130.925        Managing Conflict of Interest Inherent in New Payment Models Patient Disclosure

The Medical Society of the State of New York will seek legislation requiring complete disclosure of potential conflicts of interest by:

  1. All insurance plans: Medicare (Medicare Advantage), Medicaid, and commercial insurers.
  2. Employers of physicians (ex., Accountable Care Organizations in the Medicare Shared Savings Program).
  3. Pharmacy Benefit Managers.

The disclosures should be written in plain language and detail the following:

  1. The type of physician incentive arrangement, whether withhold, bonus, or capitation.
  2. The percentage of the withhold or bonus as the intensity of the incentives clearly affects the extent of the physician’s conflict of interest.
  3. The amount and type of stop-loss protection.
  4. A breakdown of capitation payments by the percentages for primary care, specialty, hospital, or other services.
  5. Whether physicians are at significant risk for services not personally provided by them.
  6. The possibility of a reduction in care that has a positive expected benefit but is not deemed cost-effective.
  7. Disclosure of any and all potential “shared” savings that may be potentially earned by the provider organization or individual providers from limiting patient options, access to specialist referrals, diagnostic testing and treatment.

The Medical Society of the State of New York also requests that the American Medical Association advocates for legislation requiring full patient disclosure. (HOD 2023-260)