20.00 SPECIALTY SOCIETIES AND SECTIONS

One Task Force member who could not attend the meeting asked staff to relay his opposition to the resolution. He noted that International Medical Graduates are effective in getting elected as delegates from their county societies and currently make up a significant portion of the House (in 2007,117 of 396 delegates, or 30 percent).

Other Task Force members, countered, stating that many of the ethnic medical societies are primarily social organizations and that being granted a delegate would likely encourage participation in MSMS activities as well as potentially increase membership.

Staff pointed out that there are approximately 13 active ethnic medical societies in Michigan and that about four or five currently would qualify for a delegate if based on the same criteria as that for specialty society representation.

Those Task Force members present unanimously approved the recommendation noted above.

The MSMS Board of Directors approved the recommendation of the Task Force that the 2008 House of Delegates approve this resolution.

BOARD ACTION REPORT #2 – HOD Resolution 10-07A – Grant Category I Continuing Medical Education Credit to Component County Medical Societies.

The House approved the Board’s recommendation that this resolution be ADOPTED.

RECOMMENDATION: That the 2008 House of Delegates adopt Resolution 10-07A, “Grant Category I Continuing Medical Education Credit to Component Medical Societies.”

Resolution 10-07A was referred to the MSMS Board of Directors for study. The Board assigned the resolution to the Committee on Membership Recruitment and Retention for review and recommendation.
Resolution 10-07A asked that MSMS “explore alternate ways to entice members by offering Continuing Medical Education Category I credits at county society meetings.”

While not stated in the resolution, resolution author Doctor Ismael D. Yanga explained that his intent was for MSMS to eliminate application fees for the smaller county medical societies. Rebecca Blake, Director, Center for Physician Education and Leadership, explained that currently all county medical societies, as well as state specialty societies and MSMS internal conferences, are charged $150 per CME application, compared to other accrediting bodies that charge an average of $2,000. Counties already have the ability to cut that cost by applying for multiple programs at one time for one application fee of $150. Additionally, the MSMS Center for Physician Education and Leadership completes and files the application as an additional benefit to the county society.

MSMS collects approximately $10,500 in application fees annually. This revenue is used to pay the national ACCME CME accreditation fees of approximately $6,500 and half of the salary of a staff person responsible for the CME accreditation. If these fees were waived, the cost would have to be absorbed in the general budget.

Since the resolution only asked that MSMS explore alternate ways, Committee members suggested that the MSMS Center for Physician Education consider different ways to assist the county medical societies with the application fee, including making it an annual one-time fee for unlimited programs. It was also suggested that smaller counties could add $5 to their dues statement to cover the cost of CME programs, if they wished. Committee members expressed concern about waiving fees only for county societies, and not for the other entities it currently accredits.

The MSMS Board of Directors approved the recommendation of the Committee that the 2008 House of Delegates approve this resolution.

BOARD ACTION REPORT #3 – HOD Resolution 22-07A – Simplifying Patient Access to Specialist Care.

The House REFERRED THIS REPORT BACK TO THE BOARD FOR FURTHER STUDY.

RECOMMENDATION: That the 2008 House of Delegates take no action on Resolution 22-07A, “Simplifying Patient Access to Specialist Care.”

Resolution 22-07A was referred to the MSMS Board of Directors for study. The Board assigned the resolution to the Committee on Health Care Quality, Efficiency and Economics for review and recommendation.

Resolution 22-07A asked that MSMS "seek policy to ensure inclusion on all health maintenance organization panels to any specialist regardless of PO, IPA or hospital affiliation to allow patients appropriate and expedient access to care.”

The core issue is the interaction between a health plan participating physician network and a PO or IPA. Physicians refer to the physician they feel is most suitable for care needed, and the resolution called into question whether physicians who were part of a plan participating network, but not part of the PO or IPA would not receive referrals. The author stated that physicians can refer outside of the group but will not always do so or would not submit needed paperwork for the referral.

Members of the Council of Physician Organizations agreed that physicians should refer outside of a PO if appropriate and that any needed paperwork should be handled to allow the physician to treat the patient.

Committee members understood the concern of the resolution author, but felt that they did not have sufficient clarity after several discussions to define an appropriate MSMS position on the issue. The Committee recommended to the MSMS Board of Directors that no action be taken on the resolution, but would encourage the resolution author to submit a new resolution with more specific language.

The MSMS Board of Directors approved the recommendation of the Committee that the 2008 House of Delegates take no action on this resolution.

BOARD ACTION REPORT #4 – HOD Resolution 47-07A – Allowing Patients to See Out-of-Network Physicians.

The House approved the Board’s recommendation that this resolution be ADOPTED AS AMENDED.

RECOMMENDATION: That the 2008 House of Delegates adopt Resolution 47-07A, “Allowing Patients to See Out-of-Network Physicians,” as amended to read:

RESOLVED: That MSMS work with the legislature and the Michigan Department of Community Health to establish a methodology to measure access and create a mechanism to assure access to care for Medicaid patients in the various geographic regions of the state that includes maintaining sufficient physician networks to deliver primary and specialty care.

Resolution 47-07A was referred to the MSMS Board of Directors for study. The Board assigned the resolution to the Committee on State Legislation and Regulations for review and recommendation.

Resolution 47-07A asked that MSMS "work with insurance plans and the legislature to allow patients to see out-of-network physicians in their area at no increased cost to them, instead of traveling great distances to see an in-network physician; and that MSMS work with Medicaid managed care plans to allow physicians to limit their acceptance of these plans to provide service to patients within a limited geographic area.”

The Committee concluded that the author had raised an issue of importance within the Medicaid program. When patients are forced to travel long distances in order to access relatively routine specialty care, the adequacy of physician networks is questionable. However, the Committee was not certain that the approach recommended by the author was workable.

The author asked that patients without access to an in-network physician in their local community be able to obtain care from an out-of-network physician at no additional charge. This approach would potentially eliminate any incentive for physicians to participate within the network. Health plans are often willing to pay out-of-network rates, however, payments at this level are still less than rates paid by Medicare.

As long as Medicaid rates continue to lag far behind those of other insurers, physician participation will remain a problem. While funding is the underlying problem, the Medicaid HMOs have accepted money from the state to provide a service to Medicaid patients. Therefore, the Committee believes the state has a responsibility to assure that the health plans are meeting a fundamental aspect of the service that they are contracted to provide.

The MSMS Board of Directors approved the recommendation of the Committee that the 2008 House of Delegates adopt this resolution as amended.

BOARD ACTION REPORT #5 – HOD Resolution 61-07A – Minimizing Risk of Food Borne Illness at Buffet-Type Restaurants.

The House approved the Board’s recommendation that this resolution be DISAPPROVED.

RECOMMENDATION: That the 2008 House of Delegates disapprove Resolution 61-07A, “Minimizing Risk of Food Borne Illness at Buffet-Type Restaurants.”

Resolution 61-07A was referred to the MSMS Board of Directors for study. The Board assigned the resolution to the Liaison Committee with Michigan’s Public Health for review and recommendation.
Resolution 61-07A asked that MSMS “urge Governor Granholm and the Michigan legislature to mandate that all food service buffet lines that make use of shared utensils provide disposable gloves for diners for handling said utensils.”

The Committee felt this resolution was timely and worthy of study to determine the most appropriate recommendations to achieve safer food in all restaurants. The Committee sought information and opinions from the Center for Disease Control, the Michigan Department of Agriculture, and a number of local public health departments.
Buffets do not currently have gloves available for persons to use. Typically, there are scoops, tongs, etc., that multiple people handle while taking food from the buffet line and placing onto their own plates and people handle these utensils with bare hands. The food code does require a restaurant employee trained in safe operating procedures to monitor a buffet, and they can replace utensils if there is obvious contamination, such as a ladle being dropped on the ground.

The Committee learned that these types of multi-used utensils may be a factor in the transmission of highly infectious agents, such as Norovirus, in an outbreak situation; however, Salmonella would not be highly transmissible via utensil handles on a buffet line. According to the Michigan Department of Agriculture, the use of gloves in retail food establishments is not a recommended disease control measure (in buffet serving utensils, door knobs, money, etc). Use of gloves can foster a false sense of security and studies support this. Further, latex gloves add an increased risk of allergic response.

All experts consulted agreed that simple hand washing before and after eating is the best defense against food borne illness.

The MSMS Board of Directors approved the recommendation of the Committee that the 2008 MSMS House of Delegates disapprove this resolution.

BOARD ACTION REPORT #6 – HOD Resolution 64-07A – Minimizing Transmission of Infection in School Age Children.

The House approved the Board’s recommendation that this resolution be DISAPPROVED.

RECOMMENDATION: That the 2008 House of Delegates disapprove Resolution 64-07A, “Minimize Transmission of Infection in School Age Children.”

Resolution 64-07A was referred to the MSMS Board of Directors for study. The Board assigned the resolution to the Liaison Committee with Michigan’s Public Health for review and recommendation.

Resolution 64-07A asked that MSMS “support national and local legislation that would provide full-time workers paid sick time to care for themselves or a family member with pro-rated time off for part-timers and that MSMS promote/develop educational materials and guidelines for Michigan schools and day care centers to emphasize proper hand washing and provide the capability to sequester/isolate/separate children with a presumable contagious illness in order to minimize the spread of infection to others.”

The Committee appreciated the intent of the resolution to minimize the transmission of infection in children but to legislate mandatory paid time off, especially for part time workers seemed out of the scope of the medical society. Additionally, the Committee was informed that school districts through the Healthy Schools, Health Students initiative, teach students the importance of hand washing and proper hygiene.

The MSMS Board of Directors approved the recommendation of the Committee that the 2008 House of Delegates disapprove this resolution for reasons associated with cost and feasibility.

BOARD ACTION REPORT #7 – HOD Resolution 75-07A – DO Physicians as Members of the County Society at a Reduced Rate.

The House approved the Board’s recommendation that NO ACTION be taken on this resolution.

RECOMMENDATION: That the 2008 House of Delegates take no action on Resolution 75-07A, “DO Physicians as Members of the County Society at a Reduced Rate.”

Resolution 75-07A was referred to the MSMS Board of Directors for study. The Board assigned the resolution to the Committee on Membership Recruitment and Retention for review and recommendation.

Resolution 75-07A asked that MSMS “formulate a plan in which the DO physicians who are members of the Michigan Osteopathic Association are allowed to be an associate or a non-active member of a county medical society at a reduced rate that is the equivalent of county society dues along with a nominal administrative fee so that they could participate in social and other activities of the county society without being a voting member.”

The Committee discussed how there is nothing that precludes counties from including non-member osteopathic physicians in their meetings as guests. In fact, many counties already have non-member DO physicians regularly attending their meetings as guests, charging a minimal amount to cover their meals. While county medical society bylaws must concur with MSMS’ Bylaws, counties may decide how local DO physicians participate in their meetings as guests.

The MSMS Board of Directors approved the recommendation of the Committee that the 2008 MSMS House of Delegates take no action on this resolution.