Resolutions Hit the Ground Running

CMS at work setting legislative agendas in Springfield and Washington

YOUR CHICAGO Medical Society made a proud showing at the 2017 Illinois State Medical Society House of Delegates, demonstrating the value of membership. Through our resolutions process CMS not only advances key reforms on your behalf in the ISMS House, but we also create a vehicle for physician-members who desire an active and personal role in shaping agendas, from policy to legislation.

This year’s annual meeting, held on April 21-23, saw a strong lineup of CMS proposals go on to win approval by the House, clearing the way for legislative advocacy in Springfield or for in-depth study of complex issues prior to formulating a plan for implementation. CMS delegates also heard progress reports on their efforts of years past, such as CMS proposals to address gun violence and to expand leadership opportunities for trainees and students within ISMS.

In today’s evolving practice environment and healthcare system, you can count on CMS to keep the needs and concerns of physicians front and center. Our position is that affordable, accessible health insurance coverage go hand-in-hand with regulatory and financial relief for our members. Here’s a recap of CMS resolutions activity from Oak Brook, site of the 2017 House meeting.

Elimination of Medical Center Restrictive Covenant and Noncompete Clauses
By Jerrold B. Leikin, MD, and Scott M. Leikin, DO
Medical center employment contracts impose an undue hardship on hospital-based specialists. A big issue today, these restrictive covenant clauses limit physicians who don’t even have their own patients such as emergency medicine, hospitalist medicine, pathology, radiology, and anesthesia. Taking aim against this practice, the Chicago Medical Society adopted new policy to abolish post-employment non-compete clauses from any medical center corporation contract unless the physician owns equity in the practice.

Now CMS is urging ISMS to adopt the same policy and to support or introduce legislation that eliminates the enforceability of these clauses and covenants from medical center employment contracts when the physician has no equity in the practice. The legislation also would ban the use of such clauses in medical center physician contracts.

Due to the complexity and merits of restrictive covenants for different types of physician work environments, ISMS voted to study the measure in-depth. Referred for Study and Report Back

Employed Physicians Bill of Rights
By Jerrold B. Leikin, MD, Susan Acuna, MD, Brad L. Epstein, MD, Patrick Para, DO, and Andrew Ward, MD
This multipronged Chicago Medical Society and Kane County Medical Society resolution calls for ISMS to champion an “Employed Physicians Bill of Rights.” As such, ISMS will support or introduce legislation modeled after principles laid out in the resolution, which would establish a legal basis for employed physicians’ contract provisions with healthcare corporations. These provisions address physician compensation; academic freedom; peer review of clinical activity; data entry, coding and management of electronic medical record systems; activities outside of defined employed time boundaries; and conflict of interest disclosures. Adopted

Firearm Sales Legislation
By Kathy Tynus, MD
In 2016, the Chicago Medical Society urged ISMS to support criminal background checks for all gun sales, public, private and Internet-based. Under this amended resolution, ISMS will support legislation that would restrict the sale of assault weapons with large-capacity magazines of 10 rounds or greater for civilian use. Adopted as Amended

Over-the-Counter Contraceptive Drug Access
By James Curry, Medical Student
Back in 2016, the Chicago Medical Society requested that ISMS research and develop policy for equitable access to OTC contraceptives, including those recommended for OTC sale.  Other provisions in the resolution prohibit costsharing obstacles to OTC contraceptive access, and full coverage of all contraception without regard to prescription or OTC utilization, since all contraception is essential preventive health care.

ISMS will advocate for simpler FDA OTC drug approval applications and registration, as well as regulations that promote access to sufficient varieties of OTC contraception in the marketplace, and further advocate for legislation and regulation to improve OTC contraceptive drug access and quality.

The measure now moves on to the AMA House of Delegates for similar policy and action. Adopted

Perioperative Do Not Resuscitate Orders
By Barbara Jericho, MD
Under this Chicago Medical Society initiative, ISMS policy will support the “required reconsideration” of a patient’s existing advance directives in the perioperative period, prior to a procedure or surgery and the administration of anesthesia. ISMS will educate its members on the importance of perioperative review of patients’ do-not-resuscitate advance directives. Adopted as Amended

Inappropriate Requests for DEA Numbers
By Howard Axe, MD
In response to companies requesting physicians to provide a DEA number for reasons that do not involve a prescription for controlled substances, this resolution from the Chicago Medical Society calls upon ISMS and AMA to collect information on how often and under what circumstances physicians receive these requests. The resolution also directs both ISMS and AMA to seek legislation that would penalize companies making such inappropriate requests. Adopted

Advanced Care Planning Codes
By Howard Axe, MD
Both the Chicago Medical Society and ISMS were instrumental in the enactment of new codes for advanced care planning that reimburse physicians for time spent discussing end-of-life care with patients.

Now, under this new CMS resolution, ISMS and AMA will take steps to assess the degree to which Advanced Care Planning Codes 99497 and 99498 have been used since then, with the goal of studying the barriers to advanced care planning by physicians and patients. In addition, the measure would enable use of these codes over multiple clinical visits to satisfy the time requirements, given the complexity of these discussions and the number of clinical staff involved as well as family members of the patient. Adopted

Opposing Attorney Presence and/or Recording of IMEs
By Jerrold B. Leikin, MD
A measure from the Chicago Medical Society proposes a feasibility study of state and federal policy that would prohibit the recording, videotaping, or the presence of court reporters or opposing attorneys during the independent medical exam as a condition for medical opinions being allowed in court.

The resolution would encourage legislation to prohibit courts from compelling or permitting these activities. Finally, it would add such policy to the 7th Edition of the AMA’s Guides to the Evaluation of Permanent Impairment. Given the scope and nature of the resolution, ISMS will study the measure in-depth. Referred for Study and Report Back

Acceptance of Hospital-Based Serum Alcohol Results in Litigation
By Jerrold B. Leikin, MD
This Chicago Medical Society resolution requests ISMS to seek legislation so that courts accept the validity of test results without further physician or other expert testimony. According to the measure, there is no clinical difference (and minimal analytical difference) between a hospital-based serum alcohol test and whole blood alcohol concentration. Courts should adjudicate as such, and not interpret hospital-based alcohol testing as “speculative” and not bar such testing. Finally, the resolution says hospital-based alcohol concentrations should be admissible as evidence of intoxication even without other evidence. Adopted

Improving the Insurance Appeals Process
By A. Jay Chauhan, DO
This Chicago Medical Society resolution would require insurance companies to state the criteria by which a prior authorization assessment is denied and to provide in the initial denial letter to the patient and physician the criteria for approval. CMS’ directive calls for ISMS to work with interested parties and their representatives with the goal of requiring insurance companies to provide this information. Adopted

Pronunciation of Pharmaceutical Names
By B.H. Gerald Rogers, MD
As the number of complicated brand and generic names for drugs multiply, so does the challenge of referring to them accurately in a discussion with colleagues and patients. That’s why the Chicago Medical Society is requesting ISMS and the AMA to adopt policy that AMA-sponsored medical journals develop means to convey the proper pronunciation of all new pharmaceutical names. Adopted as Amended

Voting Privileges for Trainees and Medical Students
By Kathy Tynus, MD
In 2016, the Chicago Medical Society asked ISMS to increase opportunities for students and trainees within the fold of organized medicine. Following months of study, ISMS opted to approve additional medical student and resident physician voting delegates within the House of Delegates. These additional delegates will accrue to the ISMS Medical Student Section and ISMS Resident and Fellow Section, respectively. The allocation methodology allows for one delegate for each 75 members in the Resident and Fellow Section, and one for a major fraction thereof, as determined by ISMS membership rolls on Dec. 31 of the preceding year. The Medical Student Section is entitled to send one delegate per each Illinois medical school campus. Substitute Adopted

Protecting Medical Trainees from Hazardous Exposures
By A. Jay Chauhan, DO
ISMS voted to study in-depth a Chicago Medical Society resolution that seeks the voluntary education of students, residents, physicians and surgeons about their occupational exposure to harmful substances.

The measure encourages giving trainees the option of excusing themselves from exposure to hazardous materials without negatively impacting their standing in a training program.

Trainees who may be pregnant would have the ability to excuse themselves from exposure to Methylmethacrylate without harming their standing. Referred for Decision

“Stop the Bleed” Campaign
By Raj B. Lal, MD
This important public health initiative from the Chicago Medical Society calls upon ISMS and AMA to actively promote the education of physicians, other professionals and the public through a “Stop the Bleed” campaign that prepares bystanders to save lives by rendering first aid (hand pressure, tourniquets, hemostatic pressure and gauze bandages) prior to the arrival of first-responders. Locally, CMS will bring this effort to the Chicago City Council. Adopted