Resolution 06-01 Human Papilloma Virus Vaccine for the Prevention of Cervical Cancer

Introduced by: Don Henry, M.D.

Referred to: REFERENCE COMMITTEE IV

Whereas, cervical cancer has been and continues to be a major cause of cancer morbidity and mortality in the United States; and

Whereas, cytologic screening and adjunctive procedures have reduced but not eliminated cervical cancer; and

Whereas, cervical cancer is a major pubic health problem, particularly among lower socioeconomic classes where access to, or utilization of, preventive care is not adequate; and

Whereas, human papilloma virus (HPV) has been identified as the major etiologic factor in the development of cervical dysplasia and cancer; and

Whereas, vaccines to prevent HPV infection have recently been approved by the FDA; and

Whereas, effective vaccination of the population has the potential to drastically curtail the incidence of cervical cancer, reducing both the human suffering and economic cost to society of this disease; and

Whereas, opposition to vaccination on ideological grounds has already emerged; therefore, be it

RESOLVED, that the ISMA support public education regarding the potential benefits of the HPV vaccine; and be it further

RESOLVED, that the ISMA study the feasibility of a statewide HPV vaccination program.

Resolution 06-02 Support for the Compassionate Assistance for Rape Emergencies Act (Care)

Introduced by: Don Henry, M.D.

Referred to: REFERENCE COMMITTEE IV

Whereas, emergency contraception has been for decades part of the standard of care for victims of sexual assault (endorsed by AMA, ACOG and ACEP); and

Whereas, most Catholic hospitals nationwide do not provide this service, despite the mandate for such service in the Religious and Ethical Directive for Catholic HealthcareFacilities; and

Whereas, most states, including Indiana, do not mandate this service by state law; and

Whereas, the Compassionate Assistance for Rape Emergencies (CARE) Act, currently under consideration by the U.S. Congress, would mandate this service in hospitals nationwide; therefore, be it

RESOLVED, that the ISMA support the enactment of the CARE Act, urging all members of the Congressional delegation of the state of Indiana to support this act; and be it further

RESOLVED, that the ISMA encourage individual physicians of the ISMA to contact their national legislators to support this act.

Resolution 06-03 Dispensing Of Emergency Contraception

Introduced by: Don Henry, M.D.

Referred to: REFERENCE COMMITTEE IV

Whereas, Levonorgestrel (Plan B) is an FDA-approved medication for the prevention of pregnancy; and

Whereas, numerous incidents have occurred wherein pharmacists refused to fill prescriptions for emergency contraception; and

Whereas, pharmacists are in no position to evaluate patients fully regarding the appropriateness of their prescription medication; and

Whereas, refusal to either fill a prescription or direct a patient to another pharmacy where it is available interferes with the physician-patient relationship and is tantamount to practicing medicine without a license; therefore, be it

RESOLVED, that the ISMA oppose any legislation with a conscience clause that does not require pharmacists refusing to fill Plan B or emergency contraceptive prescriptions to direct patients to another pharmacy that will fill a prescription for Plan B.

Resolution 06-04 Malpractice Reform

Introduced by: Floyd County Medical Society

Referred to: REFERENCE COMMITTEE III

Whereas, physicians in Indiana are experiencing steeply escalating premiums and inability to procure insurance; and

Whereas, escalating premiums and uninsurability are directly related to claims filed against a physician, regardless of the outcome of a claim; and

Whereas, a large number of claims filed are frivolous or without merit as evidenced by unanimous panel decisions for the defendant; and

Whereas, there is a direct and proximate financial burden shouldered by the defendant alone; and

Whereas, the plaintiffs incur minimal expense in filing a claim and bear no burden for the current crisis; and

Whereas, a common practice of plaintiffs is to name all physicians, corporate entities and hospitals in a claim, even when they have had no direct contact with the plaintiff; therefore, be it

RESOLVED, that the ISMA support changes in the current Indiana Compensation Act for Patients; and be it further

RESOLVED, that the ISMA support a change requiring plaintiffs to pay for the expense of the panel, not the defendants, in all cases found in favor of the defense; and be it further

RESOLVED, that the ISMA support a separate panel for each defendant named, including hospitals and corporate entities, and support having each panel be paid separately (panel members may be the same physicians and lawyer but render separate decisions).

Resolution 06-05 IRMIA Reform

Introduced by: Floyd County Medical Society

Referred to: REFERENCE COMMITTEE III

Whereas, some physicians in Indiana are unable to find medical malpractice insurance coverage because of the malpractice climate; and

Whereas, these uninsurable physicians are candidates for coverage by the Indiana Residual Malpractice Insurance Authority (IRMIA); and

Whereas, IRMIA does not offer claims-made policies, which are less expensive than the occurrence policies written by IRMIA; and

Whereas, IRMIA requires one-year payment in full on the first day of coverage; and

Whereas, the expense of insurance coverage requires borrowing money and interferes with normal cash flow in the business; therefore, be it

RESOLVED, that the ISMA support quarterly payments of IRMIA premiums; and be it further

RESOLVED, that the ISMA support the availability of claims-made policies for purchase through IRMIA.

Resolution 06-06 Medicaid Services

Introduced by: Bernard Emkes, M.D.

Referred to: REFERENCE COMMITTEE III

Whereas, there is lack of availability of primary care in many areas under the state Medicaid program; and

Whereas, the lack of primary care and appropriate patient–doctor relationships is fostered by current systems of plan and physician choice or auto-assignment, which then leads to excessive and inappropriate use of ER services that are costly and wasteful; and

Whereas, this causes ever-increasing amounts of uncompensated care for hospitals and ER physicians; and

Whereas, many of these problems are related to the woefully inadequate compensation for primary care, as well as specialty care physicians; and

Whereas, some physicians fail to participate in the Medicaid program due to the large enrollment panel requirements; therefore, be it

RESOLVED, that the ISMA work with Office of Medicaid Policy and Planning to take any and all actions possible to assure adequate panels of primary care and specialty care physicians in all geographic areas of the state. This should include:

• Appropriate fees for services rendered, at least covering the cost of care
• Consideration of lower panel size requirements
• Reduction of red tape and hassles as was promised in the past but not delivered
• Creating uniform processes across multiple Medicaid managed care plans
• Development of consistent formularies across all Medicaid managed care plans
• Correction of the massively flawed auto-assignment processes

And be it further

RESOLVED, that ISMA work with appropriate legislative or other regulatory bodies to:

• Promote appropriate Medicaid payments for provision of necessary medical services provided
• Exert pressure wherever appropriate to evolve the Medicaid program into an entity that meets the needs of the state, Indiana Medicaid recipients, the physicians and the hospitals of the state of Indiana.

Resolution 06-07 Pay For Performance

Introduced by: Caitilin Kelly, M.D., chair, ACP Health and Public Policy Committee, and the Monroe/Owen County Medical Society

Referred to: REFERENCE COMMITTEE III

Whereas, clinical practice guidelines are being used more and more for pay-for-performance programs; and

Whereas, these guidelines are based on clinical evidence and expert consensus to help decision-making for treating specific diseases in patients with one disease; and

Whereas, in 1999, 48 percent of Medicare beneficiaries age 65 years or older had at least three chronic conditions and 21 percent had five or more; and

Whereas, recent studies have shown that applying current clinical guidelines to patients who are either very old, seriously ill or who have three or more chronic medical conditions are often not cost effective, not appropriate and often actually decrease a patient’s quality of care; and

Whereas, pay-for-performance programs, therefore, in such circumstances are likely to encourage inappropriate prescribing and care (or at least penalize the physician for using good situation-specific, clinical judgment); therefore, be it

RESOLVED, that the ISMA work to exclude patients with three or more chronic conditions from any pay-for-performance physician evaluation; and be it further

RESOLVED, that the ISMA begin developing a more complex and appropriate set of clinical guidelines for patients with three or more chronic conditions.

Action: Adopted as amended

RESOLVED, that the ISMA encourage the consideration of patient complexity when developing pay-for-performance evaluation criteria.

Resolution 06-08 Mandatory Systematic Post- Marketing Studies

Introduced by: Caitilin Kelly, M.D., chair, ACP Health and Public Policy Committee

Referred to: REFERENCE COMMITTEE IV

Whereas, at the time a drug is approved, information is almost always lacking as to the drug’s potential long-term effects, as well as effects in special populations; and

Whereas, the current post-marketing surveillance system is problematic both because it relies on voluntary reporting by physicians and other health care personnel, and because it makes the drug manufacturers largely responsible for collecting, evaluating and reporting this data, raising the possibility of selective reporting of risks, as had been demonstrated in the past; and

Whereas, the current system of drug regulation in the United States lacks requirements for systematic post-marketing studies of all drugs (other than fast-track drugs and drugs approved with additional studies to establish safe use in children); therefore, be it

RESOLVED, that the ISMA encourage the formation of a reformed regulatory authority with adequate statutory authority, sufficient funding (possibly coming from a tax on pharmaceutical sales), and protection from inappropriate political pressure. This new Center of Post-Marketing Studies would specify and oversee mandatory post-approval looking at:

• Safety
• Long-term studies of effects of chronically used drugs performed by independent investigators
• Epidemiologic investigations of rare adverse effects
• Effects in special populations

Resolution 06-09 Creation Of A New Center For Drug Information

Introduced by: Caitilin Kelly, M.D., chair, ACP Health and Public Policy Committee

Referred to: REFERENCE COMMITTEE IV

Whereas, the current primary means for providing information to physicians is the drug label; and

Whereas, the label is drafted by the manufacturer and can be modified only following time-consuming negotiations between the manufacturer and the FDA; and

Whereas, this can lead to unacceptable delays in conveying timely, accurate, unbiased information to practitioners, such as recently occurred with the drug Vioxx, where there was a lag of greater than two years between clinical trials (VIGOR) showing an increased risk of acute myocardial infarction and a change to the label noting this fact; therefore, be it

RESOLVED, that the ISMA work to encourage the formation of a Center for Drug Information that would coordinate the communication of accurate, unbiased information to practitioners and patients in accordance with the best available data. It would write and update, as needed, an accurate label allowing the label to reflect the supporting evidence and designed to be more useful to practitioners, and use more active methods of communication when appropriate.

Resolution 06-10 Payment For Medication Authorizations

Introduced by: Caitilin Kelly, M.D., chair, ACP Health and Public Policy Committee, and the Monroe/Owen County Medical Society

Referred to: REFERENCE COMMITTEE III

Whereas, the current medication prior authorization procedure with many insurance companies can be quite time-consuming; and

Whereas, many times this authorization of medication change or obtaining pre-authorization of a medication needs to be repeated many times for one patient’s medications because the “preferred formulary” changes frequently; and

Whereas, these frequent changes almost never relate to quality of care but only to cost savings for the insurance company; and

Whereas, physicians’ decisions to authorize new medications require medical judgment, discussion with the patient, chart review (to see if a medication has been tried and not tolerated in the past), clinical follow-up and sometimes laboratory follow-up, such as with a new statin drug; and

Whereas, the majority of these above-mentioned tasks represent a clinical service that cannot be delegated to a non-physician; and

Whereas, it is unfair to expect physicians to perform this clinical service without payment; therefore, be it

RESOLVED, that the ISMA work to secure physician reimbursement for performing the clinical service of drug authorizations and pre-authorizations.

Resolution 06-11 Prior Authorizations

Introduced by: Caitilin Kelly, M.D., chair, ACP Health and Public Policy Committee, and the Monroe/Owen County Medical Society

Referred to: REFERENCE COMMITTEE III

Whereas, the current medication prior authorization procedure with many insurance companies is very non-user friendly and quite time-consuming, often requires automated steps to get a non-pharmacist clerk, and also requires responding to a series of questions before a pharmacist can be reached, (where the same questions are repeated), making a process that should take a few minutes, last up to 20 minutes; and

Whereas, many times this procedure needs to be repeated many times for one patient’s medications as the “preferred formulary” changes frequently; and

Whereas, these frequent changes almost never relate to quality of care but only to cost savings for the insurance company; and

Whereas, this places an unfair burden on physicians and takes away valuable time that could otherwise be spent in direct patient care; and

Whereas, this procedure could be easily streamlined to one or two minutes if a physician could fax one or two lines of justification for a medication to a direct fax line available 24 hours a day, seven days a week; therefore, be it

RESOLVED, that the ISMA work to encourage a more rapid, user friendly and streamlined process for prior authorization of medications, such as allowing physicians to fax one or two lines of justification for a medication to a 24-hour direct fax line or some other means.

Resolution 06-12 Higher State Excise Tax On Cigarettes

Introduced by: Robert M. Lubitz, M.D., governor, ACP Indiana Chapter, and Caitilin Kelly, M.D., chair, ACP Health and Public Policy Committee

Referred to: REFERENCE COMMITTEE II

Whereas, more than 70,000 scientific articles published since 1950 document the harmful effects of tobacco; and

Whereas, smoking is the number one cause of preventable morbidity and mortality; and

Whereas, tobacco has been linked to 90 percent of lung cancer, up to 20 percent of all other cancers, 75 percent of emphysema deaths, 25 percent of heart attacks and strokes between ages 35-69, and among other things, increases the risk of hip fracture, pregnancy complications, asthma morbidity, and Sudden Infant Death Syndrome; and

Whereas, 90 percent of smokers start in their teen years; and

Whereas, Indiana ranks number two nationally in the prevalence of smokers, resulting in 9,700 deaths per year, $1.9 billion in annual medical costs, and $448 million in Medicaid expenditures directly related to tobacco; and

Whereas, 18.5 percent of women in Indiana smoke during pregnancy, with over $20 million in tobacco-related costs; and

Whereas, 21.3 percent of Indiana high school students smoke; and

Whereas, 15 years of research has shown that as the price of cigarettes goes up, fewer children start smoking and more adults and teens quit; and

Whereas, economic data show that for every 10 percent increase in the real price of cigarettes, teen smoking declines by 7 percent and adult smoking declines by 4 percent; and

Whereas, the 2002 Indiana cigarette tax increase of 40 cents resulted in an 18 percent decline in cigarette consumption; and

Whereas, Indiana’s excise tax on cigarettes ranks lowest in the Midwest and among the lowest in the United States; and

Whereas, data from other states demonstrate that raising the excise tax on tobacco leads to a substantial and significant decrease in current and new smokers; therefore, be it

RESOLVED, that the ISMA support legislation raising the Indiana state excise tax on cigarettes by $1 per pack; and be it further

RESOLVED, that the ISMA encourage using a portion of this new tobacco tax revenue to create programs to help smokers quit and prevent recidivism; and be it further

RESOLVED, that the ISMA specifically endorse candidates for state office who support a higher state excise tax on cigarettes.

Resolution 06-13 Junk Food In Hospital Food Service And Vending Areas

Introduced by: Douglas Morrell, M.D.

Referred to: REFERENCE COMMITTEE IV

Whereas, obesity in the state of Indiana is becoming a public health disaster; and

Whereas, healthy food is fundamental for a person to have a healthy body; and

Whereas, the mission of hospitals is to improve health and care for the ill and injured; and

Whereas, hospitals state in their mission statements that their goal is to provide quality health care and be a trusted access point for all health care needs; and

Whereas, hospitals are in the health care business and not the unhealthy food business; and

Whereas, hospitals offer visitors and staff few, if any, healthy food choices in vending areas and in some facilities’ cafeterias; therefore, be it

RESOLVED, that the ISMA encourage the Indiana Hospital&Health Association to eliminate unhealthy food from hospital vending and cafeteria areas; and be it further

RESOLVED, that the ISMA support legislation that would eliminate unhealthy food from hospital vending and cafeteria areas.

Resolution 06-14 Voting Procedures For Ama Delegates

Introduced by: Marc Kappelman, M.D.

Referred to: REFERENCE COMMITTEE I

Whereas, ISMA Constitution and Bylaws Section 3.0208 Election of Delegates to the American Medical Association reads as follows: “The House of Delegates shall elect representatives to the House of Delegates of the American Medical Association in accordance with the Constitution and Bylaws of that body”; and

Whereas, the current AMA Constitution and Bylaws Section 3.4211 states, “No ballot shall be counted if it contains fewer or more votes than the number…to be elected”; and

Whereas, the AMA delegation is elected as a group on one ballot with no more and no fewer than three votes per ballot and the ballot is not counted if it contains fewer than three votes; and

Whereas, the deliberations of the ISMA are governed by parliamentary procedure as prescribed in the Fourth Edition of The Standard Code of Parliamentary Procedure, when not in conflict with the ISMA Constitution and Bylaws; and

Whereas, The Standard Code of Parliamentary Procedure states, “if several nominees for equal offices…are voted for in a group, a ballot containing fewer votes than the number of positions to be filled is valid”; and

Whereas, delegates should be able to vote for whomever they feel knowledgeable about and comfortable with, particularly when several nominees for equal offices are on the same ballot; therefore, be it

RESOLVED, that the ISMA Constitution and Bylaws be amended to revise voting procedures to elect AMA delegates so that ballots containing fewer than three votes are counted as valid.

Resolution 06-15 Use Of Lasers In Medical Practice By Non-Physicians

Introduced by: Don Stogsdill, M.D., immediate past president of the Indiana Society of Anesthesiologists

Referred to: REFERENCE COMMITTEE II

Whereas, Resolution 96-15 adopted by the House of Delegates in 1996 will expire in 2006 unless readopted; and

Whereas, Resolution 96-15 resolved to ensure that surgical practices, including laser surgery, would be kept within the practice of medical doctors; and

Whereas, it remains important that the ISMA keep scope of practice issues alive; therefore, be it

RESOLVED, that the ISMA oppose any legislation that would expand the scope of practice of any non-physician group to include the performance of surgery, including laser surgery.

Resolution 06-16 Non-Physicians Practicing Invasive Pain Management Procedures

Introduced by: Don Stogsdill, M.D., immediate past president of the Indiana Society of Anesthesiologists

Referred to: REFERENCE COMMITTEE II

Whereas, the safety of patients is jeopardized when non-physician health care providers expand their scope of practice to areas beyond their training and experience; and

Whereas, certified registered nurse anesthetists (CRNA) in many states are seeking to expand their scope of practice to include invasive procedures to diagnose and treat chronic pain, although such procedures constitute the practice of medicine and are beyond a CRNA’s training and experience; and

Whereas, the ISMA has existing policy to oppose any legislation that would extend the scope of practice of any allied health profession into the areas of the practice of medicine, including surgery and diagnosis of illness and injury; therefore, be it

RESOLVED, that the ISMA oppose any proposed legislation or regulations that would expand the scope of practice of non-physician health care providers to include invasive nerve block procedures and neuraxial injections of medications for the diagnosis and management of chronic pain; and be it further

RESOLVED, that the ISMA support legislative or regulatory efforts to strengthen Indiana law to clarify that invasive pain management procedures constitute the practice of medicine.

Resolution 06-17 Protection Of Patients Receiving Anesthesia Care

Introduced by: Don Stogsdill, M.D., immediate past president of the Indiana Society of Anesthesiologists

Referred to: REFERENCE COMMITTEE II

Whereas, the Indiana Medical Practice Act states that “ a registered nurse may administer anesthesia if the registered nurse acts under the direction of and in the immediate presence of a physician and holds a certificate of completion of a course in anesthesia approved by the American Association of Nurse Anesthetists or a course approved by the board”; and

Whereas, the safety of patients undergoing anesthesia is protected by this law, which requires the close involvement of a physician to assure that the patient’s medical conditions are appropriately managed before, during and after the administration of anesthesia; and

Whereas, the ISMA has existing policy to oppose any legislation that will expand non-physician scope of practice; and

Whereas, perceiving the statutory supervision requirement as an obstacle to access to care, and ignoring or not appreciating its importance to patient safety, some hospitals, certified registered nurse anesthetists (CRNA) and non-physician health care practitioners who perform surgery may wish to relax this statutory requirement; and

Whereas, the Indiana Health&Hospital Association has actually adopted the view that podiatrists and dentists may supervise CRNAs in direct violation of the Medical Practice Act; therefore, be it

RESOLVED, the ISMA continue to protect the safety of patients in our state by vigorously opposing any regulatory and/or legislative attempts to remove or reduce the current statutory protection afforded to patients by the provisions of the Medical Practice Act, which requires that a CRNA who administers anesthesia must do so under the direction of, and in the immediate presence of, a physician; and be it further

RESOLVED, that the ISMA actively engage in appropriate measures to assure compliance with this statute if there are reports of violation of this law.

Resolution 06-18 Use Of Medical Marijuana

Introduced by: Clark Brittain, D.O.

Referred to: REFERENCE COMMITTEE II

Whereas, marijuana has been shown to be of proven benefit in many medical circumstances; and

Whereas, marijuana has a record of proven safety and never a proven overdose-related death; and

Whereas, marijuana is not currently available as a medication for Indiana physicians to prescribe to ailing patients who may benefit from its use; therefore, be it

RESOLVED, that the ISMA seek legislation that will allow medical marijuana use by any patient as prescribed by a physician licensed to practice medicine in Indiana who also possesses a controlled substances registration certificate.

Resolution 06-19 Reimbursement Of Vaccines

Introduced by: James Leland, M.D.

Referred to: REFERENCE COMMITTEE II

Whereas, it is the goal of the state of Indiana and the nation’s health care system to have 100 percent immunization of all children and adolescents to prevent disease and ultimately lower health care costs; and

Whereas, payers prohibit this goal by reimbursing vaccines under acquisition costs; therefore, be it

RESOLVED, that the ISMA support legislation in the Indiana General Assembly that requires payers to reimburse all vaccines at the average wholesale price (AWP)* and review these fees on a quarterly basis for changes, making corrections as necessary.

(Note: Manufacturers have nothing to do with setting the AWP on vaccines. It is done independently. Information is based on 2005 Red Book.)

Resolution 06-20 Time Frame For Submissions Of Claims

Introduced by: Randall Stoesz, M.D.

Referred to: REFERENCE COMMITTEE II

Whereas, it is the goal of the health care system to cut the costs of health care wherever possible; and

Whereas, payers have many contracted time frames for the submission of health care claims that add to the burdensome administrative process and unnecessary health care costs; therefore, be it

RESOLVED, that the ISMA support legislation in the Indiana General Assembly that requires all payers to have the same contracted time frames for the submission of health care claims, and that this time frame be at least one year from the date of service.

Resolution 06-21 Uniform Timely Filing Limit

Introduced by: Cathy Yoder, M.D., and physicians of Southside Family Medical Group

Referred to: REFERENCE COMMITTEE III

Whereas, Indiana’s medical professionals provide a valuable service to cure disease and sickness in Indiana’s citizens; and

Whereas, Indiana’s medical professionals provide a valuable service to prevent future disease and sickness in Indiana’s citizens; and

Whereas, Indiana’s medical professionals need to be paid for their services in order to continue providing said services; and

Whereas, Indiana’s citizens contract with insurers to pay for medical services rendered; and

Whereas, the increasing cost of health care has led insurers to consider ways to limit and deny payments to Indiana’s medical professionals, thus affecting the cash flow of their practices; and

Whereas, one of the strategies insurers may use to reduce payments is to limit the amount of time that medical professionals have to file a “timely claim,” which can be as little as 45 days from the date of service; and

Whereas, disparate timely filing limits periodically lead to confusion in the medical provider’s billing office resulting in the denial of payment for services rendered based on arbitrary deadlines designed to reduce payment for services rendered; and

Whereas, SB 147 recognizes a medical professional’s right to be paid for service rendered beyond the initial 365 days after a patient’s date of service by placing a two-year limit on a medical professional’s ability to request additional reimbursement for an under-paid claim; and

Whereas, SB 147 gives insurer’s two years to demand a repayment of money it overpaid a medical provider for health care services; therefore, be it

RESOLVED, that the ISMA propose legislation in the Indiana General Assembly to establish a uniform timely filing limit of two years from the date of service, thereby creating parity with the insurer’s ability to demand repayment of money it overpaid for health care services, eliminating disparate arbitrary deadlines designed to limit payment for services rendered, giving medical providers sufficient time to discover and resolve billing errors, and providing insurers the necessary cut-off for reconciling their financial obligations; and be it further

RESOLVED, that the ISMA propose legislation in the Indiana General Assembly that will establish a timely filing limit of six months from notice or two years from the date of service, whichever is later, to file with the insurer responsible for the claim, when the original claim has been filed within the two-year limit to a payer who is later determined not to be responsible for the claim.

Resolution 06-22 Prior Authorization Of Drugs

Introduced by: Syed Ali, M.D.

Referred to: REFERENCE COMMITTEE III

Whereas, prior authorization of drugs has taken over a major part of a doctor’s office time; and

Whereas, each insurance company has its own favorite drugs and some have very few of them in their formulary; and

Whereas, some drugs may belong to one family (for example: Aciphex, Protonix, Prevacid, Prilosec, Nexium), but some drugs within a family, such as Aciphex, may have better outcomes than others for the treatment of Helicobacter Pylori infection; however, some insurance companies may not allow drugs to be switched without prior authorization; and

Whereas, while private insurance companies, Medicare and Medicaid do not know the patient’s history and may inform the patient the medication provided by their doctor was inappropriate and suggest their own; and

Whereas, there needs to be a uniform drug formulary that applies to all private insurers and Medicare and Medicaid; therefore, be it

RESOLVED, that the ISMA work with Indiana Medicaid and private insurers to create a uniform drug formulary that allows physicians greater flexibility in prescribing medications to patients without requiring prior authorization; and be it further

RESOLVED, that the ISMA encourage the AMA through its delegation to work with Medicare to create a standardization of policies and procedures concerning formularies and prior authorization requirements. Medicaid and private insurers also should be encouraged to do so.

Resolution 06-23 Initiating The Dr. Galbraith Leadership Award

Introduced by: ISMA Family Violence Committee

Referred to: REFERENCE COMMITTEE I

Whereas, Kathleen Galbraith, M.D., represented the best of the medical profession through her dedication to her patients and her leadership in the Indiana State Medical Association; and

Whereas, Dr. Galbraith served as past chair of the Board of Trustees and was the vice-speaker of the House of Delegates at the time of her unfortunate death; and

Whereas, Dr. Galbraith’s commitment to the younger members of our communities was exemplified by her weekly radio show addressing the health concerns of teenagers; and

Whereas, Dr. Galbraith served for many years as a vital member and chair of the ISMA’s Family Violence Committee to empower and advocate for victims of violence in our families and communities; therefore, be it

RESOLVED, that the ISMA develop the Dr. Kathleen Galbraith Leadership Award with the following criteria:

• The award will acknowledge a legislator, physician or layperson whose significant contributions have sought to promote the health and safety of the younger members of our communities by addressing issues of endangerment and/or violence.
• The awardee will be selected by the Executive Committee consistent with other ISMA awards of this nature.
• Award nominations may be submitted by an ISMA committee or commission or ISMA member in good standing and will consist of a letter detailing the qualifications of the nominated individual.
• The award may be presented annually at the House of Delegates convention (if a suitable recipient is identified).

 

Resolution 06-24 Calcium And Vitamin D Supplements For All Nursing Home Patients

Introduced by: Stacie Wenk, D.O.

Referred to: REFERENCE COMMITTEE IV

Whereas, osteoporosis is a preventable disease with appropriate treatment; and

Whereas, one in two women over age 65 and one in six men over age 65 will experience an osteoporotic-related fracture in their lifetime; and

Whereas, 20-30 percent of people experiencing a hip fracture will die in the first year following fracture; and

Whereas, prevalence of osteoporosis is expected to increase with the aging population; and

Whereas, elderly people are less likely to have adequate sun exposure to fulfill vitamin D requirements; therefore, be it

RESOLVED, that the ISMA’s AMA delegation encourage the AMA to work with Medicare to require that all nursing home patients receive 500-600 mg of calcium twice daily and vitamin D 800 units daily unless medically contraindicated (side effects such as constipation can be treated as necessary); and be it further

RESOLVED, that the ISMA encourage third-party payers and Indiana Medicaid to provide to all nursing home patients 500-600 mg of calcium twice daily and vitamin D 800 units daily unless medically contraindicated.

Resolution 06-25 Multiple Damage Recoveries To Multiple Persons For One Act Of Malpractice

Introduced by: William W. Pond, M.D.

Referred to: REFERENCE COMMITTEE III

Whereas, recently, several trial courts have awarded multiple cap-level damage awards to multiple people for one act of malpractice; and

Whereas, currently, Indiana’s Medical Malpractice Act limits damages to one cap-level recovery for one act of malpractice; and

Whereas, allowing multiple cap recoveries for one act of malpractice would severely deplete the reserves of the Patient’s Compensation Fund; and

Whereas, the ISMA has filed amicus briefs in two such cases currently pending on appeal; therefore, be it

RESOLVED, that the ISMA monitor the progress of the medical malpractice cases on appeal in which the ISMA has filed Amicus briefs, seek legislative relief if the appeals fail, and keep the membership involved in knowing about and assisting in any activity that will protect the integrity of the Patient’s Compensation Fund.

Resolution 06-26 Physician Assistant Prescribing

Introduced by: ISMA Board of Trustees

Referred to: REFERENCE COMMITTEE I

Whereas, 49 states and the District of Columbia authorize physicians to delegate prescriptive authority to physician assistants (PAs) practicing with physician supervision; and

Whereas, the AMA Guidelines for Physician/PA Practice state that the extent of involvement by the PA in the assessment and implementation of treatment will depend on the complexity and acuity of the patient’s condition and the training, experience and preparation of the physician assistant, as adjudged by the physician; and

Whereas, the AMA Guidelines for Physician/PA Practice state that the role of the PA in the delivery of care should be defined through mutually agreed upon guidelines developed by the physician and the PA based on the physician’s delegatory style; and

Whereas, the ISMA Ad-Hoc Committee on PA Prescribing raised concerns about the consistency of PA training program curricula across the United States, even though all programs must meet the flexible Accreditation Review Commission for the Physician Assistant (ARC-PA) standards developed by the American Academy of Physician Assistants (AAPA); and

Whereas, the ISMA strongly believes that ensuring quality care to patients is of critical importance; therefore, be it

RESOLVED, that in order to ensure the highest quality medical care to patients in Indiana, the ISMA believes legislative authorization of physician-delegated physician assistant prescribing privileges be conditioned on the following principles:

• Privileges for PA prescribing are delegated by the supervising physician.
• The current definition of supervision in IC 25-27.5-2-14 and of supervision requirements in IC 25-27.5-6 should be maintained.
• The PA being delegated prescribing privileges must have obtained an adequate number of contact hours in pharmacology at an ARC-PA accredited program.
• Pharmaceuticals that the physician may delegate to the PA for prescription are limited to a seven-day supply of a scheduled substance approved by the supervising physician.

Resolution 06-27 Discharge Summaries For Nursing Home Patients

Introduced by: Richard Spalding, M.D.

Referred to: REFERENCE COMMITTEE IV

Whereas, patients are often discharged from hospitals to nursing homes without

discharge summaries; and

Whereas, these patients often have multiple medical problems and are often in the hospital for longer stays; and

Whereas, these patients are often confused, weak and don = t know the details of their illness; and

Whereas, often states such as Kentucky, for better communication and patient care, require a typed discharge summary be sent with the patient to a nursing home; therefore, be it:

RESOLVED, that ISMA pursue a requirement, either through the Indiana State Department of Health, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or other appropriate agencies, that patients sent to nursing homes from hospitals have a typed discharge summary sent with them.

RESOLUTION 06-28 RENTAL (SILENT) NETWORK Ppos

 

Introduced by: William Penland, M.D., Indiana Academy of Ophthalmology, Inc.

Referred to: REFERENCE COMMITTEE III

Whereas, in recent years the health care market has spawned a secondary market in physician reimbursement discounts (rental (silent) network PPOs); and

Whereas, this market is comprised of networks that are “rented” or “leased” from the networks of other insurers; and

Whereas, physicians do not have contracts with these discounting entities; and

Whereas, these discounts make managing the physician practice very difficult; and

Whereas, this secondary market thrives in a health care market that lacks transparency and is as now unregulated; therefore, be it

RESOLVED, that the ISMA support legislation that includes the following seven principles for regulation of the secondary discount market:

1. Physicians must have the right to affirmatively opt in and/or out of any agreements of all network entities and associated discounts that the rental (silent) network has accessed.
2. A network PPO (or similar entity) that rents/leases its network must supply providers and the Indiana Department of Insurance complete and detailed identification of all entities accessing its network and associated discounts.
3. The terms of the underlying contract between the PPO (or similar entity) who is renting/leasing its network and the physician govern any agreements between the rental (silent) network PPO or similar entity and those entities accessing its network and associated discounts.
4. A rental (silent) network PPO (or similar entity) cannot rent or sell its network more than once. Any entity accessing the rental network PPO physician discounts cannot then sublease the network and associated discounts.
5. If a physician terminates the underlying contract with a PPO (or similar entity) who is renting/leasing its network, the rental network PPO and all entities accessing its network and associated discounts must cease to apply the discounted rate agreed to in the underlying contract.
6. A rental (silent) network PPO cannot rent or sell its network to non-payers (e.g. re-pricers, aggregators, etc).
7. Administrative fines, penalties and state law causes of action must apply.

Resolution 06-29 Universal Health Insurance In Indiana

Introduced by: Robert Stone, M.D.

Referred to: REFERENCE COMMITTEE II

Whereas, there are over 850,000 Hoosiers without any health insurance coverage; and

Whereas, The Institute of Medicine has determined that those without health insurance live sicker and die younger; and

Whereas, Indiana has one of the highest rates of bankruptcy due to medical causes, affecting 77,000 Hoosiers; and

Whereas, the prospect of significant health care reform at the federal level is poor; and

Whereas, Indiana has a history of passing innovative health care legislation with the passage of the Medical Malpractice Act in 1975; therefore, be it

RESOLVED, that the ISMA support passage of legislation by the Indiana General Assembly that will provide all citizens with health insurance coverage, improve affordability, ensure patients’ choice of medical providers, and focus on disease prevention and health promotion; and be it further

RESOLVED, that any such legislation to provide all citizens with health insurance coverage also achieve reduction in health insurance administrative costs by requiring uniform administrative processes including, but not limited to, claim submission, procedure authorization, prescription drug access and claim payment.

Resolution 06-30 Repeal Of Uppl

Introduced by: First District Medical Society

Referred to: REFERENCE COMMITTEE II

Whereas, Indiana’s Uniform Accident and Sickness Policy Provision Law (UPPL) was enacted in 1947; and

Whereas, this law states, “The insurer shall not be liable for any loss sustained or contracted in consequence of the insured’s being intoxicated or under the influence of any narcotic unless administered on the advice of a physician,” and thus allows health insurance companies to deny payment for alcohol-related injuries; and

Whereas, UPPL was adopted by, and is currently the law in Indiana; and

Whereas, this causes significant unfunded liability to health care providers and interferes with appropriate patient care; and

Whereas, UPPL does not save insurance companies money because hospitals have stopped documenting alcohol and drug use associated with injuries; therefore, be it

RESOLVED, that the ISMA initiate and support legislation to repeal the Uniform Accident and Sickness Policy Provision Law in Indiana; and be it further

RESOLVED, that ISMA delegation introduce and vigorously support a resolution at the next annual AMA meeting that would make national repeal of this law a high priority AMA policy.

Resolution 06-31 Changes To Indiana’s Good Samaritan Law

Introduced by: Michael Keating, M.D.

Referred to: REFERENCE COMMITTEE III

Whereas, many states have Good Samaritan laws for physicians who provide emergent medical care free of charge at the scenes of accidents; and

Whereas, many physicians provide medical care at sporting events free of charge for on-field emergencies; and

Whereas, some physicians would continue to provide this coverage even after retirement from full-time practice; therefore, be it

RESOLVED, that the ISMA seek legislation that would allow physicians providing care free of charge at sporting events be included in the Good Samaritan laws.

Resolution 06-32 Protecting Children From Second-Hand Smoke

Introduced by: Dick Huber, M.D.

Referred to: REFERENCE COMMITTEE II

Whereas, Resolution 99-19 recommended that the Indiana Family and Social Services Administration include information on the hazardous effects of second- hand smoke on children be a part of the educational program for foster parents, but it is not presently being done; and

Whereas, second-hand smoke is harmful, especially to children; and

Whereas, many children who are placed in foster or guardianship care are subjected to second-hand smoke; therefore, be it

RESOLVED, that the ISMA seek rules or regulations through the Department of Child Services and other agencies that all children placed in foster or guardianship care within the near future be protected from second-hand smoke within enclosed areas; and be it further

RESOLVED, that if the ISMA determines that such rules or regulations are very unlikely within the next six months, that a high priority be placed on seeking legislation to protect children placed in foster or guardianship care from second-hand smoke in enclosed areas.

Resolution 06-33 Reporting Health Care-Associated Infections

Introduced by: Dick Huber, M.D.

Referred to: REFERENCE COMMITTEE II

Whereas, hospital-acquired infections (HAIs) increased 20 percent from 2000 to 2003; and

Whereas, according to the Centers for Disease Control and Prevention, 90,000 Americans die each year from hospital infections, and another 1.9 million suffer from infection-related illnesses; and

Whereas, HAIs correlate most highly with overall performance on other patient safety incidents, suggesting that HAI rates could be used as a proxy of overall hospital patient safety; and

Whereas, seven states mandate that HAIs be reported, Indiana not being one of the seven; and

Whereas, according to a Health Grades study, patients are nearly 200 per cent less likely to have an incident at hospitals in the top 10 per cent; therefore, be it

RESOLVED, that the ISMA, in cooperation with other health agencies and organizations, seek legislation to require public reporting of health care-associated infections, such as proposed by the Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, and the Society for Healthcare Epidemiology of America.

Resolution 06-34 Licensing For Genetic Counselors Practicing In Indiana

Introduced by: Ruemu Birhiray, M.D.

Referred to: REFERENCE COMMITTEE IV

Whereas, the provision of genetic services has grown increasingly complex, requiring providers to possess a unique combination of scientific knowledge and counseling skills, and genetic counselors are uniquely trained in providing these services; and

Whereas, given the growing complexity and large-scale impact of recent genetic knowledge, it is important to ensure that those who provide genetic counseling services to the public are adequately trained to do so; and

Whereas, there is currently no mechanism in place to ensure that the public is protected from unqualified genetic counselors; and

Whereas, the requirement of licensure for genetic counselors would assure that the public’s health, safety and welfare will be reasonably well protected against unqualified practitioners; and

Whereas, licensure for genetic counselors would ensure that only qualified individuals will use the title genetic counselor and provide genetic counseling; and

Whereas, licensure for genetic counselors will provide a mechanism to hold genetic counselors accountable for the information they provide patients, ensuring high quality care for the citizens of Indiana, and providing recourse if inappropriate care is provided; and

Whereas, formal recognition of genetic counselors via licensure would allow the public to gain access to the valuable services of genetic counselors; therefore, be it

RESOLVED, that the ISMA support legislation that would require genetic counselors in the state of Indiana to obtain a license in order to call themselves genetic counselors and to practice genetic counseling.

Resolution 06-35 Insurance Company Complaints By Patients

Introduced by: Don Wagoner, M.D.

Referred to: REFERENCE COMMITTEE III

Whereas, patients are often denied payments and/or partial payments by their third party carriers for small dollar amounts for services, namely, those under $3,000; and

Whereas, third-party payers, namely large health insurance companies, routinely underpay, deny or refuse to recognize the patient’s problem or the payer’s obligation to the patient; and

Whereas, Indiana law (IC 27-8-28-1 et seq.) requires that all health insurance companies establish an internal grievance and appeal process for patient complaints; and

Whereas, health insurance companies, by contract, usually require that patients exhaust the statutorily-required internal grievance and appeals processes before patients can have access to the courts to adjudicate their claims; and

Whereas, the patients do not know how to navigate the appeals process in the third-party payer bureaucracy for many of these small claims and are intimidated by the system; therefore, be it

RESOLVED, that the ISMA seek cooperation and/or sponsorship from other interested groups (e.g., pharmacists, unions, AARP) to educate patients about how the health insurance companies’ internal grievance and appeal processes work; and be it further

RESOLVED, that the ISMA support legislation to prohibit insurance companies from contractually requiring patients to exhaust the insurance companies’ internal grievance and appeal procedures before accessing the courts.

Resolution 06-36 Constitutional Amendment Re- Designating Executive Director

Submitted by: Commission on Constitution and Bylaws

Referred to: REFERENCE COMMITTEE I

Whereas, Resolution 04-29 changed the title of the executive director of the ISMA to theExecutive Vice President and directed the Commission on Constitution and Bylaws to recommend the appropriate changes in the ISMA Constitution and Bylaws; and

Whereas, Article X of the ISMA Constitution states that the constitution may be amended “provided the proposed amendment shall have been introduced at the preceding annual convention and provided two-thirds of the voting members of the House of Delegates vote approval and provided that it shall have been published twice during the year and distributed to each of the members”; and

Whereas, the Commission on Constitution and Bylaws in accordance with Resolution 04-29 presented the following constitutional amendments in Resolution 05-17 for the first time to the House of Delegates at the 2005 Convention; and

Whereas, the following constitutional amendments were published twice during the year (ISMA Reports October 10, 2005, and August 7, 2006); and

Whereas, the following constitutional amendments now require approval by two-thirds of the voting members of the House of Delegates at the 2006 Convention; and

Whereas, upon passage of the following constitutional amendments the appropriate bylaws changes may then be considered; therefore, be it

RESOLVED, that the ISMA Constitution be amended in the manner provided below:

ARTICLE V - HOUSE OF DELEGATES

The legislative and policy-making body of the Association is the House of Delegates composed of elected representatives and others as provided in the Bylaws. The House of Delegates shall transact all business of the Association not otherwise specifically provided for in the Constitution and Bylaws and shall elect the officers of the Association, except Trustees, Alternate Trustees, and the Executive DirectorExecutive Vice President, as otherwise provided in the Bylaws.

ARTICLE VI - OFFICERS

The officers of the Association shall be a President, President-elect, Immediate Past President, Treasurer, Assistant Treasurer, Speaker, Vice Speaker, Trustees, Alternate Trustees, and the Executive DirectorExecutive Vice President . Their qualifications and terms of office shall be provided in the Bylaws.

ARTICLE VII - BOARD OF TRUSTEES

The Board of Trustees is composed of Trustees and Alternate Trustees, elected by the component district medical societies, the Young Physician Society, the Resident and Fellow Society, and the Medical Student Society, the President, President-elect, Immediate Past President, Treasurer, Assistant Treasurer, Speaker, Vice Speaker, and the Executive DirectorExecutive Vice President . The members of the Board of Trustees shall have the power to vote as prescribed in the Bylaws.

Resolution 06-37 Bylaws Amendment Re-Designating Executive Director AsExecutive Vice President

Introduced by: Commission on Constitution and Bylaws

Referred to: REFERENCE COMMITTEE I

Whereas, Resolution 04-29 changed the title of the Executive Director of the ISMA to theExecutive Vice President and directed the Commission on Constitution and Bylaws to recommend the appropriate changes in the ISMA Constitution and Bylaws; and

Whereas, constitutional amendments must precede related bylaws amendments; and

Whereas, ISMA Resolution 06-36, which sought amendment of the ISMA Constitution by replacing Executive Director withExecutive Vice President, was presented to the 2006 House of Delegates; and

Whereas, ISMA Bylaws provision 17.01 states, “These Bylaws may be amended by resolution as in 3.020701(b), which shall be treated as any other proposed amendment, at any meeting of the House of Delegates by a majority vote of all the voting members present. Amendments to the Bylaws must be submitted to the Association 60 days in advance of the meeting. These amendments must be presented to the Commission on Constitution and Bylaws prior to the meeting and are eligible for passage after lying on the table for one day;” and

Whereas, ISMA Bylaws provision 3.020701(b) states, “Except as noted in 3.020701(c) and in 3.021102, all resolutions to be presented to the House of Delegates for action shall be prepared and mailed to the Executive Director of the Association so that they will be received not later than 60 days prior to the session of the House of Delegates to which the resolutions will be presented;” and

Whereas, the below amendments to the ISMA Bylaws were presented to the Commission on Constitution and Bylaws prior to the 2006 House of Delegates meeting and have laid on the table for more than one day; and

Whereas, the below amendments to the ISMA Bylaws were properly and timely submitted to the ISMA; and

Whereas, the below amendments now require approval of a majority of the voting members of the House of Delegates present at the 2006 Convention; therefore, be it

Resolved , that the ISMA Bylaws be amended in the manner provided below:

Table of Contents

 

4.0305 Executive DirectorExecutive Vice President .20

6.0202 Executive Director'sExecutive Vice President’s Salary................................ 29

Bylaws of the Indiana State Medical Association

1.010201 Senior Member: Senior Members shall be eligible for Senior Membership on January 1 following their 70th birthday and they shall be physicians of the state of Indiana who have held their membership in the Indiana State Medical Association for 20 years or more; or who have held membership in the Indiana State Medical Association or in some one or more other like state organization(s) which is a component state organization of the American Medical Association, for a combined total of 20 years or more, and who, upon their application, have been certified to the Executive DirectorExecutive Vice President as eligible for such membership by the county societies of which they are members. It shall be the duty of the component county medical society to verify, through the office or offices of any other state organization or organizations, the fact of membership therein when such membership is claimed as part compliance with the eligibility requirement of 20 years of membership.

l. 010202 Disabled Member: Disabled Members shall consist of physicians of the state of Indiana who are certified by a member physician to be permanently disabled and no longer able to practice medicine. Proof of permanent disability shall be by notification to the Executive DirectorExecutive Vice President of the Association by the secretary of the component county medical society in which the permanently disabled physician holds membership

1.010203 Inactive Membership: Members who decide voluntary inactivity prior to the age of 70 shall be exempt from payment of membership dues for the duration of their inactive status when notification is received by the Executive DirectorExecutive Vice President of the Association from the secretary of the county medical society in which such inactive member holds membership. In deciding whether to approve a member's eligibility, the county medical society shall determine that the member has ceased the practice of medicine in the state of Indiana.

1.010204 Financial Hardship: In the event the county relieves a member from the payment of dues because of financial hardship, the secretary of the county medical society shall recommend in writing to the Executive DirectorExecutive Vice President of ISMA the relief from State Association dues of said member of the society, showing why such recommendation should be granted.

2.010101 Dues Refund: A request for refund of dues will be acted upon by the Board of Trustees of the Indiana State Medical Association in its wisdom. A letter of certification from the component county society secretary to the Executive DirectorExecutive Vice President of the Indiana State Medical Association to request an exemption of dues must state that the county is also exempting said dues. Upon request and approval, dues will be refunded on a monthly pro-rated basis. Dues-exempt members may receive any publication of ISMA upon payment of the applicable subscription price set by the ISMA Board of Trustees. With the exception of Senior Members, all Dues-exempt Members will be reviewed annually by their county medical societies to determine their eligibility for dues exemption.

3.020102 Non-voting Members: 1) President, 2) President-elect, 3) Executive DirectorExecutive Vice President, 4) Treasurer, 5) Assistant Treasurer, 6) Delegates and Alternate Delegates to the American Medical Association, and 7) Section Delegates or designated Alternate Delegates.

3.020503 Delegate Credentials: The names of duly elected Delegates and Alternates from each component society shall be sent to the Executive DirectorExecutive Vice President of this Association at least 45 days prior to the annual convention at which such Delegates are to serve. No one shall be entitled to a seat in the House of Delegates unless a credential card as a Delegate or Alternate, properly signed by the Secretary of the appropriate component medical society or the Executive Secretary or Executive DirectorExecutive Vice President of the larger societies, is presented to the Committee on Credentials at the time of the annual convention.

3.020701 Resolutions and Proposals:

 

(b) Deadlines for Resolutions: Except as noted in 3.020701(c) and in 3.021102, all resolutions to be presented to the House of Delegates for action shall be prepared and mailed to the Executive DirectorExecutive Vice President of the Association so that they will be received not later than 60 days prior to the session of the House of Delegates to which the resolutions will be presented.

(c) Late Resolutions: Except for matters of extreme emergent nature, all late resolutions must be received by the Executive DirectorExecutive Vice President seven (7) days prior to the opening session of the House of Delegates. Those resolutions received after 60 days prior to the first session of the House of Delegates will be referred to the Committee on Rules and Order of Business. The Committee on Rules and Order of Business shall submit a report to the House concerning all items considered by same with recommendation(s) limited to the appropriateness of consideration of said resolutions.

The Committee on Rules and Order of Business will meet approximately seven (7) days prior to the Annual Convention to consider resolutions that have been first submitted to the Committee together with a written statement setting forth the reasons why the resolution was not mailed to the Executive DirectorExecutive Vice President more than 60 days prior to the first session of the House of Delegates and also setting forth in the written statement the reasons why the resolution is of such an emergency nature that it cannot wait until the next meeting of the House.

3.021102 Responsibilities of Reference Committees: Four or more reference committees designated by numerals are hereby constituted to which all matters shall be referred, at least one of which shall be organized for the purpose of studying the addresses and reports of the President, President-elect; the report of the Executive DirectorExecutive Vice President , and the report of the Chairman of the Board of Trustees. This committee shall be expected, as it deems appropriate, to translate the reports by these officers into recommendations for presentation to the Board of Trustees.

3.0212 Election of Officers: The officers of this Association with the exception of the Executive DirectorExecutive Vice President and the Board of Trustees shall be elected by the House of Delegates, as the first order of business at the final session of the House of Delegates, and no person shall be elected to any such office who has not been an active member of the Association for the preceding two years. The officers except the Executive DirectorExecutive Vice President and the Trustees shall be elected annually. All officers shall serve until their successors are elected and installed.

• C OMPOSITION: The officers of this Association shall be a President, President-elect, Immediate Past President, Treasurer, Assistant Treasurer, Speaker, Vice Speaker, Trustees, Alternate Trustees, and Executive DirectorExecutive Vice President --each of whom shall be a member, except the Executive DirectorExecutive Vice President, who need not necessarily be either a physician or a member.

4.0301 President: Charters of county societies as defined in 11.01, and component societies, as defined in 12.01, and approved by the Board, shall be signed by the President and Executive DirectorExecutive Vice President .

4.0305 Executive DirectorExecutive Vice President: The Executive DirectorExecutive Vice President shall be the directing manager of the Association's headquarters and shall supervise the work of all salaried employees of the Association offices. Such supervision shall be subject to directives from the House of Delegates, the Board, the Executive Committee, and the President of the Association. The Executive DirectorExecutive Vice President shall discharge the administrative functions of the Association not within the duties of other offices or of committees to perform. The Executive DirectorExecutive Vice President shall assist, at their request, all offices and committees, and shall keep informed in regard to nonprofessional matters affecting the medical profession, for the purpose of keeping qualified to perform the services herein mentioned. The Executive DirectorExecutive Vice President shall be responsible for the execution of the policies of the Association and in that connection, shall perform all specific tasks required by the committees, the Board, and the officers of this Association. The Executive DirectorExecutive Vice President will personally notify a major officeholder whose dues are delinquent.

4.04 EXPENSES: The necessary expenses of the above offices incurred in the line of duty herein imposed shall be allowed for in the budget but, excepting the Executive DirectorExecutive Vice President , this shall not include the expenses of attending the Annual Convention.

• COMPOSITION/VOTING POWER : The Board of Trustees shall consist of: (1) trustees with power to vote and duly elected alternates, including the young physician trustee and alternate elected by the Young Physician Society, resident trustee and alternate elected by the Resident and Fellow Society, and the student trustee and alternate elected by the Medical Student Society each of the alternates without power to vote except when the corresponding Trustee is not in attendance; (2) ex-officio, the president, president-elect, treasurer, immediate past president, all with power to vote; assistant treasurer without power to vote except when the treasurer is not in attendance; and (3) speaker, vice speaker and the Executive DirectorExecutive Vice President , all without power to vote.

5.03 ELECTION - TRUSTEE AND ALTERNATE: The Trustees shall be elected by the respective district societies. If any district fails to meet and elect its Trustee(s) or Alternate Trustee(s) by the time of the expiration of the incumbent's term of office, the Executive DirectorExecutive Vice President of the Association shall cause a special meeting to be called by said district society for the purpose of such election.

5.0404 Attendance at Meetings: If any elected Trustee fails, without reason acceptable to the Board, in any calendar year to attend a majority of the meetings of the Board, said person shall thereby cease to be a Trustee, and the Executive DirectorExecutive Vice President shall take action in accordance with 5.05.

5.05 VACANCIES: In the event vacancies occur in any trustee district in the offices of either the trustee or alternate trustee, the vacancies shall be filled on a permanent basis by an election by the members of the association within the trustee district in which the vacancies occur. A call for such elections shall be issued by the Executive DirectorExecutive Vice President of the Indiana State Medical Association following a conference(s) with the officers of the district organization. The call shall state the date, time and place of holding the election and shall be sent registered mail to the county secretary, as filed in the Indiana State Medical Association Executive Director'sExecutive Vice President’s office, of each component society within the district. Such call shall be mailed within ten days after the Executive DirectorExecutive Vice President of ISMA has learned of the vacancies. The election may be held at a regular meeting at which business other than the election may be transacted. Such election shall be within 15 days after the Executive DirectorExecutive Vice President of the Indiana State Medical Association shall have mailed such call. If an alternate trustee is elected as trustee in such an election, the resultant vacancy in the position of alternate trustee may be filled immediately by election at the same meeting, without further notice.

5.06 ORGANIZATION AND DUTIES: Immediately following the conclusion of the Annual Convention, the Board shall organize by electing a Chairman, who shall serve for one year, and a Clerk who, in the absence of the Executive DirectorExecutive Vice President of the Association, shall keep a record of its proceedings and who in the absence of the Chairman will act as Chairman pro tem.

5.0604 Employ Executive: The Board shall employ the Executive DirectorExecutive Vice President, and fill any vacancy therein, who shall be the person to manage and direct the activities of the Association under the authority granted by the Board.

6.01 COMPOSITION: The Executive Committee shall consist of the President, the President-elect, the Immediate Past President, the Chairman of the Board, two (2) At Large Members elected by the Board, the Treasurer, the Assistant Treasurer, with power to vote in the absence of the Treasurer, and ex-officio the Speaker and Vice Speaker without power to vote. The Executive Committee shall hold its first meeting immediately following the Board meeting held at the close of the last session of the House of Delegates at the Annual Convention, and shall organize by electing its Chairman, from its voting members. If the Executive Committee is unable to select a chairman within thirty (30) days after the final session of the House of Delegates, then a meeting of the Board of Trustees shall be called and a Chairman of the Executive Committee shall be selected by the Board of Trustees. Its Secretary shall be the Executive DirectorExecutive Vice President of the Association.

• DUTIES : It shall meet with the Executive DirectorExecutive Vice President on the call of the Chairman, or of any three (3) members to plan and execute such work as may be necessary for the welfare of the Association and the conduct of the Executive Director'sExecutive Vice President’s office and such other duties as the Board may specify during the intervals between the meetings of the Board, and shall report its actions to the Board. The Executive Committee is accountable to the Board of Trustees.

6.0202 Executive Director'sExecutive Vice President’s Salary: The amount of the Executive Director'sExecutive Vice President’s salary shall be fixed by the Executive Committee on approval of the Board, at least annually.

6.05 STUDENT LOANS: The Executive Committee, with the approval of the Board, shall have the authority to make loans to medical students in accordance with the terms and conditions under which funds are made available for that purpose. Rules and regulations adopted shall be subject to the approval of the Board. The Executive DirectorExecutive Vice President shall have the duty and responsibility of keeping minutes of all transactions and shall file a copy of such minutes, as well as a copy of all papers pertaining to any applications or loans, in the Headquarters Office of the Association.

• EX-OFFICIO MEMBERS : The President, President-elect, Executive DirectorExecutive Vice President, Speaker, Vice-Speaker of the House and the Chairman of the Board of Trustees shall be ex-officio members of all committees and commissions without voting rights where their inclusion on the committee or commission is not otherwise provided for in these Bylaws.

7.1002 Indiana Medical Education Fund Committee: The Indiana Medical Education Fund Committee shall consist of eight persons, five of whom shall be from the Indiana State Medical Association, appointed by the President thereof, and shall be voting members. The other three members (the Dean, or the Dean's designee, of the Indiana University School of Medicine; the President of the Indiana State Medical Association; and the Executive DirectorExecutive Vice President of the Association, who shall also act as Secretary) shall be ex-officio and nonvoting.

11.01 CHARTERS: Charters shall be issued only upon approval of the Board and shall be signed by the President and Executive DirectorExecutive Vice President of this Association. The Board shall have the authority to revoke the charter of any component society whose actions are in conflict with the letter and spirit of this Constitution and Bylaws or those of the AMA.

• SELECTION OF DELEGATES : In advance of the annual convention of this Association, each component county society shall elect delegates and alternate delegates to represent it in the House of Delegates of this association. The secretary of the society shall send a list of such delegates and alternate delegates to the Executive DirectorExecutive Vice President of this association annually, at least 45 days prior to the annual convention at which such delegates are to serve. In the event that a component county society is unable to seat a full delegation from its elected delegates and alternate delegates, the secretary of the county society may certify other qualified members of the component county society to be seated as replacement delegates.

11.07 SECRETARIAL DUTIES: The Secretary of each component society shall prepare and send to the Trustee of the Secretary's district a quarterly report briefly stating the activities of the Secretary's component county society including meetings, programs, changes in officers and personnel or membership. A copy of this quarterly report to the Trustee shall also be sent to the Executive DirectorExecutive Vice President of the Indiana State Medical Association. The Indiana State Medical Association shall supply each County Secretary with a form for these reports.

11.08 FISCAL YEAR AND DUES: The fiscal year of the Association shall be from January 1 to December 31 of the same calendar year. The dues shall be collected by the calendar year and be payable in advance. Unless collected by the Indiana State Medical Association, the secretary of each component society shall forward the dues for the society to the Executive DirectorExecutive Vice President of this Association and shall furnish the Indiana State Medical Association Headquarters with a roster of officers, members, and a listing of non-affiliated physicians of the county, on or before January 1 of each year, and shall promptly report thereafter the names of any new members elected to membership in the society, and promptly forward to the Executive DirectorExecutive Vice President of this Association the dues for such members.

11.11 CONSTITUTION AND BYLAWS: An up-to-date copy thereof shall be filed with the Executive DirectorExecutive Vice President of the Indiana State Medical Association not later than May 1 of each calendar year; or where such copy is on file and no change has been made, it shall then be sufficient to file a certificate to that effect with the Executive DirectorExecutive Vice President.

12.01 CHARTERS: All component societies now in affiliation with this Association and those which may hereafter be organized in this state, which have adopted principles of organization not in conflict with this Constitution and Bylaws, or those of the American Medical Association, shall receive a charter from and become a component part of this Association. The acceptance or retention of this charter shall be regarded as a pledge on the part of said component society to conduct itself in harmony with the letter and spirit of this Constitution and Bylaws and other rules and resolutions of this Association. Charters shall be issued only upon approval by the Board and shall be signed by the President and Executive DirectorExecutive Vice President of this Association. The Board shall have the authority to revoke the charter of any component society whose actions are in conflict with the letter and spirit of this Constitution and Bylaws or those of the AMA.

• CONSTITUTION AND BYLAWS : Each component society shall have its own Constitution and Bylaws, which shall not be in conflict with the Constitution and Bylaws either of this Association or the American Medical Association. An up-to-date copy thereof shall be filed with the Executive DirectorExecutive Vice President of the Indiana State Medical Association not later than May 1 of each calendar year, or where such copy is on file and no change has been made, it shall then be sufficient to file a certificate to that effect with the Executive DirectorExecutive Vice President.

Resolution 06-38 Emergency Resolutions To The Isma House Of Delegates

Submitted by: Commission on Constitution and Bylaws

Referred to: REFERENCE COMMITTEE I

Whereas, Section 3.020701(c) of the ISMA Bylaws defines the procedure for consideration of late resolutions to the House of Delegates, but the Bylaws fail to clearly address the procedure for consideration of emergency resolutions submitted within seven days of the opening of the House; and

Whereas, emergency issues intermittently arise requiring urgent action by the House of Delegates prior to its next annual meeting; therefore, be it

RESOLVED, that Section 3.020701(c) of the ISMA Bylaws be amended by the addition of the following:

“For those resolutions of an emergent nature presented within seven days of the opening of the House of Delegates, the resolution(s) shall be considered in the same fashion as late resolutions at a special meeting of the Committee on Rules and Order of Business. This meeting will take place immediately prior to the opening session of the House. Emergency resolutions will be considered along with a written statement setting forth the reasons why the resolution was not submitted more than 60 days prior to the opening of the House of Delegates and why the resolution is of such an emergent nature that it cannot wait until the next meeting of the House of Delegates. The Committee’s recommendation on the emergency resolution(s) will be included in its report to the House and follow the same procedure for discussion and acceptance for consideration by the House as late resolutions, as outlined in Section 3.020701(c).

If an issue requiring immediate action by the House should arise after its opening session, the House may vote to consider an emergency resolution by a two-thirds majority. The vote shall occur after discussion on the floor, which will be limited to one speaker addressing the emergent need to consider the resolution and one speaker opposed. Discussion is to focus only on the emergent nature of the resolution and not any other of its merits.”

Resolution 06-39 Opposition of Cost-Based Credentialing/Reimbursement Programs

Submitted by: Cleve Francoeur Jr., M.D.

Referred to: REFERENCE COMMITTEE III

Whereas, the Indiana State Medical Association is dedicated to Indiana physicians and their efforts to provide the best possible health care for their patients; and

Whereas, various insurance companies, including Anthem, have begun to embrace "cost of care" performance-based reimbursement systems that shift further co-pays onto patients and/or physicians based solely on physician cost criteria; and

Whereas, in addition, insurance companies also have previously practiced "cost-based" credentialing; and

Whereas, alternative methods to address physician cost/performance exist, such as educational meetings between individual physicians and insurance companies to discuss cost control strategies; thereby, be it

RESOLVED, that the ISMA oppose efforts by insurance companies/networks/government to impose "cost-of-care" based payment systems, credentialing or other schemes to reduce physician and/or patient payments based solely on cost criteria. This includes, but is not limited to opposition to Anthem's value networks.

Action: Adopted as amended

RESOLVED, that the ISMA oppose efforts by insurance companies/networks/government to impose "cost-of-care" based payment systems, credentialing or other schemes to reduce physician and/or patient payments based solely on cost criteria.