Follow Up from Policy Forum 23-1 Submissions
Policy Forum 23-2 met September 15 in Des Moines to deliberate and act on the below policy requests, which had previously gone before the full membership for consideration.
PRS 23-1-05: Physician Non- Compete Agreements
Policy Request1) The Iowa Medical Society: Should adopt a policy position opposing state mandates related to specific contractual agreements between physicians operating a private, tax paying medical practice in the state of Iowa. This should include without limitation the use of non-competitive covenants as a mechanism to protect the significant capital investment made by physicians when recruiting other physicians to their practice.
The Policy Forum, in April, referred the issue to a taskforce of IMS members to create policy language. The taskforce recommended the following language:
“IMS recognizes independence and autonomy in employment contracting arrangements between and among employers and individual providers to engage in mutually beneficial contract arrangements with reasonable covenants as determined by the contracting entities.”
PRS 23-1-05: Certificate of Need
Policy Request1) The Iowa Medical Society: Oppose the continuation of the Certificate of Need law which is an arcane and anticompetitive instrument that makes it harder for physicians to practice medicine and offer cost effective alternatives for patients in our state.
The Policy Forum, in April, referred the issue to a taskforce of IMS members to create policy language. The taskforce recommended the following language:
“IMS supports modernization to Iowa’s current certificate of need law(s) to best support access to care and best practice provision of services, such as improved spending thresholds and elimination of restrictions on replacement of like-services/equipment, with special consideration for unique facility types which provide services in underserved areas and/or provide critical in-need services.”
PRS 23-1-09: Third Party Payer Reform
Policy Request1) The Iowa Medical Society: Advocate for third-party reforms.
The Policy Forum, in April, referred the issue to the IMS Committee on Legislation to review and operationalize the request. The committee recommended IMS create a workgroup to address the issue.
Motion to create a workgroup to support Committee on Legislation with subject matter expertise.
PRS 23-1-11: Medicare and Medicaid Reimbursement Rates
Policy Request1) The Iowa Medical Society: Advocate for a raise in Medicaid physician fees and geographic equity in payment.
The Policy Forum, in April, referred the issue to the IMS Committee on Legislation to review and review the request. The committee recommended the Policy Forum reaffirm existing AMA Policy on Medicare/Medicaid Reimbursement rates (H-390.013; H-290.010; H-290.013).
Action TakenReaffirmed preexisting AMA policy H-390.013; H-290.010; and H-290.013.
PRS 23-1-12: Stop the Bleed Kits
Policy Request1) The Iowa Medical Society: Support policy requiring stop the bleed kits in all public venues in Iowa.
Amended language from “requiring” to "encouraging"
PRS 23-2-01: Youth with Gender Dysphoria
Policy Request1) The Iowa Medical Society: Take an official position to voice support for people under 18 with gender dysphoria to be able to receive standard of care treatment, such as puberty blockers and cross sex hormone therapy, if indicated and medically recommended, and if their guardian consents.
Refer to taskforce and have recommendation to IMS Board by December 2023
PRS 23-2-02: Neurocognitive Disorders
Policy Request1) The Iowa Medical Society: Establish a workgroup to study this issue and develop potential solutions that can then be promoted by IMS.
PRS 23-2-03: Restriction of Non-Medical Switching by Insurance Companies in Iowa
Policy Request1) The Iowa Medical Society: Support legislation restricting non-medical switching practices in the State of Iowa.
Not adopted; Referred back to author for future refinement.
Sunset Policy Review
The Policy Committee recommends that the policies listed in the appendix to its report be acted upon in the manner indicated. For policies recommended for reaffirmation or reaffirmation with amendment, the committee recommends these policies be reaffirmed for a period of time to coincide with the next decennial anniversary of their original adoption to help disperse the volume of policies reviewed at each annual policy sunset review.
Policies to Sunset:
Bylaws were updated to streamline operational processes and redundant wording
Call a special meeting of the IMS Policy Forum in conjunction with the December 2022 IMS Board Meeting for the purpose of amending the IMS bylaws as noted below to implement the recommendations of the Leadership Development Committee.
Process Note: The Board of Directors may, by a simple majority vote, initiative the process of amending the IMS Bylaws. Bylaws amendment recommendations are shared with the membership for input and considered at the next regular or specially-called Policy Forum meeting. The Policy Forum may, by a two-thirds majority vote, amend the IMS bylaws.
Election of Officers and Directors
Section 4. The Leadership Development Committee shall be charged with the responsibility of selecting a slate of candidates to stand for election to offices to be filled by the Society membership prior to its presidential installation, as well as submitting recommendations to the Board of Directors for appointment of the Speaker of the Policy Forum. The Leadership Development Committee shall consist of the
President-Elect, who shall serve as Chair of the Committee ,and one representative from each active IMS committee. The President-Elect shall serve as the Chair of the Committee starting January 1 of each year and continuing in that role until the end of that calendar year as the for a term of one (1) year. The members of the Committee shall be confirmed by the Board of Directors to three (3) year staggered terms and are not eligible for nomination for any Director position while they are serving on the Committee plus one year following their service on the Committee.
Section 5. No later than
sixty (60) ninety (90) days prior to each presidential installation, members of the Leadership Development Committee shall meet to select a slate of candidates to stand for election to the offices to be filled by the Society membership prior to the presidential installation. It shall be the duty of the Committee to give careful consideration to the qualifications of all proposed candidates, always keeping in mind the best interests of the profession. Meetings of the Committee shall be open to all members of the Society, except when in executive session, and no meeting shall be held without adequate notification of all Society members. Notice of the first meeting shall include a list of names of members of the Leadership Development Committee together with an informative statement as to vacancies to be filled. Notwithstanding the foregoing, members of the Leadership Development Committee may participate in a meeting of the Committee by electronic means; provided, however, that upon request of any member of the Leadership Development Committee the electronic meeting will be replaced by an actual physical meeting at a place to be designated by the Committee chair.
Delegates, and at the discretion of the Board of Directors up to an equivalent number of alternate delegates, to the American Medical Association shall be elected in such numbers and for such terms as the American Medical Association Bylaws may prescribe, with each delegate or alternate delegate to be elected for a term of two (2) years beginning January 1 following the meeting at which they were elected. A person is not eligible to serve more than five (5) consecutive terms as a delegate to the American Medical Association, except that the term limit shall not be applicable to any delegate who has been elected or appointed to any American Medical Association council or office. A person is not eligible to serve more than five (5) consecutive terms as an alternate delegate to the American Medical Association, except that the term limit shall not be applicable to any alternate delegate who has been elected or appointed to any American Medical Association council or office. This exemption from term limitation for delegates and alternate delegates elected or appointed to any AMA council or office shall terminate effective immediately at the completion of the AMA council or office position. The delegate or alternate delegate shall be allowed to serve out the remainder of the current two-year term of office. Terms served as delegate or alternate delegate, while as an AMA officer or council member, will be counted to determine eligibility to run for re-election.Eligibility to any office shall include
Policy RequestThe Policy Committee recommends that the policies listed in the appendix to its report be acted upon in the manner indicated. For policies recommended for reaffirmation or reaffirmation with amendment, the committee recommends these policies be reaffirmed for a period of time to coincide with the next decennial anniversary of their original adoption to help disperse the volume of policies reviewed at each annual policy sunset review.
1) The Iowa Medical Society collaborate with Certified Professional Midwifery groups on legislative efforts to regulate Certified Professional Midwives through licensing.
2) The Iowa Medical Society encourage inclusion of Certified Professional Midwife representatives in stakeholder discussions involving maternal health and equity in Iowa.
3) The Iowa Medical Society support data collection on Certified Professional Midwife practice and outcomes.
4) The Iowa Medical Society study and provide education on best practices regarding the integration of home births into the healthcare system, including but not limited to consultations, collaborative management, and transfer to hospital care, as indicated by the health of the mother and newborn.
A) The Iowa Medical Society affirms American Medical Association Policy G-605.009, adopted as amended at the Annual Meeting of the House of Delegates in June 2022, and that the Iowa Medical Society, under direction of the Board of Directors, will work with the task force to accomplish its goals.
B) The Iowa Medical Society
1) Affirms that government and other third-party interference in evidence-based medical care compromises the sanctity of the physician-patient relationship and undermines the provision of quality health care;
2) Opposes any government regulation or legislative action which would criminalize physicians for providing evidence-based medical care within
theaccepted national standards of care, as informed by according tonationally recognized professional practice guidelines, as well as and the scope of a physician’s training and professional judgment;
3) Recognizes that healthcare, including reproductive health services like contraception and abortion, is a human right;
4) Opposes limitations on access to evidence-based reproductive health services deemed appropriate by a physician’s professional judgement, including fertility treatments, contraception, and abortion;
5) Will work with the American Medical Association and medical specialty societies to vigorously advocate for broad, equitable access to healthcare services, including reproductive health services, such as
includingfertility treatments, contraception, and abortion;
6) Supports shared decision-making between patients and their physicians regarding healthcare services, including reproductive healthcare;
7) Opposes any effort to undermine the basic medical principle that clinical assessments
, such as viability of the pregnancy and safety of the pregnant person, are determinations tobe made only by healthcare professionals with their patients, including but not limited to viability of the pregnancy and safety of the pregnant person;
8) Opposes the imposition of criminal and civil penalties or other retaliatory efforts against patients, patient advocates, physicians, other healthcare workers, and health systems for receiving, assisting in, referring patients to, or providing healthcare services, including reproductive health services;
9) Will advocate for legal protections for patients who cross state lines to receive reproductive health services, including contraception and abortion, or who receive medications for contraception and abortion from across state lines, and legal protections for those that provide, support, or refer patients to these services;
10) Will periodically review the Iowa Medical Society policy compendium and recommend to the IMS Policy Forum policies which should be amended or rescinded to reflect these core values.
Adopted with Amendment.
The Iowa Medical Society adopt the following policies:
PF-145.001: Firearm Safety & Counseling
1.) The Iowa Medical Society supports federal and state research on firearm-related health impacts and
encouraging physicians to access evidence based data regarding firearm safety to educate and counsel patients about firearms.
2.) The Iowa Medical Society:
the role offirearm-related s ininjury and death is a public health concern suicides and potentially violent behavior;
b.) Recognizes that suicide is the leading cause of firearm-related deaths in the U.S.;
c.) Encourages the development of curricula and training for physicians with a focus on
lethal meansfirearm safety counseling within the broad topic of suicide risk, and mental health assessment and prevention;and
d.) Encourages physicians to discuss
lethal meansfirearm safety and work with families to reduce risk of firearm injury and death access to lethal means of suicide and violent behavior.
3.) The Iowa Medical Society supports increasing efforts to improve firearm safety in households by:
a.) Inquiring as to the presence and storage practices of household firearms as a part of childproofing the home;
b.) Educating patients about best-practices in firearm safety and storage;
c.) Encouraging patients to educate their children and neighbors about firearm safety and storage.
4.) The Iowa Medical Society supports
will oppose any restrictions on the freedom ability of physicians and other members of the physician-led health care team to inquire or talk about firearm safety issues and risks with their patients.
5.) The Iowa Medical Society encourages CME providers to consider, as appropriate, inclusion of firearm safety practices and related patient counseling in continuing medical education programs.
Adopted as amended
Amend the Iowa Medical Society bylaws as noted in the Policy Request Statement to add a second Medical Student Director position.
Approved as written
PRS 21-1-02: Firearm Policy
The Iowa Medical Society establish organizational policy that mirrors the AMA’s position on gun safety, common sense gun control, and advocating for more research, and oppose any relaxation of current gun laws that might lead to more deaths and injuries.
Referred Author-Recommended Amendment to PRS 21-1-02 to Committee on Law & Ethics for further study with a
report back to a future Policy Forum.
PRS 21-1-03: Prior Authorization Regulations
The Iowa Medical Society pursue legislation to regulate the insurance prior authorization process to ensure coverage and payment for care authorized for a patient in the past twelve months without the need to do repeated prior authorizations or peer-to-peer consultations.
Referred to Committee on Legislation for further study with a report back to a future Policy Forum.
(IMS Board of Directors)
Policy Request: Amend the Iowa Medical Society bylaws as submitted.
Action Taken: Adopted as Submitted
PRS 20-2-02: Interstate Telehealth Coverage
(Rob Lee, MD, Des Moines)
Policy Request: IMS submit a resolution to the AMA House of Delegates seeking federal action to permanently allow physicians to provide telehealth services to established patients traveling out of state, including waiving medical licensure requirements for the state in which the patient is traveling, and mandating Medicare and commercial insurance coverage for telehealth services provided to patients while traveling out of state.
Action Taken: Not Adopted
PRS 20-2-03: PMP Use Mandate
(Nicola Preston, DO, Des Moines)
Policy Request: The Iowa Medical Society pursue legislation to exempt prescriptions for acute conditions from the mandate that providers check the Prescription Monitoring Program prior to issuing an opioid prescription.
Action Taken: Referred to Committee on Legislation for further study and a recommendation to a future Policy Forum.
PRS 20-2-04: Iowa Dignity in Pregnancy and Childbirth Act
Angeline Best, M2, Iowa City; Elvis Castro, M2, Iowa City; Pooja Patel, M2, Iowa City; Rebecca Peoples, M2, Iowa City; Katy Pham, M2, Iowa City; Lulua Rawwas, M2, Iowa City; Zainab Tanveer, M2, Iowa City; Kelsey Adler, M3, Iowa City; Jocquil Givens, M3, Iowa City; Anna VC White, M3, Iowa City; Christine Mbakwe, M4, Iowa City; Deepika Raghavan, M4, Iowa City
Policy Request: The Iowa Medical Society pursue legislation to require that all providers working in perinatal care complete implicit bias training.
Action Taken: Referred to the Diversity, Equity, and Inclusion Task Force for further study and recommendation back to a future Policy Forum.
Policy Forum 20-2 Met Virtually on September 17, 2020
The Iowa Medical Society actively promote legislation to the General Assembly, modeled after current Indiana Statute, that would recognize the legal right of physicians to incorporate with independently practicing non-physician clinicians in professional corporations.
Action Taken: Referred to Committee on Legislation for further study with a report back to a future Policy Forum.
PRS 20-1-02: IMS Policy Sunset Report for 2020
The Policy Committee recommends that the Iowa Medical Society policies listed in the Appendix to its report be acted upon in the manner indicated in its report.
Action Taken: Adopted as Submitted
PRS 20-1-03: 8 to 10 Program
The Iowa Medical Society actively engage in a public education initiative to promote the 8-10 concept, and that IMS encourage state and local government to do the same.
Action Taken: Adopted as Amended
The Iowa Medical Society actively engage in a COVID-19 public education initiative to promote the 8-10 concept, use of cloth face coverings, and other safety measures as circumstances become necessary, and that IMS encourage state and local government to do the same.
Policy Forum 20-1 Met Virtually on July 10, 2020
The Iowa Medical Society advocate for Medicaid and commercial insurance coverage and reimbursement for the CoCM, consistent with the Medicare coverage and reimbursement included in the 2017 and 2018 Medicare Physician Fee Schedule.
Adopted as written
PRS 19-2-02: Advancing Gender Equity in Medicine
1. The Iowa Medical Society draft and disseminate to the membership a report detailing its positions and recommendations for gender equity in medicine, including clarifying principles for state and specialty societies, academic medical centers, and other entities that employ physicians.
2. The Iowa Medical Society:
a) advocate for institutional, departmental, and practice policies that promote transparency in defining the criteria for initial and subsequent physician compensation;
b) advocate for pay structures based on objective, gender-neutral objective criteria;
c) encourage a specified approach, sufficient to identify gender disparity, to oversight of compensation models, metrics, and actual total compensation for all employed physicians; and
d) advocate for training to identify and mitigate implicit bias in compensation determination for those in positions to determine salary and bonuses, with a focus on how subtle differences in the further evaluation of physicians of different genders may impede compensation and career advancement.
3. The Iowa Medical Society recommend as immediate actions to reduce gender bias:
a) eliminate the question of prior salary information from job applications for physician recruitment in academic and private practice;
b) inform physicians about their rights under the Lilly Ledbetter Fair Pay Act and Equal Pay Act;
c) establish educational programs to help empower all genders to negotiate equitable compensation;
d) work with relevant stakeholders to host a workshop on the role of medical societies in advancing women in medicine, with co-development and broad dissemination of a report based on workshop findings; and
e) create guidance for medical schools and health care facilities for institutional transparency of compensation, and regular gender-based pay audits.
4. The Iowa Medical Society collect and analyze comprehensive demographic data and produce a
study report on the inclusion of women members including, but not limited to, membership, committee makeup, and leadership positions within IMS, including the Board of Directors, speaker invitations and recognition awards, and disseminate such findings in regular reports to membership, beginning in 2020 and continuing yearly thereafter, with recommendations to support ongoing gender equity efforts.
The Iowa Medical Society commit to pay equity across the organization by asking the Board of Directors to undertake routine assessments of salaries within and across the organization, while making the necessary adjustments to ensure equal pay for equal work.
Adopted as amended
PRS 19-2-03: Violence Against Healthcare Workers
Adopted as Amended
PRS 19-2-04: Policy Sunset Report for 2019
The Policy Committee recommends that the Iowa Medical Society policies listed in the Appendix to this report be acted upon in the manner indicated in its report.
PRS 19-2-05: Increasing Medicaid Reimbursement for Psychiatric Mental Institutions for Children
The Iowa Medical Society shall advocate for increasing the PMIC reimbursement rate and establishing a reimbursement rebasing methodology wherein future increases are made in a reliable manner, creating funding stability for Iowa’s PMICs.
Policy Forum 19-2 Met on September 19, 2019
The Iowa Medical Society submit a resolution to the AMA House of Delegates seeking federal advocacy to eliminate the educational requirements for obtaining a DATA 2000 waiver.
Not Adopted; AMA Policy D-95.972 Reaffirmed
PRS 19-1-02: Board of Medicine Physician Member Stipends
The Iowa Medical Society, in partnership with the Iowa Osteopathic Medical Association and on behalf of all Iowa physicians, will pay the physician members of the Iowa Board of Medicine a daily stipend for their service.
PRS 19-1-03: Medicare Co-Payment Medication Coupons
The Iowa Medical Society submit a resolution to the AMA House of Delegates seeking federal advocacy to amend the anti-kickback statute to allow Medicare patients to use co-payment coupons to reduce their out-of-pocket expenses for medication.
Not Adopted; AMA Policies H-330.899 & D-110.993 Reaffirmed
PRS 19-1-04: Annual Meeting Bylaws Changes
Amend the IMS Bylaws to remove replace all references to the “Annual Meeting” with “Presidential Installation.”
PRS 19-1-05: Protecting the Physician-Patient Relationship
1. The Iowa Medical Society shall adopt as organizational policy that it is the policy of IMS to oppose inappropriate interference by the government and third parties that causes a physician to compromise his or her medical judgment as to what information or treatment is in the best interest of the patient.
2. IMS will work with other organizations as appropriate to oppose legislation or state or federal rules or regulations that inappropriately interfere with the patient-physician relationship or that prevent physicians from freely discussing with, or providing information to, patients about medical care and procedures, or which direct physicians to provide specified information or perform specified tests that are not medically necessary.
3. IMS will work with other organizations as appropriate to oppose legislation or state or federal rules or regulations which require a physician to provide information which is not medically accurate, evidence-based, and appropriate for the patient or a medical service which is not evidence-based and appropriate for a patient. IMS will likewise work to oppose legislation or state and federal rules which prohibit a physician form providing information which is medically accurate, evidence-based, and appropriate for the patient or a medical service which is evidence-based and appropriate for a patient.
4. IMS will communicate to government entities and to the public the concerns inherent in rules, regulations or statutes that restrict or direct communication between physicians and their patients as stated in this policy.
Referred to Committee on Legislation for review and recommendation to a future Policy Forum.
PRS 19-1-06: Direct to Consumer Pharmaceutical Advertisements
The Iowa Medical Society submit a resolution to the AMA House of Delegates seeking federal advocacy to ban direct to consumer pharmaceutical advertisements. If such federal efforts are unsuccessful, the resolution shall call for federal advocacy to require that pharmaceutical companies disclose the list price of medications and cheaper alternatives in all direct to consumer advertisements and that such advertisements include information on patient-centered health improvement measures that are recommended for patients with the condition for which the advertised medication seeks to treat.
Adopted as Amended; AMA Policy H-105.988 Reaffirmed
PRS 19-1-07: Value-based Payment or Alternative Payment Model Promotion & Development
The Iowa Medical Society will develop a strategy, potentially working with the Iowa Healthcare Collaborative and local payers, to promote and develop alternative payment models that would offer better incentives for value-based care. These new payment methods would primarily use outcome measures and meaningful measures of quality and cost, and use benchmarks that would not penalize higher performers.
Not AdoptedPolicy Forum 19-1 Met on April 5
PRS 18-2-01 Report of IMS Committee on Medical Services on Referred PRS 17-1-04: Protections for Prescribing Epinephrine
Approved with Recommended Amendment
PRS 18-2-02 Report of IMS Committee on Medical Services on Referred PRS 17-1-06: Requiring Physician Disclosure of Investigations and Complaints
IMS adopt the following policy:
The Iowa Medical Society does not support requiring a physician to disclose, for purposes of credentialing and privileging, that a complaint was filed against him/her if the investigation into the complaint resulted in a finding that it was unfounded and ultimately dismissed.