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At Behest of NY Delegation, AMA Takes Position on "Code of Conduct" for Health Plans

Building on the survey it publicized back in September, the New York delegation to the AMA carried its efforts a step further by offering a resolution in the AMA House of Delegates "calling upon the American Medical Association to create and implement a Code of Conduct for the health insurance industry." The resolution was approved unanimously, according to a MSSNY press release issued November 10.

Of particular significance to the physician community, the adopted resolution calls upon the AMA to also develop a mechanism to monitor health plan compliance with the "Code of Conduct" and to disseminate widely health plan compliance rates to physicians and patients across the country. "While development of a health plan code of conduct is a valuable first step, the critical element of this resolution is the mechanism that will be employed to monitor health plan compliance with the Code of Conduct," said Michael Rosenberg, MD, President of the Medical Society of the State of New York. "Properly constructed, this tracking mechanism will provide employers and the public with substantive data to empower and inform their decision-making regarding their choice of health insurer. Moreover, the information that is collected can be used by State Attorneys Generals to enforce compliance or to seek significant changes to health plan policies and procedures to protect and assure patient access to medications and treatments prescribed by their practicing physicians," added Dr. Rosenberg.

I'm not entirely sure what to make of this. What I am sure of, though, is that adding state attorneys general to the already large list of entities regulating health plans is a bad idea.

In New York, health plans are already regulated directly by two state entities: the Insurance Department and the Department of Health. Both carry out extensive periodic audits, and both conduct routine investigations following up on complaints. In addition, health plans participating in the Medicare Advantage or Medicare Part D programs are subject to intensive oversight from CMS. These agencies often end up working at cross purposes, where certain activites mandated by one entity result in adverse audit findings when reviewed by another.

The heads of the insurance department, health department, and CMS are all appointed. That's no guarantee of insulation from political influences; but the individuals that end up running these agencies are usually not interested in winning elections, and therefore have less reason to play up to popular sentiment.

Attorneys general, on the other hand, are elected. It is in the nature of their office, therefore, to look for issues that play to popular sentiment and to exploit those issues for the publicity and popularity that ensures re-election or, in many cases, election to a higher office.

In addition, at least in New York, the Attorney General already has authority over health plans, in particular when consumer deception is alleged. Consumer protection is a common interest, is the AG's proper bailiwick, and in fact is in keeping with the publicly elected nature of the office. But physicians are a special interest, not a common interest, and I can't think of a good reason why a powerful authority like the AG should become the legislated champion of one particular special interest over any other.

If the AMA indeed thinks a code of conduct is required (which is another topic altogether, but a fight I'm not picking today), its seems that there would be ample opportunity to implement such a code through existing lines of authority. Indeed the New York Insurance Department has already gone in that direction. This would be preferable to the introduction of (yet) another nuts-and-bolts-level regulator to the health insurance industry.

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This page contains a single entry from the blog posted on November 13, 2008 8:17 AM.

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