225.000 PEER REVIEW

225.986           Protection of Peer Review

MSSNY will advocate through legislation or other legal means to overturn the court ruling in Siegel v. Snyder that inappropriately expanded the discovery of comments during peer review proceedings. (HOD 2022-63)

225.987           Peer Review Integrity

By legislation and/or regulation MSSNY will require insurance company peer reviewers to review all supportive documentation provided by a requesting physician prior to the insurance company mandating a physician to participate in a peer review.

By legislation and/or regulation MSSNY will also seek a significant non-compliance financial penalty on the insurance company to compensate physician time when an insurance company peer reviewer fails to review physician provided documentation prior to mandating physician participation in a peer review meeting. (HOD 2020-265) 

225.988           Peer Review Protection:

MSSNY will advocate for a change in New York Education and Public Health Laws to allow the peer review process to accomplish its goals of enhancing patient safety and quality of care by protecting from discoverability the statements made by a reviewed physician during the peer review process. Such legislation is to be pursued distinctly and separately from its effort to effect global reform of the medical tort system.

Also, MSSNY will notify its members of the current discoverability of peer review activity. (HOD 2008-70; Reaffirmed HOD in lieu of 2017-101; Reaffirmed HOD 2022-63)

225.989           Pending Legislation to Make Office Procedure Complications Public Information: Sunset HOD 2011

225.990           MSSNY To Take Lead Re Quality Performance Improvement Activities in Physicians’ Offices:

MSSNY will continue to participate in the development of quality performance improvement activities in physicians’ offices.  (HOD 1999-173; Reaffirmed HOD 2014)

225.991           IPRO Citations, Mandatory Purging of After Specified Time Period:

MSSNY will request the Centers for Medicare and Medicaid Services (CMS) to establish policy which would provide that Peer Review Organization (PRO) citations for matters that are not currently defined as quality issues, or those issues which are considered remote, be expunged.  (HOD 1996-128; Updated and Reaffirmed HOD 2014; Reaffirmed HOD 2024)

225.992           Confidentiality of Documents Submitted to Peer Review Committee:

MSSNY has adopted as policy that any materials or comments generated by a physician in response to a review by a Peer Review/Quality Committee of a hospital and/or a health care entity or organization should be confidential as regards discovery in a malpractice action.

MSSNY has pledged to work with other interested parties, the Department of Health, and the appropriate legislators to develop legislation and/or regulations that would ensure such confidentiality. (HOD 1994-59; Reaffirmed HOD 2014; Reaffirmed HOD 2022-63)

225.993           Fourth Scope of Work – PRO: SUNSET HOD 2014

225.994           IPRO Reviewers:

MSSNY is taking all necessary and immediate steps to:

(1)  Assure that IPRO disclose the names, qualifications and performance of its reviewers;  (2)  Assure that physicians in New York State be given information on the specific guidelines IPRO utilizes to assess the qualifications and performance of its reviewers;

(3)  Require IPRO to utilize a board certified practicing physician of the same specialty from a like practice setting when PRO reconsideration determinations are conducted;

(4)  Require IPRO to utilize the practice parameters as provided by the AMA and developed by its recognized specialty societies.  (HOD 1991-62; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

225.995           Physician Specific Data, Release to the New York State Department of Health – PRO: SUNSET HOD 2014

225.996           Review in Private Offices – PRO: SUNSET HOD 2014

225.997           Physicians as Reviewers: 

The MSSNY, in total cognizance of the rights and privileges of licensed practicing physicians, seeks legislation to require that all peer review activities, conducted under the auspices of the PRO, the New York State Department of Health, Office of Professional Medical Conduct, and/or any other authority commissioned to perform physician peer review, be performed by physicians currently engaged in that specialty or not more than five years removed from the practice of the same specialty.  In addition, the physician conducting peer review should submit evidence of board certification by a specialty or subspecialty as recognized by the American Board of Medical Specialties.

MSSNY is seeking legislation that would include the performance of peer review within the definition of the practice of medicine.  (HOD 1990-39; Reaffirmed; HOD 1991-62; Reaffirmed HOD 1996-52; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

225.998           Review Under Medicare Law:

MSSNY, in an effort to ensure that the quality of peer review matches the delivery of quality medical care expected from its members, is seeking to achieve the following through the Board of Directors of the Empire State Medical, Scientific and Educational Foundation, Inc.:  (1)  Utilization of physicians only, with appropriate expertise, in all cases assigned for review;  (2)  Establishment of an acceptable due process protocol through interface with the Health Care Financing Administration – for physicians perceived to have provided substandard medical care, ensuring that: local physicians are afforded due process during sanction and denial appeals within the time constraints mandated by federal regulation; no quality of care letters of denial are sent to beneficiaries until due process has been completed.

MSSNY reaffirmed its support of the American Medical Association (AMA) House of Delegates’ action on this matter which led to a significant agreement providing major improvements in the PRO sanction process.  The agreement was jointly announced on May 12, 1987 by the AMA, the Health Care Financing Administration, the American Association of Retired Persons and the Office of the Inspector General.  (HOD 1987-30 & 1987-36; Reaffirmed HOD 2013; Reaffirmed HOD 2023)

225.999           Physician Controlled Peer Review:

MSSNY, along with the AMA, endorses peer review that is physician controlled and is applicable to all patients and not just specific groups as currently exists.  Continual development and promotion of new procedures for physician assessment of the quality and efficiency of medical care must be sought.  This development and assessment can best be accomplished by organized physician groups at the local level regardless of funding source.  The local review approval by local physician- sponsored organizations must be coordinated on a statewide level, always keeping in mind that physician-controlled peer review through locally sponsored physician organizations is the basis for effective peer review.

It is, therefore, the position of the Medical Society of the State of New York that the State Society should coordinate and assist in implementing mechanisms for peer review for all patients and that such coordination will ensure the review being done by physicians at the local level.  (HOD 1981; Reaffirmed Council 3/9/95; Reaffirmed HOD 2014)