Speaking Truth to Power
Friday, June 13, 2025
Speaking Truth to Power
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Colleagues:
This week, I had the opportunity to meet directly with members of the American Medical Association (AMA) Board of Trustees and its newly announced Executive Vice President, Dr. Jon Whyte. On behalf of New York’s physicians, I expressed—unequivocally—our deep frustration over the inability to convince Congress to pass something as fundamental as full inflation-based adjustments to physician payment, as is standard for Medicare Advantage and hospitals.
Despite our concerns, I came away encouraged by the selection of Dr. Whyte and the willingness expressed by the Board to chart a new course. With MSSNY’s own Dr. Willie Underwood ascending as President-Elect of the AMA, I am optimistic that, together with other MSSNY leaders, meaningful change is more achievable than before despite a difficult political environment.
At the AMA House of Delegates meeting, an emergency resolution passed following the abrupt dismissal of all ACIP advisors. MSSNY’s Dr. Sarah Nosal, President-Elect of the American Academy of Family Physicians, quickly assembled a coalition of over 50 groups to demand their restoration and sent a formal letter calling for oversight by the appropriate committee. These baffling actions erode public trust in vaccines—at a time when preventable measles outbreaks are causing unnecessary morbidity and death. Let me be clear: vaccines save lives. There is no substitute—period. This issue will be explored further in an upcoming piece by WNYC/Gothamist.
Disappointingly, the Grieving Families Act (GFA) once again passed. I immediately drafted a response pointing out that so-called “caps”—which serve as common-sense guidance to quantify subjective damages like pain and suffering—already result in premium variability of up to 560% across New York for the same specialties. Same laws. Same covered lives. Yet vastly different—and arbitrary—outcomes. The GFA proposes to add even more subjective awards—grief, anguish, and loss of companionship—now extended even to first cousins. Unsurprisingly, this could increase malpractice premiums for New York physicians by 40%. My response drew the attention of the New York Times, and I sat for an in-depth interview lasting over 30 minutes.
Finally, in a tone-deaf move, an insurance industry lobbyist recently published an op-ed defending prior authorization. I’ve written a response to the piece, which will be published in the Buffalo News in the coming days.
Your continued membership and PAC contributions through mssnypac.org give me—and your entire elected leadership—the chutzpah to cut through the noise, call out hypocrisy and inefficiency, and fight for a better healthcare system for our patients and our profession.
All the best,
David Jakubowicz, MD, FACS
MSSNY President
MSSNY’s Dr. Willie Underwood Elected AMA President-Elect
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MSSNY proudly celebrates the election of Dr. Willie Underwood III, MD, MSc, MPH, as President-Elect of the AMA (American Medical Association). A highly respected urologic surgeon from Buffalo, Dr. Underwood brings over 25 years of clinical leadership and a tireless commitment to advancing medicine through advocacy, equity, and education. He will be inaugurated AMA President in June 2026, the first New Yorker to hold the role since 2009.
A longtime MSSNY member, Dr. Underwood has served as Chair of MSSNY’s Employed Physician Rights Committee and on the Quality Improvement and Patient Safety Committee. He has held prominent leadership positions on the AMA Board of Trustees, including board chair.
“It is an incredible honor to be chosen by my peers to represent physicians and the patients we serve at this critical moment for health care and medicine,” said Dr. Underwood. “The AMA is leading the way in fighting for a rational Medicare payment system, to rein in prior authorization, and reduce physician burnout.”
MSSNY President Dr. David Jakubowicz added, “MSSNY is so proud to have this amazing physician leader come from amongst our ranks to the highest level in our profession, a man of faith who, despite humble origins, rose through grit, perseverance, and incredible intellect. There is no harder worker than he, and I can think of no better person to lead our AMA in these turbulent times.”
WSJ Podcast Reveals Billions Lost to Medicare Advantage Abuse
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The Wall Street Journal’s two-part podcast series, Medicare, Inc., offers a critical exposé into how private insurers have profited from Medicare Advantage—often at the expense of patients and taxpayers.
From MSSNY Legal Counsel, David Vozza, Esq.:
What Physicians Need to Know about BCBS Settlement
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A $2.8 billion settlement has been reached in a multi-district litigation filed against Blue Cross Blue Shield Association (BCBSA) and its affiliates, resolving an over decade-long antitrust class action lawsuit. This settlement, one of the largest in healthcare antitrust history, addresses claims that BCBSA and its member plans violated antitrust laws by dividing the U.S. into exclusive service areas, limiting competition, and underpaying healthcare providers for reimbursements. Physicians may be eligible to claim a portion of this settlement and are encouraged to follow the guidance below.
The lawsuit, In re: Blue Cross Blue Shield Antitrust Litigation (MDL No. 2406), filed in 2012 in the U.S. District Court for the Northern District of Alabama, alleged that BCBSA and its affiliates engaged in anticompetitive practices. Hospitals, physicians, and other healthcare professionals claimed that the BCBSA’s BlueCard program and exclusive service area agreements suppressed competition, increased insurance costs, and reduced reimbursement rates. The settlement, announced on October 14, 2024, and granted preliminary approval on December 4, 2024, by Chief U.S. District Judge R. David Proctor, includes a $2.8 billion fund and significant operational changes to BCBSA’s operations.
Practitioners who are eligible to receive payments include physicians who provided healthcare services, equipment, or supplies to patients insured by a Blue Cross Blue Shield plan (commercial plans only, excluding Medicare, Medicaid, or Federal Employee Health Benefits Program plans) between July 24, 2008, and October 4, 2024. Certain other practitioners are excluded from the settlement class, including: (i) practitioners owned or employed by BCBS plans; (ii) practitioners who previously released claims against BCBS in earlier settlements, such as Love v. Blue Cross and Blue Shield Association); (iii) and practitioners who exclusively offer prescription drugs, durable medical equipment, medical devices, independent clinical lab services or standalone dental/vision insurance services.
Eligible physicians can file a claim to receive a portion of the $2.8 billion settlement fund. After attorney fees (up to $700 million), approximately 92% of the fund is allocated to hospitals and facilities, with 8% ($160 million) reserved for medical professionals, including physicians and medical groups/organizations. The respective payout amount depends on:
- Total charges billed to BCBS patients from 2008 to 2024 (higher billings yield more “points”, from 1 point for under $250,000 to 5 points for over $1 million);
- Geographic adjustment based on a “harm coefficient” reflecting BCBS’s impact in your area (multiplier from 1 to 5.3); and
- Number of claims filed by other practitioners, as funds are distributed proportionally.
Individual physicians and groups could recover significant sums, with some estimates suggesting millions for larger entities. By participating in the settlement, physicians should know that they release BCBSA from further antitrust claims related to the lawsuit’s allegations. However, claims unrelated to antitrust issues (e.g., contract disputes) are likely unaffected.
To ensure you benefit from this settlement, consider the following steps:
- File a Claim by July 29, 2025:
- Visit the official settlement website at www.bcbsprovidersettlement.com to submit a claim online (recommended) or by mail;
- Use the Professional Claim Form for individual physicians or medical groups, or the Facilities Claim Form for hospitals and facilities. Some organizations may need both to capture professional and facility fees; and
No supporting documentation is required initially, but the Settlement Administrator may request it later. Provide your National Provider Identifier (NPI) or Tax Identification Number (TIN) for the administrator to calculate your “Allowed Amounts” or submit your own billing data.
Redefining Strength: Dr. Rodriguez-Iglesias Proves What a Physician Looks Like
Dr. Realba Rodriguez-Iglesias, Councilor of MSSNY’s Minority Affairs Section, exemplifies strength, leadership, and resilience in the face of bias. A dedicated MSSNY member, Dr. Rodriguez-Iglesias has triumphed over misjudgments that questioned her role as a physician, proving her expertise through skill, compassion, and determination. In our Resilience in Practice series, she shares how her journey has shaped her clinical career and inspired others to rise above outdated assumptions. Her story is a testament to the power of representation and advocacy in medicine. MSSNY proudly features Dr. Rodriguez-Iglesias and invites all physicians to join our Minority Affairs Section to uplift colleagues like her and help build a more inclusive medical community.
Capital Update June 13, 2025
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- Governor Hochul Again Called on to Veto Disastrous Liability Expansion Bill After Passage Again by New York State Legislature
- Statement by MSSNY President Dr. David Jakubowicz, MD, Calling on Governor Hochul to Again Veto Wrongful Death Expansion Bill
- Legislature Passes Bill to Require Greater Transparency and Consent for Use of Virtual Credit Cards (VCCs)
- Legislature Passes Bill to Permit Medical Aid in Dying; Bill Must Be Acted on by Governor Hochul
- Legislature Passes Bill to Remove State Reporting Requirement When a Patient Faces Substance Abuse Issue
- Legislature Again Passes Bill to Set Forth Criteria for Public Input on Hospital Closures or Substantive Service Reductions
- Assembly & Senate Pass Legislation to Protect Healthcare Workers in Emergency Settings
- Problematic Podiatric Scope Expansion Bill Advances
- MSSNY Receives New Funding for Its Veterans Mental Health Initiative
- Legislation to Revise Professional Disciplinary System Introduced
End of Session Flood of Bills Impacting Healthcare: Some Positive, Some Adverse, & Further Grassroots Needed
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MSSNY’s Morris Auster, Esq., breaks down the end-of-session flood of healthcare bills—some wins, some threats. Hear how these changes affect you and why physician advocacy still matters, fast, focused insights from our top legislative expert.
MSSNY Dr. Willie Underwood Elected President Elect of the AMA
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Longtime MSSNY member Dr. Willie Underwood III has been elected president-elect of the American Medical Association (AMA) by delegates at the 2025 AMA Annual Meeting. Dr. Underwood is a urological surgeon from Buffalo, New York with over 25 years of clinical and leadership experience. He will assume the role of AMA president in June 2026. Dr. Underwood is a long-standing advocate for healthcare reform, physician well-being, and health equity. He has held numerous leadership roles within the AMA and beyond, including chair of the AMA Board of Trustees and co-founder of a biotechnology firm. Dr. Underwood is committed to advancing the AMA’s mission to support physicians and improve healthcare nationwide. AMA Newswire, Fierce Healthcare
Medical Aid in Dying Bill Passes Legislature, Awaits Hochul’s Decision
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After years of stalled progress, New York’s Medical Aid in Dying bill has passed both legislative chambers, moving swiftly from gridlock to final approval. The bill, which allows terminally ill, mentally competent adults to request life-ending medication, now heads toward Governor Kathy Hochul — though when it reaches her desk remains uncertain. In April, MSSNY reversed its long-standing opposition to MAID contingent on a physicians’ choice to opt-in or decline to engage in the processes and procedures as outlined in any proposed legislation.
New York Times, News Radio 810 & 103.1 WGY, News Radio 570 AM/WSYR 106.9 – 06/09/25, Democrat & Chronicle, Finger Lakes 1, Lifesite, MSN.com – 06/10/25 Newsday – 06/11/25
Dispute Closure Error Technical Assistance
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The Departments of Health and Human Services, Labor, and the Treasury published the Dispute Closure Error Technical Assistance (TA) to the Overview of Rules & Fact sheets page under the Guidance & Technical Resources section of the No Surprises Act website.
This TA (1) defines three error types—clerical, jurisdictional, and procedural—that a certified Independent Dispute Resolution entity may make but is not identified until after a dispute is closed, (2) provides examples of these error types, and (3) instructs how to request correction of such errors.
If you have questions, email [email protected].
Certification of Additional Federal Independent Dispute Resolution (IDR) Entities
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The Departments of Health and Human Services, Labor, and the Treasury (the Departments) are announcing the certification of two additional independent dispute resolution (IDR) entities, Capitol Bridge, LLC and Livanta LLC (DBA: Commence). Expanding the number of certified IDR entities from 13 to 15 is expected to increase IDR throughput and represents an important step in continuing to improve the Federal IDR process.
Review the list of certified independent dispute resolution entities, including the two additional entities.
The No Surprises Act created protections against out-of-network balance billing for consumers and established a Federal IDR process that providers (including air ambulance providers), facilities, health plans and issuers can use to determine the payment rates for certain out-of-network charges. During the Federal IDR process, disputing parties select a third-party arbitrator, known as a certified IDR entity, to resolve their dispute. The certified IDR entity must select one of the disputing parties’ payment offers as the appropriate out-of-network payment rate.
Organizations certified as IDR entities have demonstrated to the Departments that they have the experience and staffing to adjudicate disputes fairly and impartially. As a part of the application process, IDR entities must demonstrate sufficient background and experience in arbitration and claims administration of health care services, managed care, billing and coding, medical and legal expertise to make payment determinations. IDR entities must also demonstrate, among other things, the ability to ensure that no conflicts of interest exist, maintain fiscal integrity, comply with applicable regulations, and protect sensitive information.
The Federal IDR process has experienced unexpectedly high volume since its launch in 2022, but the Departments and IDR entities have made significant progress in addressing this high volume, with dispute closures equaling dispute initiations for the first time during Q2 2024, as shown in the Federal IDR PUF for 2024 Q2 (as of March 18, 2025). The Departments look forward to building on this progress with the addition of these two new certified IDR entities.
Maximize Your Practice Potential: CME Webinars
MSSNY presents three essential opportunities for New York physicians to strengthen their clinical knowledge and financial planning this June.
On Tuesday, June 17 (7:30–8:30 AM), Infectious Diseases and Disasters explores the growing intersection between climate change, emergency preparedness, and vaccine-preventable disease outbreaks. Dr. William Valenti, Chair of MSSNY’s Infectious Diseases Committee, will provide insights on how physicians can proactively protect patients and responders.
On Wednesday, June 25 (7:30–8:30 AM), join The Evolution of Artificial Intelligence in Medicine: Historical Insights, Current Applications, and Future Trends. MSSNY AI Taskforce Chair Dr. Donald E. Moore will lead a thought-provoking session on integrating AI into clinical practice, highlighting the importance of continuous learning and practical implementation.
Are You Prepared for Your Next Contract Negotiation?
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A physician-founded and physician-driven company, Resolve is bringing change to employment contracts by providing data and transparency into the physician market. Using the most accurate data on compensation and other contract terms sourced from actual contracts, Resolve delivers the insights and expertise to help physicians negotiate for what they truly deserve and take control of their careers. Please visit Resolve to receive exclusive MSSNY Pricing.
