900. Administration and Organization

900.975 Spring Conference

 

Statement of Purpose

It shall be the purpose of the CMS Spring Conference to:

  1. Create unity among physicians, a larger voice for the profession, increased involvement and a greater overall impact on the health of Colorado.
  2. Attract new faces to CMS, with specific outreach to employed physicians, less active members and non-members so as to achieve greater diversity among the attendees and a welcoming atmosphere.
  3. Build new relationships, develop and learn new ideas in order to address the critical issues facing physicians.
  4. Place an emphasis on broadening the view of attendees by bringing in outside experts and an equal emphasis on relevant policy matters.

(BOD-1, AM 2012; Reaffirmed, BOD-1, AM 2014)

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900.976 Strategic Plan

 

The Colorado Medical Society Strategic Plan
Version 10/13/14

CORE PURPOSE
To champion the health care issues of critical importance to Colorado physicians and the patients and communities they serve

CORE VALUES

  1. Leadership – Our approach to a diverse population of physicians focused on delivery of accessible, safe, high quality, patient-centered care
  2. Collaboration – Our philosophy for addressing health care challenges and issues facing our members and their patients
  3. Professionalism and Transparency – Our commitment in our operations, demonstrating both individual and organizational integrity and credibility
  4. Innovation – Our approach is data-driven, knowledge-based, and grassroots responsive

Vision Statement
Colorado Medical Society will be the leader in making Colorado the best state in which to provide and receive safe, high quality, and cost-effective medical care

GOALS

Physician Well Being and Success
Ensure physicians thrive personally and professionally throughout their careers in an evolving health care system

Objectives and strategies

  1. Increase physician knowledge about the implications of health care system evolution and how they fit into the evolving system
    1. Provide information to help members adapt their practices so that they can deliver best care through a sustainable model within the context of new reimbursement systems
    2. Create a safe environment for primary care and specialty physicians to explore together different payment models and their economic implications in a data-driven, patient-centered, evidence-based manner
    3. The Committee on Employed Physicians shall explore and recommend to the board of directors, if appropriate, support for state legislation creating a body of law enhancing physician rights when contracting their services
  2. Help physicians to understand, prepare and comply with federal and state regulatory changes

    1. Be an active participant in the development of rulemaking, while keeping members continuously apprised
    2. Provide easy to understand guidance on enacted rules
  3. Aggressively advocate for fair and reasonable reimbursement in current and future payment systems, both public and private

    1. Educate members about how the economy is driving health care change, regardless of health care reform efforts
    2. Work to reduce administrative waste
    3. Continue to build mutually beneficial relationships with payers, both public and private
  4. Support physicians in their continuing professional development

    1. Ensure access to accredited continuing medical education (CME) for physicians
  5. Increase CMS capacity to help members enhance their quality of life

    1. Assess current CMS survey data and determine the need for additional research
    2. Explore quality of life enrichment programs of other physician organizations and their applicability to member needs
    3. Partner with other organizations to deliver relevant programming

Metrics:

  1. Continue to track member satisfaction with their day-to-day life as a physician practicing in Colorado
  2. Develop a baseline assessment of member issues under the category of quality of life
  3. Successfully convene a meeting or series of meetings around the state to initiate physician dialogue on payment models
  4. Develop baseline on physician preferences around different payment models

Patient Safety and Professional Accountability
New approaches to delivering care and addressing adverse events will enhance safety, learning and accountability while appropriately compensating injured patients

Objectives and strategies

  1. Increase patient engagement in their own care
    1. Develop and implement shared decision-making pilots
    2. Partner with patient advocates to develop and implement patient education tools
    3. Keep patients included in policy development
  2. Continue to develop and implement robust, evidence-based system improvements that enhance patient safety

    1. Partner with other stakeholders to test and implement patient safety strategies
    2. Pilot innovative, non-adversarial processes for addressing adverse events that enhance learning and system improvements and reduce barriers to access to care
    3. Continue to coordinate with all other Colorado patient safety entities
  3. Develop and institute meaningful enhancements to existing professional accountability mechanisms

    1. Enhance physicians’ understanding of the importance of demonstrating continuous learning and performance improvement, and publicly meeting professional standards
    2. Develop and institute appropriate maintenance of licensure requirements
    3. Amend and reenact the Colorado Professional Review Act to make peer review work better for physicians and patients while maintaining strong immunity protections
    4. Separate compensation from injured patients from a finding of fault, while demonstrating accountability
    5. Improve the practice of medicine and health of patients through the provision of accredited CME that addresses gaps in health care
  4. Increase understanding and appreciation of the alternatives to traditional tort litigation

    1. Partner with external allies and stakeholders on outreach to opinion leaders and elected officials
    2. Demonstrate the failure of the current litigation system to achieve our patient safety goals, and use that failure to promote better solutions
    3. Continue to position safety, professional accountability and liability reform as integral to health care reform
  5. Maintain Colorado’s stable medical liability climate

    1. Continue to vigorously oppose efforts to weaken caps on damages in malpractice cases
    2. Demonstrate how Colorado’s current statutory protections help rein in costs and minimize access problems

Metrics

  1. Launch one or more comprehensive patient safety/liability reform pilot projects
  2. Successfully re-shape and re-enact the Colorado Professional Review Act
  3. Pass Maintenance of Licensure requirements that meet CMS goals
  4. Maintain existing malpractice caps
  5. Ensure that the Colorado Health Care Availability Act is not otherwise weakened

Health Care System Evolution
Health care system innovation will result in access to high quality, cost-effective care for patients and their communities.

Objectives and strategies

  1. Increase physician capacity to adapt to the evolving health care system
    1. Help physicians evolve their practices so they are prepared for new reimbursement and delivery models
    2. Work collaboratively with component societies to achieve mutual goals of advancing practice evolution
    3. Use CME to spread understanding and increase capability to adapt
  2. Influence how health care systems evolve, particularly in Colorado

    1. Build public understanding of the need for meaningful systems evolution that reflects CMS guiding principles
    2. Ensure our involvement in all key discussions shaping the development and implementation of the issues that affect system evolution
    3. Advocate for system changes that reflect CMS guiding principles and criteria for health care reform
    4. Participate in the development and implementation of new strategies to expand and diversify the physician workforce, especially in rural and underserved areas
    5. The Committee on Professional Education and Accreditation will explore the most effective role for CMS in increasing primary care residency programs in Colorado with a report to the board of directors by November 2014
  3. Improve physician stewardship of limited health care resources


    1. Expand physician and public understanding of the factors that can affect the cost of health care and health insurance
    2. Engage physicians in constructively containing health care costs
    3. The Board of Directors will monitor state cost study initiatives and provide strategic direction in 2014 depending on legislative and insurance commissioner initiative outcomes
  4. Advance team-based care

    1. Educate physicians about how team-based care can enhance and improve practice viability, while providing safe, quality and cost-effective care
    2. Encourage physicians to educate their patients about the value of team-based care
    3. Encourage development of team-based care that properly reflects the different skills and experience of each team member

Metrics

  1. Increase member awareness of the following key elements (taken from polling data)
    1. Track number of members who have become a medical home
    2. Track number of specialists who have signed a compact with a certified medical home
    3. Increase member understanding of the impact of the new federal health care law by measuring physician sentiment in 2012
  2. Use aggregated CME data and other data to demonstrate knowledge and competence
  3. Successful passage of CMS supported health insurance exchange legislation
  4. Establish a baseline number of physician practices that are participating in the Medicaid Accountable Care Collaborative

Turning data into intelligence
By owning, using and sharing data, physicians will both improve care and demonstrate their ability to provide high quality and cost-effective care

Objectives and strategies

  1. Increase physician awareness of the need for and benefits of collecting and using data
    1. Work with CIVHC, health plans, vendors and other stakeholders to strengthen member understanding
    2. Educate members about the growth of physician transparency and profiling systems by both private and public payers, emphasizing the importance of understanding the basis of these ratings and how physicians can affect their performance on those measures
    3. Use clinical data to inform the development of meaningful payment and delivery system reforms, such as accountable care organizations and patient-centered medical homes
  2. Increase the ability of members and their staffs to collect data and use the information gathered to maximum benefit

    1. Provide training
  3. Reduce barriers, most notably high costs, to sharing and using data

    1. Work with CORHIO, CIVHC, payers, hospitals and others
    2. Influence the creation of user friendly systems for data sharing and access
    3. Encourage transparency with data collection, distribution and use

Metrics

  1. Develop a baseline of the number of physicians using disease registries
  2. Increase in member use of electronic health records and health information exchange based on the baseline established in the 2010 member survey (questions 72 and 73)
  3. Acceptance/use of the Roadmap to Meaningful Use Provider Portal
    1. Satisfaction with experience
    2. Frequency of return use
    3. Evaluations from the state wide events

Organizational Excellence
CMS will be a well governed, effectively managed, fiscally sound organization that meets the needs of a diverse membership in a rapidly changing environment

Objectives and strategies

  1. Increase CMS’s value and attractiveness to members and potential members, and including employed physicians
    1. Better prepare members to make decisions about their course of action in light of how practice settings are changing
    2. Enhance outreach to maintain existing relationships and build new ones
  2. Increase overall member satisfaction with CMS

    1. Expand member understanding of programs we have in place and value they provide
    2. Explore how to get greater input and engagement from members
    3. Develop best practice proposals specific to HOD and board of directors governance reform that enhances buy-in, representation and expertise with a report to the HOD in 2014
    4. The CEO will retain a qualified consultant to perform a communications audit assessing internal and external communications functions and to develop recommendations to upgrade these functions in a manner that increases the media exposure of CMS and substantially enhances physician engagement through an effective web presence with a report to the HOD in 2014
  3. Increase efforts to develop and engage physician leaders

    1. Build a stronger leadership pipeline that includes career paths for potential leaders within CMS and component societies
    2. Develop members’ leadership skills for leading in multiple venues, including in their practices and communities
    3. Continue aggressive efforts to engage physicians in political advocacy
  4. Make CMS the most attractive employer in order to recruit and retain the best and brightest
  5. Continue to nurture current and explore additional sources of revenue to support expanded services and initiatives in support of our purpose

    1. Non-dues revenues/grants, etc.
  6. Continue to operate in a transparent manner, working collaboratively and sharing insights into not only what decisions are made but also why

Metrics

  1. Increase in member satisfaction as extrapolated from polling questions 1-10 in 2010 member survey
  2. Increase in number of new people serving on councils, committees, work groups and task forces
  3. Establish a baseline of employed physicians within the membership
  4. Increase retention rate across all members
    1. Increase conversion of lapsed dues-paying members to renewed dues-paying members
    2. Retain members who transition to “employed” status once CMS baseline of employed physicians is complete
  5. Increase the number of members overall

    1. Increase number of dues-paying members
    2. Increase the number of “employed” physician members

(BOD-1, AM 2011; Reaffirmed, BOD-1, AM 2014)

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900.977 Policy Manual

 

The Colorado Medical Society Policy Manual will be reviewed every three to five years to determine those policies that are no longer pertinent and incorporate like policies into one policy. Such changes will be brought to the House of Delegates for review and approval.
(RES-12, AM 2003; Reaffirmed, BOD-1, AM 2014)

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900.978 Investment Guidelines

 

(Motion of the Board, March 1994 • Amended July 2002, May 2003; Sunset, BOD-1, AM 2014)

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900.979 Mileage Reimbursement

 

(Motion of the Board, March 2000; Sunset, BOD-1, AM 2014)

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900.980 Funding Requests from Outside Entities

 

(Motion of the Board, March 2000; Sunset, BOD-1, AM 2014)

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900.981 In-State Travel

 

(Motion of the Board, July 1998; Sunset, BOD-1, AM 2014)

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900.982 Out-of-State Travel

 

(Motion of the Board, November 1997; Sunset, BOD-1, AM 2014)

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900.983 Participation in the Provider Coalition

 

(Motion of the Board, February 1995; Sunset, BOD-1, AM 2014)

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900.984 Conduct of Representatives of the Colorado Medical Society

 

Any individual who is publicly representing the Colorado Medical Society (CMS) will present only established CMS policy.
(RES-32, IM 1994; Reaffirmed, BOD-1, AM 2014)

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900.985 Use of Dues Monies

 

(Motion of the Board, September 1980, Motion of the Board, May 1993; Sunset, BOD-1, AM 2014)

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900.986 Requests for Money, Time or Endorsements

 

(Motion of the Board, September 1982, Motion of the Board, November 1992; Sunset, BOD-1, AM 2014)

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900.987 Gender Neutrality

 

All official speakers and presentations by and for the members and general public should be devoid of all references of physicians as being of the male gender only.
(RES-44, AM 1992; Reaffirmed, BOD-1, AM 2014)

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900.988 Exhibit Space

 

(Motion of the Board, May 1992; Sunset, BOD-1, AM 2014)

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900.989 Guidelines for Financial Contributions, Co-Sponsorships and/or Endorsements

 

(RES-1, AM 1991; Sunset, BOD-1, AM 2014)

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900.990 Relationship with the University of Colorado School of Medicine

 

(RES-1, AM 1991; Sunset, BOD-1, AM 2014)

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900.991 Spending from the Reserve Fund

 

(Motion of the Board, August 1989; Sunset, BOD-1, AM 2014)

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900.992 Antitrust Guidelines

 

Statement of Policy
It is the policy of the Colorado Medical Society (CMS) and its members to comply strictly with all laws applicable to the Medical Society’s activities. The Board emphasizes the ongoing commitment of the Medical Society and its members to full compliance with federal and state antitrust laws. This statement is being distributed to all officers, Board members, council and committee chairs, and council and committee members as a reminder of that commitment and as a general guide for our activities and meetings.

Responsibility for Antitrust Compliance
The Medical Society’s programs have been carefully designed and reviewed to insure their conformity with antitrust standards. An equivalent responsibility for antitrust compliance is yours. The Society depends on your good judgment to avoid all discussions and activities which may involve improper subject matter or improper procedures or an appearance of improper activity. Society staff members work conscientiously to avoid subject matter discussion which may have unintended implications, and counsel for the Society will provide guidance with regard to these matters. It is important for you to realize, however, that the competitive significance of a particular conduct or communication probably is most evident to you who are directly involved in medicine. For this reason you have an important and individual responsibility for assisting antitrust compliance in Society activities. Moreover, it must be clearly understood that no officer, director, or any other CMS member, whether acting in his or her individual capacity or as a committee or council member, or in any other way, is authorized to propose or to carry out in behalf of Colorado Medical Society any program, agreement, or any other activity in violation of state or federal antitrust laws.

Antitrust Statutes
The most important antitrust statutes relating to the activities of a professional association or society are the Sherman Act and the Federal Trade Commission Act. Both of these prohibit contracts, combinations, and conspiracies between two or more persons in restraint of trade. The Supreme Court has ruled that not every contract or combination in restraint of trade is a violation. Only those which unreasonably restrain trade are unlawful. To determine what is “unreasonable”, the courts will look at the surrounding circumstances and the conduct in question, and may consider benefits to the general public from the program as compared with the anti-competitive effect of that activity. This is the “rule of reason”. However, certain types of conduct have been held to be so inherently or nakedly anti-competitive that such activities are “per se” violations of the law, and further proof is unnecessary. Such per se violations include:

  • Price fixing agreements.
  • Agreements to refuse to deal with certain third parties (boycotts).
  • Agreements to allocate markets or to limit production.
  • Tie-in sales, which require the customer to buy an unwanted product or service in order to obtain the desired item.

Since a professional association, by its very nature, brings competitors together to carry out its programs, the potential for collusion exists. Because of that potential, the enforcement agencies are watching professional organizations, especially in the medical profession, very carefully.

For antitrust purposes the term “agreement” is very broadly applied. It includes oral or written, formal or informal, express or implied agreements. An unlawful agreement has been inferred from circumstantial evidence, such as the words and conduct of the parties and their course of dealing.

Section 5 of the Federal Trade Commission Act prohibits “unfair methods of competition in or affecting commerce, and unfair or deceptive acts or practices in or affecting commerce.” Unlike the Sherman Act, the Federal Trade Commission Act reaches anti-competitive acts committed by single persons or companies, whether or not there is any agreement or “combination”; like the Sherman Act, it also covers joint actions. There are Colorado statutes which closely parallel the federal law.

Antitrust Problem Areas of Activity

  • Price fixing.
  • Agreements to divide customers (patients or groups of patients).
  • Membership restrictions.
  • Standardization or stabilization of fees or charges.
  • Peer review activity.

Avoidance of Antitrust Problems
In the absence of specific legal advice on a matter, you should follow the guidelines which are set forth below, which are designed to avoid even the appearance of questionable activity:

Topics of Discussions to be Avoided:

  1. Do not discuss your own or other physicians’ current or future fees or expenses or any other financial matters which could affect fees.
  2. Do not discuss possible increases or decreases in fees.
  3. Do not take part in any discussion of what should be considered a fair level of income from practice.
  4. Do not make any public statements about your own fees or the fees of competitors, or about any other matters which could affect fees, at Medical Society functions.
  5. Do not discuss what you or other physicians plan to do in a particular geographic area or market, or with particular patients or with third party payers.
  6. Do not discuss your intention to refuse to deal with an HMO, a PPO, or any other third party payer or with any group or class of patients.
  7. Do not encourage any other physicians to refuse to deal.
  8. Do not disclose to any other person, at meetings or otherwise, information which may be sensitive competitively.
  9. If you are present at any group where any such discussion as mentioned above takes place, and if you are unable to prevent such a discussion taking place, then remove yourself from the meeting.
  10. If reasonably possible, avoid performances of peer review of the services of a competitor, and, if not reasonably avoidable, take careful precautions.

Meeting Procedures:

To avoid the appearance of questionable activity, as well as to guard against any inadvertent illegal conduct, all Society meetings, including committee, council, or section meetings, and including any meetings which are not legally constituted because of absence of a quorum, should be conducted in accordance with the following procedures:

  1. Meetings should not be held unless there are proper items of substance to be discussed which justify a proper meeting.
  2. In advance of every meeting, a notice of the meeting with an agenda should be sent to each member of the group; and the agenda should be specific. Broad topics, such as “Marketing Practices” which might look suspicious from an antitrust standpoint should be avoided.
  3. The discussion at the meeting should be limited to agenda items. Subjects not included on the agenda should not be considered.
  4. If a member brings up for discussion a subject of doubtful legality, that person should be advised that the subject is not a proper one for discussion. This would primarily be the responsibility of legal counsel for the Society. If a member has any reservation concerning the remarks or the nature of discussion at a Society meeting, those reservations should be expressed; and if the discussion is not terminated or satisfactorily resolved, that member should leave the meeting.
  5. Accurate minutes of each meeting should be prepared, and if reasonably possible, sent to the chair and the other members of the group prior to the next meeting.
  6. Secret or “rump sessions” should be strictly avoided. It is desirable that a CMS staff member attend all meetings.
  7. No recommendations or actions should be taken with regard to antitrust sensitive subjects, without the advice of the Society legal counsel.

Conclusion
Compliance with these guidelines is intended not only to avoid antitrust violations, but also any behavior which could be so construed. However, it should be understood that the antitrust laws are complex and far-reaching, and that this statement is not a complete summary of the law. It is intended only to highlight and emphasize certain basic precautions designed to avoid antitrust problems. You must therefore seek the guidance of either the Society staff, its legal counsel, or your own attorney if antitrust questions arise. If you would like further information concerning the Medical Society’s antitrust compliance procedures, please contact the CMS staff.
(Motion of the Board, April 1987; Reaffirmed, BOD-1, AM 2014)

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900.993 Expense Report Submission

 

(Motion of the Board, January 1987; Sunset, BOD-1, AM 2014)

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900.994 Registration Fees

 

(RES-10, AM 1983; Sunset, BOD-1, AM 2014)

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900.995 Sources of Non-Dues Revenue

 

(RES-9, AM 1983; Sunset, BOD-1, AM 2014)

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900.996 Budget Recommendations

 

(Motion of the Board, October 1982; Sunset, BOD-1, AM 2014)

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900.997 Budget Information

 

(Motion of the Board, October 1982; Sunset, BOD-1, AM 2014)

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900.998 Member Representatives

 

When openings arise on boards or committees of regulatory agencies and other relevant entities, the Colorado Medical Society will provide the names of interested, qualified members, along with other relevant information, to the appropriate body for consideration.
(RES-14, AM 1980; Reaffirmed, BOD-1, AM 2014)

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900.999 Evaluation of Chief Administrative Officer

 

(Motion of the Board, January 1980; Sunset, BOD-1, AM 2014)

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