MSSNY Pulse - September 11, 2026 - MEDICAL SOCIETY OF THE STATE OF NEW YORK ORGANIZED 1807

No Surprises Act: Protecting Out-of-Network Reimbursement

Friday, September 11, 2026

Can Organized Medicine Learn from Healthcare Consolidation?

Click to Enlarge

Colleagues:

Healthcare today bears little resemblance to the system many of us entered decades ago. Independent physician practices have steadily disappeared, replaced by large health systems, corporate medical groups, and increasingly concentrated health insurance companies. The physician entrepreneur who once owned and directed his or her practice has become the exception rather than the rule. Today, most physicians are employees.

This transformation did not occur overnight. Market forces, declining reimbursement, increasing regulatory requirements, electronic health records, and growing administrative complexity all contributed to the trend. The Affordable Care Act accelerated these changes by encouraging integrated delivery systems, new payment models, and greater organizational scale. Whether those outcomes were intended or not, the result has been one of the most significant consolidations in the history of American healthcare.

Hospitals are merging with other hospitals. Independent practices are increasingly becoming part of health systems. Insurance markets continue to become even more dominated by fewer, larger companies. Healthcare is becoming increasingly centralized. The consequences remain the subject of vigorous debate. While proponents argue that consolidation has improved coordination of care, many physicians have experienced something quite different. Professional autonomy has diminished. Administrative burdens have multiplied. Decisions affecting patient care are increasingly made by large organizations rather than individual physicians. Ironically, despite promises that consolidation would improve efficiency, healthcare costs continue to rise. Patient access to care is progressively more of a challenge.

One unintended consequence has received far less attention. The changing nature of physician practice has also changed physician engagement with organized medicine. When physicians owned their practices, participation in county medical societies, state medical societies, and specialty organizations was often viewed as an essential part of professional life. Those organizations provided advocacy, education, networking, leadership development, and a collective voice for the profession.

Today’s employed physician often views membership differently. Increasing financial pressures, educational debt, competing professional demands, and limited discretionary time have caused many physicians to carefully evaluate every professional membership. Rather than belonging to several organizations, many now join only one, or none at all. The result is a challenge confronting nearly every physician organization. Membership has declined. Revenues have become increasingly dependent upon non-dues sources. Financial pressures have forced difficult decisions regarding staffing, educational programming, advocacy efforts, and member services. At precisely the moment physicians face unprecedented challenges from insurers, government regulation, workforce shortages, and corporate medicine, many of the organizations representing physicians are struggling to maintain the resources necessary to fulfill their missions.

Perhaps it is time for organized medicine to ask this difficult question. If consolidation has become the defining characteristic of modern healthcare, should organized medicine also examine whether its own organizational structure has become unnecessarily fragmented? This is not a call to eliminate medical societies or diminish specialty representation. Specialty societies are indispensable. They advance scientific knowledge, develop clinical guidelines, promote research, and provide continuing medical education that simply cannot be duplicated elsewhere. They make significant contributions to medicine.

This is also not an argument that state medical societies should replace specialty organizations. Organizations such as the Medical Society of the State of New York occupy a unique role. They unite physicians across every specialty to advocate before state government, defend the physician-patient relationship, protect the integrity of the profession, and promote policies that benefit all physicians and all patients.

Maybe we should focus on the proliferation of increasingly narrow subspecialty organizations. Over the years, medicine has witnessed the creation of an extraordinary number of increasingly narrow subspecialty organizations. Many serve relatively small memberships while maintaining separate administrative offices, executive staff, financial systems, membership databases, communications platforms, annual meetings, and governance structures. At a time when physicians are becoming less likely to maintain multiple memberships, we should ask whether this proliferation of organizations remains financially sustainable.

Subspecialty organizations could maintain their unique scientific identities while becoming more closely integrated with their broader parent specialty societies. Shared administrative services, unified membership structures, coordinated advocacy, and collaborative educational programming could reduce duplication without sacrificing the individuality or expertise that makes each subspecialty unique. Such an approach could strengthen both organizations. Broader specialty societies could benefit from increased membership and financial stability. Subspecialty organizations could devote more of their resources to education, research, and scientific advancement rather than maintaining increasingly expensive administrative infrastructures. Most importantly, physicians would receive greater value from their memberships. In an era of unprecedented consolidation throughout healthcare, perhaps the future lies in closer integration rather than continued proliferation, to become stronger together, working together.

All the best,

Mark J. Adams, MD, MBA, FACR
MSSNY President

No Surprises Act Webinar: Protecting Out-of-Network Reimbursement

Click to Enlarge

The No Surprises Act changed the rules around certain surprise billing situations and created an Independent Dispute Resolution (IDR) process that providers, facilities, and health plans may use to determine payment rates for certain out-of-network charges.

MSSNY and member benefit partner Callagy Recovery are hosting “The No Surprises Act Explained: What Every New York Physician Needs to Know” on September 24, 2026, from 6:30–7:30 PM. This session is designed to give physicians and practice leaders a clear, practical understanding of what the law means for their practice.

The webinar will cover the purpose of the No Surprises Act, when it applies, how out-of-network billing is handled, and what the IDR process looks like from the provider perspective. Attendees will also learn how reimbursement disputes are addressed and what steps may help physicians recognize when they are being underpaid.

This is not intended to be a dense legal lecture. It is a physician-focused discussion for practices that need usable information about one of the most consequential federal laws affecting medical reimbursement today.

The program will feature Fernando J. Valencia, Chief Revenue Officer for Callagy Recovery, a nationally recognized educator and strategist on the No Surprises Act and federal IDR system. He will be joined by Thomas Lee, MD, MBA, Executive Vice President of MSSNY, a board-certified neurosurgeon and longtime physician advocate who helped lead the successful effort to enact New York’s surprise medical bill law.

National Physician Suicide Awareness Day: Make Time to Talk, and to Act

Click to Enlarge

September 17 is National Physician Suicide Awareness Day, a reminder and call to action to make time to talk — and to act — so physicians’ struggles do not become mental health emergencies.

MSSNY is proud to recognize National Physician Suicide Awareness Day by sharing resources that support physician well-being, including suicide prevention resources, tips for starting important conversations about mental health, crisis planning tools, and more.

Together, we must continue working to build a culture of wellbeing in medicine by reducing burnout, safeguarding job satisfaction, removing barriers to mental health services, and destigmatizing seeking care.

Seven actions can help reduce physician burnout and prevent mental health emergencies:

Learn the vital signs
Encourage mental health reflection
Share suicide prevention resources
Prepare before a moment in crisis
Check in with a physician
Remove intrusive mental health questions
Create a culture of well-being

Everyone has a role in reducing physician suicide. Visit NPSADay.org to learn more and take action.

If you or someone you know is struggling or in crisis, call or text 988 or chat 988lifeline.org.

MSSNY Urges CMS to Reject Medicare Payment Cuts; Please Join Our Efforts!

Click to Enlarge

MSSNY President Dr. Mark Adams, MD, MBA, has submitted a comment letter to CMS Administrator Oz urging that CMS withdraw two very harmful policies advanced in the 2027 Part B Medicare payment rule – measures which will have a significant adverse impact on the ability of community-based physicians to stay in practice and be available to provide needed care to their patients.

The letter urges CMS to reject both its proposal to slash the Medicare conversion factor as well as its proposed policy to reduce payment by 50 percent when a separately identifiable office/outpatient (O/O) evaluation and management (E/M) service reported with modifier -25 is furnished on the same day as a procedure with a 0-, 10-, or 90-day global period. In addition to its own letter, MSSNY has joined in letters from the AMA and the “Big 5” state medical association coalition urging that CMS reject these cuts.

MSSNY’s letter notes that “at a time when it is becoming nearly impossible for many physicians to maintain their own practices and to provide care options for our patients, these proposed measures would force even more physicians to become system employees or retire altogether.”

Physicians can join in these efforts by sending letters opposing these cuts here and here. MSSNY is also urging members of the New York Congressional delegation to join as a co-sponsor of the Patients’ First Act, HR 9693, legislation to help ensure long-term stability in Medicare Physician payment.

Advocacy in Action

Click to Enlarge

MSSNY President-Elect James E. Satterfield, MD, MBA, MS, F.A.C.S. and Senate Majority Leader Andrea Stewart-Cousins (Westchester County)

MSSNY President-Elect James E. Satterfield, MD, MBA, MS, F.A.C.S. and Senator Shelley B. Mayer (Westchester County), Chair of the Senate Education Committee and member of the Finance, Judiciary, and Labor Committees

MSSNY President-Elect James E. Satterfield, MD, MBA, MS, F.A.C.S. and Assemblymember J. Gary Pretlow, Chair of the Assembly Ways and Means Committee, member of the Black, Puerto Rican, Hispanic & Asian Legislative Caucus, and member of the Puerto Rico/Hispanic Task Force

Physician Input Needed for 2027 NYS Legislative Session

Click to Enlarge

As MSSNY gears up for the 2027 New York State legislative session, we need your help!

To help inform our 2027 legislative policy agenda, please take a few minutes to complete the following survey and tell us which of the issues included you think are most important to physicians right now: Take the 2027 Legislative Survey!

Thank you in advance for your help and participation. We will share the results in future MSSNY publications.

Big Five Coalition Urges CMS Administrator to Withdraw Dangerous Medicare Payment Proposal

Click to Enlarge

In a recent letter to Dr. Mehmet Oz, Administrator for the Centers for Medicare & Medicaid Services (CMS) the elected leadership of the medical societies of California, Texas, New York, Florida, and Pennsylvania, known as the Big Five Coalition, expressed strong opposition to the proposed CY 2027 reduction in the Medicare physician conversion factor and urged the proposal be dropped. Together, the five states represented by the coalition are home to more practicing physicians than any others in the country: over 400,000 physicians, nearly 40 percent of the entire U.S. physician workforce.

This proposal is the continuation of a policy failure that has been in effect for over three decades. Considering inflation, Medicare physician payment has collapsed 53 percent since the advent of the Resource-Based Relative Value Scale (RBRVS) in 1992, a decline without parallel anywhere else in American medicine, and one that no other sector of the economy would tolerate for a single year, let alone thirty. Physicians are still the only participant in the Medicare program with no statutory mechanism to keep pace with inflation. Hospitals, skilled nursing facilities, and Medicare Advantage plans all receive built-in, predictable updates. Physicians do not, but are expected to treat more patients, absorb higher practice costs, and put patient access at risk.

The group is urging CMS to do the following:

Withdraw the proposed CY 2027 conversion factor reduction and replace it with a positive update reflecting the Medicare Economic Index.
Establish a permanent, statutory link between the physician conversion factor and the Medicare Economic Index, ending the annual cycle of cuts and temporary congressional patches.
Eliminate the site-of-service payment differential, which pays more for identical care simply because it is billed by a hospital-owned outpatient department rather than a physician’s office. The Congressional Budget Office estimates that expanding site-neutral payment across hospital outpatient departments, imaging, and drug administration would save Medicare more than 170 billion dollars over ten years, with no reduction in the care beneficiaries receive. This is a proven, scored source of federal savings that does not require cutting physician payment to achieve.

To send a letter to your member of Congress about this critical issue, go to MSSNY’s Grassroots Action Center (GAC). MSSNY will continue to monitor this critical issue and share updates as they develop.

Who Cares for New York? A Closer Look at Physician Representation

Click to Enlarge

By Subhash Chandra, MD, DFAPA

New York’s physician workforce reflects both the strength and the challenges of a diverse healthcare system. International medical graduates (IMGs) make up a substantial share of the state’s physicians, while Black and Hispanic/Latino physicians remain underrepresented compared with the communities they serve. These are different but related aspects of physician representation, and both deserve attention.

New York has long relied on IMGs to provide care across hospitals, clinics, and underserved communities. According to the Association of American Medical Colleges (AAMC) 2025 U.S. Physician Workforce Data, based on 2024 figures, 36.2% of New York’s active physicians were IMGs, compared with 25.6% nationally. New York remains among the states and territories with the highest proportion of IMG physicians.

The pattern goes back decades. AAMC data showed that 37.1% of New York’s active physicians were IMGs in 2020, compared with 38.4% in New Jersey, and earlier workforce data placed IMG representation at approximately 36% in 2006. For nearly twenty years, roughly one in three physicians practicing in New York has been an IMG. Their contribution matters most in the communities facing the sharpest physician shortages. IMGs are an integral part of New York medicine, not a peripheral one.

IMG status and race or ethnicity, though, measure different things. An IMG may be Black, Hispanic/Latino, Asian, White, or from another racial or ethnic background, and many physicians from historically underrepresented racial and ethnic groups are U.S.-trained. Keeping these two categories separate helps clarify where New York’s workforce gaps actually lie.

The racial and ethnic gap remains significant. New York’s Center for Health Workforce Studies reported that in the mid-2000s, underrepresented minorities accounted for approximately 10% of the state’s physician workforce while representing roughly 30–35% of the population. More recent data show the disparity has not closed: a 2023 New York State Department of Health announcement found that more than 30% of New York’s population was Black or Hispanic, compared with just 12% of physicians.

So the real question isn’t whether New York’s physician workforce is diverse in the aggregate. It’s whether that workforce reflects the specific communities it serves, and whether physicians from historically underrepresented backgrounds have equitable opportunities to enter and advance in medicine.

Representation matters concretely. Physicians from underrepresented groups are more likely to practice primary care, work in hospitals and clinics, serve Medicaid patients, and practice in federally designated shortage areas, according to research from New York’s Center for Health Workforce Studies — and a workforce that better reflects the population also strengthens communication, cultural understanding, and patient trust along the way.

New York faces two workforce priorities that don’t compete with each other so much as run in parallel. One is building effective, fair pathways for internationally trained physicians to practice and contribute to patient care. The other is strengthening the educational and professional pipeline for the racial and ethnic groups still underrepresented in medicine — from early mentorship and medical school access, through residency, faculty development, and leadership roles.

New York’s physician workforce is already diverse by one measure and inequitable by another, and both facts are true at once. Recognizing what IMGs contribute while addressing racial and ethnic underrepresentation isn’t a matter of choosing a side — it’s what it will take to build a workforce that actually reflects the people of New York.

The data on both fronts already exists. What’s missing is a policy agenda that treats IMG licensure reform and pipeline investment for underrepresented minority physicians as two parts of the same project, funded and tracked together rather than as separate line items competing for the same limited attention.

MSSNY’s Call to Action
True workforce equity requires pursuing two parallel legislative and institutional priorities:

Licensure Modernization: Expanding fair, efficient pathways for internationally trained physicians to enter the New York medical system.
Pipeline Reinforcement: Securing robust, unified state funding for pipeline programs—from early mentorship through medical school tuition support and regional residency development.

We must advocate for a holistic state health policy that funds and tracks IMG licensure reform and minority pipeline initiatives as interconnected pieces of a single workforce strategy.

References

Association of American Medical Colleges. U.S. Physician Workforce Data Dashboard: 2025 Key Findings. 2024 physician workforce data.
Association of American Medical Colleges. State Physician Workforce Data Report. 2021; 2020 data.
Center for Health Workforce Studies, University at Albany, SUNY. Annual New York Physician Workforce Profile. 2006.
Center for Health Workforce Studies, University at Albany, SUNY. A Profile of New York’s Underrepresented Minority Physicians.
New York State Department of Health. “Governor Hochul Announces More Than $4.6 Million to Expand Access to Health Care, Eliminate Health Care Disparities for New Yorkers.” December 5, 2023.
New York State physician workforce research on practice in Health Professional Shortage Areas.

Dr Chandra is a General Adult and Forensic Psychiatrist and Senior Medical Director, USSNY/ Intensive Crisis Stabilization Center, CNG, NY.

Upcoming MSSNY Webinars Support Physicians Across Every Career Stage

Click to Enlarge

MSSNY is offering several upcoming webinars designed to help New York physicians, residents, medical students, and practice teams navigate timely clinical, legal, contractual, and reimbursement challenges. Register for the programs most relevant to your patients, your practice, and your professional future.

September 15, “From Social Media to the Medical Setting: What Every Medical Student Should Know,” will help medical students understand the legal and professional responsibilities that can affect their future. Topics include professionalism, ethical conduct, social media use, patient privacy, HIPAA, licensing, disciplinary consequences, and common legal risks to avoid during training and early practice.

September 16, “Medical Matters: Measles & Other Vaccine-Preventable Diseases: Nuances of Vaccine Confidence,” will help physicians respond to recent measles activity, ongoing outbreaks, and the resurgence of other vaccine-preventable diseases. Faculty William Valenti, MD, and Craig Katz, MD, will review epidemiological trends, immunization guidance, vaccine confidence, and evidence-based communication strategies to strengthen patient and caregiver trust. This live activity is designated for a maximum of 1.0 AMA PRA Category 1 Credit™.

September 24, “The No Surprises Act Explained: What Every New York Physician Needs to Know,” will help practicing physicians better understand how the law affects out-of-network reimbursement. Fernando J. Valencia of Callagy Recovery and Thomas Lee, MD, MBA, Executive Vice President of MSSNY, will explain when the law applies, how the Independent Dispute Resolution process works, and how physicians can identify opportunities to avoid systematic underpayment.

October 20, “Physician Employment Agreements: What to Know Before You Sign,” is designed for residents and early-career physicians preparing to evaluate employment offers. The session will cover compensation, wRVU targets, contract terms, termination provisions, call schedules, restrictive covenants, non-competes, malpractice tail coverage, and strategies for negotiating with confidence.