PLEASE URGE YOUR LEGISLATORS TO SUPPORT OUT-OF-NETWORK TRANSPARENCY LEGISLATION
With just three weeks left in the legislative session, all physicians must continue to call, write, and fax their legislators and Governor Cuomo’s office to express support for legislation (A.7489-B, Gottfried/S.5068-A, Hannon) to assure patients and employers are better informed regarding the scope of their health insurance coverage for out-of-network care. Aggressive health insurer opposition, as well as opposition from some business groups, is slowing down consideration of this measure, so your advocacy is absolutely essential for this measure to be enacted.
This bill would: (a) prevent insurance companies from selling policies with out-of-network coverage that fail to provide significant coverage for such costs; and (b) better assure transparency of health insurance policies that provide out-of-network coverage by requiring all such policies to expressly state the percentage of the likely actual costs of care (as reported in the FAIR Health database) it will cover. Many companies are now defining their out-of-network coverage as a percentage of the Medicare fee schedule, which deceptively gives consumers the impression that their policies cover the ability to see the physician of their choice when in fact these policies often barely cover any health care costs.
MSSNY continues to meet with key leaders in the Assembly, Senate, and Cuomo administration to urge the enactment of this or legislation incorporating similar concepts. Moreover, MSSNY has been working closely with several patient advocacy groups to coordinate action in support of addressing this problem.
To assist physicians in their grassroots advocacy, MSSNY has also created a new section on its website that includes talking points, MSSNY’s memo in support of this legislation, a patient educational flier, a template script for physicians and patients to follow in calling their legislators, recent news articles in the New York Times and New York Daily News detailing this problem, and a link to send a letter to your legislators from MSSNY’s Grassroots Action Center in support of this legislation:
Please act today!
(AUSTER, DEARS, CONWAY)
COLLECTIVE NEGOTIATION BILL—NEEDS PHYSICIAN ADVOCACY
With only eleven session days remaining in the legislative session, physician advocacy is requested in support of legislation (A.2474-A, Canestrari/S. 3186-A, Hannon) which would permit independently practicing physicians to negotiate collectively with health insurance companies. This legislation, which now has 67 co-sponsors, has advanced from the Assembly Health Committee to the Assembly Ways and Means Committee but has failed to advance further in that house. Identical legislation (S.3186-A, Hannon) is back before the Senate Health Committee after having passed the Senate last year, but it hasn’t yet moved this year.
Collective action by independently practicing physicians is now prohibited under federal antitrust laws.
As a result, with most regions of New York State being dominated by just one or two health plans, most physicians face one-sided contracts from health insurers with little if any opportunity to negotiate. It is the patient, however, who bears the brunt of this market dynamic, because the physicians’ inability to negotiate results in the imposition of unnecessary barriers for patients as they seek to access necessary care. These health plan abuses include: cumbersome pre-authorization processes that delay our patients from receiving needed care and testing; arbitrary limitations on necessary prescription medications; and overly aggressive barriers that limit patients’ ability to receive care from the specialist physician of their choice.
An all-out grass roots push is necessary because the health insurance industry is doing all in its power to stop this measure from going forward. If you want to level the playing field with the health insurers, please make these contacts!
All physicians are urged to contact their legislators in support of this critically needed legislation, and can send a letter to their legislators in support of this legislation by clicking here.
(DEARS, AUSTER, CONWAY)
MSSNY PARTICIPATES IN THE ONGOING NEGOTIATIONS ON PRESCRIPTION DRUG ABUSE AND DIVERSION ISSUE
The Medical Society of the State of New York’s leadership and staff continue to meet with various members of the legislature and the governor’s office to discuss issues pertaining to the prescription drug abuse and diversion issues. Negotiation continues regarding the extent of a potential duty on the physician to check a database prior to prescribing a controlled substance. Negotiations also continue regarding who can check the database on behalf of the physician. MSSNY leadership has indicated that the medical profession wants to be part of the solution; however, it wants to ensure that any law that is adopted does not create obstacles that unintentionally interfere with patients’ ability to obtain necessary pain medication. It is anticipated that the negotiations will result in legislation that will be enacted before the legislature adjourns for the year.
There is already legislation, such as the I-STOP legislation (A.8320/S.5720A) which would require physicians or their staff to check the database prior to writing of any controlled substance prescription and enter the prescription information into the database. Significant penalties would be imposed for failure to comply. MSSNY believes that this type of legislation could cause significant delays in patients receiving necessary pain medications. Physicians are urged to weigh in against this bill and to contact their legislators about this issue as bills such as this could cause patients to encounter significant delays in receiving their pain medication. To contact your senator, call (518) 455-2800; call your assemblymember at (518) 455-4100. Or you can use the MSSNY Grassroots Action Center to send a letter to legislators expressing opposition the I-STOP legislation.
The Medical Society of the State of New York; 18 state medical specialties, and various patient-advocacy organizations; the Leukemia & Lymphoma Society; Lupus Foundation of Mid and Northern New York, Inc.; Lupus Alliance of America; NY Southern Tier Affiliate; the Epilepsy Foundation of Northeastern NY; the International Institute of Human Empowerment; and the US Pain Foundation have joined together in the issuance of a statement entitled “Recommendations to Address the Prescription Drug Abuse and Diversion Issue.” Key recommendations include: increased law enforcement efforts to prevent and punish inappropriate diversion of prescription medications; the need for increased accessibility to treatment for patients suffering addictions so as to reduce the likelihood of inappropriate diversion of prescribed medications; 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 the need for additional resources for associations representing prescribers so that they can educate their members about the existence of the database and the characteristics of patients presenting themselves in health care settings that should trigger a prescriber to check the database.
For more information, contact Pat Clancy at firstname.lastname@example.org; Liz Dears at email@example.com; Moe Auster at firstname.lastname@example.org; or Gerry Conway at email@example.com.
(CLANCY, DEARS, AUSTER, CONWAY)
LEGISLATION TO PERMIT RETAIL CLINICS IN NEW YORK ON SENATE HEALTH COMMITTEE AGENDA
Legislation (S.3673B, Hannon) which would permit publicly traded corporations to operate diagnostic or treatment centers through which health care services may be provided within a retail business, including but not limited to a pharmacy, a store open to the general public, or a shopping mall, will be considered by the Senate Health Committee next week. MSSNY opposes this bill, which provides a mechanism to avoid existing public health law prohibitions that prevent publicly traded corporations from owning certain facilities through which health care is provided. A similar exception was utilized a few years ago, but in that instance, it was permitted to enable a discrete, definable outpatient service (renal dialysis) to continue to be offered in NYS because all other financial support (mostly federal financial support) had dissipated.
To the contrary, in this instance with retail clinics, the types of services sought to be performed in such clinics are broad, and the applicable treatments to be prescribed vary significantly. Moreover, the type of service(s) sought to be provided derive from an ever expanding list of diagnoses. While the service(s) sought to be delivered may be covered by Medicare, they may also be covered through commercial insurance and Medicaid, CHP, and FHP. Lastly, there already exist a vast health care workforce of physicians and allied health professionals to service the health care needs of the state’s residents.
In addition, MSSNY also argues that allowing retail clinics in New York was diametrically opposite to the direction taken in the recently enacted budget toward enabling models for integrated care coordination such as the patient centered medical home, accountable care organization and behavioral health organization.
Some policymakers have inquired as to how the public’s interest in coordinated quality health care is better served in a Duane Reade-like model where a physician rented space, employed or collaborated with NPs, and employed PAs to deliver care than under the “Minute Clinic” model where NPs employed by a clinic owned by a for-profit corporation provide care for certain acute illnesses (sore throats or flu). MSSNY has noted that under the Duane Reade-like model, the physician is in no way beholden to the bottom line of the company from whom he rents space. The NP in the Minute Clinic, however, may be facing intense pressure to assure that the company profits from the delivery of health care in that setting. Most importantly, however, MSSNY stated that we like neither option. Each provides only episodic patient care and only for certain conditions.
Each model diverges from the medical home model in significant ways, the most significant of which is that the PCMH model emphasizes comprehensive care which is coordinated in an integrated way across all providers and for all patients, even those with more complex and chronic illnesses. Significantly, in 2008, more than twenty physician groups or hospital chains operated retail clinics, including Mayo Clinic and Geisinger Health Systems. Each retail clinic is linked to (a) primary care practice(s). In this integrated model, the retail clinic is the extension of the patient centered medical home. This type of model would enable the PCMH to offer extended hours and convenience for the patients served by the PCMH. This model is far preferable to the Minute Clinic model advanced as part of the aforementioned legislation, which merely provides for the establishment of a care delivery structure for episodic care services more commonly provided in urgent care or ER but at a lower price-point. It is anticipated that if favorably reported, the bill will be referred to the Senate Finance Committee.
Physicians are urged to contact their state senator to voice their objection to this measure by calling the Senate switchboard at 518-455-2800 and ask that your call be directed to your state senator’s office.
(DEARS, AUSTER, CONWAY)
EXPEDITED PRESCRIPTION DRUG PRIOR AUTHORIZATION LEGISLATION ADVANCES
The Assembly Health Committee unanimously reported to the Assembly Ways and Means committee this week legislation (A.10248-A, P. Rivera) supported by MSSNY that would hasten and standardize the process for review by health plans of requests for coverage of prescription medications for patients. This legislation would enact a number of important reforms to expedite the utilization review process for prescription medications for patients, and reduce the administrative burden on physicians and their staff requesting coverage for particular medications including:
o Reducing the time frames within which a health plan must respond to a request for authorization for a particular prescription medication;
o Treating a failure by a health plan to respond to a request for authorization for a medication as an approval for coverage (under current law, failure to respond by a health plan is treated as an “adverse determination,” requiring a physician to make a further appeal); and
o Requiring the creation and use of a uniform form for obtaining prior authorization for prescription drug benefits.
MSSNY is working to find a sponsor in the Senate for this legislation.
PHYSICIANS URGED TO RETURN EXCESS APPLICATION AND ADDENDUM TO THEIR SECTION 18 CARRIERS
By now, physicians should have received provisional renewal notices from their Excess liability (Section 18) carriers asking them to complete the application and addendum and return it by June 1, 2012 in order to bind coverage for the next policy period beginning on July 1. Completion of the addendum is necessary to assist the Superintendent of Financial Services and Commissioner of Health in the completion of a report required by the recently enacted budget which will review the nature and extent of affiliations between physicians, dentists, general hospitals, private practices, and universities and conduct an actuarial analysis concerning the adequacy of premiums paid for the Excess coverage. It must be noted that the question on the questionnaire inquiring as to whether a physician has rendered emergency medical services at the primary affiliated general hospital within the past twelve months does not accurately reflect what state law has required as a condition precedent for eligibility. To be eligible for the Excess program, a hospital must certify to the Commissioner of Health those “physicians who request such certification and who have professional privileges in such hospital and who, from time to time, provide emergency medical or dental care in such hospital to persons who require such care.” Please consult with your Section 18 carrier if you have not received a provisional renewal notice or have questions concerning the addendum questionnaire.
(DEARS, AUSTER, CONWAY)
SMOKING NEAR SCHOOL ENTRANCES AND EXITS
A.19141 (Dinowitz) / S.6854 (Rivera), a bill that would prohibit smoking within one hundred feet of entrances, exits, or outdoor areas of any public or private elementary or secondary schools, was reported to the Codes Committee in the Assembly, and is on the floor of the Senate. MSSNY has policy that would support policies that eliminate exposure to secondhand smoke in the pediatric population and supports this bill.
AMA SCOPE-OF-PRACTICE CONFERENCE CALL REGARDING FTC ACTIVITY IN STATES
The AMA has launched a multi-pronged engagement to combat the FTC examination of state medical board and state legislative actions, particularly those concerning scope of practice. This action has been taken in the form of letters to a state medical board (Alabama) and state legislators (Florida, Kentucky, Louisiana, Missouri, Tennessee and Texas) commenting on bills to regulate providers of interventional pain management procedures and bills and proposed regulations to expand nursing scope of practice. The FTC’s activity has also taken the form of an enforcement action against the North Carolina State Board of Dental Examiners, which is on appeal in the US Court of Appeals for the Fourth Circuit. The AMA has started a multipronged activity including a white paper, which was distributed widely in November of 2011. The FTC painted what it did as a very minor intrusion. The AMA wanted them to realize what this would do to the practice of medicine. The FTC wants to subject state boards to antitrust laws. If boards have to be subject to antitrust laws and to large fines, with low or no pay, people won’t serve on them. Twenty-five amicus briefs have been filed so far.
MSSNY RE-ACCREDITS 23 ON-LINE COURSES ON EMERGENCY PREPAREDESS; PHYSICIANS ENCOURAGED TO TAKE COURSES
The Medical Society has re-accredited 23 on-line courses on biological, chemical, and nuclear agents and courses on the impact of trauma on mental health. The Medical Society has accredited these courses with one or two continuing medical education (CME) credits, and the courses are free to physicians throughout the state. The courses can be accessed here. Physicians who are new to MSSNY’s CME on-line program will need to register as a new user. Physicians who already registered may continue to use their log on and password.
The on-line registration contains instructions on how to view modules and to complete the post-test. A physician’s name and CME certificate can be printed following the successful completion of the post-test. The continuing medical education courses on biological, chemical, and nuclear agents curriculum is designed to assist physicians in obtaining experience in bioterrorism preparedness training. These modules will provide valuable information during any public health emergency involving these agents. Courses include anthrax, pandemic flu, H1N1, chemical overview, and nuclear radiation. The mental health curriculum is designed to assist physicians in treating trauma resulting from terrorism and natural disasters. MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism has had an instrumental role in providing these programs to New York State physicians. The program has been funded through a grant from the New York State Department of Health. Further information on the MSSNY CME website can be obtained by contacting Pat Clancy at firstname.lastname@example.org or at 518-465-8085.
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