Kent County Resolutions to the 2018 MSMS HOD
09-18 – BCBSM Disallowance of Multiple Services by Same Physician on Same Date of Service – SUBSTITUTE
Original Author: Jayne Courts, MD
The Committee decided to address Resolutions 09-18 and 22-18 together and drafted the following substitute resolution:
Title: Payment of Additional Services
Whereas, physicians may provide separate and distinct services during an office visit encounter, and
Whereas, the services provided and the relevant documentation clearly support the delivery of such separate and distinct services, and
Whereas, returning for one or more services at a future date is an inconvenience for the patient, involving more time and expense when it could have been delivered on the same date of service, and
Whereas, some patients have a difficult time arranging for additional transportation, and
Whereas, the current billing approach often necessitates a separate office visit to address other medical concerns which adversely affects patient satisfaction and physician reimbursement; therefore be it
RESOLVED: That MSMS supports the ability of physicians to perform and receive payment for the provision of separate and distinct services on the same date of service; and be it further
RESOLVED: That MSMS work with third-party payers to allow billing that accurately reflects the services provided and documented, which may include the provision of multiple, distinct services.
During testimony it was suggested that some of the resolutions addressing payment for services provided on the same date by the same physician be combined. The Committee agreed that Resolutions 09-18 and 22-18 were similar enough that a substitute resolution could be drafted to encompass the broader issues advocated by both authors.
17-18 – Limit Quality Metrics – AMEND
Original Author: Jayne Courts, MD
RESOLVED: That MSMS work with the appropriate stakeholders to align and restrict the maximum number of quality metrics for a primary care physician to follow each year to ten quality metrics; and be it further
RESOLVED: That MSMS advocate that third-party payers refrain from modifying more than two quality metrics in any given calendar year to allow more consistency in quality and cost in the delivery of health care.
The Committee removed the third and fourth Resolved statements in recognition of existing AMA policy and advocacy regarding the alignment and simplification of quality measures across payment programs.
18-18 – Code Status Through the Continuum of Care – AMEND
Original Author: Jayne Courts, MD
RESOLVED: That MSMS work with the Michigan Hospice and Palliative Care Association and related organizations to promote the transfer of code status orders upon transfer to the next site of care; and be it further
RESOLVED: That MSMS work with the Michigan Hospice and Palliative Care Association and related organizations to develop a system for sharing Advance Directives and code status for Michigan residents throughout the continuum of care; and be it further
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask our AMA to work with the Centers for Medicare and Medicaid Services to revise or rescind the rules that prevent transfer of code status across the continuum of care in order to better meet the needs of our patients and our health care system in a comprehensive, cohesive, and more cost-effective manner.
The Committee heard testimony that a patient’s advance directive and code status is not universally transmitted during transitions of care. The Committee agreed that this is problematic. An amendment was requested to apply the sharing of information for all patients regardless of age. The Committee amended the second Resolved statement to remove reference to residents “who are eighteen years of age and older” and to include the goal of sharing information across the continuum of care.
19-18 – Reimbursement for Telemedicine Visits – REFER
Original Author: Jayne Courts, MD
RESOLVED: That MSMS work with third-party payers to allow a similar charge to patients for synchronous and asynchronous telemedicine services to encourage increased access and use of these services by patients and physicians; and be it further
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask our AMA to work with third-party payers at the national level to encourage allowance of a similar charge to patients for synchronous and asynchronous telemedicine services to encourage increased access and use of these services by patients and physicians.
20-18 – Board Certification Changes Impact Access to Addiction Medicine Specialists – APPROVE
Original Author: Jayne Courts, MD
RESOLVED: That MSMS work with the Michigan Society of Addiction Medicine to lobby for acceptance of American Board of Addiction Medicine board certification as equivalent to American Board of Medical Specialties board certification for Addiction Medicine with hospitals and third-party payers in the state of Michigan; and be it further
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask our AMA to work with the American Board of Addiction Medicine (ABAM) and American Board of Medical Specialties (ABMS) to accept ABAM board certification as equivalent to any other ABMS-recognized Member Board specialty as a requirement to enroll in the transitional maintenance of certification program and to qualify for the ABMS Addiction Medicine board certification examination.
21-18 – Voluntary Legislator Conflict of Interest Disclosure – AMEND Original Author: Jayne Courts, MD
RESOLVED: That MSMS work with the Michigan Legislature to encourage voluntary public disclosure of potential conflicts of interest – personal, professional, and financial – by all Michigan legislators to improve transparency and ethics in the state of Michigan when deliberating on any legislation.
The Committee worked with the author to amend the language to focus more on legislation dealing with health care. However, the House of Delegates extracted the Resolution and amended it to apply when deliberating on “any” legislation. Resolution 21-18 was approved as amended.
22-18 – Allow Billing of Additional Services – SUBSTITUTE (See Resolution 09-18)
Original Author: Jayne Courts, MD
23-18 – Barriers to Pain Medication for Palliative Care and Hospice Patients – AMEND
Original Author: Jayne Courts, MD
RESOLVED: That MSMS work with the Michigan Hospice and Palliative Care Association and with Michigan legislators to amend each of the recently passed opioid laws to include legal exemptions to the provisions within these statutes when prescribing controlled substances for active malignancy and/or hospice patients as well as those receiving palliative care.
The Committee worked with the author of this resolution and the author of Resolution 62-18 to include the intent of both resolutions in this resolution.
46-18 – Oppose Legalized Marijuana – AMEND
Original Author: Donald P. Condit, MD
RESOLVED: That MSMS actively oppose legislation and/or ballot initiatives that seek to legalize recreational marijuana in the State of Michigan; and be it further
RESOLVED: That MSMS adopt policy opposing the legalization of recreational marijuana in the State of Michigan.
The Committee originally recommended disapproval. Although the Committee does not support legalizing marijuana for recreational use, it believed that expending the resources necessary for effective opposition was not a prudent use of Michigan State Medical Society resources which would best be spent on the education and research around this issue. The Resolution was extracted, and the House voted to amend. Resolution 46-18 was approved as amended.
65-18 – Resolution Status Reports – AMEND
Original Author: Brian Roelof, MD
RESOLVED: That MSMS staff communicate with the author of any resolution(s) by email at six (6) and 12 months to provide the status of the resolution (i.e., enacted, status with the legislators, has become policy, was dropped from consideration due to a reason, is still being worked on and by whom, etc.).
The Committee amended the resolution to clarify the timeline.
66-18 – Support for Public Health Vaccine initiatives – APPROVE
Original Author: Gerald Lee, MD
RESOLVED: That MSMS supports the broad authority of the Michigan Department of Health and Human Services to protect all Michigan citizens from vaccine-preventable disease using evidence-based policies for public health.
69-18 – End “Part 4 Improvement in Medical Practice” Requirement for ABMS MOC® – APPROVE
Original Author: Megan Edison, MD
RESOLVED: That MSMS reaffirms our professional commitment to improving patient health outcomes through quality improvement projects and medical research; and be it further
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask our AMA to call for an end to the mandatory American Board of Medical Specialties “Part 4 Improvement in Medical Practice” maintenance of certification requirement.
70-18 – Oppose Recreational Marijuana Use – APPROVE
Original Author: Sandy Dettmann, MD
RESOLVED: That MSMS opposes legalization of marijuana for general recreational use; and be it further
RESOLVED: That MSMS collaborate with other stakeholders to oppose the legalization of marijuana for general recreational use.
The Committee originally recommended disapproval. Although the Committee does not support legalizing marijuana for recreational use, it believed that expending the resources necessary for effective opposition was not a prudent use of Michigan State Medical Society resources which would best be spent on the education and research around this issue. The Resolution was extracted, and the House voted to approve.
71-18 – Educate Patients about Overdose Prevention Kits – AMEND
Original Author: Sandy Dettmann, MD
RESOLVED: That MSMS educate its members about opportunities to co-prescribe naloxone to patients at risk of overdose.
The Committee clarified the scope of education to be provided by MSMS. Per the AMA’s Opioid Task Force, “co-prescribing naloxone is supported by a broad range of stakeholders including the World Health Organization, U.S. health agencies (CDC and SAMHSA), state departments of health, and many patient, consumer and other advocacy groups.”
72-18 – Protect Physician-Led Medical Education – APPROVE
Original Author: Megan Edison, MD
RESOLVED: That MSMS affirm the rights of medical students, residents, and fellows training in the State of Michigan to be trained, supervised, and evaluated by licensed physicians; and be it further
RESOLVED: That MSMS provide Michigan medical students, residents, and fellows a clear online resource outlining their rights, as per Liaison Committee on Medical Education and Accreditation Council for Graduate Medical Education guidelines, to physician-led education and a means to report violations without fear of retaliation; and be it further
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask our AMA, in their role as a member organization of the Liaison Committee on Medical Education and Accreditation Council for Graduate Medical Education, to strongly advocate for the rights of medical students, residents, and fellows to be trained, supervised, and evaluated by licensed physicians; and be it further
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask our AMA to provide medical students, residents, and fellows a clear online resource outlining their rights, as per Liaison Committee on Medical Education and Accreditation Council for Graduate Medical Education guidelines, to physician-led education and a means to report violations without fear of retaliation.
The Committee recommended disapproval. Based on the Committee’s knowledge, the Liaison Committee on Medical Education and Accreditation Council for Graduate Medical Education currently have requirements regarding physician involvement in physician education. Additionally, there are reporting mechanisms to ensure medical students, residents, and fellows are trained, supervised, and evaluated by licensed physicians. Resolution 72-18 was extracted, and the House of Delegates approved as originally introduced.
77-18 – Streamline Mandatory Reporting of Inappropriate Sexual Behavior and Abuse- AMEND
Original Author: Gerald Lee, MD
RESOLVED: That MSMS denounce unsafe, inappropriate, unprofessional, or sexual behaviors toward patients; and be it further
RESOLVED: That MSMS work with stakeholders in law enforcement, the Michigan Department of Licensing and Regulatory Affairs, and Michigan’s Licensing Boards to develop a streamlined, confidential reporting system for medical personnel and patients to report any suspected inappropriate sexual behavior involving health care professionals and patients, with directives to report suspected criminal activity, such as sexual abuse and assault, to law enforcement, without risk; and be it further
RESOLVED: That MSMS create a free online continuing medical education program on the issue of inappropriate sexual behaviors and criminal sexual misconduct towards pediatric and adult patients and how to report behavior in Michigan, that will fulfill the 1-hour CME requirement in ethics for a Michigan license.
79-18 – Referral to Addiction Medicine Specialists – APPROVE
Original Author: Sandy Dettmann, MD
RESOLVED: That MSMS encourage the referral of persons with an opioid use disorder who would benefit from medication-assisted treatment to buprenorphine-waivered physicians when the physician has determined that the patient has an opioid use disorder; and be it further
RESOLVED: That MSMS encourage physicians to obtain the DATA 2000 waiver to prescribe opioid replacement for individuals with an opioid use disorder; and be it further
RESOLVED: That MSMS keep a database of physicians who have experience with the disease of addiction who are willing to serve as “mentors” to those physicians who are new to the use of medication-assisted treatment of opioid use disorder.
84-18 – Report Health Care Provider Sex Crimes to Law Enforcement – AMEND Original Author: Megan Edison, MD
RESOLVED: That MSMS work with the Michigan Legislature to amend the Michigan Public Health Code to require the state Board of Medicine to report criminal sexual conduct or predatory sexual behavior to the appropriate law enforcement agencies; and be it further
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask our AMA to work with the Federation of State Medical Boards to create and encourage state adoption of “model public health code language” that would require all state medical boards to report criminal sexual conduct or predatory sexual behavior to appropriate law enforcement authorities.
The Committee removed the word “potential” before criminal sexual conduct in both resolved clauses.