Archive for June, 2012

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NYS Legislative Session Ends with Mixed Results

Wednesday, June 27th, 2012

June 26th, 2012

The NYS Legislative Session ended in Albany on June 22.  All-in-all there were some disappointing (though not unexpected) outcomes in the area of Socio-Medical Economics, while some major wins were obtained in the areas of Scope-of-Practice and Public Health.  The following is a summary of the legislative issues that were of interest to physician organizations this past year, and their outcomes:

SOCIO-MEDICAL ECONOMICS LEGISLATION

SENATE PASSES OUT OF NETWORK TRANSPARENCY/COVERAGE LEGISLATION; ASSEMBLY FAILS TO CONSIDER BILL; FURTHER NEGOTIATIONS TO ENSUE

The New York State Senate passed comprehensive legislation (S.7745, Hannon), by a 55-5 vote, that would enact a number of provisions to provide much needed transparency to patients and employers regarding the scope of their health insurance coverage when they pay for coverage that provides the right to see a physician outside of a plan’s network.   This includes requiring a health insurance company offering a policy for out of network coverage to assure that there is significant coverage of such costs including offering at least one plan that will provide coverage of 80% of anticipated out of network costs, a major advocacy priority for MSSNY.

The Assembly did not take up the bill prior to the end of the Session. However, passage of this bill by the Senate sets the stage for further discussions on this legislation with the Assembly and Governor’s office, which are expected to continue over the summer and into fall. While the bill contains some provisions with which the medical community has concerns, MSSNY supported the bill because, on balance, it would enhance the ability of patients to have health insurance coverage that actually will provide significant coverage of their health insurance expenses.

In addition to the requirements for sufficiency of out of network coverage, the legislation contains a number of important provisions that would, if ultimately enacted, address several problems faced by patients concerned with the adequacy of their health insurance coverage, including assuring that:

o      All health insurance products regulated by New York State, not just HMOs, offer comprehensive provider networks that are sufficient to meet the needs of the patients enrolled in that product;

o        All health insurance products issued in New York State afford patients the right, currently available only to those enrolled in HMOs, to receive treatment from a specialist appropriately qualified to treat a patient’s particular condition at no additional cost to the patient, if the network of such insurance product fails to include such appropriately qualified specialist;

o      Consumers have a clear and accessible external review procedure to resolve disputes with their health insurers regarding, where necessary, access to out of network care;

o      Health insurance companies timely update changes to their provider networks so consumers have current knowledge of which physicians are in the network;

At the same time, because the bill seeks to address many aspects of “surprise” medical bills faced by patients, the bill proposes a number of new obligations on physicians and hospitals, including provisions which would, if enacted:

  • Require health care providers to disclose to patients and prospective patients the plans in which the physicians participate in writing or website;
  • Require health care providers not participating in a plan’s network disclose to their patients upon request reasonably anticipated charges for medical care, and disclose to their patients the identity and contact information of specific health care providers whose services are arranged by such health care provider who may be involved in the patient’s care so the patient can review the participation status of these additional providers as well as determine potential out of pocket costs;
  • Permit health insurers and patients the power to challenge charges for emergency medical care, that exceed the usual and customary cost (80% of FAIR Health) of such care as compared to similarly educated physicians in the same area. Importantly, the bill specifies a series of criteria that must be considered by an independent dispute resolution entity in determining a fair fee, including the particular expertise of the physician providing the emergency care and the complexity and circumstances. The bill also specifies that such independent dispute resolution entity cannot set the disputed fee at an amount lower than the usual and customary cost;
  • Require hospitals to post charges for items and services on its website;
  • Require hospitals to disclose to patients on its website and at the time of pre-admission testing a list of physicians providing care at the hospital whose charges will be billed separately from the hospital’s bills, and contact information for such physicians.

In a press release, Senator Hannon stated: “This proposal aims to establish balance and fair dealing to the participants involved in the financial aspects of a medical procedure. The patient, the physician and the health plans have, in very recent years, each been subjected to unfair economic results. Primarily for those medical treatments not covered in-network, reports have been prevalent of high unexpected bills to patients, sudden decreases in reimbursements to physicians and surprisingly high charges to health care plans. This legislation seeks to address the inequity in each area.”

With the Legislature likely to return to Albany later this year, discussions on this issue and legislation will continue into the summer and fall.
(AUSTER, DEARS, CONWAY)

COLLECTIVE NEGOTIATION BILLS FAIL TO PASS EITHER HOUSE

Despite the strong support of all of organized medicine and the AFL-CIO, neither the statewide collective negotiation bill (S.3186, Hannon/A. 2474A, Canestrari) nor the demonstration collective negotiation bill (S.7615, Hannon/A.2474B, Canestrari) passed either House of the New York Legislature this year. This is largely due to the very strong opposition from the health insurance industry, the business community and some major hospital associations.

Collective action 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.

MSSNY had called for a strong grassroots advocacy effort from physicians – and physicians responded in dramatic fashion. Nearly seven thousand emails, calls and faxes were sent through MSSNY’s grassroots action hotline. Unfortunately, several negative press opinion statements and articles which appeared over the past week served to increase lawmaker concerns regarding the possible inflationary impact of collective action on health care premium costs.

MSSNY thanks all physicians and advocacy organizations who reached out to express their support for this important legislation.
(DEARS, CONWAY, AUSTER)

LEGISLATURE PASSES MEDICAID STANDARD PRIOR AUTHORIZATION FORM LEGISLATION SUPPORTED BY MSSNY

The Assembly and Senate passed legislation (A.10248-A, Gottfried/S.7384-A, Hannon) that would, if signed into by the Governor, direct the Department of Health to develop a standard prior authorization form to be used by Medicaid managed care companies to determine coverage for prescription drug medications. The bill requires that this form to be available from managed care plans electronically as well as in paper format. It will also require them to accept such standard form from physicians electronically as well as on paper.   As the purpose of this legislation is to reduce some of the administrative burden faced by physicians in assuring their Medicaid patients can obtain needed medications, MSSNY supports this legislation.

As a result of changes enacted in the 2011-12 State Budget, New York State Medicaid pharmacy benefits were shifted from a fee-for-service system to become part of managed care networks effective October 1, 2011. This shift has resulted in millions of Medicaid and Family Health Plus patients in New York transitioning from one statewide prescription drug plan to over 20 managed care companies, each with it own processes for physicians to follow in assuring patients can obtain needed medications.
(AUSTER, DEARS, CONWAY)

LEGISLATION SUPPORTED BY MSSNY TO CONFORM NY PUBLIC HEALTH LAW STARK PROHIBITIONS TO FEDERAL STARK LAW PASSES LEGISLTURE- WILL ALLOW CERTAIN FINANCIAL RELATIONSHIPS CURRENTLY PROHIBITED UNDER STATE LAW BUT PERMITTED UNDER FEDERAL LAW TO OCCUR

Both Houses of the Legislature approved legislation (A. 3551A, Gottfried/S. 4660A, Hannon) to conform New York’s Health Care Practitioner Referral statute with the federal Stark law. In doing so, unless the Public Health and Health Planning Council declares an arrangement to pose a substantial risk of payor or patient abuse, certain financial relationships currently prohibited under state law but permitted under federal law would be allowed. MSSNY supported this bill.

The Federal Stark Law (named for its sponsor Congressman Pete Stark) prohibits physicians from referring Medicare patients for certain designated health services (DHS) to an entity with which the physician or a member of the physician’s immediate family has a financial relationship unless an exception applies. While the federal law covers only those referrals for which the services will be reimbursed by Medicare or Medicaid, the state law is far more expansive and covers all referrals of designated health services, regardless of payer class. All services paid by private insurance and managed care plans as well as self-pay patients are covered.

In 2003, federal law authorized an exception to the physician self-referral prohibition for certain arrangements in which the physician receives necessary non-monetary remuneration that is used solely to receive and transmit electronic prescription drug information. This exception was created to help promote widespread physician adoption of EHR technology.

Current State self-referral prohibitions do not include such an exception. MSSNY’s Division of Governmental Affairs was informed by MSSNY’s General Counsel Donald Moy and representatives from New York County Medical Society that several physician practices who previously had been provided EMR technology for free by a large clinical lab were required as a result of the existing law to repay the lab company fair market value for the EMR. This bill will now enable such arrangements to occur in NYS.
(DEARS, CONWAY)

LEGISLATION TO MAKE STATE ACCOUNTABLE CARE ORGANIZATION (ACO) DEMONSTRATION PROGRAM PERMANENT PASSES BOTH HOUSES

Legislation (A.8869B, Gottfried/S.6228B, Hannon) which would make the state Accountable Care Organization (ACO) demonstration program permanent passed both Houses of the Legislature. MSSNY supports the elimination of the ‘demonstration’ which limited the number of ACO’s authorized to obtain a Certificate of Authority under New York Public Health Law in order to assure the development of horizontally integrated physician driven ACOs. Moreover, this measure would enable Medicare Shared Savings ACOs special recognition under New York’s Public Health law and in so doing will afford, to the extent consistent with CMS regulations, safe harbor protection from state Stark, Anti-Kickback, fee slitting and self-referral prohibitions to Medicare only ACOs.

MSSNY had worked with the sponsors of the legislation to remove a provision included in earlier drafts which would have required the ACOs to be not-for-profit. This provision was removed. MSSNY also worked to assure modification of a requirement that the ACOs must include a Federally Qualified Health Center (FQHC). This provision was modified significantly to only require an ACO to use ‘its best efforts’ to include an FQHC which serves the ACO’s service area and who is willing to be a participant in the ACP. MSSNY was pleased to see these changes made to the bill so to assure flexibility and a diversity of entities sponsoring ACOs.                                                                                                            (DEARS, CONWAY)

LEGISLATION PASSED TO DE-CERTIFY DME PROVIDERS UNDER NO-FAULT

The Senate and Assembly passed legislation (S.7787, Seward/A.10784, Morelle) to permit the Department of Financial Services to “de-certify” durable medical equipment (DME) providers from submitting claims to No-Fault for fraud and abuse, similar to existing Insurance Law provisions that permit DFS to “de-certify” health care providers from submitting claims to No-Fault in certain circumstances. The purpose of the legislation is to address reports and allegations of rampant fraud in No-Fault, including with the provision of medical equipment such as TENS and EMS machines. Importantly, the provision that was passed is far different than earlier versions under negotiation in the last days of Session which would have imposed a strict prohibition on patients assigning claims to providers of medical equipment, even physicians, if they were not registered with the National Supplier Clearinghouse as an authorized Medicare supplier of DME. MSSNY argued that, since many orthopedic and rehabilitative physicians providing crutches and other “off the shelf” equipment to patients are not required to register with Medicare for providing such equipment, it would have unfairly limited physicians from being able to provide patients with such needed equipment integral to their recovery from injuries.                                                  (AUSTER)

BREAST RECONSTRUCTION BILL PASSES BOTH HOUSES

S.3801-A (LaValle) / A.7193-A (Cook), a bill that would provide for insurance coverage for breast reconstructive surgery after a patient has had a partial mastectomy as they currently do when a patient has had a full mastectomy, has passed both Houses and will be sent to the Governor for his consideration. MSSNY supported this bill.   
(ELLMAN, CLANCY)

SCOPE OF PRACTICE LEGISLATION

MSSNY DEFEATS LEGISLATION WHICH WOULD HAVE ALLOWED INDEPENDENT PRACTICE BY CERTAIN NURSE PRACTITIONERS

Legislation (A.5308A, Gottfried/S.3289A, Young) which would have permitted certain nurse practitioners to practice independently with a physician or directly with a hospital passed the NYS Assembly, but because of MSSNY’s efforts, did not pass the NYS Senate.

The Nurse Practitioners amended the original bill which would have eliminated entirely the requirement for a written practice agreement and collaborative relationship. The amended bill would have continued to require a written practice agreement and collaborative relationship for NPs in practice for less than three years/3600 hours. For NPs in practice more than three years/3600 hours, the requirement for a written practice agreement would have been eliminated. Under the bill these NPs would need to have a collaborative relationship with a physician, or with multiple physicians or a hospital. The NP would need to file with the Department of Education an attestation identifying the physician, physicians or hospital that has agreed to participate in the collaborative relationship. Written practice guidelines which provide criteria to be used regarding consultation, including methods and frequency of how consultation shall be provided, collaborative management and referral, including emergency referral plans to address the health status and risks of patients are also required to be filed with the Department.

HOWEVER, the current requirement for regular medical record review by the collaborating physician would have been eliminated as would the current requirement for the physician’s judgment to prevail in the event there is a disagreement between the nurse practitioner and collaborating physician. The disruption of these current legal requirements, in MSSNY’s opinion, would have negatively impacted upon the delivery of quality health care.

Moreover, allowing an NP to directly contract with a hospital would also have failed to assure high quality care delivery and further marginalized the private practice of medicine and would have served to further enhance a hospital dominated health care delivery system.

MSSNY would like to express its thanks to the more than 1,100 physicians who contacted their elected representatives to express their opposition to the bill. This form of grassroots advocacy was critical because the NPs also had individual physicians contacting the Legislature.

Also critical to our success on this issue was the fact that eight other Medical Specialty Societies had published memos in opposition to this bill. The sheer volume of physician contacts coupled with the unity of medicine led to the defeat of this bill. We would like to thank the following Specialty Societies for taking the time to express their opposition and to help MSSNY defeat this bill:

New York State Academy of Family Physicians

New York Chapter, American College of Physicians

American Academy of Pediatrics, District II, New York State

New York State Psychiatric Association

New York State Opthalmological Society

New York State American College of Surgeons

New York State Society of Orthopaedic Surgeons

New York State Society of Otolaryngology

(DEARS, ELLMAN, CONWAY)

DENTAL SURGEON BILL PASSES SENATE BUT NOT ASSEMBLY

A.2820-A (Morelle) / S.3059-A (Libous), a bill that would have expanded the scope of practice of oral and maxillofacial dental surgeons to allow them to perform any procedure within the maxillofacial area, including cosmetic surgery, did not advance from the Assembly Higher Education Committee at the end of the Session. Although the bill passed the Senate, it will have to be reintroduced in the next Session and start over. MSSNY strongly opposed this bill.
(ELLMAN, DEARS)

NEGOTIATED PODIATRY BILL PASSES BOTH HOUSES

S.7800 (Libous) / A.9293-A (Pretlow), a bill that was negotiated at the end of the Session between the Orthopaedic Society and the Podiatry Association, passed both Houses. After negotiations concluded, MSSNY was informed that the Radiology Society opposed the bill negotiated by the Orthopedic Society. The bill is significantly more restrictive than the original bill and requires, in addition to graduation from an accredited 2 or 3 year podiatry medicine residency program, certification in rear foot and ankle surgery by a national certifying board having certifying standards acceptable to the education department; and documentation that he or she has acceptable training and experience in advanced mid-foot, rear-foot and ankle procedures that has been approved by the education department. The bill also calls for a healthcare practitioner database related to podiatrists which will be similar to the physician profiles. In an action for podiatric medical malpractice, a physician may be called as an expert witness at trial.
(ELLMAN, DEARS)

NURSE ANESTHETIST BILL PASSES BOTH HOUSES

S.5356-D (Young) / A.8392-C (Paulin), a bill that is a title protection bill and does not expand the scope of practice of nurse anesthetists passed both Houses in the closing day of the Session. MSSNY originally opposed the bill, but it was amended based on language negotiated by the Anesthesiologists and the nurse anesthetists and MSSNY was asked to withdraw our objection to the bill. The negotiated language ensures that there is no expansion of scope of practice.

(ELLMAN, DEARS)

PHARMACISTS WILL BE ALLOWED TO GIVE HERPES ZOSTER VACCINE TO ADULTS

Legislation that would allow pharmacists to provide the herpes zoster vaccines to adults passed both houses of the Legislature   Assembly Bill 6301B, sponsored by Assemblymember Amy Paulin and S.3808B, sponsored by Senator Charles Fuschillo, authorizes physicians to issue a patient specific script to pharmacists to allow them to provide the immunization. The bill also allows a nurse practitioner to prescribe and order a specific regimen to a licensed pharmacist, pursuant to regulations developed by the Commissioner of Health, for administering immunizations to prevent acute herpes zoster. The bill also would authorize the pharmacists to administer medications required for emergency treatment of anaphylaxis for influenza, pneumococcal or herpes zoster vaccine. Pharmacists now have the ability to administer, through a non-patient specific script, the influenza and pneumococcal vaccine to adults. MSSNY opposed this measure.

(CLANCY, ELLMAN, DEARS)

CHIROPRACTOR – PHYSICIAN PARTNERSHIP BILL HELD IN ASSEMBLY HIGHER  EDUCATION COMMITTEE

A.7403-C (Lopez) / S.5012-C (Fuschillo), a bill that would permit doctors of chiropractic to form limited liability companies with medical doctors, passed the Senate but did not advance from the Assembly Higher Education Committee at the end of Session. MSSNY strongly opposed this bill, saying that it would change the Corporate Practice of Medicine Act.
(ELLMAN, DEARS)

NATUROPATH BILL HELD IN BOTH HOUSES

S.1803-e (LaValle) / A.3057-C (Perry), a bill that would license naturopathic practitioners and define their scope of practice, did not advance to the floor in either the Senate or Assembly. MSSNY had worked with the sponsors of this legislation to amend the bill and define the scope of practice and other aspects of the bill.
(ELLMAN, DEARS)

PUBLIC HEALTH AND EDUCATION LEGISLATION

PATIENTS MAMMOGRAPHY REPORT TO DISCUSS BREAST DENSITY PASSES BOTH HOUSES

Legislation has passed in the New York State Legislature which requires that every mammography report given to a patient with dense breast tissue inform the women in plain, non-technical language that she has dense breast tissue and that she should discuss the potential benefit of further screenings with her physician. A. 9586D and Senate 6769B, sponsored by Assemblywoman Ellen Jaffee and Senator John Flanagan, was the result of negotiations between the sponsors, as well as various MSSNY and American College of Radiologists physicians. Research has found several risk factors that may increase a woman’s chance of getting breast cancer. The Centers for Disease Control and Prevention indicate that risk factors include breast density.  Women whose mammograms show a larger area of dense tissue than the mammograms of women of the same age could be at increased risk of breast cancer. The magnitude of that risk is still under debate and the question of why breast density carries a risk remains unanswered. Therefore, it is critical that information provided to women about breast density be as clear and scientifically accurate as possible. This bill provides that the written notice must explain that: “Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and may also increase your breast cancer risk.” The notice must inform the patient that a report of their mammography results was sent to their physician, and that the patient should talk to their doctor about their risks for breast cancer and whether “more screening tests might be useful.” MSSNY believes that this legislation would serve as a useful tool in educating women about breast density as a risk factor and serve as opportunity to discuss other risks factors associated with breast cancer. The Medical Society of the State of New York supported this measure.
(CLANCY, CONWAY)

ELECTRONIC CIGARETTE BAN PASSES BOTH HOUSES

A.9044-B (Rosenthal) / S.2926-B (Johnson), a bill that would ban the sale and distribution of electronic cigarettes to anyone under the age of 18 years, has passed both Houses and will be sent to the Governor for his consideration. MSSNY supported this bill.
(ELLMAN, CLANCY)

BAN ON SMOKING ON PLAYGROUNDS BILL HELD IN SENATE RULES COMMITTEE

A.6451-C (Galef) / S.7627-A (Carlucci), a bill that would ban smoking on playgrounds, where children under the age of twelve years are present, passed the Assembly but was held in the Senate Rules Committee.    MSSNY supported this bill.
(ELLMAN, CLANCY)

CPR INSTRUCTION IN SCHOOLS LEGISLATION FAILS IN THE ASSEMBLY EDUCATION COMMITTEE

Legislation that would require cardiopulmonary resuscitation (CPR) to be given as part of the high school curriculum passed the Senate but failed to move forward in the Assembly Education Committee. Assembly Bill 3980A, sponsored by Assemblymember Harvey Weisenberg, did not require students to receive certification in CPR but will ensure students learn the psychomotor skills of CPR. The American Heart Association’s 2010 revised CPR guidelines make it even easier for more people to perform CPR.   A greater emphasis is now placed on the simplest step—chest compressions. Its companion measure, Senate Bill 2491A sponsored by Senator James Alessi passed the New York State Senate. Currently, school districts may opt to offer CPR to students and this was cited as a reason for not moving the legislation forward to the Assembly for a vote. The Medical Society of the State of New York adopted policy at its House of Delegates in 2011 that called for “the Medical Society of the State of New York [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”. The Medical Society of the State of New York supported enactment of this legislation.
(CLANCY)

BILL TO BAN USE OF TANNING BEDS BY CHILDREN UNDER THE AGE OF 17 PASSED BY BOTH HOUSES OF THE LEGISLATURE

Legislation (A.1074, Weisenberg/S. 2917, Fuschillo) which would build upon existing regulations in the use of tanning beds by prohibiting their use by children under the age of seventeen has passed both Houses of the Legislature. Currently, indoor tanning is permitted for children 14 and older with parental consent. However, the weight of scientific evidence shows that salon tanning raises the risk of skin cancer. Melanoma, the most commonly fatal form of skin cancer, makes up only 4% of skin cancers but is responsible for more an 80% of skin-cancer deaths. Using tanning beds before the age of 30 has been scientifically demonstrated to increase one’s risk for melanoma by 75 percent. MSSNY, along with many other Specialty Medical Societies, patient advocacy groups and the American Cancer Society, supported this measure and worked together to achieve its passage.
(DEARS, ELLMAN)

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 pclancy@mssny.org or at 518-465-8085.   
(CLANCY)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
conway@mssny.org, ldears@mssny.org, mauster@mssny.org, pclancy@mssny.org, bellman@mssny.org, eclinton@mssny.org

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Collective Negotiations and Out-Of Network Bills Need Your Support

Tuesday, June 19th, 2012

OUT-OF-NETWORK LEGISLATION NEEDS YOUR SUPPORT!

There are just a few days left in the 2012 legislative session.  All physicians must continue to call, write and fax their legislators and Governor Cuomo’s office to urge that they enact legislation to assure health insurance companies offer health insurance policies with out-of-network coverage that have meaningful coverage of such costs.  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.

MSSNY continues to meet with key leaders in the Assembly, Senate, and Cuomo Administration to urge the enactment of legislation incorporating these concepts.  Negotiations will be continuing through the weekend into early next week. 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 the MSSNY’s Grassroots Action Center in support of this legislation.

Please act today!
(AUSTER, DEARS, CONWAY)

COLLECTIVE NEGOTIATION BILL – NEEDS PHYSICIAN ADVOCACY

With only four legislative days remaining in the regular legislative session, legislation (A.2474-A, Canestrari/S. 3186-A, Hannon) to permit independently practicing physicians to negotiate collectively with health insurance companies has stalled in both houses of the legislature.  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 it passed the Senate last year but hasn’t yet moved this year.

Collective action 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 grassroots push is necessary because the health insurance industry is doing all in their 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)

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