235.000 PHYSICIAN CREDENTIALING/RECREDENTIALING

235.978           Rollback on Physician Performance Measures

MSSNY will make public statements calling for a removal of any/all unproven outcomes measures and associated mandates placed on physicians, practices, licensed clinics, nursing homes, hospitals and other places of healthcare.

MSSNY will seek legislation or regulation removing any/all unproven outcomes measures associated mandates placed on physicians, practices, licensed clinics, nursing homes, hospitals and other places of healthcare.
MSSNY will forward this resolution to the next available AMA HOD for consideration and action on a national level, including but not limited to:

– AMA statements calling for a removal of any/all unproven outcomes measures and associated mandates placed on physicians, practices, licensed clinics, nursing homes, hospitals and other places of healthcare; and legislation and regulation seek the same, and

-AMA seeking legislation or regulation mandating the removal of any/all unproven outcomes measures and associated mandates placed on physician, practices, licensed clinics, nursing homes, hospitals and other places of healthcare. (HOD 2024 – 261)

235.979           Mandating Private Payer Coverage for Delegated Credentialing by Certified Verification Organizations and Extending Delegated Credentialing to Medicaid, Including Managed Medicaid Plans

The Medical Society of the State of New York (MSSNY) will advocate for the establishment of regulations mandating insurance private payers to provide coverage for the cost of performing delegated credentialing by certified verification organizations.

MSSNY supports efforts to extend delegated credentialing to all Medicaid programs, including managed Medicaid plans, to ensure a standardized and streamlined credentialing process for healthcare providers participating in these programs.

MSSNY will bring this issue to the AMA to promote equitable, efficient, and standardized credentialing processes across the healthcare landscape. (HOD 2024 – 251)

235.980           Insurance Credentialing Demanding Physician Hospital Affiliation

MSSNY will discuss and reissue with the Department of Financial Services that, health insurances should not haphazardly oblige a Physician to obtain hospital privileges in order to be paid for their work or participate in their network. (HOD 2024 – 250)

235.981           Continuing Certification as a Condition of Employment or Reimbursement

The Medical Society of the State of New York will continue to work with the American Medical Association, state medical associations, and specialty societies to advocate for ensurance that requirements for maintaining board certification are not excessive in scope and are rationally related to ensuring ongoing physician competency in that specialty. (HOD 2020-67, referred to Council, substitute adopted 6/3/21)

235.982          Government Imposed Volume requirements for Credentialing

MSSNY will urge the AMA to create guidelines and standards for evaluation of government-imposed volume requirements for credentialing that would include at least the following considerations:

• The evidence for that volume requirement;
• How many current practitioners meet that volume requirement;
• How difficult it would be to meet that volume requirement;
• The consequences to that practitioner of not meeting that volume requirement;
• The consequences to the hospital and community of losing the services of the practitioners who can’t meet that volume requirement;
• Whether volumes of similar procedures could also reasonably be used to satisfy such a requirement.   (HOD 2020-259)

235.983           Archaic Requirement that Primary Care Physicians Maintain Hospital Privileges

MSSNY will call for an end to the insurance company requirement that physicians secure hospital admitting privileges as a condition to become participating (network) providers.

MSSNY will seek legislation or regulation that would prevent insurance companies from denying participating status to physicians who lack hospital admitting privileges. (HOD 2019-116)

235.984           Continuing Certification of Medical Competence

It is the position of the Medical Society of the State of New York (MSSNY) that verifiable demonstration of currency and competence in medical practice as an acceptable alternative to continuing board certification by the appropriate medical specialty board(s) should include:

-written attestation of good professional standing in the appropriate community(s) of practice by a minimum of two (2) peers also in good professional standing with the same community(s) of practice;

-satisfactory completion of a minimum of fifty (50) hours every two (2) years of continuing medical education experiences related to the specialty(s) of medicine in which one currently practices, in accordance with the current practices of the appropriate medical specialty(s);

-Validated self-assessment of current cognitive knowledge following no fewer than twenty (20) hours every two (2) years from the above cited continuing medical education experiences.  (HOD 2019-211)

235.985           Maintenance of Certification/Licensure (MOC/MOL)

The Medical Society of the State of New York (MSSNY) will ask the American Medical Association (AMA) to reaffirm the AMA’s policy regarding Maintenance of Certification and Maintenance of Licensure programs.  (HOD 2016-215) 

235.986           Maintenance of Certification as Restraint of Trade

The Medical Society of the State of New York will seek legislation to prohibit board certification requirements for hospital medical staff privileges, insurer contracts and state licensure.  (HOD 2016-214; reaffirmed HOD 2020-67 by Council 6/3/21; Reaffirmed HOD 2023 in lieu of Resolution 63)

235.987           Maintenance of Certification

The Medical Society of the State of New York will advocate for a moratorium on the Maintenance of Certification and Maintenance of Licensure requirements of all medical and surgical specialties until it has been reliably shown that these programs significantly improve patient care.

The New York delegation to the AMA is to advocate for a moratorium on the Maintenance of Certification requirements of all medical and surgical specialties until it has been reliably shown that these programs significantly improve patient care; and the delegation will join efforts to make specialty board recertification requirements practical, affordable and effective, such as an open book exam or demonstrated CME or meeting equivalent QI requirements.  (HOD 2015-211) 

235.988           Alternative Maintenance of Certificate

The Medical Society of the State of New York will introduce a resolution at the next American Medical Association meeting asking the AMA to explore the feasibility of developing an alternative Maintenance of Certification (MOC) program as a member benefit. (HOD 2014-66)

235.989           Restricting Prescriptions to Medicare Beneficiaries

The Medical Society of the State of New York will advocate, and seek legislation if necessary, to ensure that health insurers and hospitals do not limit network participation, staff privileges, employment, or payments solely as a result of not having specialty board certification and any measure that would require specialty board certification as a condition of licensure will be opposed. (HOD 2014-54; Reaffirmed HOD 2019 in lieu of res 210)

235.990           American Board of Medical Specialties (ABMS) Should Adhere to its Mission

The Medical Society of New York will oppose the establishment of scope of practice limitations through the use of board certifications by the American Board of Medical Specialties and its member organizations and will forward this resolution to the next American Medical Association Annual meeting. (HOD 2014-55)

235.991           Less Costly Alternatives to “Maintenance of Specialty Board Certification”

The Medical Society of the State of New York will work to enforce reducing exorbitant costs and effort required for the maintenance of certification. (HOD 2012-163; Amended and reaffirmed HOD 2022)

235.992           Eliminate Costly Monopoly for State Medical Licensure Credentialing by For-Profit Entity in New York and Enable Use of Alterative Credentialing Service

The MSSNY will work with the New York state licensing board so that the costly for-profit FCVS service no longer has an exclusive monopoly on credentialing physicians and charging physicians hundreds of dollars to be licensed in New York; that the complimentary AMA Physician Credentialing service which is recognized and used for state licensure credentialing verification in over 40 other states is also offered as an alternative to state licensure credentialing verification ion New York; and ensure the complimentary primary verification obtained directly from medical schools and post-graduate residency training programs, which is used throughout the country and which previously has been used in New York to credential physicians for licensure, is another alternative accepted to credential physicians for state licensure in New York. (HOD 2012-116; Reaffirmed HOD 2022)

235.993           Advertising for the Physician’s Performance of Specific Ancillary Services/Procedures:

MSSNY will seek legislation/regulation which would require that any advertisement for the performance of specific ancillary services/procedures, which may be unrelated to a physician’s true board certification (such as laser hair removal) clearly identify the physician’s actual ABMS board designation (or another country’s equivalent), so as not to mislead patients regarding the physician’s actual credentials. (HOD 2010-96; Amended and reaffirmed HOD 2020)

235.994           Repeal of the Fifth Pathway:  SUNSET HOD 2019

235.995           Hospital Mergers Resulting in Physician Exclusions:

MSSNY will work with appropriate agencies to ensure that where one or more hospitals are merged, a physician credentialed to perform services at any one of the merging hospitals shall be entitled to receive equivalent credentials at any of the other merging hospitals, provided that such physician meets the qualifications for credentialing at such other hospital.  (HOD 1999-77; Reaffirmed HOD 2014; Reaffirmed HOD 2024)

235.996           Granting of Provisional Credentialing Status to New York Physicians by MCOs: SUNSET HOD 2014

235.997           Physician Credentialing:

MSSNY adopts as policy the position that the NCQA is not the appropriate organization to determine criteria for physician credentialing and will ask the AMA to adopt a similar policy and seek to develop its own national physician credentialing criteria through AMAP.  (HOD 1997-87; Reaffirmed HOD 2014; Reaffirmed HOD in lieu of 2017-111; Reaffirmed HOD 2024)

235.998           Physician Recredentialing: SUNSET HOD 2014

235.999           MSSNY’s Non-Support of NYS Advisory Committee on Physician  Recredentialing Report

The Report of the New York State Advisory Committee on Physician Re-credentialing entitled “Phase One: General Principles, Proposed Process, Recommendations” was released in January of 1988.  MSSNY does not endorse this report or its recommendations. Historically, quality assurance (optimal patient care) and physician competency have been the foundations upon which the policies and positions of the MSSNY have been developed.  Over the past decade, the assurance of quality and maintaining of competence, a responsibility, which rightly belongs within the purview of the profession (all professions), has been gradually assumed to a large extent by agencies external to the profession.  Perhaps well intentioned, the regulatory mechanisms developed by these external agencies have had a deleterious effect on the delivery of medical care but have had little impact on physician clinical performance.

MSSNY agrees with the statement, made on several occasions in the report, that the re-credentialing process broadly outlined in the report “is not designed to measure medical competence.”  Indeed the report does little more than discuss those well-known methods used to evaluate those various, individual components which taken collectively are used to define knowledge and cognitive skills, not performance.  We agree with the report that there does not exist a single methodology for measuring competency and agree that employment of a combination of methodologies to measure competency would be logistically and economically unrealistic.  The evaluation of competence in the health professions has not yet reached maturity.  Measurement of changes in practice as a consequence of additional education, assessment of the validity of examinations and the determination of goals for competence are all necessary parts of the ongoing development of competence evaluation.  As stated in the beginning of this statement, MSSNY is committed to quality assurance and maintaining competence of health professionals.  However, we do not need further government intrusion to do what already is being done.  Accordingly, the MSSNY subscribes to the following recommendations of the “Health Policy Agenda for the American People”:

(1)  Health professionals are individually responsible for maintaining their competence and for participating in continuing education; all health professionals should be engaged in self-selected programs of continuing education.  In the absence of other financial support, individual health professionals should be responsible for the cost of their own continuing education.

(2)  Professional schools and health professions organizations should develop additional continuing education self-assessment programs, should prepare guides to continuing education programs to be taken by practitioners throughout their careers and should make efforts to ensure that acceptable programs of continuing education are available to practitioners.

(3)  Health professions organizations and faculty of programs of health professions education should develop standards for competence.  Such standards should be reviewed and revised periodically.

(4)  When reliable and cost-effective means of assessing continuing competence are developed, they should be required for continued practice.  This should be done without government interference or control.  (HOD 1988-25; Reaffirmed HOD 2013; Reaffirmed HOD 2023; Reaffirmed HOD 2024)