110.000 HEALTH CARE DELIVERY SYSTEMS

(See also Health System Reform, 130.000; Managed Care, 165.000)

110.981           Site of Service Availability

The Medical Society of the State of New York will continue to advocate to reduce health insurer pre-authorization burdens, including eliminating pre-authorization requirements and restrictions on site of service. (HOD 2021-54; Reaffirmed HOD 2024)

110.982           Lowering Health Care Costs

MSSNY will continue to work together with the AMA to advocate for measures that help reduce healthcare costs including but not limited to the following areas:

(a) ensuring a health care delivery environment where physicians can have a meaningful choice of whether to be in private practice or health system-employed;

(b) ensuring meaningful patient choice of health insurance coverage options in all regions of New York State;

(c) increasing patient access to needed prescription medications and reducing PBM interference;

(d) reducing litigation;

(e) reducing administrative and regulatory burdens that interfere with patient care delivery.

MSSNY will continue to work together with the AMA to advocate for measures that help reduce healthcare costs including reducing obesity and managing chronic conditions.

MSSNY will continue to work together with the AMA to more fully educate legislators, the media and the public generally of data showing that spending on physician services represents only a small component of overall health care costs. (HOD 2020-63; referred to Council; substitute resolution amended and adopted by Council 1/14/21)

110.983           Covid 19 Emergency and Expanded Telemedicine Regulations

The Medical Society of the State of New York will continue to advocate for a continuation of coverage for the full-spectrum of technologies that were made available during the Covid-19 pandemic and that physicians be reimbursed by all government and private payers for time and complexity.  MSSNY will advocate that the current emergency regulations for improved access to and payment for telemedicine services be made permanent with respect to payment parity and use of commonly accessible devices for connecting physicians and patients, without reference to the originating site, while ensuring qualifications of duly licensed physicians to provide such services in a secure environment.

MSSNY will propose that all New York insurance carriers provide coverage for New Yorkers’ telemedicine visits with any physician licensed and registered to practice in New York State.

MSSNY will forward a resolution to the AMA HOD at its next meeting in order to address these issues on a national level. (Amended and Adopted, Council 6/4/2020; HOD 2020-168 & Late F)

110.984          New Review of For-Profit-Health Insurance by Institute of Medicine

MSSNY will ask the Institute of Medicine to report again on the for-profit enterprise in health care. (HOD 2016-109)

110.985          Employed Physicians

MSSNY will examine governance structures of hospitals, physician group practices, federally qualified health centers, clinics, urgent care practices and other health care delivery facilities and physician employment contracts to determine the most effective way to provide a grievance mechanism to resolve disputes between physicians and their employers. (HOD 2016-102)

110.986           Monopolization of Healthcare by Vertically Integrated Health Systems

The Medical Society of the State of New York will seek legislation and regulation that vertically integrated hospital systems must prove to the Department of Health a need to employ an individual physician in the market place and obtain a Certificate of Need for each of their employed physician. The Certificate of Need process should include an evaluation of the employment agreement, insofar as it be limited to fair market values of physician services and not to include ancillary services. (HOD 2015-117; referred to and adopted by Council 11/5/2015)

110.987          Collaborating with Federal and State Agencies to Ensure the Provision of Long Term Care Services

Through its Long Term Care Subcommittee of the Quality Improvement and Patient Safety Committee, MSSNY will work with all relevant federal and state agencies to ensure that long term care services, including home care services, physician home visits, telehealth and palliative care, are integrated into and paid for through new initiatives underway which seek to restructure the health care delivery system, such as the Delivery System Reform Incentive Payment (DSRIP) Program, Medicare Shared Savings Accountable Care Organizations and the Fully-Integrated Dual Advantage (FIDA) Program. (HOD 2015-107)

110.988        Too Big to Fail

The Medical Society of the State of New York will work with the New York State Department of Financial Services and New York State Department of Health to assure large health care systems across New York State are adequately capitalized to withstand economic adversity when those systems take on financial risk contracts with insurers or offer health insurance coverage. (HOD 2015-67)

110.989         Long Term Care-Scope of Problem: SUNSET HOD 2024

110.990         PCORI Should Focus on Clinical Outcomes Not Cost

The Medical Society of the State of New York supports efforts by the American Medical Association to have the Patient Centered Outcomes Research Institute (PCORI) focus its priorities on achieving better clinical health outcomes. (HOD 2012-65; Reaffirmed HOD 2022)

110.991           Web-based Tele-Health Initiatives and Possible Interference with the Traditional Physician-Patient Relationship

The Medical Society of the State of New York (MSSNY) urges the NYS Department of Financial Services and Department of Health, to review tele-health initiatives being implemented by major health insurance carriers (i.e., United Healthcare, Blue Cross Blue Shield) and others to assure that proper standards of care are maintained, that such initiatives and the physicians who work with them are adherent to professional practice standards and NY State health laws and regulations; and to take appropriate actions to eliminate such initiatives that do not meet acceptable standards and regulations.

The Medical Society of the State of New York (MSSNY) will seek regulatory guidance from the NY State Department of Financial Services regarding the essential requirements of web-based tele-health technology and health care initiatives and the requirements of physicians and healthcare providers who engage in the delivery of such services. 

Concerns about tele-health initiatives and this resolution are to be brought by the MSSNY AMA delegation to the AMA for appropriate action at the Federal level. (HOD 2012-165; Reaffirmed Council 6/4/20 from HOD 2020-168 & Late F)      

110.992          Standardization of Identification for Medical Professionals

MSSNY will work with appropriate health care entities to ensure that licensed physicians and other health care practitioners wear a picture identification badge which shall be conspicuously displayed and legible, and which clearly details to the patient, the name and professional title authorized pursuant to Education Law (Physician, Physician Assistant, Nurse Practitioner, etc) of their physician and any other health care practitioner’s.

Any picture identification badge for physicians and other health care practitioners should be provided at no cost to the physician and health care provider. (HOD 2012-105; Reaffirmed HOD 2022; Reaffirmed HOD 2023 in lieu of Resolution 60)

110.993           Ionizing Radiation from Fluoroscopy Concerns:

MSSNY, in collaboration with The College of Radiology and with advice of legal counsel, will clarify the scope of practice and delineation of privileges regarding the performance of fluoroscopy by physician extenders under direct physician supervision.  (HOD 2009-150; Reaffirmed HOD 2019)

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 2007-103; Reaffirmed HOD 2017)

110.995           Appropriate Disclosure by Nurse Practitioners of Collaborating and Coverage Agreement Scope of Practice: (Sunset HOD 2017)

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 2007-98; Reaffirmed HOD 2017)

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 1998-57; Reaffirmed HOD 1999-83; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

110.998            Non-physician 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 non-physician 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 two-tiered 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 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; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

110.999         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; Reaffirmed HOD 2014; Reaffirmed HOD 2024)