YCMS Promotes Fairness in Evaluation of Physician Practice
Let’s think of medical care as a football game. The “win” is a good outcome for the patient. Success depends on excellent performance by multiple players, and they have a variety of specialized roles, as nurses, pharmacists, clerks, transport teams, etc. The owners sell the tickets, build the stadiums, write the payroll, and supervise their employees. The referees (regulators) make sure that the play follows the rules.The physician is both quarterback and coach. The physician both directs the plays and brings unique skills to execute the play.
The team will not function if other players choose their own game plans. Or if the owners step in to call the plays. Or if the owners forget that they need to have a player that can throw the ball. Or forget that collecting dollars is irrelevant if patient care suffers.
The practice of medicine has always required complex, multifactorial decision making. But in recent years, the economic power of healthcare corporations (hospitals, and others) has grown, and created a new array of pressures which are sometimes conflicting.
Because of our community’s unfortunate litigation history, Yakima County Medical Society is committed to promoting successful physician work through physician friendly initiatives to protect physician decision-making from corporate pressures. Physicians are not always right, nor are attacks on physicians always right. But we can apply the rules of science so that judgment of physician performance in Peer Review, MQAC, employment law, and malpractice law can more incisively differentiate what is safe vs. unsafe for patients
Current Washington State Medical Association policy on hospital medical staff peer review comes from a YCMS resolution passed in 2012:
The WSMA will continuously advocate for state law which will protect the right of physicians to a fair and professional peer review process as a necessary condition for hospital immunity from physician suit.
1) Medical Staff and Hospital Bylaws must be followed. RCW 70.41.200 and 2007 c 273 s 22 and 2007 c 261 s 3 have been amended to include this provision, but RCW 7.71 should also be amended.
2) The legislative intention of HCQIA and WA RCW 7.71 is to “foreclose federal antitrust actions” which were the basis of 1988 US Sup Ct decision, Patrick v. Burgets, but the intention was not to endorse “economic credentialing” in the absence of substandard physician performance. Financial biasis a prohibited motive in physician peer review.
3) “Fairness” is unbiased case selection in the peer review process. Cases that fall out of standard medical practice shall be handled in a uniform and standard way between all members of the department.
4) “Professionalism” requires that peer review body decisions conform with standard medical practice and outside expert review. WSMA will continue to develop resources for unbiased expert review.
5) Peer review procedures must allow the protections afforded in other statutes that recognize and protect health care providers and facilities from participating in, or refraining from participating in, actions or practices to which they object on the basis of conscience or religion.
6) When “disruptive physician behavior” is cited in peer review sanction, quality of care complaints that are not disruptive must be excluded. This is defined in the amendment written by the Senate Law & Justice Committee.
2021 Washington State Medical Association Virtual House of Delegates, September 24 & 25
Resolution C-5 – Corporate Interference with the Practice of Medicine
This resolution requests WSMA advocacy for draft bill H-0301.1 Increasing Accountability for Nonprofit Hospitals and Health Care Services Corporations Hospital Accountability Bill H-0310.1 (Updated by HB 1272) – Google Docs
as explained below.
Read the entire resolution: C-5_Corporate_Interference_with_the_Practice_of_Medicine
Resolution C-5 Action Statements as edited:
RESOLVED, the WSMA will advocate for introduction into the 2022 legislative session of draft
bill H-0301.1 Increasing Accountability for Nonprofit Hospitals and Health Care Services
Corporations, of legislation, including
1. Department of Health will survey licensed health professionals on the quality of care
within their institutions
2. Strike the financial disclosure section which has been addressed by passage of HP 1272
3. Defense against interference with the practice of medicine by unlicensed individuals
4. Peer review for employed physicians facing termination or sanction
1 & 3 were recommended FOR adoption by the Reference Committee and passed 74 to 11.
4 was NOT recommended for adoption by the Ref Com and failed 52 to 34. That is a good result because it’s usually difficult to get more than about 5 votes against the Ref Com.
Resolution C-9 – Support Providers Practicing Medicine
Read the entire resolution: C-9_Support_Providers_Practicing_Medicine
Resolution C-9 Action Statement adopted:
RESOLVED, that WSMA support a regular anonymous survey of Washington physicians and physician assistants on issues including, but not limited to, job conditions, quality of patient care, job satisfaction, interference with “standard of care” practice of medicine by unlicensed individuals or entities, and whether not-for-cause employment terminations (or the threat thereof) are witnessed, and survey results will be publicly available (New HOD policy and Directive to Take Action)
What happened after the 2020 WSMA Annual Meeting:
On Nov. 1st, 2020 the Yakima City Council included in their legislative priorities: “Regulatory and legislative advocacy to preserve community access to health care services”.
Yakima County legislators authorized the WA legislative Office of Program Research to draft H-0301.1 Increasing Accountability for Nonprofit Hospitals and Health Care Services Corporations https://ycms.org/wp-content/uploads/Hospital-Accountability-Bill-H-0310.1.pdf to address the root causes of the Astria closure. The provisions include:
- Department of Health survey of licensed health professionals on the quality of care within their institutions
- Increased financial disclosure for 501(c)3 hospitals.
- Defense against interference with the practice of medicine by unlicensed individuals, following the language of 2017 SB 5322 Concerning Agreements Between Dentists and Third Parties That Provide Supportive Services to Dentists,
- Peer review for employed physicians facing termination or sanction, and
During the 2021 legislative testimony for HB 1272 – Concerning Health System Transparency, the Astria Hospital closure was specifically cited by the legislators on the House Healthcare Committee. Yakima Citycouncilmember, Kay Funk MD, also testified in favor of this bill. The bill was passed into law, amending RCW 43.70 and 70.41.
2020 Washington State Medical Association Virtual House of Delegates, September 26 & 27
In keeping with our Mission Statement of “Empowering Yakima County physicians to advocate for their profession”, and our Vision to “Assure that physicians can use the power and responsibility of their professional licenses to advocate for their patients”, YCMS presents these resolutions:
B-5 Support Equal Employment of Physician Assistants
This resolution would require the WSMA to support equal opportunity employment for PAs in clinical practice where advanced practice providers are being sought. It also requires the WSMA to educate physicians, corporate institutions, and hiring administrators regarding the implications of the PA Practice Modernization Act.
Read the entire resolution: B-5 Support Equal Employment of Physician Assistants - Final
This Resolution was PASSED.
B-7 Corporate Practice of Medicine
This resolution would require the WSMA to support the DOH surveying physicians on care quality at the hospitals and other corporate entities in which they work, as well as investigating complaints of substandard care. It also requires the WSMA to advocate that hospital boards include an independent watchdog. It would require the WSMA to support legislation restricting hospitals from classifying physicians as “at-will” employees.
Read the entire resolution: B-7 Corporate Practice of Medicine - Final (3)
This Resolution was REFERRED to the WSMA Board of Trustees for Further consideration.
B-15 Washington Physician Health Program must be ADA compliant and scientifically validated
This resolution would have the WSMA advocate for unbiased Cochrane-type meta-analysis of published research on PHP effectiveness, open publication of the WPHP’s plan for ADA compliance, and provide information to physicians regarding malpractice insurance related to defense against regulatory actions.
Read the entire resolution: B-15 WPHP Must Be ADA Compliant And Scientifically Validated (1)
Read the February 7, 2020 letter from the Washington Department of Health which orders American Disabilities Act compliance for the Washington Physician Health Program. DOH_Horiagon - Order for WPHP Compliance with ADA
This Resolution was DEFEATED.
2019 Washington State Medical Association House of Delegates Sea-Tac, October 12 & 13
B-1 Towards A More Effective Washington Medical Commission (WMC; previously called Washington Quality Assurance Commission, MQAC)
This resolution argues that the quality of medical care cannot be accurately judged in this abbreviated regulatory format. Problematic actions have been reported. We request that WSMA advocate for increased oversight of outcomes. We also ask WSMA to advocate for model defense litigation insurance policies from Physicians Insurance and physician education on how to seek improved policies from other carriers.
Read the entire resolution:
Res B-1 - More Effective Medical Commission (3)
This Resolution was REFERRED in part, and PASSED in part. Final wording:
RESOLVED, that the WSMA will advocate for independent tracking of physicians for 10 years after sanction, to provide numerical data on how many are alive and actively practicing, and to specifically enumerate physician suicides (Directive to Take Action –
Referred to BOT with report back)
RESOLVED, that the WSMA will educate physicians that their malpractice insurance, especially when employer contracted, may not cover defense against regulatory actions. Using Physicians Insurance as a model, all Washington physicians are encouraged to ask for a clear statement of coverage and consider private purchase of additional coverage for legal defense for the protection of medical license, professional reputation, civil rights, ADA rights, and due process rights. (Directive to Take Action – PASSED)
B-2 An Ethical and Effective Physician Health Program for Washington
The mission of the WPHP is to provide optimal support for physician addiction or disability, but these programs have inadequate evidence base, limited civil remedies, and limited Americans with Disabilities Act protections. This resolution asks WPHP for increased outcomes tracking including physician suicide. We also ask for improved defense litigation insurance policies and physician education on how to defend against unwarranted charges and continue effective professional practice.
Read the entire resolution:
This Resolution was REFERRED in part, and PASSED in part. Final wording:
RESOLVED, that the WSMA will advocate for independent tracking of Washington Physician Health Program enrollee physicians for 10 years, to provide numeric data on how many are alive and actively practicing, to document feedback from physician clients, and to specifically enumerate physician suicides (Directive to Take Action – REFERRED to BOT with report back)
RESOLVED, that the WSMA will educate physicians that their malpractice insurance, especially when employer contracted, may not cover defense against regulatory actions. Using Physicians Insurance as a model, all Washington physicians are encouraged to ask for a clear statement of coverage and consider private purchase of additional coverage for legal defense for the protection of medical license, professional reputation, civil rights, ADA rights, and due process rights. (Directive to Take Action – PASSED)
B-15 Tracking Physician Suicide
Increased risk of suicide is a known occupational hazard for physicians and medical students, but there is no accurate data. This resolutions asks that the WSMA explore options for tracking Washington state physician suicides and report its findings back to the House of Delegates in 2020.
Read the entire resolution:
Res B-15 - Tracking Physician Suicide (1)
This Resolution was PASSED as written. Final wording:
RESOLVED, that the WSMA explore options for tracking Washington state physician
suicides and report its findings back to the House of Delegates in 2020. (Directive to
Take Action – PASSED)
2019 Physician Whistleblower Protection Bill passed unanimously in both houses of the WA State Legislature
Gov. Inslee signs Substitute House Bill No. 1049, April 19, 2019. Relating to health care provider and health care facility whistleblower protections. Primary Sponsors: Representative Nicole Macri and Senator Karen Keiser
The Washington Legislature has an excellent website where you can read the complete text of the bill. Use this link:
https://app.leg.wa.gov/billsummary?BillNumber=1049&Initiative=false&Year=2019
2018 Washington State Medical Association House of Delegates Spokane, October 13 & 14
C-3 – Physician Whistleblower Protection
This resolution would have WSMA advocate for the physician whistleblower protection bill which was passed unanimously in the Senate during the 2018 legislative session, but did not pass the House of Representatives in the short session.
C-3 2018 Physician Whistleblower Protection (ADOPTED)
RESOLVED, that the WSMA find legislative sponsors to introduce into the 2019 Washington Legislature a physician whistleblower protection bill comparable to Senate Bill 5998/House Bill 2258 from 2018 (Directive to Take Action); and BE IT FURTHER
RESOLVED, that the WSMA vigorously support the physician whistleblower protection bill and identify it as a legislative priority. (Directive to Take Action)
RESOLVED, that the WSMA write and find legislative sponsors to introduce into the 2019 Washington Legislature a corporate practice of medicine bill with protections comparable to Senate Bill 5322, “concerning agreements between dentists and third parties that provide supportive services to dentists” (Directive to Take Action); and BE IT FURTHER
RESOLVED, that the WSMA legislative advocacy staff consult with the Washington State Dental Association on its path to success. (Directive to Take Action)
RESOLVED, that the WSMA Nominating Committee continue open, responsible, and
standardized vetting of nominees, which will include recognition of diversity in
traditional categories, but will also specifically include:
1. A statement of the candidate’s program priorities, i.e. “what is most important for
the WSMA to do for its members?”
2. A statement of what percentage of the physician’s time is devoted to direct
patient care (Directive to Take Action); and BE IT FURTHER
RESOLVED, that all WSMA members nominated for election (with the exception of
president and past president) and deemed qualified by the Nominating Committee be
placed on a ballot for vote by the House of Delegates. Ranked-ballot voting may be used
when appropriate. (Directive to Take Action)
2017 Washington State Medical Association House of Delegates Sea-Tac, October 13 & 14
B-1 Informed Choices in WSMA Elections
Introduced by: Yakima County Medical Society
This resolution addresses controversy in WSMA governance, and will create an elective process in which the program priorities of candidates for WSMA offices will be more transparent.
Read the ResolutionFinal Language B-1 – Informed Choices In WSMA Elections (ADOPTED AS AMENDED)
RESOLVED, that the WSMA convene a task force to ensure that the process followed by the WSMA Nominating Committee is transparent, fair and responsive to issues of diversity, including, but not limited to, medical specialty, geography by congressional district, age, gender, culture and practice setting (Directive to Take Action); and BE IT FURTHER
RESOLVED, that the task force be comprised of WSMA members at large, to include individuals not currently in a WSMA leadership position (Directive to Take Action); and BE IT FURTHER RESOLVED, that the task force prepare a report on its findings for the May 2018 WSMA Board of Trustees meeting. (Directive to Take Action)
C-1 Corporate Practice of Medicine
Introduced by: Yakima County Medical Society
In the 2017 Washington legislature, SB 5322 Concerning agreements between dentists and third parties that provide supportive services to dentists, (Sen. Curtis King; R, Yakima) passed unanimously in both houses, indicating that our legislators have a strong concern for protecting the public from conflict of interest inherent in corporate practice controlled by unlicensed individuals. This resolution seeks to extend those protections to physicians.
Read the ResolutionFinal Language C-1 – Corporate Practice of Medicine (REFERRED)
RESOLVED, that the WSMA write and find legislative sponsors to introduce into the 2018 Washington Legislature a Corporate Practice of Medicine bill with protections comparable to Senate Bill 5322 “Concerning agreements between dentists and third parties that provide supportive services to dentists” (Directive to Take Action); and BE IT FURTHER
RESOLVED, that the WSMA’s legislative advocacy staff consult with the Washington State Dental Association on their path to success. (Directive to Take Action)
C-16 Reduce Repeat Drunk Driving
Introduced by: Dave Krueger, MD, Delegate & WSMA Trustee
This resolution recognizes new technology in drunk driving enforcement and will bring Washington state into alignment with national stanndards.
Read the ResolutionFinal Language C-16 – Reduce Repeat Impaired Driving (ADOPTED AS AMENDED)
RESOLVED, that the WSMA support policies aimed at reducing repeat impaired driving that could include:
- Monitoring installation and use of mandatory ignition interlock devices for all convicted DUI offenders with the following actions that the National Highway Traffic and Safety Administration has found to reduce impaired driving:
1) incentives for early installation,
2) eliminate eligibility of repeat offenders for diversion programs,
3) coordination across all agencies involved in interlocks,
4) implement uniformly across the state,
5) strong, swift penalties for violations of use, and
6) ongoing evaluation and publication of programs’ effectiveness for improving interlock use;
- Requiring mandatory substance abuse assessment and treatment for all convicted DUI offenders;
- Recommending blood toxicology testing at the accident scene by qualified officers for all traffic crashes resulting in fatalities or serious injury;
- Requiring permanent ignition interlock device installation and monitoring for people with a second DUI conviction.
2016 Washington State Medical Association House of Delegates Sea-Tac, October 1 & 2
Attending from Yakima: Roy Gondo, as WSMA Trustee; Dave Krueger, as WSMA Trustee; Alan Greenwald, as Washington State Orthopedic Association President; Kay Funk, as Yakima Delegate; Meg MacLeod, as Yakima Delegate; Katina Rue ,as Washington State Osteopathic Association Delegate.
In keeping with our Mission Statement of “Empowering Yakima County physicians to advocate for their profession”, and our Vision to “Assure that physicians can use the power and responsibility of their professional licenses to advocate for their patients”, Yakima presented three resolutions. All three were passed, in part.
C-3 Fair Process for Employed Physicians
Introduced by: Yakima County Medical Society
In 2015, WSMA adopted a policy in support of fair peer review for employed physicians. This resolution asks to give that policy some teeth by lobbying to create a Washington statute comparable to California Health and Safety Code section 1278.5, which will protect physicians who advocate for improved patient care from retaliation by their employers.
WSMA will draft a bill on whistleblower protection bill, but the House of Delegates voted against establishing a specific deadline.
Read how the resolution was passed
C-4 Fair and Professional Medical Staff Peer Review
Introduced by: Yakima County Medical Society
Because of YCMS advocacy, WSMA has had a Fair and Professional Peer Review policy in place since 2012, but has done little to actualize that goal. The 2016 House of Delegates confirms support for efforts to draft legislation or policies to protect the right of physicians to fair and professional peer review, but declined to establish a specific deadline.
Read the ResolutionRead how the resolution was passed
B-2 WSMA House of Delegates
Introduced by: Yakima County Medical Society
This resolution concerns controversy over the process of WSMA governance. WSMA will continue with the current House of Delegates format and structure, but will also add online policy discussion through Virtual Reference Committees. WSMA will also seek direct member input by periodically surveying its entire membership regarding member concerns, and will facilitate members’ discussion via the WSMA website.
Read the ResolutionRead how the resolution was passed
WSMA House of Delegates meeting in Spokane on Sept. 27, 2015
YCMS presented three more physician friendly resolutions. All three passed the House of Delegates by large margins and now become WSMA policies.
B-1 Fair Process for Employed Physicians
Introduced by: Yakima County Medical Society
This resolution explores why “At Will” employment which prevails in other industries is not consistent with the physician’s duty to patients.
B-3 Fair and Professional Medical Staff Peer Review
Introduced by: Yakima County Medical Society
Reaffirms WSMA Peer Review policy, and requests that the WSMA Judicial Council provide an unbiased review of the Smigaj vs. YVMH court documents in order to help other physicians and hospitals avoid a repetition of this worst case scenario.
B-4 Physician and Physician Assistant Recredentialing
Introduced by: Dave Krueger, MD, Delegate Yakima County Medical Society
The “Washington Practitioner Application Authorization and Release of Information” form requires physicians and PAs to agree to abide by the bylaws, rules, regulations, contractual agreements, and policies of all of the healthcare organizations in which they practice. Under this new policy, those rules and regulations must be disclosed.