Legislative Planning for 2008 Medical Society of the State of NY

Legislative Planning for 2008

Medical Society of the State of NY

MSSNY Committee on Legislation and Physician

Advocacy

September 11, 2007George O. Stasior, MD, ChairGeorge O. Stasior, MD, ChairRobert J. Hughes, MD, Vice ChairRobert J. Hughes, MD, Vice Chair

Welcome and Introduction of Guests

George O. Stasior, MD, ChairGeorge O. Stasior, MD, ChairRobert J. Hughes, MD, Vice-ChairRobert J. Hughes, MD, Vice-Chair

Recap of 2007 LEGISLATIVE SESSION: Was MSSNY Successful?

Gerard L. Conway , Esq.

Senior Vice-President & Chief Legislative Counsel

Lobby Day 2007: Guests

MSSNY Secured $130M allocation for Excess program.MSSNY defeated Regressive Liability Bills-one of which was introduced in closing days of Session:

Legislation to impose pre-judgment interest (S.6365, Maltese, et al)Legislation to Eliminate the Limitations on Attorney Contingency Fees (S.790, DeFrancisco)Legislation to Expand “Wrongful Death” Damages (S.54, DeFrancisco/A.5856, Weinstein)

Liability Environment

MSSNY Secured introduction of legislation (A.8066, Towns/S. 4149, Volker) to establish medical courts pilot programMSSNY representative (Dr. Richard Peer) to serve on Dinallo/Daines Medical Liability Reform Task ForceMSSNY instrumental in creation of provider coalition for Reform -comprised of representatives from Specialty Medical Societies, HANYS, GNYHA and certain group practicesMSSNY Driving re-creation of NYCJR Campaign and involvement of broad business and private sector of NYS

Defeated a proposed $400 increase in the physician registration fee

Assured continuation of ‘physician prevails’ language under Preferred Drug Program and defeat of proposed inclusion of anti-depressants on PDL

Secured additional $3M and re-appropriation of $6M for physician HIT/education

Secured $1M additional reimbursement to physicians who provide home medical care

NYS Budget

Managed Care

Enacted into law: C.451 (S.3986, Hannon/A.8128, Gottfried) Requires plan to pay for pre-authorized services unless it is

discovered patient was not insured when service was rendered provided that plan asserts this defense within 120 days after date care provided.

Permit patient to seek independent external appeal when plan denies request for access to out of network specialist and patient’s physician believes treatment is “materially different” from

the care available in network.

Managed Care

Enacted into law: C.451 (Continued) Prohibits a health plan from denying payment for lack of pre-

authorization for a surgical or other invasive treatment requiring sedation performed at the same time a pre-authorized procedure was performed provided.

Requires health plans and hospitals to continue to abide by the terms of a contract for two months following termination by either party, or renewal, which benefits the staff physicians and patients

who become “pawns” during these often high-profile disputes.

Public Health

Accreditation for Practice Performing Office-Based Surgery (C.365)

• Bill crafted by physician-directed Advisory Panel in conjunction with DOH.

• Practices must be accredited by July 14, 2009. Must begins reporting Adverse events on January 14, 2007.

Healthy Schools Act• A.8698 (Nolan), and S.5892 (Saland): Each would establish

nutrition standards for schools, Each Passed one House. Compromise expected in future.

Public Health

Requires HIV Testing of Defendant in Sexual Assault Cases (C. * )

• Requires testing of defendant accused of sexual assault.

Making HIV Testing Routine A.9195 (Gottfried)/S.6326 (Hannon)- Would require

physicians to routinely offer HIV tests to patients but continues written informed consent requirements. Passed

Assembly; remains in Senate Health Committee.

Public Health

Physician Shortage A.3389 (Koon)/S.476 (Bonacic)- Would provide a tax credit to

physicians who provide specialty medical services in designated specialty shortage areas. Passed Senate; remains in Assembly Health Committee.

S.4914(Johnson)- Would provide tax credit for medical student loan interest expenses. Remains in Committee in Senate.

A.7605 (Pretlow)- Transfers unspent funds from undersubscribed to oversubscribed physician scholarship programs within State Education Department to facilitate more scholarship awards to medical students. Remains in Committee in Assembly.

Non-Physician Practice

Defeated several measures including: Dentists performing cosmetic surgery (A.7044, Morelle)

Collaborative drug therapy management (S.2426, LaValle/A.3933, Canestrari)

Podiatrist expansion (S.1443, Libous/A.3168, Pretlow)

Naturopathy (S.2790, LaValle/A. 4510, Libous)

Optometry (S.4519, Libous/A.8001, Paulin)

Pharmacy immunization (S.1312, Fuschillo/A.2140, Paulin)

Chiropractor equal pay (S.1150(Johnson)/A.2830, Lentol)

Other Coverage Issues

Mental Health Parity A.9263 (Morelle)/S.6234(Seward)- Clean up bill which

among other things, changes the outpatient coverage from "twenty days of active treatment" to "twenty visits“. C.502

A. 8617(Tonko)/S.5929(Morahan); Would apply parity to governmental programs. Passed Assembly; remains in Senate Rules Committee.

Anticipated Areas of Anticipated Areas of Legislative Activity Legislative Activity Affecting Organized Affecting Organized Medicine In 2008Medicine In 2008Gerard L. Conway, Esq.

Senior Vice-President and Chief Legislative Counsel

Civil Justice Reform/Regressive Liability Legislation Re-Authorization of the Health Care Reform Act

(HCRA) and Budget Issues Managed Care Non-Physician Health Care Provider Scope of

Practice Public Health and Education Enhancing Quality of Health Care Federal Issues

Legislative Agenda

2008 Legislative Agenda

CIVIL JUSTICE REFORM&

REGRESSIVE LIABILITY PROPOSALS

14% Increase NOW Brings Aggregate Cost Increases over six years to:

Surgeons: up 122-136% Radiologists: up 112-122% ED Physicians: up 122-136% OB-GYNs: up 102-112% Neurosurgeons: up 122-136% Internists: up 112-122%

Severity Continues to Rise- Up 25% between 2001-2005 Random Nature of Awards and Verdicts- Occur even

where no negligence proven

Number of Lawsuits Filed Remains HighCurrently:

62% Surgeons (all classes) sued with claims pending 67% OB-GYNs sued with claims pending71% Neurosurgeons sued with claims pending

(MLMIC insureds)

Documented Physician Supply Problem16% Decrease in Number of General Surgeons in NYC

8% Decrease in Number of Primary Care Physicians in North Country

Strategy for 2008 MSSNY will work closely with Dinallo/Daines Task Force to advocate for reform

Alternate Resolution ForumsIdentification/Accountability of Medical Expert WitnessesReduce Threshold for Periodic PaymentsPersonal Asset ProtectionClear and Convincing Evidence StandardsFrivolous LawsuitsState-Funded Subsidy to defray costs to PhysiciansContinuation of the Excess Insurance Program

Strategy for 2008 MSSNY will provide Dinallo/Daines Task Force historical data regarding operational impact of Cap on Pain and Suffering in Other States

Strategy for 2008 Oppose Regressive Liability Bills

Legislation to Permit the Awarding of Pre-Judgment InterestLegislation to Eliminate the Limitations on Attorney Contingency FeesLegislation to Expand “Wrongful Death” DamagesLegislation to Create a “Date of Discovery” Rule for the Statute of LimitationsLegislation to Expand Damages Against a Non-Settling Defendant when Another Defendant Settles

Strategy for 2008

MSSNY working with many industry partners and friends has raised close to $1M to inform and energize the public to weigh-in in support of Civil Justice Reform

MSSNY working with Rubenstein and Associates on media campaign

NYS BUDGET & THE RE-AUTHORIZATION OF THE

HEALTH CARE REFORM ACT (HCRA)

Budget Exigencies Continue To Exist

Health Care Reform Act/Budget IssuesInsurance Coverage Initiatives

Reimbursement ReformExcess Medical Liability ProgramPhysician Registration Fee/OPMCPublic Health InitiativesGraduate Medical EducationIndigent Care

HCRA/Budget

Strategy for 2008Work with Dinallo/Daines Task Force on Universal Coverage -Explore strategies to address problem of uninsured (public and private)Work with Daines on Reimbursement Reform for Physicians serving beneficiaries of public programsEnsure continued funding for Excess program at an adequate rate Target Resources to Address Physician Supply and Mal-Distribution ProblemsObtain greater funding for physician-driven health information exchanges (HIEs)Ensure appropriate funding for Trauma CarePrevent taxation of medical services/increase in registration fees

HCRA/Budget

Managed Care Reform

Consolidation within the Managed Care Industry Continues–Today, 80% of Managed Care enrollees are enrolled in just seven HMOsIn NYS, Managed Care Industry Profit is Up by over 93% between 2001 and 2005Abusive Practices Continue–Tiering Programs Based on Cost and Not Quality (United, Aetna, Cigna)–Unfair Contract Amendments–Offensive Claims Processing Practices–Unacceptable Limitations on Non-Par Assignment

Managed Care

Strategy for 2008 Work with Attorney General, Superintendent of Insurance

and Commissioner of Health to curb illegal and offensive contracting, claims processing and tiering practices.

Seek Legislative intervention– Collective Negotiation – Restrict Contract Amendments and Sale of Networks– Payment Assignability– Peer Review– All Products Clause Ban – Any Willing Provider– Physician Due Process– Hastening Payment Timeframe

Non-Physician Practice

Series of Bills Introduced To Inappropriately Expand Scope of Practice of Non-Physician Practitioners Certified Nurse Practitioner Dentists Pharmacists Certified Nurse Anesthetists Optometrists Naturopathy Chiropractors Registered Nurses Genetic Counselors Psychologists Podiatrists

Public Health

Influenza and Vaccine Supply

Healthy Schools

Healthy Lifestyle

Public Health Preparedness

Enhance Quality

Protect Integrity of Quality Assurance Process – Protect against disclosure of statements made during peer review.

Mandate CME For All Physicians- Not Just Those Affiliated with Hospitals or Participating With MCOs.

Facilitate Utilization of Inter-Operative Health Information Technology By Physicians

Assure Physician Interests Incorporated in Properly Structured, State Initiated Pay for Performance Demonstrations

Federal Issues

SGR Reform and SCHIP Pay For Performance GPCI And Other Medicare Payment Reforms ICD-10 Comprehensive Professional Liability Reform Facilitate Purchase of Inter-Operative Health

Information Technology By Physicians

Sometime in November, 2007: Structure of Budget Announced

January 2, 2008: Opening Day of Session

January 16, 2008: Deadline for Submission of Budget by New Administration

Legislative Day: March 4, 2007

April 1, 2008: Budget Due Date June 19, 2008: End of Session (Anticipated)

Important Dates

Discussion of County Medical Discussion of County Medical Society and Specialty Society and Specialty Medical Society Legislative Medical Society Legislative PrioritiesPriorities

George O. Stasior, MD, ChairGeorge O. Stasior, MD, ChairRobert J. Hughes, MD, Vice ChairRobert J. Hughes, MD, Vice Chair

Timeline for Program Development

September 28, 2007: Draft program incorporating your suggestions mailed to Committee Members and Attendees.

October 16, 2007: Meeting of State Legislative and Physician Advocacy Committee

December 13, 2007: Council Consideration

December 2007: Print Legislative Program

December 2007/January 2008: Press Conference

Important Dates

Resolutions Referred by the 2007 House of Delegates

Resolution 62: HMOs Decreasing Reimbursement & Patient Co-payments

Resolution 64: Ordering of Medically Indicated Diagnostic Tests By Specialists/Sub-Specialists

Resolution 90: Physician Reporting of Patients Who Should Not Drive

Resolution 104: United States Health Care and Gratuitous Privatization

We Look Forward to Seeing You

on October 16th.

Thank You!

Legislative Planning for 2008 Medical Society of the State of NY

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