Advocacy


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.

2017 Washington State Medical Association House of Delegates Sea-Tac, October 13 & 14

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 presented resolutions.

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 Resolution

Final 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 Resolution

Final 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.

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Final 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 the Resolution

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 Resolution

Read 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 Resolution

Read 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.

Read the resolution

 

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.

Read the resolution

 

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.

Read the resolution