165.997 Physician Participation in Managed Care Plan:
MSSNY reaffirms current policy on managed care adopted by the Council on March 10, 1994 which is consistent with AMA policy and addresses the right of any physician to seek participation in any health care system. The relevant provisions of this policy read as follows:
(1) Physicians should have the right to join any health care plan or network in which they desire to participate and to have that application judged on the basis of objective criteria that are available to both applicants and enrollees.
(2) Those managed care plans that contract with selected physicians to furnish care should utilize selection criteria based primarily on professional competence and quality of care. Any economic criteria used in such selective contracting should have a demonstrated positive relationship to the quality and appropriateness of care and to professional competency.
(3) Selective contracting decisions made by any health delivery or financing system should be based on an evaluation of multiple criteria related to professional competency, quality of care, and the appropriateness by which medical services are provided. In general, no single criterion should provide the sole basis for selecting, retaining, or excluding a physician from a health delivery or financing system.
MSSNY further espouses the policy that no managed care entity may discriminate against the application of any properly credentialed physician licensed to practice in New York State regardless of board certification status. MSSNY will urge the New York State Department of Health and the New York State Health Maintenance Organization Council to support the MSSNY Managed Care Policy provision which are advanced in the interest of: (1) Continued quality patient care through sustained physician/patient relationships; (2) Equity through the elimination of demeaning, discriminatory, and prejudicial physician enrollment practices and will communicate these principles to all managed care systems doing business in New York State. (HOD 1994-259; Reaffirmed HOD 1996-270, HOD 1997-222 & HOD 2003-100; Reaffirmed HOD 2013; Reaffirmed HOD 2023)
