130.000 HEALTH SYSTEM REFORM

130.921        Formation of a Physician Patient Coalition

The Medical Society of the State of New York will continue to lead, engage, and interact with patient advocacy groups to find common ground regarding healthcare issues. When there is common ground, MSSNY and the patient advocacy groups will work together to advocate for mutually agreed upon legislative and institutional reforms in our healthcare system. (HOD 2024 – 116)

130.922        Ask NYS to Expand Medicaid 1332 Waiver to Immigrants

The Medical Society of the State of New York supports legislation or other efforts to expand eligibility for state health insurance coverage programs to all New Yorkers regardless of immigration status. (HOD 2024 – 63)

130.923        An Assessment of Unintended Consequences of Value Based Payment Models

The Medical Society of the State of New York will ask the AMA to perform a study, including a member survey, to reveal value-based payment programs’ impact on physicians and patient care. (HOD 2024 – 204)

130.924        Union

MSSNY will support the establishment of unions for its employed member physicians. With the establishment of a physicians-based union, MSSNY will form a strong bond with that union to better advocate for the needs of its physician members and their ability to provide the best care to their patients. (HOD 2023-130)

130.925        Managing Conflict of Interest Inherent in New Payment Models Patient Disclosure

The Medical Society of the State of New York will seek legislation requiring complete disclosure of potential conflicts of interest by:

1. All insurance plans: Medicare (Medicare Advantage), Medicaid, and commercial insurers.
2. Employers of physicians (ex., Accountable Care Organizations in the Medicare Shared Savings Program).
3. Pharmacy Benefit Managers.

The disclosures should be written in plain language and detail the following:

1. The type of physician incentive arrangement, whether withhold, bonus, or capitation.
2. The percentage of the withhold or bonus as the intensity of the incentives clearly affects the extent of the physician’s conflict of interest.
3. The amount and type of stop-loss protection.
4. A breakdown of capitation payments by the percentages for primary care, specialty, hospital, or other services.
5. Whether physicians are at significant risk for services not personally provided by them.
6. The possibility of a reduction in care that has a positive expected benefit but is not deemed cost-effective.
7. Disclosure of any and all potential “shared” savings that may be potentially earned by the provider organization or individual providers from limiting patient options, access to specialist referrals, diagnostic testing and treatment.

The Medical Society of the State of New York also requests that the American Medical Association advocates for legislation requiring full patient disclosure. (HOD 2023-260)

(See also Education, 85.000; Health Care Delivery Systems, 110.000; Managed Care, 165.000; Reimbursement, 265.000)

130.926           Collective Bargaining by Physicians

MSSNY will advocate for legislation that will end prohibitions which limit independent physicians from forming collective bargaining entities (unions). (HOD 2022-109)

130.927           MSSNY Preparation for the New York Health Act

MSSNY will create a Task Force to evaluate potential legislative changes in health care reimbursement and coverage methodology.  (HOD 2020-61) 

130.928           Improving Consumer Operated and Oriented Plans (Co-Ops) as a Public Option for Health Care Financing

MSSNY will review Consumer Operated and Oriented Plans as a potential option for health insurance in the State of New York.  MSSNY will request that the AMA study options to improve the performance of Consumer Operated and Oriented Plans as a potential public option to improve competition in the health insurance marketplace and improve the value of healthcare to patients.  (HOD 2020-62)

130.929           Health System Improvement Standards

MSSNY will advocate for health care reform proposals that would achieve the following goals:

• Reduce the number of uninsured;
• Reduce barriers to insured patients receiving needed health care including assuring full transparency of patient-cost sharing requirements, preventing unjustified denials of coverage, assuring comprehensive physician networks including through fair reimbursement methodologies, and providing meaningful coverage for out-of-network care;
• Reduce administrative burden on physicians;
• Prevent imposition of new costs or unfunded mandates on physicians;
• Provide needed tort reform; and
• Provide meaningful collective negotiation rights for physicians.

This resolution will be transmitted to the American Medical Association for consideration at its next House of Delegates meeting. (HOD 2019-71)

130.930                Any Willing Provider with Universal Credentialing

MSSNY will advocate for legislation or regulation that would enable a patient to have coverage for treatment by an out-of-network physician where exigent circumstances exist or where there is a prior treatment relationship. (Adopted Council Nov, 2017 [sub res for 2017-111])

130.931           Healthcare Delivery System Including Single Payer Insurance

MSSNY will continue to consider the feasibility of other payment methodologies including single payer and will also continue to work collaboratively with physicians who both support and oppose such proposals in order to assess the strengths and weaknesses of such proposals. MSSNY will continue to advocate that physicians are ensured direct input and ongoing involvement on all aspects of any single payer system or other system that may be considered by the New York State Legislature or United States Congress. Among the critical aspects that should be considered and included: the ability of patients to receive needed quality care and medications in a timely manner; whether the administrative burden to physicians of participation and facilitating needed patient care in such a system are an improvement from, or worsening of, existing systems; and whether the payment methodology is and will continue to be fair to physicians regardless of practice setting or specialty.(Adopted Council Nov, 2017 [sub res for 2017-62 & 63]; Reaffirmed HOD 2019 in lieu of resolution 69; 2019-70 Referred to Council, amended and adopted 11/2019; Reaffirmed HOD 2020-61; HOD 2021-57 and 2021-58 reaffirmed by Council 3/9/22 in lieu of resolutions; Reaffirmed HOD 2023 in lieu of resolutions 66 and 67; Reaffirmed HOD 2024 in lieu of resolutions 69 and 70).

130.932                Encourage Use of NYS Record Release Form: SUNSET HOD 2024

130.933                Workers’ Compensation and No-Fault Carriers to Use Diagnosis Codes Consistent with HIPAA Electronic Standards

The Medical Society of the State of New York (MSSNY) will seek legislation at the state level that requires all insurance carriers operating in New York State to utilize a consistent International Classification of Diseases (ICD) system. (HOD 2014-262; Reaffirmed HOD 2024)

130.934                MSSNY Single Payer Healthcare Survey

MSSNY, with input from the medical student section, design and conduct an objective poll by email of the collective opinion of MSSNY members and non-members ascertaining both their knowledge of the single payer health care system and their support or opposition of such a system in the State of New York. (HOD 2014-109; Reaffirmed HOD 2024)

130.935                 Long Term Care – The Impending Crisis

The Medical Society of the State of New York recognizes the crisis of long term health care financing and will look for innovative programs which would balance individual responsibility for long term health care costs and society’s role in making long term health care insurance available to all. It is position of the Medical Society that people should be allowed to purchase long term care insurance with continued positive and no negative tax implications and those who exhaust private insurance benefits be automatically enrolled in the Medicaid program without a need to spend down their assets.

The Medical Society of the State of New York work will work with the AMA to support a public option to cover the long term health insurance needs of all Americans through a Long Term Health Insurance Trust Fund financed with fees paid by all Americans during their lifetime. (HOD 2014-115; Reaffirmed HOD 2024)

130.936                  Affordable Care Act and NYS Medical Tort Reform

As part of its advocacy efforts to achieve comprehensive medical liability tort reform, the Medical Society of the State of New York should educate the public that patient access to necessary care is being threatened by the confluence of decreased payment from health insurers resulting from implementation of the Affordable Care Act and the exorbitant cost of medical liability insurance. (HOD 2014-51; Reaffirmed HOD 2024)

130.937                Exclusion of Physicians from the New York State Health Benefit Exchanges

The Medical Society of the State of New York will continue to advocate to the Governor’s office, New York State Health Insurance Exchange officials, the New York State Legislature and New York’s Congressional delegation that all plans sold inside and outside of New York’s Health Insurance Exchange have robust physician networks that enable patients to have sufficient choice of treating physicians and enable patients to continue to be covered for care provided by physicians with whom there are long-standing treatment relationships. The Medical Society of the State of New York will take efforts to prevent hospitals from directing their physician employees to not refer patients to private-practice physicians. The Medical Society of the State of New York will continue its ongoing public relations efforts to assure the public and policymakers are aware of the problems of narrow insurer networks. (HOD 2014-57; Reaffirmed HOD 2024)

130.938:             Affordable Long Term Care Insurance

MSSNY’s Long Term Care Committee should meet regularly with state officials to work toward the creation of affordable long term care insurance options with a clearly defined premium and benefit structure. (HOD 2013-115 and 116; Reaffirmed HOD 2023; Reaffirmed HOD 2024)

130.939:            Initiation of the Physician Patient Relationship

MSSNY should establish as policy that the doctor patient relationship is formed when the physician first evaluates the patient and a consensual relationship has been initiated.

(HOD 2013-101; Reaffirmed HOD 2023; Reaffirmed HOD 2024)

130.940:           Medical Liability Reform

MSSNY re-affirms Policies 130.965 and 130.975 and will continue to seek the enactment of comprehensive medical liability tort reform legislation, as well as new sources of revenue to subsidize physician medical liability insurance costs, including evaluating new strategies to achieve these ends. (HOD 2013-62, 63 and 64; Reaffirmed HOD 2023)

130.941             Expand “Any Willing Provider” Legislation

MSSNY will continue to advocate for legislation that requires health insurers to include, within the network of any product offered by the insurer, any physician who is able to meet the terms of participation in that network. (HOD 2013-61; Reaffirmed HOD 2014-57; Reaffirmed HOD 2016-58; Reaffirmed HOD in lieu of 2017-111)

130.942              Repeal PPACA Restrictions on Physicians

MSSNY supports federal legislation to repeal provisions in PPACA that require physicians to enroll in Medicare, Medicaid and other governmentally sponsored health insurance programs as a condition of referring, ordering or prescribing for patients enrolled in these programs. MSSNY will forward this resolution to the AMA for consideration at its next annual meeting. (HOD 2013-54; Reaffirmed HOD 2014-53; Reaffirmed HOD 2024)

130.943             Call for Action for Support of Continuation of CO-OP Applications

MSSNY will request the New York Congressional delegation to take appropriate action to restore necessary funding for new health insurance co-operatives, as had applied prior to enactment of the American Tax Relief Act of 2012, which eliminated this funding; and will urge the American Medical Association to work with the National Alliance of State Health Co-Ops (NASHCO) to request the US Congress and US Department of Health and Human Services to re-establish such funding as well. (HOD 2013-52; Reaffirmed HOD 2023)

130.944              Excise Taxes on Health Insurance Policies: SUNSET HOD 2023

130.945               Surprise Fee in Patient Protection and Affordable Care Act (PPACA)

MSSNY should advocate that any proposed assessment on “issuers of insurance” (scheduled to commence in 2014 for a 3-year period) intended to fund a “risk adjustment program” to cushion insurers against any actual uncertainties surrounding the health status of the uninsured, not be passed along to consumers, and bring a resolution on same advocacy to the AMA. (HOD 2013-50; Reaffirmed HOD 2023)

130.946              Appoint Task Force on Medical Liability Insurance

In addition to current advocacy efforts to achieve meaningful liability reform, MSSNY will work with the Cuomo administration to develop a Task Force on Medical Liability Reform with significant physician/MSSNY representation. (HOD 2012-51)

130.947              Expert Witness Program For New York State

MSSNY will work with the NYS Bar Association and the NYS Court System to develop a system to better assure appropriately qualified witnesses to testify in medical liability actions. (HOD 2012-52)

130.948             Expression of Concerns Through AMA Regarding Implementation of COOP Program: SUNSET HOD 2022

130.949            Cost Containment is the Antithesis to Performance Improvement

The Medical Society of the State of New York (MSSNY) opposes any health policy which supports capping payments because it is antithetic to innovation and true health care system reform.

MSSNY will urge the AMA to adopt as policy opposition to any health policy which seeks to cap payments because it is antithetic to innovation and true health care system reform. (HOD 2012-106; Reaffirmed HOD 2022)

130.950              Credentials for Doctors Reviewing Appeals to Insurers

MSSNY will advocate for a change in law or regulation which requires physicians who hear appeals regarding payment for imaging studies be licensed and actively practicing clinical medicine in New York State and that such company physician be of a specialty satisfactory to the appealing physician for a particular case. (HOD 2012-111; Reaffirmed HOD 2022)

130.951           Reform 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:

-repeal of the Independent Payment Advisory Board (IPAB);
-repeal of the Medicare Cost/Quality Index;
-repeal of the non-physician provider non-discrimination provision;
-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 2011-68; Reaffirmed with title change HOD 2021)

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 2011-52; Reaffirmed HOD 2019 in lieu of res 102)

130.953           Medical Liability Reform: 

MSSNY supports legislation which would allow physicians to carry 1^st tier insurance of $500,000/$1.5 million funded by physicians and that there would be a 2^nd 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:

• Cap on non-economic damages of $250,000 per defendant with a total of $750,000.
• Medical Courts.
• A No-fault system for claims involving neurologically-impaired infants.
• Medical expert witness reform.

Certificate of merit reform.  (HOD 2011-51; Reaffirmed HOD 2016-61; Reaffirmed HOD 2019 in lieu of res 102)

130.954           Tort Reform as a Major Priority:

MSSNY will 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 2010-66; Reaffirmed HOD 2020)

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; Reaffirmed HOD 20

130.956           MSSNY Position on Health System Reform: SUNSET HOD 2019

130.957           MSSNY Position on Medical Liability Reform:

MSSNY’s current position on Medical Liability Reform is to be amended to also include the following:

• 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 will work with:

• 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.
  • 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; Reaffirmed HOD 2019)

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 2009-158; Reaffirmed HOD 2019)

130.959           Excess Liability Insurance:

MSSNY will ask medical liability insurance carriers to determine the cost of providing Excess medical malpractice insurance coverage to physicians in non-hospital settings.  (HOD 2009-72; Reaffirmed HOD 2019)

130.960           “Consent to Settle” Clause and Frivolous Lawsuits:

MSSNY will:

1. 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;

1. 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;

1. work to encourage medical liability carriers to be explicitly transparent in their pricing policies, including specifying costs for consent vs. non-consent policies;

1. collect, collate, compare and publish up-to-date data regarding costs, clauses, and features of malpractice insurers doing business in New York State. (HOD 2009-51; Reaffirmed HOD 2019)

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 2009-50; Reaffirmed HOD 2019)

130.962                     Health Care as Economic Stimulus:

MSSNY opposes health care funding cuts that impose undue burdens on both physicians and patients; promotes increased health care investment both for its social and economic benefits; and strives to educate the public and policy makers on how decisions on health care spending will affect the overall economy.  (HOD 2008-211; reaffirmed and amended by HOD 2018-200)

130.963                       Mandated Clinical Practice Guidelines: 

MSSNY policy is to be established against any legislation mandating strict compliance with Clinical Practice Guidelines.  (HOD 2008-104; Reaffirmed HOD 2018)

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 2008-95; Reaffirmed HOD 2016-250)

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
e) Work to assure that the Legislature appropriates sufficient funds to support the Excess Insurance Program.  (HOD 2008-94; Reaffirmed HOD 2018)

130.966           Universal Access to Healthcare:  (HOD 2008-91; SUNSET HOD 2018)

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; Reaffirmed HOD 2017; Reaffirmed HOD 2019 in lieu of res 102)

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 2007-106; Reaffirmed HOD 2017)

130.969           Universal Health Care: 

MSSNY opposes funding universal health insurance through decreased reimbursement, or any tax on physicians.  (HOD 2007-105; Reaffirmed HOD 2017)

130.970           Unfair Billing of the Uninsured:

MSSNY will 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 2006-89; Reaffirmed HOD 2016)

130.971           Long Term Care – Quality Initiatives:

MSSNY adopts 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; Reaffirmed HOD 2015)

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 health care arena likely to benefit the general public and the medical profession.  (HOD 2005-202; Reaffirmed HOD 2015)1

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 2004-259; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

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. (HOD 2003-88; Reaffirmed HOD 2013; Modified and Reaffirmed HOD 2023)

130.975           MSSNY’s Actions Toward Tort Reform:

MSSNY continues 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 2003-97; Reaffirmed HOD 2013 DGA; Reaffirmed HOD 2023)

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 2002-67; Reaffirmed HOD 2013; Reaffirmed HOD 2023)

130.977           Organize Task Force for Health Care in America:  SUNSET HOD 2013

130.978           Tort Reform:  SUNSET HOD 2013

130.979           Equal Fees for Panel Physicians and Non-Panel Physicians: Sunset HOD 2011

130.980           Federal Laws Controlling Medical Savings Accounts Should be Revisited:  Sunset 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 1997-277; Reaffirmed HOD 2014)

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 1997-276; Reaffirmed HOD 2014)

130.983           Point of Service Plans For Group Insurance Policies: SUNSET HOD 2014 — See 165.998

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 1996-61; Reaffirmed HOD 1997-62 & HOD 2000-76; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

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 1997-61; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

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 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 1997-59; Reaffirm HOD 2014; Reaffirmed HOD 2024)

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)  Guarantee consumer choice of insurer, inclusive of programs providing freedom of choice of physicians;  (9)  Medical liability tort reform, including limitations on non-economic 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); Reaffirmed HOD 2021):

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

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 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 H-460.909 Comparative Effectiveness Research.

(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 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 1995-85; Policy Reaffirmed HOD 2014; Modified and reaffirmed HOD 2024)

130.989           Funding Academic Medicine and Teaching Hospitals: SUNSET HOD 2014

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 1994-60; Reaffirmed HOD 2000-262; Reaffirmed HOD 2014)

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 1994-56; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

130.992             Reimbursement for Medically Necessary Emergent Services Provided by Non-participating 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 1994-84; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

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 1994-86; Reaffirmed HOD 2008-96; Reaffirmed HOD 2016-61 & 250; Reaffirmed HOD 2019 in lieu of res 102)

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 1994-57; Reaffirmed by Council 11/29/2012 in lieu of 2012-260; Reaffirmed HOD 2022)

130.995                   Long Term Care: SUNSET HOD 2014

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 1992-13; Reaffirmed HOD 2014; Reaffirmed Council Nov 2017 [res 2017-62 & 63]; Reaffirmed HOD 2019 in lieu of resolution 69)

130.997                Maternal and Infant Care:

MSSNY supports universal access to maternal and infant care; 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. (HOD 92-56; Modified and reaffirmed HOD 2014; Reaffirmed HOD 2024)

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; Reaffirmed HOD 2013; Reaffirmed HOD 2023)

130.999                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 1986-14; Reaffirmed HOD 2013; Reaffirmed HOD 2023)