; and that MSSNY aggressively pursue increases to the Workers’
Compensation regional conversion factors, on an annual basis, so as to bring Workers’
Compensation reimbursements up to current acceptable levels. (HOD 05-267)
325.968
Workers’ Compensation Panels: MSSNY continue to work with the Workers’
Compensation Board to encourage the enlistment of physicians to serve on arbitration
panels. (HOD 04-258)
325.969
Amendment of the Workers’ Compensation HP-1 Requests for Administrative
Award Process: MSSNY will seek an amendment to the Workers’ Compensation
Law stating that for every day on which a carrier ignores or refuses to acknowledge a
properly tendered HP-1 Request for Administrative Award, that carrier must pay
punitive damages to the Board and to the physician per day in an amount to support
significant, productive and viable enforcement. (HOD 02-258; Reaffirmed
HOD 03-268 & 278)
325.970
Workers’ Compensation Law New Sections 300.37 and 325-1.25:
(Sunsetted HOD 2011)
325.971
Reducing the Costs of Submitting Workers’ Compensation Claims:
(Sunsetted HOD 2011)
325.972
Workers’ Compensation C-4 Form: (Sunsetted HOD 2011)
325.973
“C” Rated Physicians Performing IMEs: (Sunsetted HOD 2011)
325.974
Modification of Workers’ Compensation Law Sections 110A and 32: MSSNY
will seek through legislation, regulation, or whatever means necessary, amendments to
the NYS WC Law Sections 110A and 32 regarding the physician’s ability to be listed
as a Party in Interest. (Council 11/2/00)
325.975
Surgical Ground Rule Number 5: MSSNY will seek through legislation, regulation,
or whatever means necessary, the amendment to the NYS WC Schedule of Medical
Fees modifying Surgical Ground Rule Number 5, as follows, to better reflect the
current state of medicine and surgery and to allow injured workers to achieve
maximum benefit of procedures available:
“When multiple procedures, unrelated to the major procedure and adding significant
time or complexity are provided at the same operative session, payment is for the
procedure with the highest allowance plus half of the lesser procedures up to a total
maximum of twice the higher fee. The same rule applies for bilateral procedures when
such are not specifically identified in the schedule.” (Council 11/2/00)
325.976
Clarification in Workers’ Compensation Board Regulations Pertaining to the
Performance of Independent Medical Examinations in NYS: MSSNY will seek
243
the following clarifications in the anticipated Workers’ Compensation Board
regulations pertaining to the performance of IMEs in New York State:
(1)
The regulations should clarify that performance of IMEs should be conducted
by NYS licensed physicians who are:
A.
(2)
325.977
Board Certified in accordance with the specialty boards recognized by
the American Board of Medical Specialties (ABMS) and the American
Osteopathic Association (AOA) (i.e. C-Ratings)
Increased costs with regard to copying or mailing of the IME reports need to be
considered compensable by the WC employer/carrier. (Council 11/2/00)
Caps for Maximum Medical Improvement Exams (MMIEs)(i.e. AMA-CPT
Codes 99455 and 99456: MSSNY will seek legislation, regulation, or whatever
means necessary, the adoption of the following chart by the Workers’ Compensation
Board for MMIEs provided within the State of New York for injured claimants.
MMIE Standard, established patient
MMIE Extended, established patient
MMIE Standard, new patient
MMIE Extended, new patient
99455
99455-22
99456
99456-22
$250.00
$375.00
$375.00
$499.00
MSSNY will seek the inclusion of payment consideration by the WCB in the Official
NYWC Medical Fee Schedule for Review of Records either by a fee or By Report
designation under AMA-CPT Code 99080. (Council 11/2/00)
325.978
Timely Processing of Claims: MSSNY will petition the New York State legislature,
using all available resources and alliances it deems necessary – including HANYS and
the New York State Bar Association – to amend the current Worker’s Compensation
law as follows: 1) Within 90 days of a claim having been filed, there must be a
hearing or an interim hearing before issues are finally resolved to determine if a case is
likely to be worker’s compensable under the law; 2) To allow for interim payment to
the claimant patient; 3) To allow for interim payment to those who provided medical
care to the patient; and 4) That these interim determinations shall not replace any final
determinations in the adjudication process. (HOD 00-286)
325.979
Additional Workers’ Compensation Billing Codes: MSSNY will petition the New
York State Worker’s Compensation Board to establish billing codes to allow
physicians to bill for their time when reviewing reports and charts, writing reports, or
communicating on the telephone about a case.
MSSNY will encourage the NYS Worker’s Compensation Board to work together
with MSSNY to establish the fee structure for billing codes to allow physicians to bill
for their time when reviewing reports and charts, writing reports, or communicating on
the telephone about a case.
MSSNY will urge the NYS Worker’s Compensation Board to direct all worker’s
compensation carriers in New York State, including the New York State Insurance
Fund, to honor and pay for billing codes to allow physicians to bill for their time when
reviewing reports and charts, writing reports, or communicating on the telephone
about a case. (HOD 00-285)
244
325.980
Role of a Physical Therapist in Electrodiagnostic Medicine: MSSNY will request
that the Workers’ Compensation Board request a specific statement from the
Department of Education regarding the role of a physical therapist in the performance
of electro-diagnostic testing, specifically as it relates to diagnosis and needle
electromyography;
MSSNY will request that the Workers’ Compensation Board consider the role of
physical therapists in electro-diagnostic testing, be limited to technicians under direct
supervision of a physician. Additionally, on the basis of the Practice Act for Physical
Therapists, which does not permit diagnosis by a physical therapist, and does not
specify permission to insert a needle into muscles, that physical therapists not be
allowed to perform, interpret and diagnose, independent of a physician.
MSSNY will act to ensure the adherence and enforcement of specific scope of practice
laws annotated by the New York State Education Department for each of the 38
professions licensed in the State of New York. (HOD 00-283)
325.981
Workers’ Compensation Claims Reimbursement: MSSNY will seek legislation
and/or regulation to: (a) mandate that the Workers’ Compensation Board resolve any
question of liability for injury of a worker within a thirty-day period from the initial
submission of the required 48-hour medical report; (b) mandate that the private
payers’ time restriction for claim submission in cases of questionable liability be
waived; (c) require a claimant’s private health insurance plan to pay the claim within
45 days on presentation of a Workers’ Compensation and/or No-Fault Auto denial.
(HOD 00-277)
325.982
Augmentation of Damages in Workers’ Compensation Arbitration Cases:
MSSNY will urge the Workers’ Compensation Board to amend its new streamlined
appeals process, requiring that: (1) If a carrier makes misrepresentations to the Board
concerning timely and proper receipt of bills, such misrepresentation be considered an
act of bad faith, subjecting the carrier to judgment of treble damages; and (2) If a
carrier fails to comply with a decision of the Board, such failure likewise be
considered an act of bad faith, subjecting the carrier to judgment of treble damages.
(HOD 00-275)
325.983
Timely Authorizations of Procedures: MSSNY will work with the appropriate
agencies to require health care plans to provide adequate staffing/personnel to support
the volume of incoming requests for authorizations via telephone in a timely fashion
so that the waiting time for answering said calls does not exceed 5 to 10 minutes;
MSSNY will work with the appropriate state agencies to require health care plans to
accept requests for authorizations by electronic transmission in lieu of telephone
requests, and MSSNY will work with the appropriate agencies to ensure that the
response time to requests for authorization submitted via FAX not exceed 1 (one)
business day. (HOD 00-259)
325.984
Increase in Workers’ Compensation Arbitration Fees: MSSNY will negotiate with
the Workers’ Compensation Board a payment increase from $300 up to $500 per
session for physicians serving on Arbitration Panels in view of the inordinate amount
of time physicians often expend at the arbitration sessions. (Council 5/20/99)
245
325.985
Timely Authorizations: MSSNY will urge the New York State Department of
Insurance and the New York State Workers Compensation Board to require insurance
companies to provide a mechanism for authorizing requests for medical or surgical
services in a timely fashion and that such an approval mechanism be available 24
hours a day, seven days a week. A response to a requested authorization will be
returned within 24 hours for in-hospital care and 7 days for outpatient care.
(HOD 99-272)
325.986
Hearing Outcomes in Workers’ Compensation Cases: MSSNY will urge the New
York State Workers’ Compensation Board to enforce its current regulation that deems
the physician as “an interested party,” and requires the concurrent provision of notices
of dates and time of pending hearings to physicians, claimants and representatives, as
well as outcomes of any hearing of the Board within 15 days. (HOD 99-270)
325.987
Receipt of Bill in Workers’ Compensation Cases: MSSNY shall urge the Workers’
Compensation Board to adopt rulings predicated on the following premises:
•
That faxed documentation of submitted bills, on C-4 forms or HCFA 1500 forms
or other viable forms of appropriate acknowledgement to the State Insurance
Fund, New York City Law Department and WC Carriers for reimbursement of
physician provided services be sufficient to substantiate their previous filings on a
timely basis;
•
That in the event of arising disputes concerning the timeliness of filings, any
postmarked certified receipts provided be considered as final evidence that bills on
claim forms have been timely and received by the State Insurance Fund, New
York City Law Department and WC carriers;
Such legislation will empower the Workers’ Compensation Board to have direct
regulatory authority and oversight of the WC activities of the State Insurance Fund
(presently overseen by the Office of the Governor), New York City Law Department
and WC Carriers to remediate the prevailing intolerable impasse reflected in the ability
of these entities to essentially function independently of appropriate Board
recommendations and directives, much to the detriment of authorized physicians
providing legitimate services under the program. (HOD 99-269)
325.988
Repeal Of Increased Fees For Workers’ Compensation Arbitration: MSSNY will
urge the Chairman of Workers’ Compensation Board to: (a) re-evaluate the recently
increased WC arbitration fee structure, which tends to preclude physicians from
entering the arbitration process, particularly for disputed bills of lower amounts
involving multiple patients; (b) reduce the fees to levels permitting enhanced
physician access to the system; and in conjunction with the foregoing request, will
urge the Chairman to reintroduce legislation calling for a “desk arbitration” process
wherein disputed bills of $500 or less may be promptly arbitrated by a neutral
physician arbiter of the appropriate physician discipline consistent with the claims
under review, and at commensurately reduced registration fees. Also, MSSNY will
request the Workers’ Compensation Board to share the details/fees associated with
such a recommended process with the MSSNY Committee on Workers’
Compensation and Occupational Health for its timely review, input, and
recommendations. (HOD 97-265)
246
325.989
Treating Physician Is A Party At Interest: MSSNY will request that the Chairman
of the Workers’ Compensation Board issue a regulation that states that the treating
physician is a party at interest, and order the presiding judge at a hearing at which
matters pertaining to medical care are discussed to expeditiously send to the treating
physician, or other treating professional person, a copy of the decision promulgated.
(HOD 97-264)
325.990
Payment Of Interest To Physicians By Health Insurers For Claims Exceeding 30
Days: MSSNY strongly supports the introduction of appropriate legislation to require
all health insurers in this State, including HMOs, to pay a statutory interest penalty in
an amount no less than that currently provided pursuant to the Workers’ Compensation
law on all unpaid claims submitted by health care providers in which liability has
become reasonably clear, such penalty to commence 30 days after billing.
(HOD 97-70)
325.991
AMA Guide to the Evaluation of Permanent Impairment: MSSNY supports the
immediate implementation and usage of the more appropriate and scientifically precise
AMA Guide to the Evaluation of Permanent Impairment in the place of the current
WC Medical guidelines.
A complete copy of the AMA Guide is on file at Headquarters, Division of SocioMedical Economics, ext. 322. (Council 7/18/96) (Reaffirmed HOD 06-268)
325.992
Work Hardening Program Ground Rules and Medical Fee Schedule: MSSNY
approves the Work Hardening Program Ground Rules and Medical Fee Schedule as
promulgated by the Workers’ Compensation Board for inclusion in the Workers’
Compensation Schedule of Medical Fee as follows: Definition: (1) Work Hardening
Programs are interdisciplinary, goal-specific, vocationally driven treatment programs
designed to maximize the likelihood of return to work through functional, behavioral,
and vocational management. (2) Not all claimants require these programs to reach a
level of function which will allow successful return to work. (3) Only those programs
which meet all of the specific guidelines will be defined as Work Hardening Programs.
(4) Programs will be reimbursed per the fee schedule after meeting all other
requirements. Pre-Admission Criteria: (1) All claimants must complete a preprogram assessment including a Functional Capacity Evaluation (FCE) and Vocational
Evaluation. (2) The goal of the program is return to work, therefore for all anticipated
returns to previous employment or placement with a new employer, the following
must be provided. (a) Specific written critical job demands and/or job site analysis;
(b) Verified written employment opportunities. Evaluation Process: (1) Initial
screening evaluation is performed by the treatment team consisting of: (a) Physical
Therapy and/or Occupational Therapy PLUS (b) Psychology/Psychiatry and/or
Vocational Rehabilitation, or other providers suitable by scope of practice as
determined in the State Education Law. (2) The outcome of this evaluation will be: (a)
Recommendation of release to return to work (b) Acceptance into the program with
an Individual Written Rehabilitation Plan stating specific goals and recommended
services (c) Rejection from program for specific reasons (d) Referral back to
provider for medical evaluation (e) Recommendation of vocational rehabilitation,
either by referral to and acceptance by VESID, or by other providers if approved by
the carrier. (3) Claimants being treated by an attending provider who is not a
physician must be referred to a physician authorized by the NYSWCB to provide care
to injured claimants, who will provide a written prescription for evaluation and
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treatment. Programs Providers: Claimants will be provided with the availability of
the following providers as determined by the needs of the claimant: (a) A minimum
of two (2) of the following: Physical Therapist, Occupational Therapist, Vocational
Rehabilitation Counselor, Psychologist/Psychiatrist, or other provider suitable by
scope of practice as determined in the State Education Law; in addition to a Case
Manager, either internal or external to the program. (b) Providers who can provide
initial medical evaluation, participation in the development of the treatment plan, and
coordination of work restrictions and discharge planning with the recommendation of
specialists in Physical Medicine and Rehabilitation. Discharge Criteria: (1) Discharge
criteria must be provided to all claimants in writing prior to initiation of treatment at
the time program goals are determined. (2) Voluntary discharge is achieved by: (a)
Meeting program goals; (b) Early return to work (c) Acute or worsening medical
conditions (d) The claimant declining further treatment. (3) Non-voluntary
discharge may be necessary in cases of: (a) Failure to comply with program policies
(b) Absenteeism (c) Lack of demonstrable benefit from treatment (4) Nonvoluntary discharge requires written documentation of prior and repeated counseling
of the claimant, and immediate notification of the employer, insurer, case manager,
and referring and attending (if different) provider. (5) Under all circumstance of
voluntary and non-voluntary discharge, the claimant will return to the referring
attending provider for release from program. (6) The attending provider must sign a
release to return to work when the program goals are achieved. Program Evaluation:
(1) Programs are subject to disclosure and evaluation as permitted by local and state
health care agencies and other appropriate individuals or groups in the state of New
York, including issues of: (a) Written policies and procedures (b) Program
implementation (c) Maintenance of medical records (d) Outcomes achieved (e) Site
design and equipment (f) Affiliations with non-site based providers (g) Admission
and discharge criteria. (2) Programs must provide insurers and referring providers
with: (a) Initial interdisciplinary team evaluation report (b) Proposed treatment plan
(c) Progress reports at weekly intervals (d) the opportunity to attend team meetings (e)
Final discharge summary report (f) Any of the information described in section
above. Integration of Vocational Rehabilitation Services: (1) Work Hardening
Programs are vocationally directed and driven rehabilitation services. The vocational
rehabilitation counselor serves to: (a) Coordinate efforts between the claimant,
program, and employer (b) Obtain job descriptions and critical job demands from the
employer (c) Gather and provide information to the treatment team (d) Educate
employers toward work tasks and work-site design (e) Assist claimants toward
appropriate employment opportunities within their safe maximal capabilities. (2)
Programs that do not retain the services of vocational rehabilitation counselors on a
full time basis may utilize private rehabilitation agencies, specialists provided by
insurance carriers, or VESID. These individuals are required to make continuous onsite contact with claimants and program providers, including participation in team
meetings. (3) The qualifications for serving as a vocational rehabilitation counselor
with respect to Work Hardening Programs shall be determined by the Director of
Rehabilitation and Social Services of the State of New York Workers’ Compensation
Board. Vocational rehabilitation counselors should be reimbursed at the usual and
customary rate currently paid by insurers in each region. Program Duration: Work
hardening programs will be provided on the following time schedule. (a) Daily
treatment, full or partial days, with fee differential (b) Minimum of ten (10) treatment
days and maximum of thirty (30) treatment days, subject to carrier prior approval (c)
Treatment to be completed within six (6) consecutive weeks (d) Any additional
treatment days beyond thirty (30) upon approval by the carrier. Fee Schedule: Fees
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for work hardening programs will be paid in accordance with the medical fee
schedule, with written prior approval by the carrier, utilizing the following guidelines:
(a) In all cases, for both voluntary and non-voluntary discharge, payment is for the
actual duration of treatment provided (b) Payment differential for partial and full day
program (c) CPT codes 97545 and 97546 will be reimbursed for Work Hardening
Programs as described above only (d) Non-multidisciplinary “work conditioning”
programs will be reimbursed utilizing existing PT, OT, and Physical Medicine codes
(e) Psychology /psychiatry services as requested in the Individual Written
Rehabilitation Plan and approved by the carrier will be billed separately from codes
97545 and 97546, in accordance with the appropriate fee schedules (f) Payment for
external case managers and vocational rehabilitation counselors will be the
responsibility of the carrier, exclusive of program codes 97545 and 97546 (g) Billing
will not exceed eight (8) hours for any given treatment day.
97545 - Work Hardening, First two (2) hours*
RVU
Conv.
Total Fee
Region I
MD
PT/OT
14.0
14.0
6.49
5.91
$ 90.86
$ 82.74
Region II
MD
PT/OT
14.0
14.0
6.80
6.20
$ 95.20
$ 86.80
Region III
MD
PT/OT
14.0
14.0
7.78
7.09
$108.92
$ 99.26
Region IV
MD
PT/OT
14.0
14.0
8.45
7.70
$118.30
$107.80
* Although CPT Code 97545 is for first two (2) hours, for this program the code shall
be used for the first four (4) hours, doubling the listed fee.
97546 - Work Hardening, each additional hour
RVU
Conv.
Total Fee
Region I
MD
PT/OT
3.3
3.3
6.49
5.91
$ 21.42
$ 19.50
Region II
MD
PT/OT
3.3
3.3
6.80
6.20
$ 22.44
$ 20.46
Region III
MD
PT/OT
3.3
3.3
7.78
7.09
$ 25.67
$ 23.40
Region IV
MD
PT/OT
3.3
3.3
8.45
7.70
$ 27.89
$ 25.41
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(Council 7/18/96)
325.993
Prescription of Lenses: MSSNY approves an amendment to the Workers’
Compensation Schedule of Medical Fees in the appropriate section of the Medicine
Ground Rules, as follows: “Prescription of lenses may be deferred to a subsequent
visit and is reported separately and may be billed as a separate item. This is based on
medical necessity and documentation which will usually pertain to the final submitted
Attending Ophthalmologist’s Report.” (Council 7/18/96)
325.994
Billing for Interpretation of Plain Film X-Ray Examinations Performed on
Emergency Department Patients Covered by Worker’s Compensation During
“Off Hours:” MSSNY accepts HCFA’s policy covering Medicare patients as it
appears in the Federal Register regarding payment to the specialist who performs the
review and written interpretation of the radiograph at the time of treatment. However,
all other conditions of the policy must also be adhered to. The stipulations include:
(a) When a radiologist is available at the time of the performance of the study and
treatment, the radiologist’s bill for the performance of the “interpretation and report”
of the examination will be the bill that is paid. The availability of teleradiography will
be equivalent to that of a radiologist being present. When “interpretation and report,”
which is a written report should be distinguished from a “review” of the radiograph by
the treating practitioner. The performance of an actual “interpretation and written
report” is payable, whereas a “review” without a formal written report is not a
reimbursable procedure. The ability to perform this interpretation function will need
to be in conformity with medical staff bylaws, credentialing criteria, and procedure for
delineation of privileges at each individual hospital and will have to be agreed to by
the governing bodies of each institution. Furthermore, MSSNY maintains the
following: (1) There can only be one formal, official examination report in the
patient’s medical records. (2) Radiologists, by virtue of their training, experience, are
best qualified to perform this function. Comprehensive comparison with prior exams
and review of prior reports are also best performed by radiologists. Radiologist, in
addition, perform elaborate quality management services as well as monitor radiation
protection at hospitals as required by JCAHO, managed care organizations, the New
York State Department of Health, and other various accrediting bodies. (3)
Radiologist, who are not involved in the primary evaluation and in the treatment of the
patient, are in a good position to provide the most objective and unbiased analysis after
taking into account evidence on the film or lack thereof and correlation with the
clinical history provided. An interdisciplinary look at the problem provides an
element of “peer review” which is in the best interest of patient care. (4) Institutions,
in recognition of the radiologist’s qualifications to perform such interpretations as
well as administrative functions, have engaged in exclusive contracts with radiology
groups to perform such services. (5) There should only be one bill submitted for each
service. Third party payers should not be confronted with the dilemma of deciding
which of two or possibly more bills to pay. The mechanics and logistics of
determining which specialty should be billing for a given procedure needs to be
defined at each individual institution. (6) There is increasing emphasis on appropriate
utilization of imaging studies both to optimize patient care and control escalating
health care costs. As institutions and practitioners enter into various risk-sharing
arrangements to provide health care, hospitals are increasingly seeking out guidance
and advice from radiologists in the utilization review process and development of
clinical pathways. It is important to have the radiologists involved at the point of
service. It is in the best interest of all practitioners for such services to be not only
250
appropriately utilized, but also to allow for appropriate compensation to all involved.
(7) Despite its current relative unpopularity in the political and economic climate,
specialization adds to the quality of care. (8) In the interest of rendering the best
possible medical care, in cases of multi-system injury or trauma, the radiologist should
be responsible for performing the interpretation of all studies. Thus, the patient’s
entire medical status can be evaluated and correlated rather than single isolated organ
systems or localized sites of injury as would be the case when multiple individual
specialists are involved. Radiologists will evaluate all anatomy on the films, not just
localized areas or organ systems of clinical concern. Under these circumstances,
again, the radiologist should have the right to bill for such services. MSSNY also
suggests adding in Section 13 of the Radiology Ground Rules: The interpretation of
radiologic procedures and the formal written report of that interpretation be performed
by a radiologist. In the event that a radiologist is not in house and not available by
teleradiography, the treating physician may render the interpretation and provide a
formal report. That physician can then bill for this service with the modifier 26
provided that this report is the official part of the medical record. (Council 7/18/96)
325.995
Uniform Fee Schedule in Workers’ Compensation/No-Fault Cases: It is the policy
of MSSNY that in keeping with one of the basic elements of the Medicare Resource
Based Relative Value Scale (RBRVS) system, the payment modality of all other
Workers’ Compensation programs throughout the country, that the President acting
under the provision of Section 13 of the Workers’ Compensation Law, will urge the
Chairperson of the Workers’ Compensation Board to promulgate the planned revision
of the Workers’ Compensation Schedule of Medical Fees in a modality which will
ensure that all qualified physicians responsible for rendering medical care under its
provisions to receive the same payment for identical services performed by them. The
President of MSSNY shall oversee a study of the revised fee schedule by the
designated subcommittee(s) of the MSSNY Committee on Workers’ Compensation
and Occupational Health and the MSSNY Committee on Interspecialty to: (a) make
recommendations for changes to the Workers’ Compensation Medical Payment
Schedule in the best interest of injured workers’; (b) provide fair and equitable
reimbursements for physician services rendered without any payment differentials as
presently exist in the current Workers’ Compensation Schedule of Medical Fees; (c)
urge that a revised payment schedule should be established and devoid of any
constraints inherent in a budget neutrality application. (HOD 95-255)
325.996
Medical Equipment and Supplies, Payment for: (Sunsetted HOD 2011)
325.997
Differential Payment Based on Specialty Board Certification and Scope of
Practice: It is the position of MSSNY that the differential payment policy based on
specialty board certification and scope of practice be maintained under the applicable
sections of the revised Workers’ Compensation schedule of Medical Fees.
(Council 11/10/94)
325.998
Physician Assistants, Payments for Services Under the Workers’ Compensation
Program: MSSNY has adopted the following Guidelines relative to WC payments to
employing physicians for patient care provided their Physician Assistants:
A. General Rules: (1) Care must be rendered under the supervision of a physician
who is authorized to care for Workers’ Compensation patients. (2) The term
“supervise” within the meaning of this recommendation encompasses the Medicare
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supervision requirement, i.e., that where state law enables (as in New York State): a)
the services of non-physicians must be rendered under the physician’s direct
supervision; b) direct personal supervision in the office setting does not mean that the
physician must be present in the same room with the PA. However, the physician
must be present in the office suite and immediately available to provide assistance and
direction throughout the time the PA is performing services. In this instance,
reimbursement should be made at the normal physician payment level, i.e., as if the
physician had provided the service. (3) The bill for care must be rendered by the
physician, with the ensuing payment for the PA service made directly to the physician
employer.
B. Management of new patient or an old patient with a new Workers’ Compensation
problem: (1) If the physician supervises the physician assistant’s evaluation, payment
should be made at the physicians normal Worker’s compensation level for the PA
services rendered in the out-patient office setting. (2) Similar to Medicare Regulations which provide that where on-site direct physician supervision is not available
in rural areas which meet the definition of Health Professional Shortage Areas
(HPSAs) and the physician assistant providing patient care is only able to
communicate with a physician supervisor by telephone or other effective means of
communication, payment for this service should be made at three-quarters (3/4) of the
Physician Payment Schedule. (3) A physician’s assistant is not permitted to care for a
new problem under the Workers’ Compensation Program without discussing the
findings in person or by telephone with a responsible physician prior to instituting
treatment. No payment should be made for care provided by the PA that does not
meet this requirement.
C. Follow-up care of a patient with a compensable problem: (1) If the physician
supervises the physician assistant’s evaluation, payment should be made at the
physician’s normal reimbursement level for the PA services rendered in the out-patient
setting. (2) Similar to Medicare regulations which provide that where on-site direct
physician supervision is not available in rural areas which meet the definition of
Health Professional Shortage Areas (HPSAs) and the physician assistant providing the
patient care is only able to communicate with a physician supervisor by telephone or
other effective means of communication, payment for this service should be made at
three-quarters (3/4) of the Physician Payment Schedule.
D. Services of physician assistants providing assistance at surgery will be paid at twothirds (2/3) of the physician’s WC surgical assistant payment percentage, i.e., twothirds of twenty percent (2/3 of 20%).
E. Services of physician assistants performing surgical procedures within the scope of
the supervising physician’s practice and that are paid as line items under the Workers’
Compensation Fee Schedule be paid at two-thirds (2/3) of the physician surgical
payments. (Council 9/22/94)
Subsequent to the above approval, the Council approved the following
recommendation of the Committee on Workers’ Compensation and Occupational
Health:
That MSSNY accepts the WCB suggested change in the above proposed protocol for
payment of PA assistance at surgery from 2/3 of 20% of the Surgical Allowance (i.e.
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13.4%) to 65% of 16% of the surgical allowance (i.e. 10.4%) as essentially provided
under the Medicare program. (Council 3/9/95)
325.999
Fee Negotiations: At the request of the Chairman of the Workers Compensation
Board, representatives of the Medical Society of the State of New York are authorized
to provide input where feasible and when the situation arises, into the establishment of
fees under Workers’ Compensation Law and to negotiate a fixed fee schedule.
MSSNY representatives are not restricted to the usual and customary concept.
(HOD 83-13)
Review and Sunset Policy for Medical Society of the State of New York
(MSSNY) House of Delegates (HOD) Resolutions and Policies
Existing for at least 10 Years
1. 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.
2. In the implementation and ongoing operation of this review and sunset mechanism, these
procedures shall be followed:
a. Each year, the Speakers, through the Office of the Executive Vice President, shall
provide a list of policies that will be reviewed;
b. The President shall assign each policy to the appropriate committee or subcommittee
for review;
c. Each committee or subcommittee shall submit a report to the HOD with
recommendations on how each policy assigned to it should be handled;
d. 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;
e. 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;
f.
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
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recommendations and accompanying support shall be forwarded on the appropriate
HOD reference committee;
g. 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;
h. 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. (Council 9/16/10)
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