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 supports access to emergency contraception, including making emergency contraception pills more readily available through hospitals, clinics, emergency rooms, acute care centers, and physicians’ offices.  (HOD 2003-158; Modified and reaffirmed, HOD 2013)

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 supports requiring any prescription drug plans offered by insurance companies and health maintenance organizations to cover the cost of prescriptive contraceptives.  Furthermore, the Medical Society supports direct access for women to obstetric and gynecologic services.  (W hite Paper on Women’s Health Initiatives Council 11/2/00; Modified and reaffirmed HOD 2014)       

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 supports the requirement for insurance coverage for infertility treatments.  (HOD 2000-91; Reaffirmed HOD 2002-152; Modified and reaffirmed HOD 2013)    

5.995               Contraceptive Prescription Drugs, Insurance Coverage for Payment of:
Sunset 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 1989-27; Reaffirmed HOD 2013)

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 a87ct 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 from the case so long as the withdrawal is consistent with good medical practice.  (Council 10/13/83; Reaffirmed HOD 2003-158; Reaffirmed HOD 2013) 

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 1982-5; Reaffirmed HOD 2013)

MSSNY opposes any legislation that criminalizes the exercise of clinical judgment in the delivery of medical care. (HOD 2013 amended and added policy)

5.998               Contraceptive Sales:
MSSNY supports efforts to 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; Modified and Reaffirmed HOD 2013)

5.999               Family Planning for Persons on Public Welfare Assistance:
Sunset HOD 2013

10.000        ACCIDENT PREVENTION:
(See also Public Health and Safety, 260.000)

10.969             Rumble Strips:
MSSNY will 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 2010-150)

10.970          Physician Reporting of Patients Who Should Not Drive:
MSSNY will 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 will 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 New York State Resorts:
MSSNY supports 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 outlining the benefits of helmet use in reducing serious injury in ski and snowboarding accidents.  (HOD 2006-151)

 

10.973          Require Backup Warning Devices On New SUVs As Standard 
                     EquipmentSUNSET HOD 2015

10.974           ATV Safety:  SUNSET HOD 2015

10.975           Use of Protective Headgear to Prevent Injuries:  SUNSET HOD 2015

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 2001-161; 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. (HOD 2000-171; Reaffirmed HOD 2014) 

10.979             “Drive Now, Talk Later”:  
SUNSET HOD 2014 

10.980             Ski Helmet Requirement:  
SUNSET HOD 2014 

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 1998-167; Reaffirmed HOD 2014) 

10.982             Expanded Use Of Safety Helmets:
MSSNY will pursue legislation which would require the use of helmets for all cyclists, inline skaters, skateboarders, alpine skiers, snowboarders, scooters and roller skaters, regardless of age.  (HOD 1997-176; Modified and reaffirmed HOD 2014) 

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 in-line 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; Reaffirmed HOD 2014) 

10.984             Air Bags in Automobiles:  
SUNSET HOD 2014 

10.985             Handrails in Hallways:  
SUNSET HOD 2014 

10.986             Jogging Attire:  
SUNSET HOD 2014 

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 2007-153) 

10.988             Videotaping Drunken Drivers:  SUNSET HOD 2014 

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 1992-16 & HOD 2007-154) 

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  

10.991             Safety Regulations for Motorcycle Operators:  
SUNSET HOD 2013 

10.992             Safety Belt Usage:
SUNSET HOD 2014 

10.993             Shoulder Harnesses for Outboard Rear Seat Occupants:
SUNSET HOD 2013 

10.994             Safety Belts for Front Seat Occupants:  SUNSET HOD 2013 

10.995             Additional Death Benefits for Deceased’s Use of Safety Belts:
SUNSET HOD 2013 

10.996             Leadership for Successful Promulgation of Mandatory Safety Belt Law:
SUNSET HOD 2013 

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 1982-19; Reaffirmed HOD 2013) 

10.998             Proper Use and Design of Car Seats:  
SUNSET HOD 2013 

10.999             Car Seats for Children:  
SUNSET HOD 2013

15.000 ACQUIRED IMMUNODEFICIENCY SYNDROME - (AIDS):
(See also Children and Youth, 30.000; Medicaid, 175.000; Public Health & Safety, 260.000)

15.952 HIV Testing Guidelines
MSSNY supports routine HIV testing according to the 2006 CDC Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Healthcare Settings – 2006. MSSNY will advocate for removal of all special consent requirements relating to HIV testing and that physicians be allowed to collect specimens for HIV testing using the same procedures and protocols used for all other specimens. (HOD 2012-158)

15.953 Support of a National HIV/AIDS Strategy:
MSSNY will 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 evidence-based 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; 6 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. 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 2009-169)

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 2009-160)

15.955 Condom Availability in Jails and Prisons:
MSSNY supports a policy of making condoms accessible to all incarcerated persons. (HOD 2009-159)

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 2008-156)

15. 957 Expedited Partner Therapy in the Management of Sexually Transmitted Infections
MSSNY will (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 a sexually transmitted infection (STI) in an individual to prescribe or dispense antibiotics to that person’s sex partner in instances where the CDC has recommended the use of EPT; and (3) continue to ensure that physicians participating in the delivery of EPT are protected from liability.
(HOD 2008-155; Amended HOD 2013-172 with title change)

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 endorses 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 2007-
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 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 will promote and implement the following recommendations on the state and federal level:

 ~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 (opt-out 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 supports efforts to permit the local public health official or department to implement the necessary procedures to ascertain whether the HIV/AIDS patient is obtaining treatmentand the preservation of the right of a physician to make appropriate clinical judgments without interference from local and state health officials.  (HOD 2006-170)

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. (Council 6/9/05; Reaffirmed HOD 2006-170)

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 1997-157; Reaffirmed HOD 2014)

15.966 MSSNY Position on HIV Surveillance and Partner Notification:
SUNSET HOD 2014

15.967 Physician Discussion of AIDS with Patients 50 and Older:
SUNSET HOD 2014

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 1997-154; Reaffirmed HOD 1998-157; Reaffirmed HOD 2006-170)

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 1997-171; Reaffirmed 2006-159; Reaffirmed Council 3/6/06)

15.970 Limited Disclosure of Patient’s HIV Status:  SUNSET HOD 2014

15.971 Prophylactic Drug Treatment for Health Care Workers:
SUNSET HOD 2014

15.972 Needle Exchange Program, Expansion of:  SUNSET HOD 2014

15.973 HIV Reduction Through Harm Reduction Measures:   SUNSET HOD 2013

15.974 HIV Testing Mandatory  to Prevent Prenatal Transmission of:
SUNSET HOD 2014

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 1996-164; Reaffirmed HOD 2014)

15.976 HIV Testing, Mandatory in Criminal Cases:  
SUNSET HOD 2014

15.977 Epidemiologic Control Measures Against Aids:
MSSNY supports the concept that all findings of AIDS/HIV testing be made available to all treating physicians involved in the care of the patient.  (HOD 1995-185; Modified and reaffirmed HOD 2014)

15.978 Testing - Mandatory of all NYS Prison Inmates for HIV and Tuberculosis Infection:  
SUNSET HOD 2014

15.979 Physicians’ Duty to Treat HIV Seropositive Patients:
MSSNY endorses the position 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.  Persons who are HIV seropositive should not be subjected to discrimination based on fear or prejudice.  (Council
1/31/91; Modified and reaffirmed HOD 2014)

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; Reaffirmed HOD 2014)

15.981 Ambulatory Treatment of HIV Infection:  
SUNSET HOD 2014

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 long-standing, 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. Therefore, the FDA allows only latex condoms to be labeled for the prevention of STDs, including AIDS.  (HOD 1990-27; Modified and reaffirmed HOD 2014)

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 1989-30; Council 3/21/91; Reaffirmed HOD 1995-159; Amended and Reaffirmed HOD 2006-153; Reaffirmed HOD 2009-161)

15.984 Confidentiality of Test Results:
SUNSET HOD 2013

15.985 Reporting HIV Status to Public Health Officers:  
SUNSET HOD 2013

15.986 Testing - Mandatory for HIV:  
SUNSET HOD 2013

15.987 HIV Infected Children, Immunization of:  
SUNSET HOD 2013

15.988 HIV Infection and Drug Abuse:  
SUNSET HOD 2013

15.989 HIV Infection Status of Patient, Right of Health Care Workers to Know:
SUNSET HOD 2013

15.990 HIV Testing Laboratories  
SUNSET HOD 2013

15.991 Blood Transfusions Contaminated by HIV:  
SUNSET HOD 2013

15.992 HIV Transmission in Health Care Setting:  
SUNSET HOD 2013

15.993 Testing - Voluntary for Persons at High Risk of AIDS:
SUNSET HOD 2014

15.994 Needles and Syringes (Sterile), Providing to Drug Abusers:
SUNSET HOD 2013

15.995 Public Reservoirs of Sexually Transmitted Diseases, Control of:
SUNSET HOD 2013

15.996 Notifying Sexual Partners of HIV Status:  
SUNSET HOD 2013  

15.997 Contact Tracing:  
SUNSET HOD 2013

15.998 Counseling:  
SUNSET HOD 2013

15.999 Heroin Addicted Population:  
SUNSET HOD 2013

 

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)

20.896 Increasing Awareness of Potential Drunk Drivers’ Blood Alcohol Content
The Medical Society of the State of New York will request that the New York State Liquor Authority research the use of blood alcohol content testing devices as a tool to reduce drunk driving in the state.  (HOD 2015-158)

20.897 Age-based Alcohol Policies
MSSNY supports opening discussion regarding federal and state age based alcohol policies including review of the positive and negative consequences of these policies and ways to reduce harm from age appropriate and underage drinking and that such discussion include review of the research literature and other appropriate evidence in light of te recent increase in underage binge drinking and adverse consequences of underage binge drinking.  The resolution is to be sent to the AMA for further study by its House of Delegates.  (2011-162, amended, adopted Council 11/3/2011)

20.898 Blood Alcohol Level and Driving:
MSSNY supports efforts to lower the current drinking level standard from 0.08% to the more desirable alcohol level of 0.05%.  (HOD 1997-182; Modified and reaffirmed HOD 2014)

20.899 Continuation of the Hospital Intervention Services Program for
Alcoholism Screening:  SUNSET HOD 2014

20.900 Sales Tax Increase on Alcohol and Cigarettes:
MSSNY supports an increase in the tax on alcohol and cigarettes in order to discourage alcohol and cigarettes use.  (HOD 1993-124; Modified and reaffirmed HOD 2014)

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 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
1992-100 & 1992-101; Reaffirmed HOD 2014)

20.992 Blood Alcohol Levels in Automobile Accident Cases
SUNSET HOD 2014

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; Reaffirmed HOD 2014)

20.994 Classification of Disease:  
SUNSET HOD 2014

20.995 Deleterious Effects of Alcohol Consumption:
MSSNY supports programs which warn the public about the risk associated with the consumption of alcohol as it affects both men and women.  (HOD 1991-120; Modified and affirmed HOD 2014)

20.996 Detoxification Coverage in Minimum Benefits Package of Uninsured:
SUNSET HOD 2014)

20.997 Alcohol and other Drug Misuse 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)  Maintain 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 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.

(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)  W arning labels on prescription and over-the-counter drugs describing possible adverse interactions with alcohol and other drugs.

(f)  W arning 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)  Age-appropriate 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) (Modified and Reaffirmed HOD 2013)

20.998 Driving While Intoxicated (DWI):  
SUNSET HOD 2014

20.999 Alcoholism Health Insurance Coverage:  
SUNSET HOD 2013

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
1995-66; Reaffirmed HOD 2014)

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)

30.987 Treatment of Youths by the Justice System

The Medical Society of the State of New York (MSSNY) will support legislation or regulation that requires that youth under 18 years of age who are arrested for nonviolent crimes are processed as children, placed and remain in the juvenile justice system; and further

MSSNY will support legislation or regulation that requires that youth in the juvenile justice system who are identified with mental health or substance use disorders receive appropriate treatment, psychosocial recovery and support services for these mental health and substance use disorders. (HOD 2015-203)

30.988 Maintaining Tax Exempt Status for Youth Service Organizations
The MSSNY will oppose any New York State legislation that would remove the property tax exemptions currently granted to non-profit youth service organizations, such as 4H, Boy Scouts, Girl Scouts, and religious groups for the purpose of maintaining wilderness camps throughout New York State for the purposes of providing outdoor experiences for any of our youth. (Amended and adopted Council 11/20/2014.  From HOD 2014-209)

30.989 Availability of Self-Injectable Epinephrine Devices in New York State Schools
The Medical Society of the State of New York will support legislation that requires all schools (public and private) to stock auto-injectable epinephrine devices in standardized dosage formulations and train personnel for the administration of this medication.  MSSNY will urge the State Education Department (SED) to provide information to public and private schools about the ability for nurses and other trained individuals to administer auto- injectable epinephrine devices to children or adults who have had a severe allergic reaction and that these trained individuals are covered by the New York State “Good Samaritan” statute.

The Medical Society of the State of New York will educate its members about physicians being authorized to issue a non-patient specific regimen to a registered professional nurse under the provisions of Article 6527 (6) of the NYS Education Law. (HOD 2014-150)

30.990 Dangers of Youth Football
The Medical Society of the State of New York will promote the New York State Department of Health’s "W hen in Doubt...Take Them Out!" sports related concussion prevention campaign and the Sports Concussion Tool Kit developed by the  American Academy of Neurology to its members.  (HOD 2014-151)

30.991 Support Juvenile Justice
MSSNY will support efforts to study the etiologies of recidivism among juvenile delinquents, with a significant focus on incarcerated juveniles who have mental health factors involved in their delinquency compared to those with other factors; comparing treatment interventions that decrease juvenile delinquency recidivism and how intervention success varies when delivered in the institutional versus community–based settings.(2011-66 referred, amended, adopted by Council 3/19/12)

30.992 Graduated Drivers’ Licensing:  
SUNSET HOD 2013

30.993 Classification for Video Games:
Sunset 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 2001-63; 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 1996-157; Reaffirmed HOD 2014)

30.996 Students with Complicated Medical Conditions:  
SUNSET HOD 2014

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 electronic communications or mailing lists for any matters pertaining to school health.  (Council 12/15/94; Modified and reaffirmed HOD 2014)

30.998 AIDS, School Health Education to Prevent the Spread of AIDS:

SUNSET HOD 2013

30.999 Handicapped Newborns:  SUNSET HOD 2013

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; Reaffirmed HOD 2014)

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; Reaffirmed HOD 2013)

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 1988-72; Reaffirmed HOD 2013)

35.999 Spinal Manipulation:  
SUNSET HOD 2013

40.000 CLINICAL JUDGMENT:
(See also Hospitals, 150.000)

40.997  Pain as the “Fifth Vital Sign”
The Medical Society of the State of New York (MSSNY) affirms as policy that the clinical highlighting of pain as “the fifth vital sign” and a focus on eradication or total resolution of a patients pain is misguided and leads to 1) inappropriate pain management demands by patients; 2) inappropriate pressure on clinical pain management practices by clinicians; and 3) consequently, the diffuse overuse of opioids.

MSSNY will recommend that “pain as the fifth vital sign” be removed from the clinical practice environment and that the Joint Commission remove “pain as the fifth vital sign” from its standards.

The New York delegation will forward this resolution to the American Medical Association encouraging it to request that the Joint Commission remove “pain as the fifth vital sign” from its standards.  (HOD 2015-154)

40.998 Communication in the Physician-Patient Relationship:
SUNSET HOD 2014

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 1995-64; Reaffirmed HOD 2014)

45.000 COMPUTER MAILING LISTS:

45.999 Guidelines For Mailing Lists and Address Files:
(1)  Requests from Members:  All requests from members for lists of physicians will generally be referred to MSSNY’s Division of Information Technology.(2)  Requests from Nonmembers:  (

a)  Requests from nonmembers will be considered on an individual basis. Factors bearing on acceptance involve commercial aspects as well as value of the subject matter to physicians and/or their patients.  (b) Lists are usually available to vendor organizations approved by the Council.
(3)  General Considerations:  
 (a)  MSSNY’s policy will be quite circumspect in making mailing lists available, and MSSNY will not share email addresses, except with members’ county medical societies, or with the American Medical Association, when AMA members grant permission for MSSNY to do so.  MSSNY’s general policy will be to protect the confidentiality of these lists.  
(b)  Any questions regarding suitability of requests will be referred to the Executive Vice President.  (Council 2/16/84; Modified and reaffirmed HOD
2013)

50.000 CONTINUING MEDICAL EDUCATION:
(See also Education, 85.000)

50.988 Prevention of Unintended Consequences of the Physician Payments Sunshine Act (PPSA). 
The Medical Society of the State of New York reaffirms its support for the current ACCME Standards for CME and Commercial Support. The Medical Society of the State of New York supports the position of the AMA and Alliance for CME: that regulations implementing the Physician Payment Sunshine Act assure that manufacturers not be required to report payments made for a program where the topic, the speakers, and educational materials are independently chosen and have no relationship with a manufacturer which might be supporting the CME activity. (HOD 2012-64)

50.989 Continuing Medical Education for Maintenance of Certification
(CME for MOC):
MSSNY is to support: ß 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; ß 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;
ß 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 2011-168)

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 2011-167) 50.991 CME Credits for Attending MSSNY House of Delegates:17 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 Medical Education (ACCME) for implementation at the 2011 House of Delegates. (HOD 2009-154) (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.) Shouldn’t this have been removed from the PPS 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:

ß Didactic presentations, seminars, symposia, workshops, grand rounds ß Enduring material in a print, audio, video or internet format

ß Interactive, live audio and video conferencing and web casting activities that ß 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:

ß Assessment of the achievement of MSSNY’s overall CME Mission

ß Participant satisfaction

ß Measure practice performance through follow up surveys and evaluation

ß 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; Reaffirmed HOD 2015)

50.995  ACCME’s Standards for Commercial Support:  Standards to Ensure Independence in CME Activities

MSSNY approved the following standards:

STANDARD 1: INDEPENDENCE

Standard 1.1 A CME provider must ensure that the following decisions were made free of the control of a commercial interest. (See www.accme.org for a definition of a "commercial interest" and some exemptions.) (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.

Standard 1.2 A commercial interest cannot take the role of non-accredited partner in a joint provider relationship.

STANDARD 2: RESOLUTION OF PERSONAL CONFLICTS OF INTEREST

Standard 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.  

Standard 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.  

Standard 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

Standard 3.1 The provider must make all decisions regarding the disposition and disbursement of commercial support.  

Standard 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.  

Standard 3.3 All commercial support associated with a CME activity must be given with the full knowledge and approval of the provider.

Standard 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 provider.

Standard 3.5 The written agreement must specify the commercial interest that is the source of commercial support.  

Standard 3.6 Both the commercial supporter and the provider must sign the written agreement between the commercial supporter and the provider.

Standard 3.7 The provider must have written policies and procedures governing honoraria and reimbursement of out-of-pocket expenses for planners, teachers and authors.

Standard 3.8 The provider, the joint provider, 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.

Standard 3.9 No other payment shall be given to the director of the activity, planning committee members, teachers or authors, joint provider, or any others involved with the supported activity.

Standard 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.

Standard 3.11 Social events or meals at CME activities cannot compete with or take precedence over the educational events.

Standard 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 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 provider or educational partner.

Standard 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

Standard 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.  

Standard 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.

 Also, ACCME-accredited providers may not place their CME activities on a Web site owned or controlled by a commercial interest. With clear notification that the learner is leaving the educational Web site, links from the Web site of an ACCME accredited provider to pharmaceutical and device manufacturers’ product Web sites are permitted before or after the educational content of a CME activity, but shall not be embedded in the educational content of a CME activity. Advertising of any type is prohibited within the educational content of CME activities on the Internet including, but not limited to, banner ads, subliminal ads, and pop-up window ads.      

For audio and video recording, advertisements and promotional materials will not be included within the CME. There will be no ‘commercial breaks.’

 For live, face-to-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.

 For Journal-based CME, none of the elements of journal-based CME can contain any advertising or product group messages of commercial interests. The learner must not encounter advertising within the pages of the article or within the pages of the related questions or evaluation materials.

Standard 4.3 Educational materials that are part of a CME activity, such as slides, abstracts and handouts, cannot contain any advertising, corporate logo, trade name or a product-group message of an ACCME-defined commercial interest.

Standard 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.  

Standard 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

Standard 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.  

Standard 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

Standard 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.

Standard 6.2 For an individual with no relevant financial relationship(s) the learners must be informed that no relevant financial relationship(s) exist.  

Standard 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.  

Standard 6.4  Disclosure of commercial support must never include the use of a corporate logo, trade name or a product-group message of an ACCME-defined commercial interest.

Standard 6.5 A provider must disclose the above information to learners prior to the beginning of the educational activity.  

POLICIES SUPPLEMENTING THE STANDARDS FOR COMMERCIAL SUPPORT

DEFINITION OF A COMMERCIAL INTEREST

A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

The ACCME does not consider providers of clinical service directly to patients to be commercial interests.  A commercial interest is not eligible for ACCME accreditation. Commercial interests cannot be ac-credited providers and cannot be joint providers. Within the context of this definition and limitation, the ACCME considers the following types of organizations to be eligible for accreditation and free to control the content of CME:

• 501-C Non-profit organizations (Note, ACCME screens 501c organizations for eligibility. Those that advocate for commercial interests as a 501c organization are not eligible for accreditation in the ACCME system. They cannot serve in the role of joint provider, but they can be a commercial supporter.)

• Government organizations

• Non-health care related companies

• Liability insurance providers

• Health insurance providers

• Group medical practices

• For-profit hospitals

• For profit rehabilitation centers

• For-profit nursing homes

• Blood banks

• Diagnostic laboratories

ACCME reserves the right to modify this definition and this list of eligible organizations from time to time without notice.

FINANCIAL RELATIONSHIPS AND CONFLICTS OF INTEREST

Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria for promotional speakers’ bureau, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

The ACCME has not set a minimum dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship.

With respect to personal financial relationships, contracted research includes research funding where the institution gets the grant and manages the funds and the person is the principal or named investigator on the grant.

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.

The ACCME considers financial relationships to create actual conflicts of interest in CME when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. The ACCME considers “content of CME about the products or services of that commercial interest” to include content about specific agents/devices, but not necessarily about the class of agents/devices, and not necessarily content about the whole disease class in which those agents/devices are used.

With respect to financial relationships with commercial interests, when a person divests themselves of a relationship it is immediately not relevant to conflicts of interest but it must be disclosed to the learners for 12 months.

DISCLOSURE OF FINANCIAL RELATIONSHIPS TO THE ACCREDITED PROVIDER

Individuals need to disclose relationships with a commercial interest if both (a) the relationship is financial and occurred within the past 12 months and (b) the individual has the opportunity to affect the content of CME about the products or services of that commercial interest.

COMMERCIAL SUPPORT: DEFINITION & GUIDANCE REGARDING WRITTEN AGREEMENTS

Commercial Support is financial, or in-kind, contributions given by a commercial interest which is used to pay all or part of the costs of a CME activity.

When there is commercial support there must be a written agreement that is signed by the commercial interest and the accredited provider prior to the activity taking place.

An accredited provider can fulfill the expectations of SCS 3.4 - 3.6 by adopting a previously executed agreement between an accredited provider and a commercial supporter and indicating in writing their acceptance of the terms and conditions specified and the amount of commercial support they will receive.

A provider will be found in Noncompliance with SCS 1.1 and SCS 3.2 if the provider enters into a commercial support agreement where the commercial supporter specifies the manner in which the provider will fulfill the accreditation requirements.

Element 3.12 of the ACCME’s Updated Standards for Commercial Support applies only to physicians whose official residence is in the United States.

VERBAL DISCLOSURE TO LEARNERS

Disclosure of information about relevant financial relationships may be disclosed verbally to participants at a CME activity. When such information is disclosed verbally at a CME activity, providers must be able to supply the ACCME with written verification that appropriate verbal disclosure occurred at the activity. With respect to this written verification:

1. A representative of the provider who was in attendance at the time of the verbal disclosure must attest, in writing:

a. that verbal disclosure did occur; and

b. itemize the content of the disclosed information (SCS 6.1); or that there was nothing to disclose (SCS 6.2).

2. The documentation that verifies that adequate verbal disclosure did occur must be completed within one month of the activity.

COMMERCIAL SUPPORT: ACKNOWLEDGMENTS

The provider’s acknowledgment of commercial support as required by SCS 6.3 and 6.4 may state the name, mission, and areas of clinical involvement of an ACCME-defined commercial interest but may not include corporate logos and slogans.

COMMERCIAL EXHIBITS AND ADVERTISEMENTS

Commercial exhibits and advertisements are promotional activities and not continuing medical education. Therefore, monies paid by commercial interests to providers for these promotional activities are not considered to be commercial support. However, accredited providers are expected to fulfill the requirements of SCS 4 and to use sound fiscal and business practices with respect to promotional activities.   (Council 3/14/05; Updated/Adopted Council January 15, 2015)


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 22 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; Reaffirmed HOD 2013)

50.998 Hardship or Disability:
SUNSET HOD 2013

50.999 Retired and Semi-retired Physicians:
SUNSET HOD 2013

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 socio-economic 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; Reaffirmed HOD 2013)
NB: The MSSNY Board of Trustees recommends that the new legal guidelines concerning monies allocated to legislative activities be communicated to county medical societies and the MSSNY continue the policy of reimbursing counties for 50% of the costs incurred for such activities, with a cap of $1,000.

55.997 Health Care Coalitions for the Needy SUNSET HOD 2013

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 Medical Society or its Members23
(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; Reaffirmed HOD 2013)

55.999 Patients’ Complaints Against Physician Members - Guidelines for Handling:
SUNSET HOD 2013

60.000 DEATH:

65.985       MSSNY Opposes Recreational Marijuana Legalization

The Medical Society of the State of New York opposes recreational marijuana legalization. (HOD 2015-166)

65.986       Treatment Rather than Arrest for Marijuana Possession

The Medical Society of the State of New York supports promotion of drug treatment to those arrested or fined for marijuana related offenses and encourages communities to develop programs that emphasize drug treatment and rehabilitation rather than criminalization of marijuana. (HOD 2015-165)

65.987       Increasing Access to Care for Patients with Opioid Use Disorders

The Medical Society of the State of New York will encourage primary care physicians and psychiatrists to voluntarily complete appropriate training which would best increase access to care for opioid use disorders, and which would include, but not be limited to:

a) CME courses on screening, brief intervention, prescribing of medications for substance use disorders and referral for specialized care,

b) CME courses on opioid use disorders and

c) CME which meets the requirements for certification to become licensed to prescribe buprenorphine.

The Medical Society of the State of New York will support policies and initiatives to provide adequate compensation for primary care physicians and psychiatrists for the treatment and counseling of patients with opioid use disorders, as well as efforts to end the limitation of 100 patients per certified physician treating opioid dependence after the second year of treatment as currently mandated by the Drug Addiction Treatment Act

A copy of this resolution will be transmitted to the AMA House of Delegates for its consideration.  (HOD 2015-163)


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 2007-
261)

60.998 Determination of Death: SUNSET HOD 2013

60.999 Pronouncement of Death: SUNSET HOD 2013


65.000 DRUG ABUSE:

65.988 Availability of Treatment Slots for Substance Abusers
The Medical Society of the State of New York will urge the New York State Department of Health to commission a study analyzing the projected substance abuse treatment slots needed from drug crime sentencing to ensure the system will be equipped to handle the increased volume and if there is a shortage of substance abuse treatment slots projected, the Medical Society of the State of New York will lobby to increase the number of treatment slots available to meet the need. (HOD 2014-114)

65.989 Driving While Intoxicated, Impaired or Distracted by All Substances 
The Medical Society of the State of New York will advocate to ensure that when the ability to drive is impaired by recreational intake of drugs which are not listed as controlled substances under New York’s Public Health Law, those persons are still subject to penalties under New York law which prohibits driving while intoxicated or driving while ability impaired. The Medical Society of the State of New York will continue to support programs that educate the public on the dangers of driving while intoxicated, or impaired. (HOD 2014-62)24

65.990 Use of Naxolone to Prevent Drug Overdoses
MSSNY supports the use of intra-nasal Naxolone in the prevention of drug overdoses. (Council 3/10/2014)

65.991 Recommendations to Address the Prescription Drug Abuse and Diversion Issue
The Medical Society of the State of New York adopted the following consensus statement:
There have been several New York State legislative proposals from state legislators and officials to combat the abuse of prescription drugs. The Medical Society of the State of New York and the above referenced specialty societies believe that any solution to the abuse of prescription drug problem must be multipronged. This approach includes increased law enforcement efforts to prevent and punish inappropriate diversion of prescription medications. It includes the need for increased accessibility of treatment for patients suffering addictions so as to reduce the likelihood of inappropriate diversion of prescribed medications. It includes improvement in and better use of the existing database that is currently maintained by the New York State Health Department on all controlled substance prescriptions. And it includes the need for additional resources for associations representing prescribers so that they can educate their members about the existence of the database and the circumstances of patients presenting themselves in health care settings that should trigger a prescriber to check the database.

New York State has for many, many years collected information on prescription drugs and has a Prescription Monitoring Program (PMP)—an electronic monitoring system that is operated by New York State’s Department of Health Bureau of Narcotics Enforcement (BNE). The issue is not the need to create a new database. The issue is how the information that already exists within the database can be best used and improved upon in order to inform physicians and other non-physician prescribers, as well as pharmacists dispensing these medications, so as to prevent or reduce “doctor-shopping,” diversion and abuse. Physicians have indicated that the present system which is operated on the Health Commerce System (HCS) is very difficult to use, has a significant lag in the reporting of such data, and requires a password that expires if the physician does not go onto the HCS within a certain period of time. In addition, no information at all is given about an individual patient unless their prescription usage hits a too high threshold of obtaining multiple prescriptions from multiple doctors and filling them at multiple pharmacies in a short timeframe. Specifically, no information at all is available unless a patient has two or more prescriptions written by two or more physicians that are filled at two or more pharmacies over the last couple of months or so. Finally, since pharmacy data may be entered on a monthly basis, often the prescription information for the most recent few weeks is incomplete.

The Medical Society of the State of New York and the above referenced specialty societies note that as the State looks to identify ways to prevent misuse and inappropriate diversion, it will need to be careful that it does not “over correct” this problem. In fact, there is a body of recognized expertise that has concluded that physicians are not actually prescribing pain medications enough. As such, the medical community has serious concerns with proposals that would mandate reporting and checking a database each and every time a controlled substance prescription is written. The Medical Society and the above referenced specialty societies are greatly concerned that such proposals would add to the already tremendous administrative burden facing physician practices and worse, would potentially discourage physicians from writing prescriptions for controlled substances in situations where they are necessary. In addition, strict mandatory reporting may result in the unintended consequences of preventing patients with substance use disorders or chronic pain from seeking or staying in treatment or prevent them from reporting such behaviors to their treating physicians.

Therefore, the Medical Society of the State of New York and the above referenced specialty societies recommend that the following changes be made via regulation and/or statute:
E-Prescribing of Narcotics - The Medical Society and the above referenced specialty societies support the implementation of E-prescribing for all controlled substances.
- The Medical Society and the above referenced specialty societies support the implementation of connecting the PMP Database with Health Information Exchanges.

Improving the PMP Database 

- The Medical Society of the State of New York and the above referenced specialty societies support physicians having access to the PMP for ANY controlled medication prescriptions as far back as database will allow.
- The Medical Society and the above referenced specialty societies are supportive of allowing a physician’s designee to have access to the PMP. The Medical Society and the above referenced specialty societies support authorizing pharmacists to have access to the existing PMP database which would better enable pharmacists to provide relevant information to the prescribing physician.
- The Medical Society and the above referenced specialty societies support the use of improved technology to allow easier usage of the PMP.
Physician Access to PMP and Physician Education
- MSSNY and the above referenced specialty societies support the principle that if a physician believes a patient is attempting to access a prescription for any reason other than treatment of an existing medical condition such physician has the obligation to decline to write the prescription or check the current data base before a script is written or submitted electronically.
- The Medical Society and the above referenced specialty societies support developing regulatory guidance with the input of appropriate physician organizations to treat acute pain and for chronic pain management care provided that this guidance is developed in consultation with physicians and appropriate physician organizations and that such guidance is mindful of the need for individualized medical evaluation and decision making. Such guidance may include information relative to the clinical conditions which would indicate physician recourse to the PMP database.
- The Medical Society and the above referenced specialty societies support voluntary education programs for providers on pain management, substance abuse and dependence,
diversion and on the use of the PMP as a tool for prescribing, with the caveat that the prescribing authority remains independent of any educational requirement.
Patient Education
- The Medical Society and the above referenced specialty societies believe it is imperative that NYS educate the public regarding the dangers of prescription misuse and diversion and the
requirement to inform all prescribers of any controlled drugs they are taking.
Prescription Drugs
- The Medical Society and the above referenced specialty societies support elevating Hydrocodone to Schedule II and Tramadol to Schedule III. Importantly, this will limit the duration of
Hydrocodone prescriptions to 30 days.
Prevention Methods26
- The Medical Society and the above referenced specialty societies support data sharing of information through the PMP with other states.
- The Medical Society of the State and the above referenced specialty societies support drug take-back programs for all prescriptions.

Additionally, the Medical Society of the State of New York opposes any legislation requiring physicians to do patient background checking prior to prescribing controlled substances.
The Medical Society of the State of New York submitted a resolution to the AMA House of Delegates opposing federal legislation which would require physicians to do background
checking prior to prescribing controlled substances. (HOD 2012-161 and 162 PHE)

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 2011-155)

65.993 Preventing Overdose Deaths - “911 Good Samaritan”:
MSSNY supports 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 healthrelated 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 2011-154)

65.994 Dextromethorphan Abuse in Adolescents:
MSSNY supports regulation and/or legislation which would mandate that dextromethorphan-containing products be placed behind pharmacy counters to prevent
abuse in adolescents. (HOD 2007-150)

65.995 Opioid Dependent Patients: Changes in Treatment Venue of Stable Patients:
MSSNY supports efforts of 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; Modified and reaffirmed HOD 2014)

65.996 Marijuana Alert 2000:
SUNSET HOD 2014

65.997 Hypodermic Needle and Syringe Exchange Program:
SUNSET HOD 2014

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 1998-90; Reaffirmed Council 9/11/03; Reaffirmed HOD 2013)

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 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; Reaffirmed HOD 2014)

70.000 DRUG DISPENSING:
(See also Children and Youth, 30.000)

70.945  Federal Agency Compliance with State Laws on Controlled Substances Databases

In order to better coordinate controlled substance prescribing with other physicians, the Medical Society of the State of New York, working with the AMA, will request that the Veterans Administration and other federal health programs comply with applicable State laws which require checking databases of controlled substance prescriptions and that they additionally comply with state laws with regard to respective requirements for entering data on prescription fills into controlled substance tracking databases.

MSSNY will work with the NYS Department of Health to address any technological obstacles that exist to impede the transfer of data from VA practitioners and other federal health programs to the NYS Prescription Monitoring Program.  (HOD 2015-100)

70.946                    Generic Drug Pricing

The Medical Society of the State of New York (MSSNY) recognizes that generic drugs are not identical to their brand name precursors.  MSSNY will advocate to ensure that a patient’s physician has final decision-making authority regarding which prescription medications are necessary for that patient’s well-being and it will further advocate to ensure the availability of affordable prescription medications for patients, including opposition to sudden unjustified price increases in prescription medications.

The Medical Society will continue to work with the Department of Financial Services, Department of Health and Attorney General’s office to expedite reviews of situations where insurers and their agents improperly delay responding to requests for pre-authorization of needed medications and further, MSSNY will advocate for sufficient fines to be imposed on insurers who fail to respond to pre-authorization requests in a timely manner. (HOD 2015-52)

70.947                    Physical Appearance of Generic Drugs

The Medical Society of the State of New York will work with the pharmaceutical industry to help educate patients and physicians regarding the numerous online databases that help provide tools to enable the easy identification of medications. (HOD 2015-51)

70.948 Point of Care Dispensing
The Medical Society of the State of New York will seek legislation that permits in-office physician dispensing of prescription medication to the patients. (HOD 2014-113) 70.949: Insurance Coverage For A 90 Day Supply Of Maintenance Medications Insurance plans should be required to fill prescriptions as written up to a 90 day supply for all maintenance medications at a pharmacy or by mail order. (HOD 2013-155)

70.950: E-Prescribing for Controlled Substances
MSSNY supports use of e-prescribing for controlled substances with the ability to screen for multiple prescribers of controlled substances. (HOD 2013-107)

70.951: Electronic Prescription for Controlled Substances
MSSNY supports use of electronic prescriptions for controlled substances and termination of the requirement for “hard copy” prescriptions, unless an exception to the e-prescribing
mandate applies. (HOD 2013-106)

70.952 E-Prescribing of Class III-Narcotics and Other Controlled Substances
MSSNY will urge the New York State Department of Health to work proactively with all appropriate authorities on the state and federal level to make it possible for physicians to eprescribe all medications including Class-III narcotics and other controlled substances.
(HOD 2012-102 )

70.953 Inappropriate Export of Pharmaceutical Services:
MSSNY will 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 2011-211)

70.954 Electronic Submission of All Prescriptions:
MSSNY will work proactively with the Department of Health to implement regulations that will permit the electronic submission of all prescriptions in New York State. (HOD 2011-
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 2011-67)

70.956 Return of Unused Medications

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 2010-250) 

70.957 List of Patients’ Medications Provided by Pharmacists:
MSSNY will 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 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 2010-103)

70.958 Use and Acceptance of E-Prescription:
MSSNY will [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 EPrescription from physicians. (HOD 2010-101)

70.959 Pharmacy Benefit Managers’ or Payors’ Interference with the Course of Good Treatment and Requiring the Provision of Dangerous Quantities of Medicine:
MSSNY is 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 costsharing 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;29
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 2010-61)

70.960 Cancellation or Rescission of Renewals after the Prescriptions Have Been Delivered to the Pharmacy:
MSSNY will 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 2010-60) 70.961 NYS Prescription Pads:
MSSNY opposes 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 2005-97)

70.961                    NYS Prescription Pads: 

MSSNY opposes 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 2005-97; Reaffirmed HOD 2015)

70.962          Two-Part Official Prescriptions:  SUNSET HOD 2015

70.963 Electronic Prescription System: SUNSET HOD 2014

70.964 Pharmacies Should Be Required to Accept Faxed Prescriptions for Non-controlled Substances:
MSSNY will work for legislation requiring all New York State pharmacies to accept faxed or electronically-transmitted prescriptions for non-controlled substances, when in the pharmacist’s professional judgment that faxed or electronically-transmitted prescription is legible and valid. (HOD 2002-76; Reaffirmed HOD 2013)

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 2002-57; Reaffirmed HOD 2013)

70.966 Mandatory Acceptance of the Currently Utilized Physician Prescription
Form by Pharmacy Benefit Plan Administration: SUNSET HOD 2013

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 2002-53; Reaffirmed HOD 2013)

70.968 Single Dose Labeling of Medication in a School Setting by Registered
Professional School Nurses: Sunset 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 2001-154; 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 2001-56; Reaffirmed HOD 2011)

70.971 Administration of Prescription Drug Programs Insuring Patient Access to Necessary Medication:
MSSNY will:
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) Policy 70.971 Reaffirmed HOD 2014

70.972 Require Pharmacies to Print the Expiration Dates of Medications On All Prescription Labels:
MSSNY will support legislation to require that expiration dates 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 2000-162; Reaffirmed HOD 2014-
65)

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 2000-83; Reaffirmed HOD 2014)

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 doctorpatient 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 2001-53; 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 1998-74; Reaffirmed HOD 2001-53; Reaffirmed HOD 2011)32

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 1998-55; Reaffirmed
HOD 2001-53; Reaffirmed HOD 2011)

70.977 Sanctioning More Than One Non-Controlled Substance To Be Prescribed On The Same Prescription Blank: SUNSET HOD 2014

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 1996-180; Reaffirmed HOD 2014)

70.979 Expiration Date on Medicine Containers: SUNSET HOD 2014
See 90.972

70.980 Generic Drug, Use of ‘A’ Rated: SUNSET HOD 2014

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 1994-152; Reaffirmed 2010-97; Reaffirmed HOD 2014) 

70.982 Optometrists Prescribing Drugs
MSSNY opposes legislation which would permit optometrists to administer or prescribe drugs for treatment of patients. (HOD 1992-39; Reaffirmed HOD 2014)

70.983 Triplicate Prescription Program: SUNSET HOD 2014

70.984 Expiration Date and Control Number on Prescription Drugs:
SUNSET HOD 2014 see 90.972

70.985 Opposition to Legalization of Non-Prescriptive Drugs Such as Heroin and Cocaine: 33
MSSNY physicians 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. 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. 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; Modified and reaffirmed HOD 2014)

70.986 New Medications - Testing: SUNSET HOD 2014

70.987 Generic Drug Prescription: SUNSET HOD 2014

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;
Reaffirmed HOD 2014)

70.989 FDA ‘A’ Generic Drug Prescribing:
SUNSET HOD 2013

70.990 Political Pressure and Release of New Medications: SUNSET HOD 2013

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; Reaffirmed HOD 2013)

70.992 Marijuana: SUNSET HOD 2013

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; Reaffirmed HOD 2013)

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; Reaffirmed HOD 2013)

70.995 Generic Drug Labeling:
All generic medications should have an identifying number or symbol. (Council 12/13/84; Reaffirmed HOD 2013)

70.996 Heroin for Pain Relief:
MSSNY opposes the use of heroin for pain relief in patients because there are sufficient pain medications available for treatment. (Council 6/21/79; Reaffirmed HOD 1984-57;
Modified and Reaffirmed HOD 2013)

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 1983-8; Reaffirmed HOD 2015)


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 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 Reaffirmed HOD 2013)

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; Reaffirmed HOD 2013)35

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)

75.974       Pharmaceutical Practices

All pharmaceutical insurers must operate with complete transparency so as not to monopolize the industry.  MSSNY shall take action to immediately refer to the New York State Attorney General any evidence of collusion within the pharmaceutical supply chain.  (HOD 2015-103)

75.975       Availability of Pharmaceuticals

The Medical Society of the State of New York will work with the New York State Department of Health and the American Medical Association to ensure that the Food and Drug Administration (FDA) appropriately uses its statutory power to aggressively investigate, remediate and prevent drug shortages, including imposing significant penalties on pharmaceutical manufacturers who fail to timely report shortages or discontinuances of medications. (HOD 2015-50)


75.976 Cannabis for Seriously Ill Patients
The Medical Society of the State of New York (MSSNY) adopts as policy the following principles:
1) That the use of cannabis may have a role in treating patients who have been diagnosed with serious, debilitating illnesses, when all other treatments have failed; or when clinical
trials have shown to demonstrate comparable efficacy to currently accepted treatments.
2) The Medical Society of the State of New York recognizes the risk of smoking cannabis and encourages the use of alternate delivery systems.
3) Physicians who recommend cannabis for patient use, subject to the conditions set forth above, shall not be held criminally, civilly or professionally liable.
The Medical Society of the State of New York supports continued high quality clinical trials on the use of cannabis for medical purposes. (HOD 2014-161)

75.977: Reducing Cost of Prescription Drugs to Low Income Seniors
AMA should engage in a dialogue with appropriate stakeholders (i.e., state medical associations, national specialty societies, consumer organizations, patient advocacy
groups, etc.) in support of the concepts in the “Senior Protection Plan” that would reduce excessive costs of prescription drugs incurred by low income seniors. (HOD 2013-270)

75.978: Oppose Legislature Approval of Smoked Medical Marijuana
MSSNY reaffirms the process in which medications in the USA are regulated and approved by the FDA and not by state legislative action; opposes any process that entrusts the state
legislature with the function of approving medications; reaffirms the fact that medication preparation needs to be strictly regulated by the FDA to assure safety, purity and
effectiveness; and opposes, except for the terminally ill, any smoking formulation for medical marijuana as a delivery system for medication unless the FDA approves that
delivery system. (HOD 2013-157)

75.979 Medical Marijuana:
MSSNY will 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 2009-173)

75.980 Inappropriate Incentives for Recommending Generic Drugs over Brand Name Drugs:
MSSNY will 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 2009-103) 

75.981 “Pay for Delay” Arrangements by Pharmaceutical Companies:
MSSNY will 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 2008-207)

75.982 Extend Phase-out Period for Proven CFC Inhalers:
MSSNY will 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 2008-170)

75.983 Limiting Coverage for Psychiatric Drugs:
MSSNY will 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 will 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 2008-54)

75.984 Medical Use of Marijuana/Synthetic Cannobinoids:
MSSNY will 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 2007-151)

75.985 Availability of Nicotine Replacement:
MSSNY will 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 2006-161)

75.986 Herbal Supplements:
(1) MSSNY will work with the American Medical Association to educate physicians and the public to report potential adverse events associated with dietary supplements and herbal
remedies to help support FDA’s database of adverse event information on these forms of alternative/complementary therapies;
(2) MSSNY, in conjunction with the AMA, supports efforts 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 37 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 will 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) MSSNY will continue its efforts to educate patients and physicians about the possible
ramifications associated with the use of dietary supplements and herbal remedies. (HOD
2004-151; Modified and reaffirmed HOD 2014)

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 2004-169) (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 2009-173)
(Reaffirmed and amended Council 12/9/10)

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.  (HOD 2004-67; Modified and reaffirmed HOD 2014; Reaffirmed HOD 2015-53)

75.989 Unregulated Sympathomimetic Amines:
MSSNY will 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. MSSNY will 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. MSSNY will 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, MSSNY will 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 2003-164; Reaffirmed HOD 2013)

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: SUNSET HOD 2014

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 2000-160; Reaffirmed HOD 2014)

75.993 Schedule I Drug Butyrolactone (GBL or 2G3H)-furanone dihydro): 
SUNSET HOD 2014

75.994 Enhanced Funding for ADAP (Aids Drug Assistance Program),
including Drug Availability and Post Exposure Prophylaxis):
SUNSET HOD 2014

75.995 Payment for Medications Containing Estrogen and Progesterone:
SUNSET HOD 2014

75.996 Use Of Marijuana For Treatment of Glaucoma:
SUNSET HOD 2014

75.997 Serialized Prescriptions:
SUNSET HOD 2014

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; Reaffirmed
HOD 2013)

75.999 Amphetamines:
SUNSET HOD 2013

80.000 DUE PROCESS FOR PHYSICIANS:
(See also Reimbursement, 265.000)

80.991 Free John Natale, MD
The Medical Society of the State of New York sent a letter to the Natale Family outlining MSSNY’s opposition to the criminalization of good faith errors in medical judgment and record keeping. The Council approved a resolution to the AMA which was adopted and amended AMA policy H-160.954 to read:
 (1) Our AMA continues to take all reasonable and necessary steps to insure that errors in medical decision-making and medical records documentation, exercised in good faith, does not become a violation of criminal law.
(2) Henceforth our AMA opposes any future legislation which gives the federal government the responsibility to define appropriate medical practice and regulate such practice through the use of criminal penalties. (Council 4/14/13)

80.992 Proposal for a “Two-Tier” Pain and Suffering System in Medical Liability Cases:
MSSNY will 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
d. the judge’s decision regarding any pain and suffering award would not be limited to the $250,000 cap. (HOD 2010-63)

80.993 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 2009-

55)


80.994 Expungement of Record of Liability:
MSSNY will 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 supports 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 2008-97)

80.996 Bifurcation of Trial:
MSSNY will seek legislation to require bifurcation of trial in all medical liability cases. (HOD 2007-53)

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 pre-trial 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 pre-approved by appropriate medical experts. (HOD 2007-52)

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
2007-51; Reaffirmed HOD 2010-64) 

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 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; Reaffirmed HOD 2013)

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)

85.954          Educating Physicians and Students on the Identification and Care of Human Trafficking Victims

MSSNY will publicize the availability of existing screening tools to assist in the identification of victims of human trafficking, and make them available through linkage on the Society’s website.  MSSNY will also work with all appropriate specialty societies to increase human trafficking awareness among medical students and physicians. (HOD 2015-205)


85.955 MSSNY to Endorse the “Choosing Wisely” Program
The Medical Society of the State of New York endorses the American Board of Internal Medicine’s Choosing Wisely program and the New York delegation to the American Medical
Association will encourage the AMA to consider endorsing the ABIM’s Choosing Wisely program. (HOD 2014-205)

85.956: Life-Sustaining Treatment in the Developmentally Disabled with Severe Dementia
MSSNY requests that the New York State Department of Health (DOH) study the problems physicians and surrogates face when seeking the required permission from the Office for
People With Developmental Disabilities (OPWDD) and the Mental Hygiene Legal Service (MHLS) to withdraw or withhold cardiopulmonary resuscitation and life-sustaining treatment
in people with developmental disabilities who develop severe dementia. The DOH should educate the agencies (OPWDD, MHLS, and Commission on Quality of Care and Advocacy
for Persons with Disabilities (CQC)) that make healthcare decisions for this population on the implications of severe dementia in people with developmental disabilities, as well as the
futility and burden of care created for these patients by cardiopulmonary resuscitation and life-sustaining treatments such as long term artificial hydration and nutrition. MSSNY should
work with the AMA and DOH to establish guidelines that define terminal dementia and give guidance for its diagnosis in the developmentally disabled. (HOD 2013-259)

85.957: Protecting Biomedical Research
MSSNY supports legislation to further protect all participants in bio-medical research from violence, harassment, and cyberstalking from protesters
(HOD 2013-70) 

85.958 First Do No Harm-Initiative to Improve Mistreatment Transparency of Medical Students, Residents And Fellows
The Medical Society of the State of New York is very concerned about mistreatment of medical students, residents, and fellows; defined by the Association of American Medical
Colleges in its Graduate Questionnaire of 2001 as behavior that “shows disrespect for the dignity of others and unreasonably interferes with the learning process. It can take the form
of physical punishment, sexual harassment, psychological cruelty, and discrimination based on race, religion, ethnicity, sex, age or sexual orientation.”
The Medical Society of the State of New York will request that the AMA Council on Medical Education produce a report in which the ACGME, LCME, and Commission on Osteopathic
College Accreditation (COCA) accredited institutions and residency and fellowship training programs be invited to participate in a “First Do No Harm Initiative” by voluntarily disclosing
to the Council recent internal records containing, but not limited to, anonymous individual institutional annual rate of formally and informally reported mistreatment, which may be
reported by department and by course/rotation, including mechanisms for reporting and efforts at transparency; and that the AMA Council on Medical Education report back to the
Interim 2013 AMA House of Delegates. (HOD 2012-164, amended & adopted by Council 11/29/12)

85.959 Increasing Funding for Graduate Medical Education:
MSSNY will:
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 will 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 2011-165)

85.961 AMA Encouragement of State Medical Societies to Form Committees to Eliminate Health Care Disparities:
MSSNY’s Delegation to the American Medical Association will 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 2011-163)
85.962 Specialty Exams:

MSSNY will 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 2011-115)

85.963 Promotion of Financial Aid Opportunities for New York Medical Students:
MSSNY will: (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 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 2011-108)

85.964 Non-Alcohol Fatty Liver Disease:
Through its website and numerous publications, MSSNY will educate the public and physicians about the emerging entity, Non-Alcoholic 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 2010-156)

85.965 Use of Prefilled Insulin Syringes:
MSSNY will 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 2010-155) 

85.966 Use of Waiting Room Educational DVDs:
MSSNY will 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 2010-154)

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 2009-165)

85.968 Reform the Methodology for Calculating Direct Graduate Medical Education Payments:
MSSNY will 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 2009-153)

85.969 Increasing Matriculation of Medical Students:
MSSNY will 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 2008-102)

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 2008-99)

85.971 Health Promotion Visits:
MSSNY should seek to assist in the education of members on the appropriate coding for clinical prevention services. (HOD 2007-152)

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 2007-96)

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 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-basedphysicians 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 2006-91)

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)

85.976          Task Force to Eliminate Ethnic and Racial Health Care Disparities Recommendations
                     SUNSET HOD 2015

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 2005-68; Reaffirmed HOD 2015)

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 2005-68; Reaffirmed HOD 2015)

85.979 Academic Medical Centers Resident/Fellow Recruitment:
SUNSET HOD 2014

85.980 Nutrition, Physical Activity and Weight Management Curriculum in Medical Schools:
MSSNY encourages all New York State medical schools to develop a nutrition, physical activity 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 and physical activity education into their residency programs and encourage the
development of bariatric medicine fellowship programs. (HOD 2004-161; Modified and reaffirmed HOD 2014)

85.981 State Mandated Training Programs:
SUNSET HOD 2013

85.982 Resident Work Hours:
SUNSET HOD 2013

85.983 Registration of MSSNY CME Credits:
MSSNY will enter continuing medical education (CME) information into the MSSNY database for its members who have taken a MSSNY CME course thereby allowing the
physician to have his/her CME information available. (HOD 2002-167; Modified and Reaffirmed HOD 2013)

85.984 Impact of Changes to Section 405 of Title 10 of the New York Code of Rules and Regulations:
Sunset 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 2001-74; Reaffirmed HOD 2011)

85.986 Funding for Graduate Medical Education:
Rescinded HOD 2011-166; Replaced by 85.959

85.987 Adjusting Medical School Curricula:
SUNSET HOD 2014

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; Reaffirmed HOD 2014)

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 work with other organizations, including physician
organizations and government toward maintaining and increasing relative numbers of minority physicians. (HOD 1998-160; Modified and reaffirmed HOD 2014)

85.990 The HCFA Demonstration Project’s Potential for Abuse: 
SUNSET HOD 2014

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 1997-228; Reaffirmed Council 3/19/98;
Reaffirmed HOD 2014 with recommendation for development of more relevant policy)

85.992 Residents’ Ability to Write Restraint Orders:
 SUNSET HOD 2014

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 1997-86; Reaffirmed HOD 2014)

85.994 Hepatitis Vaccinations for all Medical Students:
MSSNY supports efforts to 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; Modified and reaffirmed HOD 2014)

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 1995-67;
Reaffirmed HOD 2014)

85.996 Funding for Medical Schools and Teaching Hospitals:
SUNSET HOD 2014

85.997 Animals in Biomedical Research:
MSSNY supports the humane use of animals in biomedical research and advocates support of regulatory policies to protect animals from unnecessary uses in biomedical
research. (HOD 91-49; Modified and reaffirmed HOD 2014)

85.998 Graduate Medical Education:
SUNSET HOD 2014

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; Reaffirmed HOD 2013)

87.000 EMERGENCY CARE:
(See also Drug Dispensing, 70.000; Managed Care, 165.000; Medicaid, 175.000; Reimbursement, 265.000)

87.992: ST Elevation Myocardial Infarction
MSSNY supports efforts by the New York State Emergency Medical Advisory Committee and the Department of Health Bureau of EMS to encourage the adoption of protocols by the
regional emergency advisory councils to transfer suspected STEMI patients, when feasible, directly to a PCI capable facility. (HOD 2013-162)
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 2011-153; Reaffirmed HOD 2014-151)

87.994 CPR Training 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 2011-152)

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 government to cover the costs of the medical care required by Haitian medical evacuees receiving care in
the US. (HOD 2010-264)

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 2008-110)

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 2007-158)

87.998          Automated External Defibrillators:
                     SUNSET HOD 2015

87.999          Cardiopulmonary Resuscitation Training

MSSNY support the training of private citizens in cardiopulmonary resuscitation and defibrillation to enable them to assist others within their community.  (HOD 2005-152; Modified and Reaffirmed HOD 2015)

90.000 ENVIRONMENTAL HEALTH:

90.990          Smoke Free Residential Housing
MSSNY shall encourage those health care institutions that provide employee housing to make such housing smoke free to the extent allowed by applicable local laws. (HOD 2015-202)

90.991          Public Health Implications of Natural Gas Extraction using Hydraulic Fracturing

The Medical Society of the State of New York will support the planning and implementation of a Health Impact Assessment to be conducted by a New York State School of Public Health; advocate for the establishment of an industry-funded, independently-arbitrated state trust fund for people that may be harmed as a result of hydraulic fracturing; and oppose any non-disclosure provisions related to the practice of hydraulic fracturing that interfere with any aspect of the patient-doctor relationship and/or the ready collection of epidemiological data for future health impact studies. (HOD 2013-171)

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; Reaffirmed HOD 2013-171)

90.993 Latex Gloves:
MSSNY supports legislation to ban the commercial use of latex gloves in New York State. (HOD 2010-152)

90.994 Global Climate Change and Public Health Implications:
MSSNY agrees 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 will 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
2008-151)

90.995 Safe Disposal of Toxic Materials in Consumer Products:
MSSNY will seek clearer and more effective laws regarding the disposal of consumer products containing toxic substances sold in New York State to effectively deal with the
future public health and financial impacts. (HOD 2008-166)

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 1989-40; Reaffirmed HOD 2013)

90.998 Toxic/Hazardous Substances:
SUNSET HOD 201349

90.999 Radioactive Waste, Disposal of Low Level:
MSSNY supports 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 (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; Modified and Reaffirmed HOD 2013)

95.000 ETHICS:

95.970          Increasing Organ Donation
The Medical Society of the State of New York will support educational efforts by the New York State Department of Health to promote organ donation. MSSNY will support laws and corporate policies allowing employees to use paid sick time to become living organ donors.  (HOD 2015-168)

95.971 A More Ethical Legislature and Advancing Medicine’s Agenda The Medical Society of the State of New York (MSSNY) will advocate for legislation and
regulation to promote improved ethics and transparency in the state legislature including but not limited to:

• Measures that would sensibly limit all campaign contributions.
• Measures that would restrict the campaign contributions made by law firms of which a
legislator is a member, to that legislator only,
• Measures to promote greater transparency and accountability with regard to the lawmakers’ professional activities outside the legislature.
MSSNY will pursue collaboration with health care stakeholders as well as key affinity groups to promote legislative accountability by means of
• Limiting campaign financing,
• Improved transparency and accountability, and
• Limiting the outside impact of the relationship between lawmakers and the legal profession, in order to promote unity and more effective advocacy particularly as it relates
to medical liability reform. (HOD 2012-112)

95.972 Organ Donation:
MSSNY will: (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.
(HOD 2010-157 referred and adopted 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. 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 will 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 2009-203)

95.975 Politics Should Not Overule FDA Scientific Findings:
MSSNY urges 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 2006-167)

95.976 No Place for Vicarious Liability:
MSSNY seeks 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 2006-62)

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:
Sunset 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 2000-82; Reaffirmed HOD 2014)

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 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. 397, E-mail: pschuh@mssny.org. 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 non-clinical
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; Reaffirmed HOD 2014)

95.981 Cloning:
It is the policy of MSSNY that there should be a 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; Modified and reaffirmed HOD 2014)

95.982 Gerald Einaugler, MD Full Pardon by Governor Pataki:
SUNSET HOD 2014

95.983 Physician-Assisted Suicide SUNSET HOD 2014

95.984 Health Care Proxy Identifier:
SUNSET HOD 2014

95.985 Physician Participation in Capital Punishment:
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 1995-
71; Modified and reaffirmed HOD 2014)

95.986 DNR Within New York State Correctional Facilities:
SUNSET HOD 2014

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 2000-82; Reaffirmed HOD 2014)

95.988 Ownership of Medical Facilities and Self-Referral:
SUNSET HOD 2014

95.989 Physician Assisted Suicide and Euthanasia:
“Patients, with terminal illness, uncommonly approach their physicians for assistance in dying including assisted suicide and euthanasia. Their motivations are most often concerns of loss of autonomy, concerns of loss of dignity, and physical symptoms which are refractory and distressing. Despite shifts in favor of physician-assisted suicide as evidenced by its legality in an increasing number of states, physician-assisted suicide and euthanasia have not been part of the normative practice of modern medicine. Compelling arguments have not been made for medicine to change its footing and to incorporate the active shortening of life into the norms of medical practice. Although relief of suffering has always been a fundamental duty in medical practice, relief of suffering through shortening of life has not. Moreover, the social and societal implications of such a fundamental change cannot be fully contemplated.  MSSNY supports all appropriate efforts to promote patient autonomy, promote patient dignity, and to relieve suffering associated with severe and advanced diseases. Physicians should not perform euthanasia or participate in assisted suicide.”   (Original Policy From 5/14/1992 Revised at 2015 HOD).

95.990 Futile Cardio-Pulmonary (CPR) Resuscitation Therapy:
SUNSET HOD 2014

95.991 Gender Disparities in Medical Care and Research:
SUNSET HOD 2014

95.992 Capital Punishment - Physician Participation:
SUNSET HOD 2014

95.993 Advance Directives1
:
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. (HOD 1988-
40; Modified and Reaffirmed HOD 2013)

95.994 Pharmaceutical Companies - Compensation for Specified Prescribing Practices:
SUNSET HOD 2013

95.995 Terminal Care - Directives For:
SUNSET HOD 2013

95.996 Life Sustaining Apparatus, Withholding and Terminating:
SUNSET HOD 2013

95.997 DNR - Do Not Resuscitate - Guidelines for Physicians, Hospitals, and
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.

Nursing Homes:.
SUNSET HOD 2013

95.998 Neonates - Decision Making for Treatment of Disabled:
SUNSET HOD 2013

95.999 Euthanasia: SUNSET HOD 2013

100.000 FAMILY AND MEDICAL LEAVE:
(See also Hospitals, 150.000)

100.999 Family and Medical Leave
SUNSET HOD 2014

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 1996-172; Reaffirmed HOD 2014)

105.999 Preconception/Prenatal Counseling:
The physician has a responsibility to inform the pre-conception/prenatal 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; or the physician may refer the patient to the appropriate counselor or facility. Physician responsibility should be based on the standard of medical practice and the methods of procedures prevailing at the time of counseling.
(Council 5/17/79; Modified and Reaffirmed HOD 2013)

110.000 HEALTH CARE DELIVERY SYSTEMS:
(See also Health System Reform, 130.000; Managed Care, 165.000)

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
The Medical Society of the State of New York (MSSNY) will urge the New York State Department of Financial Services to develop an educational program on long term health
care financing and MSSNY will request that the New York State Department of Financial Services promote and make this program available to all New Yorkers. (HOD 2014-165)

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)

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)

110.992 Standardization of Identification for Medical Professionals
MSSNY will work with appropriate health care entities to assure (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)

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)

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)

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) Medical 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 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 2007-99)

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 2007-98)

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

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 nonphysician 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 58
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 nonphysician
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)

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)

115.000 HEALTH CARE PROFESSIONALS/PROVIDERS:
(See also Acquired Immunodeficiency Syndrome [AIDS], 15.000) 115.987: Healthcare Provider Representation and Patient Protection
MSSNY endorses the enactment of legislation that would establish requirements for all licensed health care providers who deliver direct care in an Article 28 licensed hospital,
ambulatory surgical center, diagnostic and treatment center, or private physician’s office that is accredited (OB), to wear identification badges that in addition to current State
Education Department identification requirements, also contain large bold lettering indicating the practitioner’s licensure (i.e. PHYSICIAN, RN, NP, PA, etc.). (HOD 20 13-113) 

115.988: Physician Extender Payment *
MSSNY should lobby our state legislators and congressional delegation for an increase in physician payment commensurate with training, experience and responsibility, so that physicians who collaborate with or supervise physician extenders are paid for this role because of the increased expertise they must provide and responsibility they must accept. Also, the MSSNY delegation to the AMA should bring to the AMA a similar resolution for immediate and high priority legislative action. (HOD 2013-111) * Title and Resolves amended to reflect the will of House to use the term ‘payment’ or ‘paid’ in lieu of terms ‘reimbursement’ or ‘reimbursed.

115.989 Physician Surrogates:
MSSNY to urge the American Medical Association to examine programs developed by government or managed care organizations where 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 2011-114)

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 11/19/2009 

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 2006-87)

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 2006-165)

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 2002-66; Reaffirmed HOD 2013)

115.994 Certified Medical Assistants/Medical Assistants - Preservation of Physician Autonomy in Employment and Assignment of Duties: 60
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 1996-68; Reaffirmed HOD 2014)

115.995 Education Programs for Nurses: SUNSET HOD 2013

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.

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 1988-51; Reaffirmed HOD 2013)

115.997 Hepatitis B Immunization: SUNSET HOD 2014
115.998 Nurse Practitioners - Independent Practitioners:
MSSNY opposes legislation which would permit nurse practitioners to practice without a written practice agreement and collaborative relationship with a physician. (Council 4/22/82; Modified and reaffirmed HOD 2013)

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; Reaffirmed
HOD 2013)

117.000 HEALTH INFORMATION TECHNOLOGY:
(See Managed Care, 165.000; Medicare, 195.000)

117.977 Quality Improvement in Clinical/Population Health Information Systems
The Medical Society of the State of New York will request that the American Medical Association invite other expert physician associations into the AMA consortium to further the quality improvement of electronic health records (EHR’s) and Population Health as discussed in the consortium letter of January 21, 2015 to the National Coordinator of Health Information Technology.

MSSNY will support efforts by the AMA to secure specific changes to the EHR certification process which will enhance security of information contained in an EHR, prioritize functionality testing, decouple EHR certification from the meaningful use program and support greater standardization and greater transparency of standards which support interoperability of EHR’s.  (HOD 2015-105)

117.978 Meaningful Use Requirements
The Medical Society of the State of New York will work with the American Medical Association to ensure that the Centers for Medicare & Medicaid Services and the National Coordinator for Health Information Technology: (1) adopt a more flexible approach for meeting Meaningful Use; (2) expand hardship exemptions for all meaningful use stages; (3) improve quality reporting; and (4) address physician electronic health record usability and interoperability.  (HOD 2015-104)

117.979 Scheduled Medications
MSSNY will work with New York State to improve the I-STOP program by including a link to patient prescription histories which will appear at the time of prescribing as well as at the pharmacy where said prescription is filled. (HOD 2015-101)

117.980 Shared Savings and I-STOP
The Medical Society of the State of New York will urge the New York State Department of Health and Department of Financial Services to require health insurers to identify cost savings they have experienced as a result of compliance with the I-STOP law, and that the savings accrued through the use of the I-STOP law be directed toward the development and distribution of electronic medical records (EMR) and electronic prescribing resources which are to be made available to active MSSNY members for use in electronic prescribing and the development of a secure central prescription registry. (HOD 2015-59)

117.981 Patient Consent for Uploading Patient Records to the SHINY-NY And RHIOs
The Medical Society of the State of New York (MSSNY) will seek legislation or regulation that requires patient consent for uploading patient records to Regional Health Information Organizations (RHIOs) and the Statewide Health Information Network of New York (SHINYNY).

The MSSNY will seek legislation or regulation to tighten access to patient records so as to restrict access without patient consent, ie “break the glass,” only when the patient is not in a conscious or rational state of mind or their legal representative is unable to provide consent and the healthcare provider documents the life-threatening reason for having to access the patient record.

MSSNY will seek to educate patients and patient advocacy organizations concerning thedata contained within the SHIN-NY database. (Amended and adopted Council 11/20/2014;
from HOD 2014-105)

117.982 Exemption Criteria for Electronic Health Record Adoption and CloudBased
Electronic Health Record Packages
The Medical Society of the State of New York will ask that the American Medical Association (AMA) not give up the fight for Electronic Health Records (EHR) exemptions and continue to petition the Centers for Medicare and Medicaid Services (CMS) to: 

(a) Grant solo physician practices and physicians nearing the age of retirement an exemption from the disincentives associated with not using Electronic Health Records (EHR); and

(b) Provide government EHR adoption subsidies for any small and/or solo physician practices that demonstrate a need for these subsidies, beyond the present incentive
payment structure; and

(c) Provide cheaper alternatives to commercial EHR systems, either through a lowest-bid Request for Proposal (RFP) process with commercial vendors, or the development of a lowcost
or free, CMS-based and administered, cloud-based system for physicians in solo practice and physicians nearing the age of retirement.

The Medical Society of the State of New York will urge the American Medical Association (AMA) request the Centers for Medicare and Medicaid Services (CMS) grant a “temporary waiver” for physician practices that are, in good faith, in the process of obtaining and attempting to implement meaningful use of an Electronic Health Records system, but due to technical issues beyond their control will be unable to meet the October, 2014 attestation deadline. (HOD 2014-107)

117.983: Quality of Care, Not Cost, Must be the Criterion Used in Online Patient Searches for Physicians
MSSNY should seek legislation requiring health plans in New York State that offer online physician rankings to include, as part of their rankings, quality criteria such as following quality of care guidelines and evidence-based protocols, as well as treatment outcome and patient satisfaction criteria, as well as legislation prohibiting health plans in New York State from limiting patient searches for physicians by specialty solely to those physicians who
meet the plan’s cost criteria. (HOD 2013-267)

117.984: Electronic Health Record Problems
MSSNY will work with New York’s congressional delegation, as well as encourage the AMA to work proactively with MSSNY, to assure that additional federal financial incentives are
Formatted: Font: Not Bold62 provided to encourage physicians to adopt HER, and to assure that physicians who use
cloud based electronic health record systems are indemnified for security breaches caused
by defects in such systems. (HOD 2013-105)

117.985: EHR Standardization
MSSNY will seek legislation or regulation to require all EHR vendors in New York State to utilize standard and interoperable software technology components to enable cost efficient
use of electronic health records across all health care delivery systems, including institutional and community based settings of care delivery, and will transmit a copy of this
resolution to the AMA for consideration at its next House of Delegates meeting. (HOD 2013-104)

117.986 AMA – My Medications APP
As a means of promoting the core values, vision and mission of the American Medical Association, while also helping to “brand” the AMA in a more positive light among
physicians and patients, the New York Delegation urged the AMA to allow a free download (rather than the 99 cent charge) of their “My Medications” App, (which allows patients to
store, carry and share their critical medical information on their iPhone, iPad, and iPod Touch), to all interested patients who utilize the services of an AMA member physician.
(HOD 2012-207) (AMA House Action: Not Adopted)

117.987 Internet Ranking/Rating of Physicians
The Medical Society of the State of New York will:
(1) work with appropriate entities to encourage the adoption of guidelines and standards consistent with AMA policy governing the public release and accurate use of physician
data;
(2) continue pursuing initiatives to identify and offer tools to physicians that allow them to manage their online profile and presence;
(3) seek legislation that supports the creation of laws to better protect physicians from cyber-libel, cyber-slander, cyber-bullying and the dissemination of Internet misinformation
and provides for civil remedies and criminal sanctions for the violation of such laws; and (4) work to secure legislation that would require that the Web sites purporting to offer
evaluations of physicians state prominently on their Web sites whether or not they are 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, and whether or not they are a for-profit
independent business and have or have not substantiated the authenticity of individuals completing their surveys. (HOD 2012-257)

117.988 Role of Organized Medicine in Cyberspace Evaluations of Physicians:
MSSNY will 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 for-profit 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 will:
-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)

117.990 AMA Masterfile and AMA Physician Profile:
MSSNY will 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 2009-216)

117.991 Waivers - Mutual Privacy Agreements:
MSSNY will 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 precondition the provision of medical services upon the waiver of individual patient rights.
(HOD 2009-212

117.992 Update nydoctorprofile.com:
MSSNY will:
-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];
-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;
-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;
-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 2009-156)

117.993 Information Technology and Stimulus Money:

MSSNY will (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 2009-93)

117.994 Medical Smart Cards:
MSSNY will 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 2009-92; Reaffirmed HOD 2014)

117.995 Fully Functional Universal Health Information Network:
MSSNY will 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 2009-91; Reaffirmed HOD 10-100)

117.996 EHR Interfaces:
MSSNY will 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 2009-90)

117.997 Medical Smart Cards:
MSSNY will:
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. making patients’ information readily available;
b. simplifying the task of eligibility verification in physician offices, and 
c. 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.
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 will 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. 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:
MSSNY will 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 2006-92)

117.999 Putting Economics in Health Information Technology:
MSSNY will 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 2006-81)

120.000 HEALTH INSURANCE COVERAGE:
(See also Abortion and Reproductive Rights, 5.000; Alcohol and Alcoholism, 20.000; Reimbursement, 265.000)

120.933 Limitation on Outpatient Therapy Copayments
As a result of increased physical therapy co-pays, which often cause patients to delay medically necessary treatment, the Medical Society of the State of New York should seek legislation or regulation which would limit a patient’s out-of-pocket co-pay for  a prescribed course of physical therapy treatment, thereby making it financially viable for a patient to obtain these needed services.  (HOD 2015-266)

120.934 Payments by Medicare Supplemental Policies
The Medical Society of the State of New York will take appropriate action to educate MSSNY members through the E-news and the News of New York about their patients Medigap Plans so that physicians can, in turn, educate their  patients’ about the benefits associated with the supplemental policies they have purchased.  (HOD 2015-265)

120.935 Non-Experimental Status Determined by Centers for Medicare and Medicaid Services
The Medical Society of the State of New York will seek by regulation and/or legislation New York State policy/law requiring that any medical service deemed non experimental by the Centers for Medicare and Medicaid Services for government programs also be deemed non-experimental by private payers. (HOD 2015-254)

120.936 Requiring Insurance Companies to Cover ADD/ADHD Medications
For children who have already previously been successfully stabilized on a specific ADD/ADHD medication, the Medical Society of the State of New York (MSSNY) will pursue legislation and/or regulation that requires an insurer to continue to cover, at lowest tier cost, or patient cost-share, that same medication for children, and do so without obstructions, such as prior authorization or required trials of alternate medications, if and when that insurer changes their formulary policies.

For children who have already previously been successfully stabilized on a specific ADD/ADHD medication, but change insurer, or have a change in policy program within that same insurer, MSSNY will pursue legislation and/or regulation that requires an insurer to continue to cover, at lowest tier cost, or patient cost-share, that same medication for children, and do so without obstructions, such as prior authorization or required trials of alternate medications, if and when that insurer changes their formulary policies.  (HOD 2015-252)

120.937 HCV Testing and Treatment
The Medical Society of the State of New York will send a letter to the New York State Division of Financial Services seeking a requirement that commercial insurers provide coverage for the HCV test.  MSSNY will seek, by legislation if needed, to ensure that commercial insurance coverage for the HCV test and access to HCV treatment is required. (HOD 2015-160)

120.938 Out of Network Coverage Denials for Physician Prescriptions and Ordered Services
MSSNY will pursue regulation or legislation to prohibit any insurer from writing individual or group policies which deny or unreasonably delay coverage of medically necessary prescription drugs or services based on network distinctions of the licensed health care provider ordering the drug or service.  (HOD 2015-69)

120.939 Physician-Directed Medication Access
The Medical Society of the State of New York will continue to advocate for:

Legislation which will ensure that the physician’s judgment regarding the necessity of a particular medication for their patient prevails over an insurer’s judgment, including for all patients insured through Medicare and Medicaid;

Legislation or regulation that would prohibit an insurer from denying care for needed treatment or medications unless it is reviewed by a physician of the same specialty as the treating physician; and

Legislation, regulation, or other appropriate means to assure that health plans consult with appropriate specialty physicians in the creation of formularies and policy regarding drug-tiers.  (HOD 2015-53)

120.940 Patient Educational Tools on Insurer Administrative Policies
The Medical Society of the State of New York will develop a series of educational tools for members to give to their patients that will inform patients about policy and administrative problems caused by insurance plans making it more difficult for physicians to provide needed, quality health care and these Patient Educational Tools on insurer processes will state how insurers have interfered with physicians or otherwise constrain physicians from delivering what they believe to be the best quality care. (Amended and adopted by Council, 11/20/2014. From HOD 2014-257)

120.941 Affordable Care
The Medical Society of the State of New York will advocate for regulation and legislation which provides that insurers give reasonable credit for out of network expenses based on Fair Health toward a participant’s annual deductibles and out of pocket maximums. MSSNY will submit a resolution to the annual meeting of the American Medical Association seeking federal regulation and legislation to provide that insurers give reasonable credit for out of network expenses toward a participant’s annual deductibles and out of pocket maximums. (HOD 2014-253)

120.942 Thoroughly Informing Patients and Physicians About Out-Of-Network Benefit Reduction and Cancellation
The Medical Society of the State of New York (MSSNY) will take all possible appropriate steps, utilizing all possible methods including public relations, to fully and thoroughly educate patients and the public about the emerging realities of out-of-network benefits, and the Medical Society of the State of New York will make every conceivable effort to communicate more fully and completely with its membership regarding what will transpire regarding out-of-network care since physicians too are under-informed. (HOD 2014-254)

120.943 Physicians and Health Care Institutions as Providers of Health Insurance
In the case where a provider or health care institution provides such insurance it should be held to the highest standards and oversight to prevent conflicts of interest that impair quality care; and any institution in the business of health care insurance have on its governance board and/or advisory boards, community providers as long as they are not employees of the institution providing such insurance. (HOD 2014-112)

120.944 Changes in Pre-certification for Medications to Reduce Delays
The Medical Society of the State of New York will continue to advocate to reduce the circumstances when pre-authorization for needed patient medications are required, including eliminating the requirement for annual re-authorization once a prior authorization for a prescription medication has been approved.  The Medical Society of the State of New York will advocate to ensure that health plan pre-authorizations for prescriptions be completed within 24 hours. (HOD 2014-58; Reaffirmed HOD 2015-53)

120.945 Access to Timely Care
The Medical Society of the State of New York will advocate for legislation or regulation to assure the right of a patient to have insurance coverage which permits them to be treated by an out of network physician of the patient’s choice if the plan network is inadequate to enable a patient to be treated by a needed specialist within 14 days of the patient’s request, with payment based upon usual and customary rates. (HOD 2014-60)

120.946: Cost-saving Public Coverage for Renal Transplant Patients
MSSNY will ask the AMA to support private and public mechanisms that would extend insurance coverage for the full spectrum of renal transplant care for the life of the transplanted organ; and ask the AMA to offer technical assistance to individual state and specialty societies when those societies lobby state or federal legislative or executive bodies to implement evidence-based cost-saving policies within public health insurance programs. (HOD 2013-266)

120.947: Collapse Individual and Small Group Insurance Markets
MSSNY will seek legislation and/or regulation to eliminate the (newly obsolete) health insurance premium pricing differential that exists between the individual and small group
pools. (HOD 2013-264)

120.948: Third Party Payer Coverage of Follow Up Exams for Patients with Dense Breast Tissue
MSSNY will seek legislation to require insurance companies and other third party payers to pay for follow up exams for women who receive a report of dense breast tissue.
(HOD 2013-154)

120.949 Health Insurance Policies for Small Groups
In view of health insurance companies moving to eliminate many or all of the health insurance plans being offered to small groups (2-50 employees), while also dramatically reducing the
financial incentives for brokers to market their plans, and continuing to raise premiums on small businesses at rates that are making such insurance unaffordable, that the Medical
Society of the State of New York urge the Department of Financial Services to require all health insurance companies operating in the State of New York to offer a wide array of health
insurance sufficient number of affordable products to small groups, both within the health insurance exchange and outside of the exchange. (HOD 2012-55; referred, modified &
adopted by Council 11/29/2012)

120.950 Regulation and Transparency of Imaging Benefit Managers’ Contracts
The Medical Society of State of New York will seek legislation that any health plan, or its business partner, conducting prior authorization for non-urgent and non-emergent services
or procedures 1) respond to these requests within two business days; 2) utilize recognized standards of care and comply with any published specialty society-approved practice
guidelines; 3) ensure that their authorization criteria conform with their health plan’s published policy available to the public for any and all service needing prior authorization;
and 4) in the event of denied authorization, an expedited peer-to-peer appeal be conducted within the day (24-hour period) so that no potentially harmful delays befall the patient and
that compliance with these rules be monitored by the NYS Department of Health. (HOD 2012-253)

120.951 Clear Statement of Coverage on Health Insurance ID Cards
The Medical Society of the State of New York (MSSNY) work with insurers to develop standardized information to be required on all health insurance ID cards which clearly
states services, co-pays, and other vital coverage data purchased by the insured. (HOD 2012-255)

120.952 Insurance Companies Dis-enrollment of Participating Physicians
The Medical Society of the State of New York will seek legislation that would expand physician protections similar to those enunciated in Public Health Law § 4406-d for nonrenewal
of a network contract for both managed care plans and HMOs in order to enable physicians to have the right to appeal a plan’s non-renewal decision and have a hearing, if
needed.

The Medical Society will urge the Department of Financial Services to require that all health insurance companies doing business in the State of New York, provide clear and concise
justification with appropriate documentation, which substantiates a decision to terminate or non-renew a physician’s participation status. When a physician receives a notification that
his/her participation agreement is being terminated or not renewed, an appropriate appeals mechanism be provided which allows adequate time for the physician to seek appropriate
counsel (if necessary) and to assemble any necessary and supporting documentation which may be needed to assist in the appeal. (HOD 2012-259)

120.953 Transparency in Insurance Contracts:
MSSNY will 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 2010-260)

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 2010-91)

120.955 Truth in Out-of-Network Healthcare Benefits Act:
MSSNY will 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 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 2010-58)

120.956 Out-of-Network Care by Health Plan Providers:
MSSNY will 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 2009-262)

120.957 Outsourcing of Claims:
MSSNY will 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 2009-105) 

120.958 Eligibility for Enrollment in Family Health Plus:
MSSNY will 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 2009-102)

120.959 Revision of the Federal Tort Claims Act:
MSSNY will 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 2009-75)

120.960 Assuring Seamless Coverage for Patients Changed from HMO Products into PPO Products:
MSSNY will seek federal and state legislation to eliminate the 12-month 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 2009-68)

120.961 Impediments to Obtaining Pre-authorizations for Medically Indicated Diagnostic Tests:
MSSNY will 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; Reaffirmed HOD 2014-58)

120.962 United States Health Care and Gratuitous Privatization:
MSSNY supports 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 2008-93)

120.963 Retail Clinics:
MSSNY will 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 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 2008-68)

120.964 Universal Bill:
MSSNY will seek legislation or other appropriate means to assure that all durable medical equipment (DME) vendors have a universal bill that is consumer-friendly 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 2008-61)
120.965 Medically Necessary Procedures and Pre-certification & Pre-authorization Protocols: 

MSSNY will:
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 pre-authorization or precertification; 

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 2008-50)

120.966 Coverage by Carriers for Annual Physical Examination in Healthy NY Program:
MSSNY will encourage the Healthy NY Program to negotiate a benefit package that allows for an annual health maintenance visit. (HOD 2008-264)

120.967 Hearing Aids:
MSSNY will 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 2008-263)

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 2008-262)

120.969 Removing Barriers to Care for Transgender Patients:
MSSNY supports 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 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 2008-171)

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; Reaffirmed by Council 11/29/2012 in lieu of 2012-260)

120.971 Medical Outsourcing:
MSSNY will 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 2007-263)

120.972 Association Health Insurance:
MSSNY will seek legislation or regulation to enable insurers to provide association-specific health insurance alternatives for 501(c)(6) not-for-profit associations in the State of New York. (HOD 2007-211)

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 2007-156)

120.974 Access to Health Insurance for Domestic Partners:
MSSNY will 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 2006-267)

120.975 Home Visits:
MSSNY work to assure appropriate reimbursement for rendering care to homebound individuals. (HOD 2004-64; Reaffirmed HOD 2014)

120.976 Geriatric Care:
MSSNY will work to assure appropriate reimbursement by all payors for care provided to the elderly. (HOD 2004-62; Reaffirmed HOD 2014)

120.977 Patients’ Out of Pocket Financial Responsibility for Emergency Room Services Provided:
SUNSET HOD 2014

120.978 Public Access to Health Insurance Policy Options Available to Government Employees:
SUNSET HOD 2013

120.979 Patient Responsibility for Notification of Change in Insurance Coverage:
SUNSET HOD 2013

120.980 Clean Claim:
Sunset HOD 2011

120.981 Standardized Referral Form:
SUNSET HOD 2014

120.982 “Bare Bones” Health Insurance Policies:
SUNSET HOD 2014

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 1999-264; Reaffirmed HOD 2007-156)

120.984 Parity in Reimbursement for Mental Health Services
SUNSET HOD 2014

120.985 Call for the Closure of Wellcare of New York
SUNSET HOD 2014

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 seek legislation that would prohibit non-assignability of benefits clauses from all health insurance contracts. (HOD 1999-61; Reaffirmed HOD 01-66; HOD 2008-56; Reaffirmed HOD 2009-63) 

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; Reaffirmed HOD 2014)

120.988 MSSNY Position on Child Health Plus Program (CHPlus): 
SUNSET HOD 2014

120.989 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 1998-78; Reaffirmed HOD 2014)

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 1998- 52; Reaffirmed HOD 2014)

120.991 Certain Types Of Well Examinations To Be Covered By All Insurers:
SUNSET HOD 2014

120.992 Insurance Companies To Cover Screening Mammography:
MSSNY will seek requiring all health insurance products to cover mammography whenever the patient’s physician deems it medically appropriate. (HOD 1997-255; Modified and reaffirmed HOD 2014)

120.993 Smoking Cessation Reimbursement:
SUNSET HOD 2014

120.994 Insurers To Cover Hepatitis B Immunization
SUNSET HOD 201473

120.995 Parity of Coverage for Mental Illness, Alcoholism and Substance Abuse in Medical Benefits Programs endorsed by MSSNY:
SUNSET HOD 2014

120.996 Standardized Insurance Claim Forms:
SUNSET HOD 2014

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 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 1992-37; Reaffirm HOD 2014)

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; Reaffirmed HOD 2014)

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 ina 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 1991-34; Reaffirmed HOD 2014)

125.000 HEALTH SCREENING PROGRAMS:

125.993 Physician Health Programs and Membership Recruitment
Together with county medical societies, district branches and the Committee for Physician Health, the Medical Society of the State of New York will develop a series of programs, which may include CME credit, to assist physicians in early identification and management of stress.  The programs will concentrate on the physical, emotional and psychological aspects of responding to and handling stress in physicians’ professional and personal lives, and when to seek professional assistance for stress-related difficulties.  (HOD 2015-200)

125.994 Use of CT Scans for Early Detection of Lung Cancer
The Medical Society of the State of New York supports screening for lung cancer with low dose computed tomography for patients who meet current nationally recognized guidelines.
(HOD 2014-157)

125.995 Breast MRI for High Risk Women
The Medical Society of the State of new York supports the American Cancer Society and the American College of Radiology recommendation that screening breast MRI is indicated 74
in patients who are at high risk for breast cancer in addition to mammography. (Council 1/12/2012)

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
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 75
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 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 2007:57:75-89).

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 immunocompromised, 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 Obstetrician-Gynecologists, 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).

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 in lieu of 2010-163)

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 2010-164)

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 2007-164)

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 follow-up 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; Reaffirmed HOD 2013)

130.000 HEALTH SYSTEM REFORM:
(See also Education, 85.000; Health Care Delivery Systems, 110.000; Managed Care, 165.000; Reimbursement, 265.000)

130.932 Encourage Use of NYS Record Release Form
The Medical Society of the State of New York (MSSNY) recommends to physicians that their office staff utilize the New York State Authorization for Release of Health Information
pursuant to HIPAA (OCA Office Form No. 960). (HOD 2014-250)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

130.944: Excise Taxes on Health Insurance Policies
MSSNY supports the adoption of federal legislation to repeal the component of PPACA that imposes excise taxes on comprehensive health insurance policies starting in 2018.
(HOD 2013-51) 

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)

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
MSSNY will advise AMA that in implementing the COOP provisions of PPACA, the COOP advisory board crafted regulations that enabled an established issuer of insurance to
benefit from start-up loans, thus defeating the intended purpose of those loans and depriving New Yorkers of a new issuer.
The Medical Society of the State of New York (MSSNY) will seek AMA advice or assistance in crafting a response to the action of the COOP advisory board that enabled an
established issuer of insurance to benefit from start-up loans, thus depriving New Yorkers of a new issuer. (HOD 2012-204)

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)

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)

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:
-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)

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)

130.953 Medical Liability Reform:
MSSNY supports 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 2011-51)

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)

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 will 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 81 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

· 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)

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)

 

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)

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)

130.960 “Consent to Settle” Clause and Frivolous Lawsuits:
MSSNY will:
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 2009-51)

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 2009-50)

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 2008-211)

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)

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)

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; and83
e) Work to assure that the Legislature appropriates sufficient funds to support the Excess Insurance Program. (HOD 2008-94)

130.966 Universal Access to Healthcare:
MSSNY will 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 2008-91)

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 2007-106)

130.969 Universal Health Care:
MSSNY opposes funding universal health insurance through decreased reimbursement, or
any tax on physicians. (HOD 2007-105)

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)

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)

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)

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 2003-88;

130.975 MSSNY’s Actions Toward Tort Reform:

Reaffirmed HOD 2013)

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)

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)

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)

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)

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)

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 healthand 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):

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; 88
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 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 1995-85; Policy Reaffirmed HOD 2014)

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)

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)

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 1908-96)

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)

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)

130.997 Maternal and Infant Care:
MSSNY supports universal access to maternal and infant care; to family planning, prepregnancy related health care evaluation, pregnancy diagnosis, nutritional support, substance abuse counseling, full pregnancy related services, labor and delivery, 91
postpartum evaluation, neonatal care, and infant care. (HOD 92-56; Modified and reaffirmed HOD 2014)

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)

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)

135.000 HOME HEALTH CARE:
(See also Reimbursement, 265.000)

135.994: Support of Three Point Legislative Plan for Home Care
MSSNY backs the Three Point Plan to Support and Ensure Success Of State Redesign Efforts (transition support, regulatory relief, and stable fiscal environment) and supports efforts to keep MSSNY’s Long Term Care Subcommittee members informed of the progress being made in this endeavor. (HOD 2013-114)

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 1908-107)

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; Reaffirmed HOD 2013)

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 1988-79; Reaffirmed HOD 2013)

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 1980-37; Reaffirmed HOD 2013)

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.

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;
Reaffirmed HOD 2013)

140.000 HOMELESS SHELTERS:

140.999 Armories as Shelters for the Homeless:
SUNSET HOD 2014

145.000 HOSPICE AND PALLIATIVE CARE:

145.996 Maintaining and Developing High Quality Hospice and Palliative Care
The Medical Society of the State of New York recognizes that there is a shortage of physicians in geriatrics, hospice and palliative care. By submitting this resolution to the AMA House of Delegates, will urge the American Medical Association to work with the various national medical specialty organizations to petition the American Board of Medical Specialties to develop alternative pathways to board certification for physicians with high quality experience and additional education to sit for the boards in hospice, palliative care, and in geriatric medicine. (HOD 2014-163)

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 2005-160; Reaffirmed HOD 2015)

145.998 Medicare Hospice Benefits for Nursing Home Residents:
SUNSET HOD 2014

145.999 Hospice Care:
Hospice is provided at home or in freestanding hospice centers, nursing homes and other
long term care facilities. Hospice is a concept of patient and family centered, designed to 93
meet the physical, psychological, spiritual, and social needs of terminally ill patients and
their families. This care shall be rendered by a physician-led inter-disciplinary team.
The goals of hospice care are: 1) Manages the patient’s pain and symptoms; 2) Assists
the patient with the emotional, psychosocial and spiritual aspects of dying; 3) Provides
needed drugs, medical supplies and equipment; 4)To support the family on how to care for
the patient (5) Provides bereavement care and counseling to surviving family and friends.
(Council 6/21/79; Modified and Reaffirmed HOD 2013)

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)

150.966 Hospital Closures
MSSNY will ask the New York State Legislature to enact laws that require hospitals which
are going to be closed or significantly change the level of clinical services, to develop a
clinical impact statement and that the statement be presented at a public hearing run by the
Health Department; that this clinical impact statement be used to document the diminution
in services and outline ways that the community can be compensated or continue to receive
these services in another venue; and that the public should have a chance to comment on
this document, with the Health Department as the final arbiter if the removal of the services
creates a danger to the community. (HOD 2014-111)

150.967 Taskforce on Hospital Mergers
The Medical Society of the State of New York will solicit relevant agencies to routinely
engage MSSNY as a significant stakeholder in the evaluation of hospital mergers or
closures regarding characteristics including, but not limited to:
1. Maintenance of patient choice and market competition
2. Cultural sensitivity and minority and community representation among key
personnel
3. Compliance with MSSNY Position Statement 235.996
4. Provision of charity care consistent with the designation as a non-profit
5. Assurance of adequate access to primary and subspecialty care
6. Ability to achieve and maintain high scores on measures of patient satisfaction,
patient safety and quality metrics
7. Preservation of the continuity of the physician-patient relationship
8. Effect on graduate and undergraduate medical education. (HOD 2014-201)
150.968 Operating Room Quiet Zones
The Medical Society of the State of New York will work with the Healthcare Association of
New York State and the Greater New York Hospital Association to develop policies
regarding the use of electronic devices in operating rooms and procedure rooms to ensure
patient safety. (HOD 2012-150)

150.969 Stop Closure of Kingsboro Psychiatric Center as Recommended by the Berger Commission
MSSNY will advocate that Kingsboro Psychiatric Center in Brooklyn stay open and not
move to South Beach Psychiatric Center in Richmond County for the best interests of the
patients and their families. (HOD 2012-113)

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 2011-111)

150.971 HHS and Hospital-Acquired Conditions:
MSSNY will 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 2008-
258)

150.972 Gain-sharing:
MSSNY will ask the American Medical Association to study and prepare a report on gainsharing
programs. (HOD 2008-206)

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 2002-269; Reaffirmed HOD 2013)

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 2002-78; Reaffirmed HOD 2013)

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 2000-77; Reaffirmed HOD 2014)

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.
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 1999-172;
Reaffirmed HOD 2014)

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 1998-126; Reaffirmed HOD 2014)

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; Reaffirmed HOD
2014)

150.979 In-House Testing, Prohibition of Institutions from Mandating:
MSSNY believes that institutions should allow physicians to perform any mandated preoperative
testing outside the institution and will encourage institutions to adopt this policy.
(HOD 1996-126; Reaffirmed 2014)

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 1996-127; Reaffirmed HOD 2014)

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
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;96
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 1997-180; Reaffirmed HOD 2014)

150.982 Guidelines Regarding the Role of Medical Directors in New York State:
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 1995-72; Reaffirmed HOD 2014)

150.983 Faculty/Staff Appointments at Medical Schools:
MSSNY supports having the New York State Department of Health develop regulations or
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 1993-131; Modified and reaffirmed HOD 2014)

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 1992-88; Reaffirmed HOD 2014)

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 communitybased
practitioners are held. (HOD 1993-77; Reaffirmed HOD 2014)

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 1992-40; Reaffirmed
HOD 2014)

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 1991-91;
Reaffirmed HOD 2014)

150.987 Medical Staff Involvement in Development of Plan of Correction:
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 1991-105; Reaffirmed HOD 2014)

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; reaffirmed HOD 2014)98
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 its70
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 1991-67; Reaffirmed HOD 2014)

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 1990-20; Reaffirmed HOD 2013)
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 1988-82;
Reaffirmed HOD 2013)

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;
Reaffirmed HOD 2013)

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 1989-15; Reaffirmed HOD 2013)

150.991 Physician Credentialing:
SUNSET HOD 2013

150.992 Bed Reductions: 
MSSNY vigorously opposes any reduction of hospital beds throughout New York State
unless very specific rationale supports it. (HOD 1987-31; Reaffirmed HOD 2013)

150.993 Newborn - Resuscitation of: SUNSET HOD 2013

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 1986-23; Reaffirmed HOD 2013)

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 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. 100
(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 1986-11; Amended Council 2/12/87; Amended HOD 3/14/87; Reaffirmed
HOD 2013)

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; Reaffirmed
HOD 2013)

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 1982-58; Reaffirmed HOD 2013)

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 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. 101
(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 1982-51; Reaffirmed HOD 2013)
The Guidelines of the New York Academy of Medicine are available, upon request, at the
Society Headquarters in Westbury.

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 1980-25;
Amended Council 1/22/81; Reaffirmed HOD 2013)

155.000 INDEPENDENT PRACTICE OF MEDICINE:

155.997     Survival of Independent Practice

The Medical Society of the State of New York will set up a task force to explore all legally permissible options for independent physicians to collaborate and create practice models to achieve the goals of diversity of service, economy of scale, and collective negotiations.

This task force will consult with all necessary parties and examine models that have been used in other states in order to obtain the information necessary to conduct its assigned task; and the task force will report its findings to the Council of the Medical Society of the State of New York within six months of the ending of the 2015 meeting of the House of Delegates. The Council of the Medical Society of the State of New York will then develop a plan of action to preserve independent practice in New York State. (HOD 2015-210)

155.998 Support For “Concierge” Practices

The Medical Society of the State of New York supports the concept that a physician should be free to define a business model to practice medicine in New York that is most appropriate to that physician and his/her patients. (HOD 2012-58)

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 102 the Board of Regents as assisted by the New York State Board for Medicine. (HOD 1982-
1; Reaffirmed HOD 2013)

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 2011-119)

160.000 LICENSURE:
(See also Managed Care, 165.000; Medicare, 195.000)

160.967 Automatic Link to Updating Physician Profile at Time of Licensure Renewal
The Medical Society of the State of New York will request, through regulation and/or legislation if needed, that the New York State Education Department and the New York State Department of Health (DOH) create an automatic link from the online education licensure renewal site to the DOH physician profile site to enable a physician who is re-registering with the state to also update his/her physician profile in a seamless manner.  (HOD 2015-112)

160.968 Retirement of a Physician Medical Licensure
The Medical Society of the State of New York will seek legislation which provides nondisciplinary retirement of a physician license so long as there are no pending disciplinary matters. (HOD 2014-103)

160.969 Maintenance of Licensure (MOL)
The Medical Society State of New York (MSSNY) shall oppose any Maintenance of
Licensure (MOL) initiative that creates barriers to practice, is administratively unfeasible, is
inflexible with regard to how physicians practice (clinically or not), that does not protect
physician privacy, and that is used to promote policy initiatives (rather than competence)
such as participation in health plans, subscription to data exchanges, and specialty board
certification, etc.
MSSNY shall submit to the American Medical Association (AMA), at its annual meeting, a
resolution seeking its opposition to any MOL initiative that creates barriers to practice, is
administratively unfeasible, is inflexible with regard to how physicians practice (clinically or
not), that does not protect physician privacy, and that is used to promote policy initiatives
(rather than competence) such as participation in health plans, subscription to data
exchanges, and specialty board certification and further urging that the AMA oppose the
FSMB MOL program as a condition of licensure. (HOD 2014-56)

160.970: Transparency and Accountability for Specialty Boards and MOC
MSSNY calls on the American Board of Medical Specialties (ABMS) and its component
specialty boards to increase their transparency and accountability to the physician
community, and asks them to publish detailed reports of revenues and expenses, including
compensation to board members and senior staff; require all board members and senior
staff to annually disclose any potential conflicts of interest, professional or financial, to the
physician community; and publish evidence -based data in peer reviewed articles in support
of each component of their maintenance of certification (MOC) processes. MSSNY will
bring this resolution to the AMA HOD for consideration at its June 2013 annual meeting.
(HOD 2013-169)

160.971: Opposition to Maintenance of Licensure
MSSNY opposes any efforts by the New York State Education Department, Office of the
Professions, to require the Federation of State Medical Boards (FSMB) maintenance of
licensure (MOL) program as a condition of medical licensure. (HOD 2013-166 and 167;
Reaffirmed HOD 2014-56)

160.972: Opposition to Mandatory Maintenance of Certification
MSSNY opposes mandating Maintenance of Certification (MOC) until such time as
evidence-based research demonstrates MOC is linked to improved patient outcomes.
MSSNY acknowledges that the certification requirements within the MOC process are
costly, time intensive and result in significant disruptions to the availability of physicians for
patient care, and acknowledges and affirms the professionalism of individual physicians to
self-determine the best means and methods for maintenance of their knowledge and skills.

MSSNY will communicate to the American Medical Association and American Board of
Medical Specialties examples of disproportional fees, onerous time requirements and
unnecessary fragmentation of commonly recognized specialties, and will bring a copy of
this resolution to the AMA House of Delegates for its consideration. (HOD 2013-165 and
168)

160.973: Avoid Restrictions on Medical Licensure
MSSNY believes that the ability to practice to the full extent of NYS medical licensure
should not be infringed based on enrollment and/or participation in any publicly funded or
private health-insurance program, and that physician participation in the Excess Medical
Liability Insurance Program should not be based upon participating in Medicare/Medicaid,
the State Insurance Exchange, and/or any governmentally subsidized health insurance
program. (HOD 13-53; Reaffirmed HOD 2014-53)

160.974 Physicians Should Not Be Penalized For Non-Participation In Government Medicine
It is the policy of the Medical Society of the State of New York that medical licensure in New
York State shall not require participation in Medicare, Medicaid, or any other
governmentally sponsored health insurance program. (HOD 2012-60; Reaffirmed HOD
2014-53)

160.975 Accurate Reporting of State Medical License Registration Expiration Dates on the AMA Physician Profile
MSSNY will work with the American Medical Association (AMA) to ensure that the AMA
Physician Profile and AMA Masterfile include the actual date of expiration of medical
licensure registrations so that the AMA Profile does not continue to routinely truncate by
one month all of the registration expiration dates for physicians. (HOD 2011-214)

160.976 Promoting Physician Retention in New York State:
MSSNY will 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 2009-155)

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 2009-110

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:
MSSNY will oppose any future increase to the biennial physician registration fee. (HOD 2007-107)

160.980 Opposition to Non-Physicians Performing Laser and Intense Pulsed Light Source Skin Enhancement Procedures:
MSSNY vigorously opposes certification of non-physicians (including non-medical
personnel) to perform laser and intense pulsed light source skin enhancement procedures.
(HOD 2001-95; Reaffirmed Council 11/13/03; Reaffirmed HOD 2013)

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 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; Reaffirmed HOD 2014)

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 non-physician practitioners to perform services beyond
the scope of their licensure. (Council 3/13/00; Reaffirmed HOD 2014)

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; Reaffirmed
HOD 2013)

160.984 Citizenship Requirement for Medical Licensure:
 SUNSET HOD 2014

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 1998-75; Reaffirmed HOD 2014)

160.986 New York State Licensure Requirements: SUNSET HOD 2014

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;
Reaffirmed HOD 2014)

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 is 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 is to be eliminated, but to permit the
state board the option of calling for a personal appearance. (Council 2/6/97; Reaffirmed
HOD 2014)

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-tophysician
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; Reaffirmed HOD 2014)

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 1996-80; Reaffirmed HOD 2014)

160.990 Laser Surgery - HOD 1991-45;
SUNSET HOD 2014

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 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 1994-161;
Reaffirmed HOD 2014)

160.992 Mandated CME for Re-registration of Medical Licensure:
The Society strongly reaffirmed its opposition to any linkage between legislatively mandated CME
with re-registration of medical licenses. (HOD 1993-15; Reaffirmed HOD 2014)

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; Reaffirmed HOD 2014)

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 1991-47; Reaffirmed HOD 2014)

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 1991-46; Reaffirmed HOD 2014)

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 1991-48; Reaffirmed HOD 2014)

160.997 Single National Examination for Medical Licensure:
SUNSET HOD 2013

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 1989-6 ; Reaffirmed HOD 2013)

160.999 Licensure as a Prerequisite for Membership in the Medical Society of the State of New York:
At the present time there is no official State Society policy as to the requirement of licensure as prerequisite for membership. (Council 12/16/76; Modified and reaffirmed HOD 2013)