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Physicians in New York want the American Medical Association to support a "universal out-of-network benefits" proposal.
The drafters of the proposal say that all health plans should pay a reasonable amount for out-of-network care.
The current U.S. provider network rules give managers of health plans without out-of-network benefits a financial incentive to create artificial provider shortages, by refusing to pay physicians enough to persuade physicians to join their networks, according to the resolution.
"State laws that require insurers to allow patients to seek an out-of-network physician when appropriate will always be entirely inadequate, because insurers will always determine that a patient doesn't need an out-of-network physician," the drafters say in the resolution preamble. "The now frequent need to wait months to see a physician would largely resolve if patients all had out-of-network benefits and could see any practicing physician."
Simply requiring plans to provide an adequate level of out-of-network benefits would be a much better strategy than trying to increase the supply of care by letting nurses and physician assistants provide care without physician supervision, the drafters add.
The proposed resolution is one of many proposals included in a packet prepared for a four-day American Medical Association House of Delegates meeting that started today in National Harbor, Maryland.
About 270,000 of the 1.3 million U.S. physicians belong to the AMA.
The AMA's House of Delegates has no direct effect on federal or state law, but it determines what AMA lobbyists tell state and federal legislators and regulators.
The body has weighed in on many issues over the years, ranging from guidelines for health savings accounts to restrictions on plans' efforts to manage participants' use of care.
For the current AMA meeting, the New York AMA delegation has also proposed resolutions calling for increased regulation of for-profit health insurance; requiring health plans that cut physicians out of plan networks to help the physicians' patients find new in-network physicians; and requiring insurers to feed information about their coverage and payment policies into electronic health record systems.
Other groups have submitted proposals related to topics such as medical education; efforts to improve the quality of care; and ways to rein in health insurers' prior authorization programs.
The backdrop: Patients and benefits advisors hate having to play detective to determine which providers are in a plan's network.
Officials in the U.S. Health and Human Services Office of the Inspector General recently reported that only about 40% of the plans they reviewed kept the percentage of inactive providers listed in their provider directories below 33%.
But health plan sponsors and administrators see use of provider networks as a way to get volume discounts by sending a large number of patients to efficient, affordable providers.
Mark Bertolini, the chief executive officer of Oscar Health, suggested during a recent conference call with securities analysts that putting people in small, high-quality, well-tailored provider networks can be a good way to hold down health care spending without hurting the quality of care.
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