Ceja defines laws and ethics regarding healthcare. what group is represented by the letters ceja?

Principle V: Financing – Health care coverage should be equitable, affordable and sustainable. The financing strategy should strive for simplicity, transparency and efficiency. It should emphasize personal responsibility as well as societal obligations, due to the limited nature and resources available for health care.

Principle V Section A: Financing

(CONG-1, AM 2007; Reaffirmed, BOD-1, AM 2014)

As was originally envisioned by the Colorado Medical Society (CMS) (see original concept paper approved September 1996), the CMS supports the following American Medical Association (AMA) policies on individual health insurance (AMA H-165.920, excerpted portions). The CMS supports the principle of the individual’s right to select his/her health insurance plan and actively supports the concept of individually selected and individually owned health insurance. The CMS supports individually selected and individually owned health insurance as the preferred method of people to obtain health insurance coverage. The CMS advocates a system where individually purchased and owned health expense coverage is the preferred option, but employer-provided coverage is still available to the extent the market demands it. The CMS supports the individual’s right to select his/her health insurance plan and to receive the same tax treatment for individually purchased coverage, for contributions toward employer-provided coverage, and for completely employer provided coverage; equal tax treatment for the costs of health insurance is necessary, whether that coverage is purchased fully by individuals, partially by employers or fully by employers. The CMS supports and promotes efforts to establish and use medical savings accounts (MSAs). The tax-free use of such accounts for health care expenses, including health and long-term care insurance premiums and other costs of long-term care, are an integral component of CMS efforts to achieve universal coverage and universal access. The CMS supports enactment of federal legislation to expand opportunities for employees and others to individually own health insurance through vehicles such as medical savings accounts.

The Colorado Medical Society (CMS) believes that a universal health insurance proposal is needed that would provide coverage for all Coloradans. The goal of health system reform must be to allow Coloradans access to the most appropriate site of care. The CMS recognizes the complexity of developing and implementing such a proposal. It is imperative that the medical profession participates in the health system reform process as it evolves. The CMS views the following issues as the top priorities within health system reform:

(Motion of the Board, March 2004, Amended, AM 2005; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) acknowledges the important, active leadership role it must play in partnership with other public and private providers, employers, health insurers, community leaders and the residents of Colorado to meet the health needs of indigent Coloradans. The CMS believes that Colorado can reach its full potential only if the residents of the state are healthy. In seeking solutions to the problems of the underserved CMS is guided by the following core values:

The CMS supports both comprehensive and incremental efforts that will reduce the number of uninsured in Colorado and ultimately provide access to affordable, quality health care and preventive programs for all Coloradans. The following general principles guide CMS action:

(Motion of the Board, March 2004; Reaffirmed, BOD-1, AM 2014)

(Substitute RES-28, IM 1996; Sunset, BOD-1, AM 2014)

The Colorado Medical Society (CMS) will keep the journal exchange, with journals mailed to CMS and then reposited with Denver Medical Library.
(Motion of the Board, April 1982; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) will use the Denver Medical Library as now structured and not establish a CMS library.
(Motion of the Board, April 1982; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society supports the following Notice Requirements for Health Plans

The Colorado Medical Society supports enhanced beneficiary/provider protections related to transparency and quantitative standards for network adequacy of health insurance plans. CMS supports the following principles:

CMS opposes the disruption in an existing physician-patient relationship caused by plan changes to provider networks in the middle of a plan year. When an insurer terminates a physician’s participation agreement without cause, if both parties agree, the physician and patient should be allowed to continue the relationship for the remainder of that plan year as if the physician was still part of the network.

CMS will convey support of these principles to the Colorado congressional delegation and encourage their support of legislation which upholds these principles.

CMS will engage with the Colorado division of insurance and other stakeholders to evaluate the adequacy of current standards for health plan networks and notification procedures when providers are dropped from those networks.
(RES 1-P, AM 2014)

The Colorado Medical Society supports the requirement that insurance companies and agents inform each subscriber how their insurance plan is likely to impact or restrict their health care needs.
(RES-22, IM 2004; Revised, BOD-1, AM 2014)

Review current policies in Medicaid and the criminal justice system to determine whether patients with substance use disorders are receiving necessary, evidence-based treatment.
(BOD action, March 10, 2017)

(RES-62, AM 1996; Sunset, BOD-1, AM 2014)

(RES-39, AM 1987; Sunset, BOD-1, AM 2014)

(RES-15, AM 1980; Sunset, BOD-1, AM 2014)

Colorado Medical Society supports informed patient autonomy and supports the removal of the statutory mandate of the physician’s signature on the CPR directive;

(RES-7-A, AM 2007; Reaffirmed, BOD-1, AM 2014)

The social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the preferences of the patient should prevail. The principle of patient autonomy requires that physicians respect the decision to forego life-sustaining treatment of a patient who possesses decision-making capacity.

Life-sustaining treatment is any treatment that serves to prolong life without reversing the underlying medical condition. Life-sustaining treatment may include, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and artificial nutrition and hydration. There is no ethical distinction between withdrawing and withholding life-sustaining treatment. A competent, adult patient may, in advance, formulate and provide a valid consent to the withholding or withdrawal of life-support systems in the event that injury or illness renders that individual incompetent to make such a decision. A patient may also appoint a surrogate decision maker in accordance with state law.

If the patient receiving life-sustaining treatment is incompetent, a surrogate decision maker should be identified. Without an advance directive that designates a proxy, the patient’s family should become the surrogate decision maker. Family includes persons with whom the patient is closely associated. In the case when there is no person closely associated with the patient, but there are persons who both care about the patient and have sufficient relevant knowledge of the patient, such persons may be appropriate surrogates. Physicians should provide all relevant medical information and explain to surrogate decision makers that decisions regarding withholding or withdrawing life-sustaining treatment should be based on substituted judgment (what the patient would have decided) when there is evidence of the patient’s preferences and values. In making a substituted judgment, decision makers may consider the patient’s advance directive (if any); the patient’s values about life and the way it should be lived; and the patient’s attitudes towards sickness, suffering, medical procedures, and death.

If there is not adequate evidence of the incompetent patient’s preferences and values, the decision should be based on the best interests of the patient (what outcome would most likely promote the patient’s well-being). Though the surrogate’s decision for the incompetent patient should almost always be accepted by the physician, there are four situations that may require either institutional or judicial review and/or intervention in the decision-making process:

When there are disputes among family members or between family and health care providers, the use of ethics committees specifically designed to facilitate sound decision-making is recommended before resorting to the courts. When a permanently unconscious patient was never competent or had not left any evidence of previous preferences or values, since there is no objective way to ascertain the best interests of the patient, the surrogate’s decision should not be challenged as long as the decision is based on the decision maker’s true concern for what would be best for the patient. Physicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care. This includes providing effective palliative treatment even though it may foreseeably hasten death. Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment in accordance with a proper substituted judgment or best interests analysis.
(CEJA Progress Report, AM 2007; Reaffirmed, BOD-1, AM 2014)

Health Care Delivery Issues

(1) The Care of Dying Patients: A Position Statement from the American Geriatrics Society JAGS 43:577-578.
(RES-12, IM 1996; Revised, BOD-1, AM 2014)

The Colorado Medical Society believes that nursing home residents’ rights and autonomy regarding transport to their designated hospital ought to be honored as often as possible, when specified as part of an advance medical directive.
(RES-40, AM 1993; Revised, BOD-1, AM 2014)

The Colorado Medical Society supports and encourages frequent and forthright discussions between the patient, the family, the physician, and others providing medical care, concerning the patient’s wishes regarding the goal and extent of medical treatment. These discussions are particularly encouraged prior to occurrences which mark a potentially significant change in social or medical circumstances, such as admission to a hospital or long term care facility, the recognition of a significant health condition, the use of general anesthesia, pregnancy, as well as on a regular basis.
(RES-14, AM 1986; Reaffirmed, BOD-1, AM 2014)

Colorado Medical Society (CMS) supports the granting of privileges to physicians by Colorado hospitals and managed care organizations as stated below: The CMS believes that:

(RES-31, AM 1996; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society supports the development of a statewide standard credentialing form to be used by entities that credential physicians such as managed care organizations, hospitals, medical malpractice carriers, etc.
(RES-56, AM 1994; Reaffirmed, BOD-1, AM 2014)

Colorado Medical Society supports ensuring that hospital evaluation of physician performance resulting from Diagnostic Related Group physician profiling will be through an appropriate committee of the hospital medical staff which will have access to the raw data and will participate in the development of the data system.
(RES-HMS-5, AM 1984; Reaffirmed, BOD-1, AM 2014)

(RES-HMS-9, AM 1984; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society supports hospital governing board bylaws that do not contain provisions whereby the hospital corporate board or administration could unilaterally amend the medical staff bylaws, or its rules and regulations.
(RES-HMS-7, AM 1984; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) supports the Colorado Department of Health definition of Medical Staff as “...those physicians and dentists granted the privilege by the governing authority of a licensed facility to practice medicine or dentistry therein…” and the definition of physician in Colorado statute as “...a doctor of medicine or doctor of osteopathy duly licensed in the State of Colorado…”. The CMS opposes any attempts to include other care practitioners in these definitions.
(AM 1984; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society encourages hospital medical staffs to secure their own legal counsel separate and apart from the hospital administration.
(RES-22, IM 1984; Reaffirmed, BOD-1, AM 2014)

Hospital medical staff shall have sole authority to select and remove their own officers, set standards for medical staff/patient care and recommend clinical privileges. These principles should be incorporated into model hospital medical staff bylaws.
(RES-21, IM 1984; Reaffirmed, BOD-1, AM 2014)

Utilization of hospital resources by members of the hospital medical staff should not be the sole consideration in staff reappointment and renewal of staff privileges, but rather be considered in conjunction with professional performance and in performance of their role as patient advocate, and hospital medical staff bylaws should include these criteria.
(RES-20, IM 1984; Reaffirmed, BOD-1, AM 2014)

Hospital administrations should seek medical staff participation in hospital decisions regarding marketing and advertising. Additionally, the medical staff should actively seek participation in hospital decisions regarding marketing. The intent of this bilateral involvement is to prevent presentation to the public of medical misinformation.
(RES-19, IM 1984; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society supports the concept that all health plans and hospitals be required to be not-for-profit and provide adequate and sensible remuneration to their administrative personnel and their capital requirements. All assets over and above the mentioned monetary requirements be actuarially returned to the patients (payers of premiums) and providers both in lower or sensible premiums and adequate and sensible provider reimbursements. Monetary consideration should always be secondary to excellent and sensible patient care.
(RES-22, AM 1999; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society considers the tactics by some attorneys in demanding production of information not related to the independent medical examination (IME) itself, as inappropriate, burdensome and harassing. Following is a list of items considered inappropriate and may be considered a violation of Health Insurance Portability and Accountability Act (HIPAA) if releases are not obtained:

Note: The Physician has an ethical responsibility to disclose relationships that may result in a conflict of interest.

The Colorado Bar Association, the Plaintiff’s Bar and others should condemn these tactics.

Following is a list of information that may be requested and is considered appropriate for disclosure. Law does not mandate the information in bold print.

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

(Motion of the Board, February 1990, Motion of the Board, March 2000; Sunset, BOD-1, AM 2014)

1. Direct CMS to develop a Colorado-specific maintenance of licensure framework.
2. Direct Maintenance of Licensure Subcommittee to partner with Colorado Medical Board to make this a national pilot.
3. Direct Maintenance of Licensure Subcommittee to phase in MOL requirements.

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

In recognition of volunteer services provided by retired physicians and to encourage further volunteer participation in the area of indigent medical care, the Colorado Medical Society will work with the Colorado State Board of Medical Examiners, and if necessary develop legislation, to waive the fee for renewal of license of retired Colorado physicians who can provide confirmation that their only professional practice involves volunteer medical services for recognized charitable 501(c)(3) organizations or government agencies. If the aforementioned is unsuccessful, an alternative source of funding shall be explored.
(RES-29, AM 1997; Sunset, BOD-1, AM 2014)

The Colorado Medical Society believes that medical license fees and any associated fees and taxes should only be used to support the quality practice of medicine by doctors of medicine and doctors of osteopathy.
(RES-17, IM 1996; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) reaffirms its support for the goals of the Colorado Physician Health Program and conveys to the Colorado Medical Board CMS’ concerns with regard to the possibility of taking funding from the Colorado Physician Health Program.
(RES-69, AM 1990; Revised, BOD-1, AM 2014)

The Colorado Medical Board will be encouraged to enlist the resources of the Colorado Physician Health Program when physicians can reasonably benefit from the program’s resources.
(RES-76, AM 1987; Revised, BOD-1, AM 2014)

The Colorado Medical Society (CMS) recommends that Colorado physicians caring for frail, elderly residents in long term care settings as medical directors and/or primary care physicians maintain appropriate clinical knowledge in the practice of geriatrics, including appropriate use of medications, restraint reduction, hydration, pain control and palliation, appropriate vaccinations, fall prevention, pressure sore prevention and treatment, advance directives, and neglect/abuse recognition, including 2014 statutory changes to legal elder abuse.

Geriatric clinical knowledge additionally includes appropriate diagnosis and treatment of dementia and delirium in frail patients in long-term care settings prior to the initiation of psychotropic medications.

CMS encourages physicians working in long-term care settings to share their clinical knowledge with other non-physician practitioners working with the same frail, elderly patients.
(RES-5, AM 2003; Revised, BOD-1, AM 2014)

The Colorado Medical Society (CMS) endorses the utilization of qualified geriatric case managers for the coordination of screening and assessment of long-term care applicants, and for the subsequent development, implementation, monitoring and reassessment of a plan of care. The CMS support legislation to assure the qualification of case managers, to include licensure by an appropriate regulatory agency.
(RES-41, AM 1989; Sunset, BOD-1, AM 2014)

The Colorado Medical Society supports the development of guidelines for case management to insure the safety and well being of the patient. Special attention should be paid to the role of family case managers and other caring non-professional case managers, recognizing their functions in cost containment. Physician case management time should be considered an appropriate activity worthy of reimbursement.
(RES-46, AM 1988; Reaffirmed, BOD-1, AM 2014)

B. Fees for medical services - A physician should not charge or collect an illegal or excessive fee. For example, an illegal fee occurs when a physician accepts an assignment as full payment for services rendered to a Medicare patient and then bills the patient for an additional amount. A fee is excessive when after a review of the facts a person knowledgeable as to current charges made by physicians would be left with a definite and firm conviction that the fee is in excess of a reasonable fee. Factors to be considered as guides in determining the reasonableness of a fee include the following:

C. Out-of- network charges – Notification of patient rights - CMS encourages physicians to assist consumers facing out-of-network charges by informing them of their rights under this statute. CMS recommends that when a physician is unable to accept the insurer’s payment as payment in full, then the physician should:

CMS accepted the report of the CMS-CAHP Work Group on Prior Authorization (PA) and will continue the process of working with Colorado Association of Health Plans (CAHP).

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

Following are recommendations for CMS advocacy regarding the profiling of physicians. As such, the Board of Directors may amend or add to these principles as they deem necessary.

COPE further recommends that CMS leadership and staff shall engage in dialogue about physician profiling with the Colorado Association of Health Plans, and with individual plans as needed.  The goal of such dialogue shall be to attempt to secure adoption of as many of the above guiding principles as possible.  A report on these efforts shall be given to the Board of Directors prior to AM’11.
(COPE-1, AM 2010; Reaffirmed, BOD-1, AM 2014)

(RES-10, AM 2008; Sunset, BOD-1, AM 2014)

Colorado Medical Society supports physician networks based on the full complement of quality aspects, as described by the Institute of Medicine: safe, effective, efficient, patient-centered, timely and equitable.

CMS opposes physician networks that fail to include all of the Institute of Medicine’s quality aspects.
(RES-17, AM 2007; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) continue to provide detailed updates on PAC meetings in Colorado Medicine and in written reports with minutes to the Council on Practice Environment (COPE) and CMS Board of Directors. The lack of progression on physicians’ concerns raised at the merger hearing be brought to the attention of both UnitedHealthcare and the Commissioner of Insurance and/or the American Medical Association.
(RES-15, AM 2006; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) supports legislation or other remedies to require all insurers in Colorado using drug formularies to fully disclose the basis for the decision to put a medication in the preferred position on the formulary, e.g., cite the studies demonstrating safety and/or efficacy, and disclose any financial and/or business arrangements between the health plan and pharmaceutical companies related to formulary choices. The CMS supports formularies that are evidence based and cost-effective for the patient. The CMS supports the use of less restrictive formularies by all insurers and supports the concept that senior health plan formularies for any insurance company licensed in Colorado cannot be more restrictive than the least restrictive commercial plan marketed by that company. The CMS supports the concept that pharmaceuticals that are “non-formulary” be made available at a higher co pay. The CMS supports the development of a uniform and state wide prior authorization and appeal process for non-formulary medications with no more than two appeal steps required prior to review by the plan physician medical director. The CMS encourages all insurers to standardize the format used in their formulary publication. The formulary publication should also include an informational page containing such information as:

The CMS encourages all insurers to limit the amount of updates to the formularies to no more often than quarterly, and that updates be published in a uniform format.
(RES-57, AM 1996, RES-25, AM 1997, Revised RES-6, AM 2002; Reaffirmed, BOD-1, AM 2014)

1. Hospitalists systems when initiated by a hospital or managed care organization should be developed consistent with American Medical Association policy on medical staff bylaws and implemented with approval of the organized medical staff to assure that the principles and structure of the autonomous and self-governing medical staff are retained;
2. Colorado Medical Society opposes any hospitalist model that disrupts the patient/physician relationship or the continuity of patient care and jeopardizes the integrity of inpatient privileges of attending physicians and physician consultants.

(RES-7, AM 2002; Revised, BOD-1, AM 2014)

At the time of enrollment in a health plan, all lists of network providers contracted with a health plan shall be correct and up to date. The Colorado Medical Society shall support legislation or seek other means which would allow a person to opt out and change a health plan before that person’s policy expires if his/her physician’s participation is incorrectly represented in the insurance company provider list at the time the patient contracted with that health insurance plan.
(RES-9, AM 2002; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society opposes the inclusion of “all-products clauses” in managed care contracts.
(Revised RES-7, AM 2000; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society is opposed to health plans marketing physicians as members of their network without the written consent of the physician unless the physician is under signed contract 120 days prior to the effective date of the contract year of the health benefit plan.
(RES-8, AM 2000; Revised, BOD-1, AM 2014)

HMOs and health care insurers shall include in their calculation of plan expenditures only payments for patient care. The health plan shall exclude from the calculation of health care expense data, any funds retained by “carve out” or “carve in” managed care companies under contract with the insurer for administration and profit.
(RES-21, AM 1999; Reaffirmed, BOD-1, AM 2014)

Physicians have an obligation to evaluate a health plan’s capitation payments prior to contracting with that plan to ensure that the quality of patient care is not threatened by inadequate rates of capitation. Capitation payments should be calculated primarily on relevant medical factors, available outcomes data, the costs associated with involved providers, and consensus-oriented standards of necessary care. Furthermore, the predictable costs resulting from existing conditions of enrolled patients should be considered when determining the rate of capitation. Different populations of patients have different medical needs and the costs associated with those needs should be reflected in the per member per month payment. Physicians should seek agreements with plans that provide sufficient financial resources for all necessary care and should refuse to sign agreements that fail in this regard.

Physicians must not assume inordinate levels of financial risk and should therefore consider a number of factors when deciding whether or not to sign a provider agreement. The size of the plan and the time period over which the rate is figured should be considered by physicians evaluating a plan as well as in determinations of the per member per month payment. The capitation rate for large plans can be calculated more accurately than for smaller plans because of the mitigating influence of probability and the behavior of large systems. Similarly, length of time will influence the predictability of patient expenditures and should be considered accordingly. Capitation rates calculated for large plans over an extended period of time are able to be more accurate and are therefore preferable to those calculated for small groups over a short time period.

Stop-loss plans should be in effect to prevent the potential of catastrophic expenses from influencing physician behavior. Physicians should ensure that such arrangements are finalized prior to signing an agreement to provide services in a health plan. Physicians must be prepared to discuss with patients any financial arrangements that could impact patient care. Physicians should avoid reimbursement systems that cannot be disclosed to patients without negatively affecting the patient-physician relationship.
(RES-24, AM 1997; Reaffirmed, BOD-1, AM 2014)

Based upon a complaint by a policyholder or participating provider, the Colorado Division of Insurance shall review any prospective utilization review requirement such as prior authorization, etc., for a denial rate. Any utilization review requirement, which does not result in a denial rate of at least five percent, shall be eliminated by the health plan. The Colorado Medical Society shall support legislation to prohibit “hold harmless” clauses in managed care contracts that hold physicians liable for harm to patients as a result of any utilization review decisions made by the payer.
(RES-17, AM 1997; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) objects to any prior authorization process that is implemented solely for the purpose of creating a barrier to care. Prior authorization mechanisms created as barriers to care increase overall health care expenses by adding an unnecessary administrative burden.The CMS encourages all managed care organizations with a prior authorization process, to have the process contain at least the following elements:

(RES-24, IM 1997; Reaffirmed, BOD-1, AM 2014)

Definition
Use of a planned and coordinated approach to providing health care with the goal of quality care at a lower cost. Managed care techniques most often include one or more of the following:

Case Management/Coordination of Care

(RES-40, AM 1994, RES-7, IM 1997; Reaffirmed, BOD-1, AM 2014)

(RES-56, AM 1996; Sunset, BOD-1, AM 2014)

(RES-8, IM 1996; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) urges physicians practicing in managed care plans and systems to take the initiative in developing and implementing criteria and peer review oriented processes to access and assure the quality of care provided in these plans. The CMS urges managed care plans, hospitals, review entities, third party administrators and any other organizations that are compiling information on physician performance to share that information with the practitioners concerned in order to enhance and modify practice patterns through education where needed.
(RES-41, AM 1994; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) shall support the following statements regarding changes to relevant antitrust laws:

(RES-43, AM 1994; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) supports in concept, the following position paper on the Affiliation/Disaffiliation from Managed Care Entities, developed to provide CMS a policy basis from which to continue deliberations with members of the Colorado Association of Health Plans (CAHP) on issues of concern to physicians:

COLORADO MEDICAL SOCIETY
COLORADO ASSOCIATION OF HEALTH PLANS

WHITE PAPER ON PHYSICIAN AFFILIATION/DISAFFILIATION

Introduction
A number of factors have resulted in expansion or contraction of panels of physicians which contract with HMOs. Such factors include, but are not limited to the following: growth in HMO enrollment; intense competition among HMOs and insurance carriers; PPO development; development of Physician-Hospital organizations; and Employer Report Card (Health Plan Employer Data Information Set (HEDIS).

Purpose and Scope
The purpose of this White Paper is to address issues of mutual concern arising in the affiliation/disaffiliation process among physicians and HMOs.

The Colorado Medical Society (CMS) and the Colorado Association of Health Plans (CAHP) recognize that the relationship between a physician and an HMO is voluntary and contractual in nature. It is not the intent of this White Paper to alter current contracting practices between HMOs and physicians. This White Paper should not be construed as endorsing physician disaffiliation solely “for cause” or an adversary hearing process for disaffiliation.

The CMS and the CAHP believe that issues arising among physicians and HMOs could be ameliorated by enhanced communication between physicians and HMOs. They wish to develop an alternative to the expensive and time consuming adversary hearing process, while emphasizing mechanisms for dispute prevention.

Affiliation/disaffiliation issues involving quality of care or professional competence of physicians that lead to termination “for cause” are outside the scope of this White Paper. Such matters have implications under both state and federal law.

This White Paper contains the view and commitments of CMS and the CAHP. However, each organization is comprised of individuals whose adherence to views stated herein may differ. Some HMOs contract with groups of physicians (e.g., IPAs) that have primary responsibility for affiliation/disaffiliation actions. The recommendations of this White Paper are applicable to such groups of physicians as appropriate. The actions contemplated by this White Paper are recommendations that may or may not be adopted by an individual physician, groups of physicians or each HMO.

Recommendations
HMOs and physicians recognize that two-way communication is a critical part of maintaining an effective working relationship in the provision of quality, cost effective health care to HMO members. The following recommendations are intended to enhance the communication process.

When disaffiliation occurs because of change in network size or composition, the disaffiliated physician should be provided with the reason, including the criteria and methodology utilized for disaffiliation decision.

When a physician chooses to disaffiliate, the physician should provide the HMO or physician group with the reason for such action.

Joint Actions
The CMS and the CAHP will work collaboratively to undertake actions, which will foster communication between physicians and HMOs and provide for non-adversarial dispute resolution.

The CMS and the CAHP will annually review the mediation process and jointly implement any needed changes to it.

Colorado Medical Society and Colorado Association of Health Plans

CMS/CAHP WHITE PAPER
MEDIATION PROCESS

The Colorado Medical Society/Colorado Association of Health Plans Joint Committee have agreed to the following mediation process as provided for in the “White Paper on Physician Affiliation/Disaffiliation”.

This is a voluntary process on the part of each physician and each HMO or physician group and invoked only after exhaustion of any internal appeal process available to a physician.

The steps involved in mediation usually include: (1) application or agreement to mediate, (2) selection of a mediator, (3) preparation for the mediation session, (4) conducting the mediation session, and (5) settlement. There are also separate fees for the services of the mediator.

Based on our needs, the American Arbitration Association (AAA) seems to be our best option. AAA has an outstanding reputation and is known as the oldest, wisest and best organization of its kind. It has been around for 69 years. It is also one of the most reasonably priced organizations.

AAA charges a $300.00* administrative fee per mediation and $175.00* per hour for the mediator. The length of the mediations will obviously depend on the individual case, but could be anywhere from a half day to a few days. All expenses would be shared equally between both parties.

As mentioned above, AAA maintains a panel of mediators from which the physician and the plan would mutually select an individual mediator for each mediation.

In summary, we recommend selecting AAA to provide for our mediation needs. The white paper states that CMS and CHMOA “shall develop and jointly adopt a procedure for implementing a mediation program for physicians involved in the affiliation/disaffiliation process”. By using AAA services, we have met that requirement while expending minimal effort and resources of our organizations.

* These charges were in effect in June 1995 when this document was developed.
(Motion of the Board, July 1994; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) opposes policies related to discrimination against physicians and other health care professionals with a history of physical or mental health issues. The CMS supports physicians who are being discriminated against based on any physical or mental health issue. The CMS supports providing appropriate assistance to physicians at the local level who believe they may be treated unfairly by managed care plans, particularly with respect to selective contracting and credentialing decisions that may be due, in part, to a physician’s history of physical or mental health issues. The CMS urges managed care plans and third party payers to refer questions of physician physical or mental health issues to state medical associations and/or county medical societies for review and recommendation as appropriate.
(RES-29, IM 1994; Reaffirmed, BOD-1, AM 2014)

All managed care plans and medical delivery systems must include significant physician involvement in their health care delivery policies similar to those of self-governing medical staffs in hospitals Any physicians participating in these plans must be able without threat of punitive action to comment on and present their positions on the plan’s policies and procedures for medical review, quality assurance, grievance procedures, credentialing criteria and other financial and administrative matters, including physician representation on the governing board and key committees of the plan.
(RES-16, IM 1994; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society encourages all health plans that restrict access by enrollees or members to health care providers to offer coverage for health care services provided by out-of-network providers through an alternative “Point of Service Option”. The benefit level of such plans shall not be set so low as to act as a prohibitive deterrent to patient utilization of this option.
(RES-30, IM 1994; Reaffirmed, BOD-1, AM 2014)

CMS will vigorously advocate for increased fees and/or improved processes in the Colorado Medicaid program that benefits all specialties or where there is a consensus desire from the house of medicine.

(Board action, Jan. 19, 2018)

Colorado Medical Society supports adequate Medicaid funding provided by the state and federal government.

The Colorado Medical Society places a high priority on access to specialty care in the Medicaid Accountable Care Collaborative Program and advocates to maintain primary care reimbursement at least at Medicare parity levels.

CMS will explore and find consensus on specialty access tactics including, but not limited to:

The Colorado Medical Society supports the alignment of Colorado statutes with federal law to allow physicians to continue to engage in the dispensing of prescription medications to patients, and the adjudication of such transactions with Pharmacy Benefit Managers (PBMs).

The Colorado Medical Society affirms the need to remove restrictions on the adjudication of physician dispensed prescription medication transactions with Pharmacy Benefit Managers (PBMs).

(RES 14-P, AM 2013; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) supports the expansion of Medicaid under the terms of the 2010 Patient Protection and Affordable Care Act (ACA).

To facilitate successful expansion of access to health care under Medicaid and the ACA, we recommend that the following reforms be addressed urgently. We stand ready to work with the state and other stakeholders on these changes to enhance the value of the Medicaid program to patients and taxpayers.

Improving Medicaid
CMS has championed the longstanding goal of achieving health care coverage for all Coloradans. We have argued that efforts to redesign Medicaid and the larger health care system have to be about more than just improving coverage. They have to be about providing cost-effective, quality and safe medical care. That is one of the reasons we strongly support the Accountable Care Collaborative and it’s focus on cost-effectively improving the health of Medicaid patients through the use of local, patient-centered systems of care. Improving upon the ACC by developing and following a clearly defined, transparent pathway addressing the following high priority areas will accelerate the already promising cost, quality and patient satisfaction trends within the program. CMS strongly encourages efforts to address these systemic issues:

(Motion of the Board, January 2013; Reaffirmed, BOD-1, AM 2014)

If the state of Colorado elects to receive federal dollars to expand its Medicaid program under the Affordable Care Act, the Colorado Medical Society supports the rapid enactment of parity between Medicare and Medicaid physician reimbursement that encourages physician participation.
(LATE RES 8-P, AM 2012; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society support if proposed legislative relief to remove from 25.5-5-501 1(a) the exemption for generic substitution for medications to treat biologically based mental illness, cancer, epilepsy and HIV.
(RES 4, AM 2010; Reaffirmed, BOD-1, AM 2014)

Goal of the “Medicaid Reform Task Force: To improve the quality of care for Medicaid recipients and increase the efficiency of the program which would create cost savings and enhance provider participation.

Improve quality of care and health outcomes

Enable informed decision-making

Enabling more informed decision-making by physicians and patients at the point of care is essential to improving the quality and efficiency of care. The Medicaid Reform Task Force supports a Medicaid care management delivery system that encourages and supports the interoperable exchange of health information using secure health information technology applications. Functions should include:

Promote culture of collaboration among all stakeholders

(BOD-1, Progress Report, Attachment 1, AM 2007; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) endorses the concept that the Medicaid program may establish a list of preferred drugs that should be used for treatment of Medicaid beneficiaries, provided that such list should include drugs of every class of clinically useful medication, selected so as to establish cost savings and yet preserve professional choice in selecting agents of expected clinical effectiveness without inefficient and time wasting approval procedures.

The CMS supports a preferred drug list as developed by a committee including practicing physicians of multiple specialties for Medicaid in order to encourage cost-effective, quality health care.
(Late RES-36, AM 2003; Revised, BOD-1, AM 2014)

The Colorado Medical Society shall continue to work with legislators, other appropriate individuals and private/state organizations to educate them regarding:

(Late RES-31, AM 2002, RES-12, AM 1985; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society (CMS) supports efforts to create a streamlined Medicaid program that will promote state innovation and efficient use of funds, while maintaining the program’s role as a safety net for the state’s poorest and most vulnerable populations. This Policy is detailed in the CMS Position Paper on Medicaid.

(Motion of the Board, March 1996; Reaffirmed, BOD-1, AM 2014)

The Colorado Medical Society supports a unified accreditation system for allopathic and osteopathic physicians which:

1. Grants equal access to application to all residency positions for both osteopathic and allopathic medical students, and
2. Grants equal access to application to all postdoctoral fellowships for graduates of both osteopathic and allopathic residency programs.

(RES 18-P, AM 2013; Reaffirmed, BOD-1, AM 2014)

 

245.989 Discrepancies in Clerkship Cost

The Colorado Medical Society supports and encourages continued dialogue between the University of Colorado School of Medicine and Rocky Vista University College of Osteopathic Medicine regarding clerkship costs to arrive at a resolution that satisfied both parties.
(RES 17-P, AM 2013; Reaffirmed, BOD-1, AM 2014)

 

245.990 Workforce-Centered Education Funding

The Colorado Medical Society supports a funding structure for student education at the University of Colorado Anschutz medical campus determined by the workforce and medical needs of Colorado.
(RES 7-P, AM 2013; Reaffirmed, BOD-1, AM 2014)

 

245.991 Adolescent and Young Adult Cancer in Medical Education

The Colorado Medical Society recognizes the importance of Adolescent and Young Adult Cancers and supports the work of AAMC, AACOM, ACGME, AOA, and other relevant organizations in developing core competencies to ensure that medical students and residents are familiar with the unique medical, social and psychological issues posed by AYA cancer.

(LATE RES-7-A, AM 2011; Reaffirmed, BOD-1, AM 2014)

 

245.992 Health Policy Education in Medical School

The Colorado Medical Society (CMS) supports improving medical student education on health policy. The CMS shall help the Medical Student Component educate its members on the creation of a health policy forum.
(RES-3, AM 2008; Reaffirmed, BOD-1, AM 2014)

 

245.993 Medical Student Tuition and Debt

The Colorado Medical Society (CMS) supports legislation that would decrease medical school tuition debt.
(RES-8, AM 2006; Revised, BOD-1, AM 2014)

 

245.994 “All Payer” Funding for Medical Education

The Colorado Medical Society supports the American Medical Association’s efforts to achieve “all payer” funding for medical education.
(RES-10, IM 1996; Reaffirmed, BOD-1, AM 2014)

 

245.995 Training or Retraining Physicians for Rural Practice

The Colorado Medical Society encourages and supports broad-based, cross-specialty training and retraining for primary care physicians wishing to practice in rural areas and for physicians wishing to improve and increase their skills.
(RES-5, AM 1995; Reaffirmed, BOD-1, AM 2014)

 

245.996 Specialty Choice Requirements for Student Financial Aid

The Colorado Medical Society (CMS) supports efforts to increase medical student interest in primary care. The CMS supports incentives that enhance the practice of primary care as a means of encouraging selection of primary care specialties by medical students.
(RES-8, IM 1994; Reaffirmed, BOD-1, AM 2014)

 

245.997 Topics and Responsibility for the Annual Meeting Educational Program

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

 

245.998 Resident Working Hours

The Colorado Medical Society supports safe working hours and conditions for resident physicians.
(RES-54, AM 1990; Reaffirmed, BOD-1, AM 2014)

 

245.999 Maternity Leave for Residents

The Colorado Medical Society encourages all Residency program directors to review maternity leave policies so as to allow pregnant residents the same leave and benefits as designated for residents who are ill or disabled as defined in Federal law, and the Colorado Medical Society encourages written maternity leave policies which allow residents to return to their training program after said maternity leave without loss of eligibility to complete their training program.
(RES-54, AM 1988; Reaffirmed, BOD-1, AM 2014)

250. Medical Records

 

250.998 Medical Record Fees-Guidelines

Physicians may charge a reasonable cost-based fee for the copying of medical records. The reasonable cost-based fee may include the costs of supplies for and the labor of copying the medical records, as well as postage.
(RES-2, AM 2002; Reaffirmed, BOD-1, AM 2014)

 

250.999 Access to Physicians’ Personal Medical Records

The Colorado Medical Society opposes the request and use of medical record releases for physicians’ individual medical records by hospitals, other credentialing and privileging entities, and other similar entities.
(RES-25, AM 2000; Reaffirmed, BOD-1, AM 2014)

255. Medical Societies

 

255.999 Unified Voice for Physicians

Colorado Medical Society (CMS) supports the American Medical Association’s (AMA) goal to be the unified voice of the medical profession speaking for all physicians; and the CMS supports the AMA to act as a catalyst to encourage and assist specialty societies to meet and discuss differences and to resolve problems where possible in a specialty society forum.
(RES-34, IM 1992; Reaffirmed, BOD-1, AM 2014)

260. Medicare

 

260.994 Medicaid/Medicare Parity in Reimbursement Rates

If the state of Colorado elects to receive federal dollars to expand its Medicaid program under the Affordable Care Act, the Colorado Medical Society supports the rapid enactment of parity between Medicare and Medicaid physician reimbursement that encourages physician participation. Co-located as 260.994.
(LATE RES 8-P, AM 2012; Reaffirmed, BOD-1, AM 2014)

 

260.995 Analysis of Individual Procedures for Payment Reduction

The Colorado Medical Society (CMS) encourages the Centers for Medicare and Medicaid Services to conduct a thorough analysis of data prior to the implementation of any multiple procedure percentage reduction (MPPR) into the Medicare program to determine what efficiencies actually exist. CMS believes that the best avenue for this analysis and recommendation is done at the individual procedure/service level through the existing AMA RUC process.
(Reaffirmed, BOD-1, AM 2014)

 

260.996 Correction of Medicare Under-reimbursement to Colorado Physicians

The Colorado Medical Society (CMS) continues to support our AMA delegation encouraging our congressional delegation to introduce and support legislation that would remedy the Medicare’s Geographic Practice Cost Indices (GPCI) adjustment for Colorado, so that Medicare reimbursement to Colorado physicians becomes comparable to the reimbursement in regions with similar costs of living. The CMS shall continue to work with the Governor and other state officials to document the impact of low Medicare reimbursement on Colorado and encourage the Centers for Medicare and Medicaid Services to support legislation to remedy the current inequities.
(Revised Late RES-28, AM 2002; Revised, BOD-1, AM 2014)

 

260.997 Terminating Participation in Medicare - Managed Care Plans’ Responsibility to Patients

While the Colorado Medical Society (CMS) recognizes the managed care plan’s right to make business decisions, they are responsible for assuring their enrollees receive the health care needed with a minimal amount of disruption. It is ultimately the responsibility of the HMO to help minimize the financial impact to the patient and to assist in the transition of care.

The CMS encourages any managed care organization terminating a particular line of business or terminating a particular group of insureds to:

• Establish education sessions for enrollees outlining options available to them and steps to be taken to review those options;
• Develop a list of resources available to assist patients, such as government agencies, consultants etc.; and
• Implement the CMS/Colorado Association of Health Plan’s “Recommended Elements of Transition of Care”.

Additional Information: Recommendations for Transition of Care

(RES-15, AM 1999; Reaffirmed, BOD-1, AM 2014)

 

260.998 Medicare Changes to Ensure Patients’ Access to Physicians

The Colorado Medical Society encourages the federal Congressional Delegation and their health advisors, to affect changes that would encourage doctors to continue to see Medicare patients. Some suggested changes are: reduction of the massive paperwork, difficulty in obtaining ancillary services, and hassles inherent in the threat of fraud charges.
(RES-23, AM 1999; Reaffirmed, BOD-1, AM 2014)

 

260.999 Control of Medicare Spending Growth

The Colorado Medical Society opposes the use of Expenditure Targets/Sustained Growth Rate to control the volume of services rendered to Medicare beneficiaries and supports a more appropriate approach through funding research on the effectiveness of medical interventions to determine the effect on their outcomes, or the use of accountable focused peer review to examine the variant utilization patterns of Medicare Part B providers. These recommendations take into account the variables of new technologies and other factors that contribute to increased volume.
(RES-50, AM 1989, and RES-22, AM 1988; Reaffirmed, BOD-1, AM 2014)

265. Mental Health

 

265.998 Nondiscrimination in Mental Health and Substance Abuse Insurance Benefits

Similar to American Medical Association policy 185.986, the Colorado Medical Society (CMS) opposes discriminatory benefit limitations, referral mechanisms, co-payments or deductibles for the treatment of psychiatric illness and substance abuse under existing care plans, and opposes discrimination in any proposed plans for national health care coverage or universal access for the people who are uninsured. The CMS affirms its opposition to discriminatory benefit limitations, co-payments or deductibles for the treatment of psychiatric illness and substance abuse under any health care plan. The CMS supports parity of medical coverage for mental illnesses and substance abuse.
(Motion of the Board, March 2004; Reaffirmed, BOD-1, AM 2014)

 

265.999 Parity for Mental Health in Medical Benefits Programs

The Colorado Medical Society supports parity of medical coverage for mental illness and substance abuse and opposes discrimination in benefit limitations, referral mechanisms, co-payments or deductibles for the treatment of mental illness and substance abuse.
(RES-19, AM 2002; Reaffirmed, BOD-1, AM 2014)

270. Non-Physician Providers

 

270.992 CMS and Specialty Society Principles Regarding APN Scope of Practice

Physician-Led Health Care Teams

1. Health care that is effective, efficient, and safe results from the work of patient-centered provider teams – networks of individual providers acting in well-integrated and well-defined relationships. This has always been so for in-patient hospital care, and is increasingly a hallmark of high-quality health care in every medical setting.
2. Provider teams may work in a number of forms, varying with the needs of the patient, the environment in which the care is being provided, and the skills and training of the members of the team.  In all cases each provider’s work is integrated with the work of others for the betterment of the patient.
3. All effective health care teams respect the specialized skills and knowledge of each participating member; and each member contributes in a defined and coordinated way to achieving optimal care and optimal patient outcomes.
4. The duties, responsibilities, supervisory relationships and boundaries for each member of the team should be explicitly delineated by protocols, medical staff rules, or other similar means.
5. Leadership and overall responsibility for patient care are essential requirements for all effective, efficient and safe medical care.  While every provider working in a team contributes a specialized capability, leadership is necessary to integrate the whole to maximize the health benefits to the patient.  By the greater depth, length and breadth of their medical education, training, and experience physicians are in most circumstances uniquely qualified for this role.

Scope of Practice

1. The optimal degree of interaction among the members of a team is environment-dependent.  It may vary with the setting, the facility, and the area of health care.  An Advanced Practice Nurse, for example, may have less direct physician contact or supervision in a rural clinic than in a major-city hospital, yet for the same reason require more readily available access to physician expertise.  The central criterion is that which provides the best quality and safest care.
2. In no circumstance may Advanced Practice Nurses or other health care professionals practice beyond their license, education, training and experience.
3. Facilities such as hospitals, group practices, out-patient clinics, ACOs and other integrated-care arrangements must establish guidelines or protocols describing the scope of practice for Advanced Practice Nurses and other health care professionals.  Such guidelines must be established with participation from physicians having experience and skill in the type of health care being provided.  In hospitals the protocols and guidelines should have approval of the medical staff and governing board of the facility.
4. Where facilities establish the scope of practice with guidelines or protocols, the facility must be accountable for the effects of their application.

Nurse Anesthetists

1. The practice of Nurse Anesthetists is subject to all of the preceding principles, and to additional considerations reflecting the nature of anesthesiology and its diverse applications.
2. A nurse anesthetist must be supervised either by an anesthesiologist or by the operating physician for the procedure.  If not in continuous physical presence, the supervising physician must be immediately available to attend to the patient when needed.
3. In settings without anesthesiologists the supervising physician may be the operating surgeon, obstetrician, or other physician performing the procedure if the facility’s medical staff and governing board determine that the supervising physician has the necessary skill and training to provide such supervision.
4. If in any case the supervising physician or the nurse anesthetist determines that there is not the necessary expertise within the team to perform a procedure safely, that procedure should not be performed.

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

 

270.993 Scope of Practice

(BOD-1, AM 2009; Sunset, BOD-1, AM 2014)

 

270.994 Naturopaths

The Colorado Medical Society opposes the licensing of naturopaths and supports enforcing the Medical Practice Act, which prohibits the unlicensed practice of medicine and the use of the term physician by any person other than an MD or DO.
(RES-4, AM 2005; Reaffirmed, BOD-1, AM 2014)

 

270.995 Physical Examinations

(RES-14, AM 2003; Sunset, BOD-1, AM 2014)

 

270.996 Opposition to Psychologists Prescribing Medication

The Colorado Medical Society opposes prescriptive authority for psychologists.
(Late RES-29, AM 2002; Reaffirmed, BOD-1, AM 2014)

 

270.997 Non-Physician Providers

The Colorado Medical Society (CMS) defines non-physician providers (NPPs) as physician assistants (PAs) and advanced practice nurses (APNs). The CMS defines APNs as professional nurses with additional education and clinical experience beyond traditional nursing education. APNs include clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners.

The CMS encourages the profession of medicine to study the roles, education, scope of practice, potential for autonomy and accountability, and quality issues regarding NPPs to create a basis for informed recommendations and ongoing dialogue with public policy makers and other health professionals.

Role: The CMS supports incentives to facilitate the education and practice of NPPs that focus on the need for (medical) primary care skills.

Education: The CMS supports minimum education requirements and minimum clinical experience requirements for all NPPs. The CMS supports the requirement for a master’s level of education in order to be eligible for the title of APN. The CMS supports the definition of APN in Colorado statute to assure title protection and appropriate educational preparation. In addition to specific education requirements the CMS supports a clinical experience criterion, such as a formal internship. The CMS believes that the PA programs, which include minimum education requirements, clinical experience and certification, provide an excellent model for NPP licensure. The CMS recommends that physicians have input into the education and clinical requirements of NPPs in Colorado, specifically with regard to that content which is in the domain of medicine.

Scope of Practice: The CMS supports the development and implementation of uniform regulations for both APNs and PAs. Any functions that are traditional to the practice of medicine must be accompanied by specific education, certification, clinical experience, and require physician review and approval.

• Independent Medical Functions: The CMS believes that independent medical functions should be limited to those practitioners who are licensed to practice medicine as defined in the Medical Practice Act. NPPs do not have the minimum education, clinical experience and certification tests required by the Medical Practice Act.
• Collaborative Practice: The CMS supports the concept of collaborative practice between physicians and NPPs. Collaborative practice includes those medical functions that relate to self-limited and stable chronic conditions, as well as preventive services, provided by an NPP, which do not require the physical presence of the participating physician. The CMS supports mechanisms to facilitate collaborative practice plans.
• NPP Practice with Delegated Medical Functions: The CMS recognizes that currently NPPs perform delegated medical functions under existing statutes. The CMS recommends no modifications of this practice with the following exceptions:
 
1. On-site physician supervision shall not be limited to a specific number of NPPs, provided the physician supervisor can document adequate supervision.
 
2. Specific protocols are not required with on-site supervision.
 
3. Physician sign off on charts is required weekly.
 

 
Representation of NPPs in the CMS: The CMS supports dialogue between organized medicine and NPPs in order to promote the role of NPPs as members of the health care team.

Additional Information: Collaborative Practice Plan Guidelines

(RES-44, AM 1994; Reaffirmed, BOD-1, AM 2014)

 

270.998 Collaboration Among Physicians, Physician Assistants, Nurses and Pharmacists

The Colorado Medical Society supports the collaboration of advanced practice nurses, clinical pharmacists, physician assistants and physicians which would define and clarify educational standards and expand the role of this team especially in medically underserved areas and populations.
(RES-54, AM 1993; Reaffirmed, BOD-1, AM 2014)

 

270.999 Regulation of Allied Health Professionals

The Colorado Medical Society supports the following position on regulation of allied health professionals:

1. Regulation should be imposed upon a profession for the primary purpose of protecting the public.  Secondarily, regulation should be imposed to protect the allied health professional practice in a safe manner.
2. If regulation is needed, the form of regulation should be that which is the minimum necessary to protect the public and ensure that the allied health professional can practice in a safe manner.
3. All regulation of allied health professionals must be subject to periodic review by the legislature to insure its continuing necessity and appropriateness.  This ensures that the regulations are current and most effective in protecting the public.
4. Definitions: Certification (also called Title Protection): granted to an individual who has met certain prerequisite qualifications. Includes the right to use the “title” of the profession or occupation or to assume of use the term “certified” in conjunction with the title. Licensure: a process by which a statutory regulatory entity grants to an individual who has met certain prerequisite qualifications, the right to perform prescribed professional and occupational tasks and to use the title of the profession or occupation. Registration: a process which requires that, prior to rendering services, all practitioners formally notify a regulatory entity of their intent to engage in the profession or occupation.

(RES-21, IM 1990; Revised, BOD-1, AM 2014)

275. Nurses and Nursing

 

275.999 Aid to Nursing Profession

The Colorado Medical Society will pursue an active liaison with the nursing profession, offer active support to the nursing profession in terms of non-financial help and work in conjunction with the nursing profession to address the shortage of nurses in Colorado with the legislature as well as concerned medical institutions.
(Late RES-36, AM 2002; Reaffirmed, BOD-1, AM 2014)

280. Occupational Health

 

280.990 Workers’ Compensation Benefit Caps

The Colorado Medical Society supports legislative efforts to increase the total amount of disability benefits payable under the “Workers’ Compensation Act of Colorado.”
(RES-5, AM 2002; Reaffirmed, BOD-1, AM 2014)

 

280.991 Evaluation of Permanent Impairment

The Colorado Medical Society supports adoption, by the appropriate regulatory agencies, the most recent edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment.

Formerly Policy 140.999

(RES-26, AM 2000; Reaffirmed, BOD-1, AM 2014)

 

280.992 Workers’ Compensation Utilization Review

The Colorado Medical Society supports a policy for provider disciplinary actions under Workers’ Compensation utilization review that includes peer review of all clinical issues, an opportunity for providers to present their case, present additional information and answer questions. The provider will be afforded at least two (2) levels of appeal.
(Late RES-13, IM 1998; Reaffirmed, BOD-1, AM 2014)

 

280.993 Division of Workers’ Compensation Peer Review Activities

Any peer review activities by the Division of Workers’ Compensation shall be implemented in compliance with state and federal regulations governing peer review activities and confidentiality.
(RES-64, AM 1996; Reaffirmed, BOD-1, AM 2014)

 

280.994 Workers’ Compensation - Level 1 Accreditation

(Motion of the Board, January 1996; Sunset, BOD-1, AM 2014)

 

280.995 Independent Medical Examination

Colorado Medical Society supports the integrity of the “Independent Medical Examination” by assuring that a physician can determine who will be present during examination. If the physician’s integrity is abridged by judicial action, the physician has the right to refuse to perform the examination.
(RES-14, IM 1993; Reaffirmed, BOD-1, AM 2014)

 

280.996 Patient Solicitation

The Council on Ethical and Judicial Affairs considers the practice of soliciting patients through the “Independent Medical Examination” process to be unethical and constitutes a violation of the Colorado Medical Society’s Code of Ethics.
(Motion of the Board, January 1993; Reaffirmed, BOD-1, AM 2014)

 

280.997 Workers’ Compensation and Health System Reform

The following aspects of Workers’ Compensation health care are critical and must be considered when developing an overall health care reform plan:

• Medical decision-making must continue to be a physician responsibility.
• We support managed care within the Workers’ Compensation system with employer and employee input into the structure of that system.
• Maintain recognition of physician case management reimbursement including appropriate reimbursement for impairment ratings.(4) Provider payments must be commensurate with current prevailing reimbursement levels in the State of Colorado.

(Motion of the Board, November 1992; Reaffirmed, BOD-1, AM 2014)

 

280.998 Unfair Treatment of Occupationally Injured Patients

The Colorado Medical Society (CMS) continues to support fair and equal treatment of occupationally injured patients in the Workers’ Compensation system. The CMS will continue to work with the Governor and Legislature on an on-going basis to ameliorate inequities in the Workers’ Compensation Act.
(RES-75, AM 1991; Reaffirmed, BOD-1, AM 2014)

 

280.999 Continued Improvements to the Colorado Workers’ Compensation System

The Colorado Workers’ Compensation system should provide the highest level of benefits to the worker with proper incentives for the worker to return to productive employment as soon as possible. The Colorado Medical Society shall work directly with the business community, the state legislature, the Department of Labor and Employment, labor organizations and other appropriate groups to improve the Workers’ Compensation System.
(RES-28, IM 1990; Reaffirmed, BOD-1, AM 2014)

285. Peer Review

 

285.993 Colorado Professional Peer Review Act Sunset

Colorado Professional Peer Review Act Sunset
Guiding principles for peer review sunset:

CMS believes that statutory changes to CPRA should strengthen professional review processes that:

• Improve patient safety and contribute to ongoing education in the health care system
• Improve provider accountability
• Are fair
• Provide for consistency in data collection
• Contain safeguards to minimize the potential for abuse
• Minimize adversarial situations
• Promote teamwork among stakeholders

Recommendations

1. Schedule sunset for five years in order to create momentum for continued work by physicians and hospitals on consistency and predictability of peer review processes.
2. Harmonize CPRA with federal peer review law to minimize conflicts.
3. Clarify the definition of records to eliminate disputes about what is and is not admissible in court.
4. Expand the definition of entities that qualify as professional review committees to reflect new, non-hospital-based models of care.
 
5. Procedural improvements, including:
   • Expand the jurisdiction of the Committee on Anticompetitive Conduct to include any claim of unreasonable conduct related to peer review.
   • Require training for service on professional review committees.
    
   • Require all professional review organizations to have, and uniformly apply, written triggers for review and investigation.
    
   • Require that physicians under review have reasonable notice and an opportunity to respond to issues being considered, as well as access to such information and documents as are reasonably necessary to respond to a review or investigation.
    
   • Require all professional review organizations to institute a process for objectively validating the efficacy of its professional review system, e.g., external audits.
   • Stipulate that CPRA confidentiality protections may not be undermined by technical defects in a review, provided the process itself complies with CPRA and an individual review is in substantial compliance with the process.
   • Allow credentialing entities to share peer review data without losing confidentiality protections (this recommendation echoes a bill that CMS and COPIC tried to pass some years ago).

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

 

285.994 Quality of Care and Medical Staff Review

The Colorado Medical Society (CMS) believes that all quality of care issues pertaining to inpatient care should be referred to and evaluated by the hospital medical staff to determine whether physician and/or hospital quality assurance problems exist. The CMS maintains that medical staffs must be involved in resolving all hospital quality assurance problems pertaining to patient care and should be encouraged to take the initiative in these matters. The CMS supports the following principles regarding medical staff and quality assurance:

1. The care of the hospitalized patient should be under the direction of a physician (M.D. or D.O.) who is a member of the medical staff;
2. Peer review of medical care should be conducted by physicians on the medical staff;
3. Utilization review and Quality Assurance activities should be conducted under the direction of the medical staff;
4. Nursing and allied health staff should participate in quality assurance activities when appropriate; and
5. Quality assurance activities should not be conducted without medical staff involvement.

(Motion of the Board, March 2004; Reaffirmed, BOD-1, AM 2014)

 

285.995 Support of Physician Peer Review

The Colorado Medical Society (CMS) supports the concept of physician peer review and the direct involvement and participation of Colorado physicians in the peer review process.
(Motion of the Board, March 2004; Revised, BOD-1, AM 2014)

 

285.996 Health Plan External Grievance Review

All external grievance review procedures for adverse health plan decisions shall include the following basic components:

1. It should apply to all health carriers in Colorado;
2. Grievances involving adverse determinations can be submitted by the policy holder, their representative or their attending physician;
3. Issues eligible for external grievance review should include, at a minimum, denials for a) medical necessity determinations; and b) determinations by a carrier that such care was not covered because it was experimental or investigational;
4. Internal grievance procedures should generally be exhausted before requesting external review;
5. An expedited review mechanism should be created for urgent medical conditions;
6. Independent reviewers in the same community should be used whenever possible;
7. Patient cost-sharing requirements should not preclude the ability of a policyholder to access such external review;
8. The overall results of external review should be available for public scrutiny with procedures established to safeguard the confidentiality of individual medical information; and
9. External grievance reviewers shall, whenever possible, obtain input from physicians involved in the area of practice being reviewed. If the review involves specialty or sub-specialty practice, the input shall, whenever possible, be obtained from specialists or sub-specialists in that area of medicine.

(RES-26, AM 1998; Reaffirmed, BOD-1, AM 2014)

 

285.997 Peer Review, Corrective Action and Exclusive Contracts

Exclusive contracts should never be used as a mechanism to solve quality assurance problems in lieu of appropriate peer review processes. When there are quality assurance issues, exclusive contracting may result but the medical staff should be involved through the application of appropriate peer review processes, bearing in mind due process procedures.
(RES-37, AM 1991; Reaffirmed, BOD-1, AM 2014)

 

285.998 Center for Personalized Education for Physicians (CPEP)

The Colorado Medical Society supports the Center for Personalized Education for Physicians.
(RES-1, AM 1991; Reaffirmed, BOD-1, AM 2014)

 

285.999 Peer Review Organization (PRO) Data Dissemination

(RES-66, AM 1991; Sunset, BOD-1, AM 2014)

290. Physician Fees

 

Reimbursements for prior authorizations

CMS acknowledges the fact that time is required of physicians to obtain prior authorizations on behalf of their patients and this time must be recognized and compensable.

 

290.999 Medicare Fees

(Substitute Resolution in lieu of RES-15 and RES-25, IM 1987; Sunset, BOD-1, AM 2014)

295. Physician Payment

 

295.985 Physician Preparedness for Payment Reform

Goal
CMS should help physicians to understand, prepare and transition to new and evolving payment system.

Objectives

1. Educate physicians about alternative systems of payment and the opportunities and challenges they present for different physician specialties
2. Identify opportunities in each specialty for reducing health care costs that do not harm physicians or patients, and identify the barriers to realizing those opportunities
3. Develop physician consensus on specific recommendations about payment system design that will best enable physicians to help improve value in health care
4. Identify assistance needed to ensure the success of those preferred payment systems
5. Identify roles that the Colorado Medical Society can play to ensure that Colorado implements payment and delivery reforms in the most effective way
6. Help physician practices make the necessary changes to be successful under new payment models

Strategies

1. Develop and drive a multi-pronged educational campaign that helps physicians understand the evolution of payment systems from those that reward volume to those that reimburse for value.
2. Contract with nationally-recognized payment reform expert Harold Miller in a three-part engagement to include a multi-specialty summit in the winter, at the 2011 Spring Conference and at the fall 2011 Annual Meeting
3. Utilize the Systems of Care/Patient-centered Medical Home Initiative to connect payment reform to existing work on building out patient-centered medical homes, medical neighborhoods and other systems of care
4. Create a framework and promote forums for intra- and inter-disciplinary dialogue on payment reform
5. Connect reasons why use of data and clinical/business performance improvement activities can help to position a practice/specialty for alternative payment systems and broader system transformation
6. Closely coordinate physician education campaign with Colorado’s Center for Improving Value in Health Care (CIVHC), the American Medical Association and other physician-driven organizations

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

 

295.986 Payment Reform

CMS will actively monitor payment reform initiatives at national and local levels, educate physician members on how new payment models can and will impact their practices and the quality and cost of care, and aggressively seek out opportunities to participate in payment reform initiatives in Colorado to ensure that physicians are well represented in new programs from the start.
(COPE-1, AM 2010; Reaffirmed, BOD-1, AM 2014)

 

295.987 Budget Neutrality Factor

(RES-19, AM 2008; Sunset, BOD-1, AM 2014)

 

295.988 Delivery of Multiple Services to Patients at a Single Encounter

The Colorado Medical Society supports the reform of payment rules amongst all payers that penalize the delivery of more than one service to patients at single encounter or on a single day.
(RES-13, AM 2008; Revised, BOD-1, AM 2014)

 

295.989 Medical Directors’ Responsibility in Denial of Procedures

(RES-12, AM 2005; Sunset, BOD-1, AM 2014)

 

295.990 National Prompt Payment

The Colorado Medical Society supports federal legislation that would extend the Colorado Prompt Payment Statute nationwide.
(RES-18, AM 2004; Reaffirmed, BOD-1, AM 2014)

 

295.991 Reimbursement for Telephonic and Electronic Communications

Physicians should be compensated for their professional services based on a uniform policy, at a fair fee of their choosing, for established patients with whom the physician has had previous face to face professional contact, whether the current consultation service is rendered by telephone, fax, electronic mail or other forms of communication.

The Colorado Medical Society (CMS), both singularly and jointly through their American Medical Association delegation, press the Centers for Medicare & Medicaid Services and other payers for separate recognition of such supplemental communication work as discrete services, not as bundled into existing service codes or, have such services recognized as “not covered by Medicare” and therefore chargeable as a patient convenience outside the benefit package of Medicare.

The CMS shall continue to work with employers and insurers to discuss the value of electronic communications to their employees/insureds both from a triage and cost effective basis and is worthy of coverage. In addition, CMS shall prepare a public education initiative to explain the appropriateness and necessity of paying for physicians’ professional time.
(RES-25, AM 2002; Reaffirmed, BOD-1, AM 2014)

 

295.992 Retroactive Denial of Payment

The Colorado Medical Society opposes the unfair practice of retroactively denying payment of claims.
(RES-21, AM 2000; Reaffirmed, BOD-1, AM 2014)

 

295.993 Physician Charge Audit Procedures

The Colorado Medical Society supports the averaging of coding discrepancies with respect to audits of physicians’ charging practices so that both high and low coding is taken into account in arriving at a final audit report.
(RES-14, AM 2000; Reaffirmed, BOD-1, AM 2014)

 

295.994 Reimbursement for Paperwork Completion

The Colorado Medical Society believes physicians should receive reimbursement for completion of mandated forms.
(RES-36, AM 1993; Reaffirmed, BOD-1, AM 2014)

 

295.995 Fair and Equitable Payment

The Colorado Medical Society supports the concept of payment that is fair and equitable across specialty lines and across geographic areas.
(RES-48, AM 1993; Reaffirmed, BOD-1, AM 2014)

 

295.996 Standardized Eligibility for Health Benefits

The Colorado Medical Society supports a standardized system of verifying eligibility for health benefits. Health insurers shall pay physicians for any services rendered to patients whose eligibility for benefits have been verified and approved.
(RES-66, AM 1992; Reaffirmed, BOD-1, AM 2014)

 

295.997 Reimbursement of Expenses Incurred with Office Procedures

(RES-34, AM 1991; Sunset, BOD-1, AM 2014)

 

295.998 Excessive Requests for Information

The Colorado Medical Society opposes excessive and unnecessary requests for additional information and unexplained delays in processing and payment by third party insurance carriers where a completed standard claim form for reimbursement has been submitted.
(RES-44, AM 1991; Reaffirmed, BOD-1, AM 2014)

 

295.999 Endorsement of Resource-Based Relative Value Scales

The Colorado Medical Society supports a resource-based relative value approach as a method of Medicare reimbursement.
(RES-2, IM 1989; Reaffirmed, BOD-1, AM 2014)

300. Physicians

 

ABMS Definition of Medical Professionalism (Short Form)

A Brief Definition of Medical Professionalism

Medical professionalism is a belief system about how best to organize and deliver health care, which calls on group members to jointly declare (“profess”) what the public and individual patients can expect regarding shared competency standards and ethical values, and to implement trustworthy means to ensure that all medical professionals live up to these promises.

How Does Professionalism Work?

For medical professionalism to function effectively there must be interactive, iterative and legitimate methods to debate, define, declare, distribute, and enforce the shared standards and ethical values that medical professionals agree must govern medical work. These are publicly professed in oaths, codes, charters, curricula, and perhaps most tangible, the articulation of explicit core competencies for professional practice (see, for example, the ABMS/ACGME Core Competencies). Making standards explicit, sharing them with the public, and enforcing them, is how the profession maintains its standing as being worthy of public trust.

The ABMS Definition of Medical Professionalism (Short Form) was adopted by the ABMS Board of Directors, Jan. 18, 2012. It was developed by the Ethics and Professionalism Committee-ABMS Professionalism Work Group Frederic W. Hafferty, MD, Maxine Papadakis, MD, William Sullivan, PhD, and Matthew K. Wynia, MD, MPH, FACP.

(Motion of the Board of Directors, Jan. 22, 2022)

 

300.992 Returning the Joy of Medicine: Elimination or Mitigation of Administrative Burdens

CMS adopt the following policies on administrative tasks to mitigate or eliminate their adverse effects on physicians, their patients and the health care system as a whole, as originally developed and approved by the Board of Regents of the American College of Physicians (ACP) on January 21, 2017.

• CMS calls on stakeholders external to the physician practice or health care clinician environment who develop or implement administrative tasks (such as payers, governmental and other oversight organizations, vendors and suppliers, and others) to provide financial, time and quality-of-care impact statements for public review and comment. This activity should occur for existing and new administrative tasks. Tasks that are determined to have a negative effect on quality and patient care, unnecessarily question physician and other clinician judgment, or increase costs should be challenged, revised or removed entirely.
• Administrative tasks that cannot be eliminated from the health care system must be regularly reviewed, revised, aligned and/or streamlined in a transparent manner, with the goal of minimizing burden, by all stakeholders involved.
• Stakeholders, including public and private payers, must collaborate with professional societies, frontline clinicians, patients and electronic health record vendors to aim for performance measures that minimize unnecessary clinician burden, maximize patient and family centeredness, and integrate the measurement of and reporting on performance with quality improvement and care delivery.
• To facilitate the elimination, reduction, alignment and streamlining of administrative tasks, all key stakeholders should collaborate in making better use of existing health information technologies, as well as developing more innovative approaches.
• As the U.S. health care system evolves to focus on value, stakeholders should review and consider streamlining or eliminating duplicative administrative requirements.
• CMS calls for rigorous research on the effect of administrative tasks on our health care system in terms of quality, time and cost; physicians, other clinicians, their staff and health care provider organizations; patient and family experience; and, most important, patient outcomes.
• CMS calls for research on best practices to help physicians and other clinicians reduce administrative burden within their practices and organizations. All key stakeholders, including clinician societies, payers, oversight entities, vendors and suppliers, and others, should actively be involved in the dissemination of these evidence-based best practices.

(Board action, Sept. 15, 2017)

 

300.993 H-1B Visas for International Medical Graduates

CMS supports the already established process of legal immigration granting H-1B visas to people wishing to further their education and/or careers in medicine.

(Board action, May 12, 2017)

 

300.994 Physician Rights in Workers’ Comp

Board Action 1: Approved increased due process protections that allow providers to fairly challenge adverse credentialing, quality, or service reviews.
Board Action 2: Approved objective review triggers for provider reviews that are written and consistently applied.

Board Action 3: Approved change in Pinnacol’s Network Affiliation Committee to a majority of physicians with the power to make binding recommendations.

Board Action 4: Approved change in Pinnacol’s “Without Cause Termination” policy to make clear that the guidelines providing due process protections apply when disaffiliation involves any Quality of Care or Quality of Service matter, eliminating use of “without cause” contract provisions to circumvent these processes.

Board Action 5: Written notice, investigations, and adverse actions: Approved a change in Pinnacol’s policies to require existing processes provide for written notice and an opportunity for physicians to be heard until Pinnacol has made a determination about taking adverse action.
(BOD-1, AM 2011; Reaffirmed, BOD-1, AM 2014)

 

300.996 Commitment to Physician Rights

The Colorado Medical Society reaffirms its commitment to the principles of the physician as a patient advocate, the right of the physician to peer review and medical staff privileges and the right of the physician to work.
(Late RES-26, AM 2001; Reaffirmed, BOD-1, AM 2014)

 

300.997 Increase in the Numbers of Primary Care Physicians

The Colorado Medical Society encourages the identification and funding for incentives to increase the number of primary care physicians in Colorado, especially in rural areas, with emphasis on improving access to quality health care in those rural areas in general.
(RES-16, IM 1993; Reaffirmed, BOD-1, AM 2014)

 

300.998 Second Opinions

The Colorado Medical Society supports the right of the patient to participate in the selection of the physician to provide a second opinion.
(RES-37, AM 1987; Reaffirmed, BOD-1, AM 2014)

 

300.999 Definition

Colorado Medical Society recommends that the term “physician” wherever used continue to be only applied to persons having graduated from a school of medicine or osteopathy and otherwise satisfied the legal requirements to practice medicine as outlined by the Medical Practice Act.
(RES-16, IM 1979; Reaffirmed, BOD-1, AM 2014)

305. Practice Parameters

 

305.998 Clinical Practice Guidelines

The Colorado Medical Society encourages the development of clinical practice guidelines that conform to the following principles:

1. Clinical practice guidelines state that they are guidelines, not standards;
2. Clinical practice guidelines be developed with the involvement of physicians who use them;
3. Clinical practice guidelines include a rating scheme for strength of evidence, such as that published by the U.S. Preventive Services Task Force;
4. Clinical practice guidelines be periodically reviewed for conformance to best medical practice, based on reasonable medical evidence. Such review will occur no less often than every two years; and
5. Clinical practice guidelines be distributed to those who might use them, and that any organization or individual making use of such a clinical practice guideline will use the guideline only for educational and/or quality improvement purposes.

(RES-1, AM 1999; Reaffirmed, BOD-1, AM 2014)

 

305.999 Guidelines for Use of Standards in Physician Office Assessment

(RES-58, AM 1996; Sunset, BOD-1, AM 2014)

310. Pregnancy and Child Birth

 

310.998 Home Delivery of Newborns

The Colorado Medical Society (CMS) believes that in-hospital obstetrical care should be a healthy, family oriented experience. The CMS supports efforts to educate patients about the relative risks of home delivery in order to enable more informed decision-making. The CMS does not support the practice of home deliveries in Colorado because of the increased risk for adverse outcomes for mother and baby.
(Motion of the Board, March 2004; Reaffirmed, BOD-1, AM 2014)

 

310.999 Length of Hospital Stay Following Obstetric Delivery

(RES-18, IM 1996; Sunset, BOD-1, AM 2014)


315. Prisons

 

315.998 Executions

An individual’s opinion on capital punishment is the personal moral decision of the individual. A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution. Physician participation in execution is defined generally as actions which would fall into one or more of the following categories: (1) an action which would directly cause the death of the condemned; (2) an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (3) an action which could automatically cause an execution to be carried out on a condemned prisoner.

Physician participation in an execution includes, but is not limited to, the following actions: prescribing or administering tranquilizers and other psychotropic agents and medications that are part of the execution procedure; monitoring vital signs on site or remotely (including monitoring electrocardiograms); attending or observing an execution as a physician; and rendering of technical advice regarding execution. In the case where the method of execution is lethal injection, the following actions by the physician would also constitute physician participation in execution: selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel.

The following actions do not constitute physician participation in execution: (1) testifying as to medical history and diagnoses or mental state as they relate to competence to stand trial, testifying as to relevant medical evidence during trial, testifying as to medical aspects of aggravating or mitigating circumstances during the penalty phase of a capital case, or testifying as to medical diagnoses as they relate to the legal assessment of competence for execution; (2) certifying death, provided that the condemned has been declared dead by another person; (3) witnessing an execution in a totally nonprofessional capacity; (4) witnessing an execution at the specific voluntary request of the condemned person, provided that the physician observes the execution in a nonprofessional capacity; and (5) relieving the acute suffering of a condemned person while awaiting execution, including providing tranquilizers at the specific voluntary request of the condemned person to help relieve pain or anxiety in anticipation of the execution.

Physicians should not determine legal competence to be executed. A physician’s medical opinion should be merely one aspect of the information taken into account by a legal decision maker such as a judge or hearing officer. When a condemned prisoner has been declared incompetent to be executed, physicians should not treat the prisoner for the purpose of restoring competence unless a commutation order is issued before treatment begins. The task of re-evaluating the prisoner should be performed by an independent physician examiner. If the incompetent prisoner is undergoing extreme suffering as a result of psychosis or any other illness, medical intervention intended to mitigate the level of suffering is ethically permissible. No physician should be compelled to participate in the process of establishing a prisoner’s competence or be involved with treatment of an incompetent, condemned prisoner if such activity is contrary to the physician’s personal beliefs. Under those circumstances, physicians should be permitted to transfer care of the prisoner to another physician.

Organ donation by condemned prisoners is permissible only if (1) the decision to donate was made before the prisoner’s conviction, (2) the donated tissue is harvested after the prisoner has been pronounced dead and the body removed from the death chamber, and (3) physicians do not provide advice on modifying the method of execution for any individual to facilitate donation. (I) Issued July 1980.

Updated June 1994 based on the report “Physician Participation in Capital Punishment,” adopted December 1992, (JAMA. 1993; 270: 365-368); updated June 1996 based on the report “Physician Participation in Capital Punishment: Evaluations of Prisoner Competence to be Executed; Treatment to Restore Competence to be Executed,” adopted in June 1995; Updated December 1999; and Updated June 2000 based on the report “Defining Physician Participation in State Executions,” adopted June 1998.
(Substitute RES-26, IM 1996; Revised, BOD-1, AM 2014)

 

315.999 Health Care and Corrections

The Colorado Medical Society supports sanitary conditions in jails and the humane treatment of inmates during the delivery of health care services in correctional facilities.
(RES-18, IM 1981; Reaffirmed, BOD-1, AM 2014)

320. Professional Liability

 

320.996 Reporting on Applications

(RES-28, AM 2004; Sunset, BOD-1, AM 2014)

 

320.997 Colorado Tort Reform Priority

The Colorado Medical Society will make the preservation and expansion of civil liability tort reform by legislation and all other means a top priority.
(RES-22, AM 2002; Reaffirmed, BOD-1, AM 2014)

 

320.998 Governmental Immunity

(RES-40, AM 1996; Sunset, BOD-1, AM 2014)

 

320.999 Malpractice Liability/Tort Reform

The Colorado Medical Society supports both tort reform and innovative solutions to liability insurance problems that affect the citizens of Colorado.
(Substitute RES-79, AM 1987; Reaffirmed, BOD-1, AM 2014)

325. Public Health

 

Public Health Measures Taken in Response to Novel Public Health Threats

CMS adopts the following policy principles to guide public health measures taken in response to novel public health threats:

• Public health measures must be grounded in science.
• CMS recognizes that science and medicine continually evolve, particularly as knowledge is gained with respect to novel public health threats.
• CMS recognizes that physicians play a key role in responding to novel public health threats.
• Physicians and other health care providers, public health departments, and governments must be allowed to respond to evolving situations, while remaining mindful of the impact of public health policies on individuals. 
• CMS opposes efforts to block appropriate public health responses.
• When faced with novel public health threats, physicians remain committed to protecting patients and the community from harm, and safeguarding patient welfare based on the application of the best available scientific evidence.

(Motion of the Board of Directors, Jan. 22, 2022)

 

325.971 Opposition to In-Situ and Open Uranium Mining in Colorado

The Colorado Medical Society opposes the practice of in-situ and open pit mining of uranium due to the adverse health impact of radioactively contaminated water on our agriculture, livestock and civilian population.
(RES-16, AM 2007)

 

325.972 Firearm Safety

Colorado Medical Society recognizes and calls for action on firearm safety in the following areas:

Public health crisis

• CMS recognizes firearm violence as a public health crisis.
• Public health expertise should be utilized and supported by federal and state research to study firearm injuries and deaths. This includes increased funding for and the use of state and national firearm injury databases, including the expansion of the National Violent Death Reporting System to all 50 states and U.S. territories, to inform state and federal health policy.

Regulation of firearms and firearm crimes

• CMS supports the enactment of reasonable laws that seek to regulate the sale and distribution of firearms in order to protect public health and safety.
• CMS supports enforcement of existing firearm safety and firearm control laws.
• CMS supports universal background checks at purchase.
• CMS supports legislative efforts that specifically penalize those who commit crimes with firearms.

Mental health

• CMS supports initiatives to enhance access to mental and cognitive health care, with greater focus on the diagnosis and management of mental illness and concurrent substance abuse disorders.
• CMS supports the development and use of standardized approaches to mental health assessment for potential violent behavior.
• CMS supports strengthening mental health checks at the time of purchase of a firearm.

Education and awareness

• CMS encourages physicians to include inquiry of gun ownership and subsequent discussion of gun safety as an element of their practice, as appropriate.
• CMS supports the rights of physicians to have free and open communication with their patients regarding firearm safety.
• CMS encourages physicians to consider this issue every time an opportunity presents itself to educate patients about firearm safety.
• CMS encourages physicians to access evidence-based data regarding firearm safety to educate and counsel patients about firearm safety.
• CMS supports and encourages physicians to educate patients about the importance of using gun locks in their homes.
• CMS supports educational efforts designed to increase awareness, especially among children, about the dangers of firearms and to reduce firearm violence in our society.
• CMS encourages physicians to become involved in local firearm safety classes as a means of promoting injury prevention and the public health.
• CMS encourages awareness among physicians and school faculty about traits that may indicate an individual could be capable of violence. Although these individuals may never display violent behavior, they still may benefit from professional help. CMS also encourages physicians to collaborate with school officials in developing programs to achieve zero tolerance toward school violence.
• CMS encourages local projects to facilitate the low-cost distribution of gun locks in homes.
 

325.973 Firearm Safety & Research, Reduction in Firearm Violence & Enhancing Access to Mental Health

(RES 4-P, AM 2014; Sunset, replaced by 325.972)

 

325.974 Inquiry of Gun Ownership

(RES 3-P, AM 2013; Reaffirmed, BOD-1, AM 2014; Sunset, replaced by 325.972)

 

325.975 Firearm Safety Policies

(Motion of the Board, March 2013; Reaffirmed, BOD-1, AM 2014; Sunset, replaced by 325.972)

 

325.976 Preventing Violent Crime through Expanding Mental Health Services

The BOD voted to support Gov. Hickenlooper’s proposal to strengthen Colorado’s mental health system in response to firearm violence and, in addition to the elements set forth in his proposal, the Board further suggests more mental health workers and patient beds, more emergency mental health workers, more mental health workers that are available to treat dual diagnosis of substance abuse and mental health illness, and more emphasis on pediatric mental health care.”

The five key strategies of the Governor’s plan include:

1. Provide the right services to the right people at the right time.
   • Align three statutes into one new civil commitment law. This alignment protects the civil liberties of people experiencing mental crises or substance abuse emergencies, and clarifies the process and options for providers of mental health and substance abuse services (requires legislative change).
   • Authorize the Colorado State Judicial System to transfer mental health commitment records electronically and directly to the Colorado Bureau of Investigation in real-time so the information is available for firearm purchase background checks conducted by Colorado InstaCheck (requires legislative change).

2. Enhance Colorado’s crisis response system ($10,272,874 budget request).

   • Establish a single statewide mental health crisis hotline.
   • Establish five, 24/7 walk-in crisis stabilization services for urgent mental health care needs.

3. Expand hospital capacity ($2,063,438 budget request).

   • Develop a 20-bed jailed-based restoration program in the Denver area.

4. Enhance community care ($4,793,824 budget request).

   • Develop community residential services for those transitioning from institutional care.
   • Expand case management and wrap-around services for seriously mentally ill people in the community.
   • Develop two 15-bed Residential Facilities for short-term transition from mental health hospitals to the community.
   • Target housing subsidies to add 107 housing vouchers for individuals with serious mental illness.

5. Build a trauma-informed culture of care ($1,391,865 budget request).

   • Develop peer support specialist positions in the state’s mental health hospitals.
   • Provide de-escalation rooms at each of the state’s mental health hospitals.
   • Develop a consolidated mental health/substance abuse data system.

The Governor’s plan would be:

• Implemented through the Office of Behavioral Health at the Colorado Department of Human Services.
• Coordinated and in partnership with the state’s Behavioral Health Organizations, Community Behavioral Health Centers, state and local law enforcement, the Department of Public Safety, the Department of Health Care Policy and Financing, the Department of Public Health and Environment, the numerous highly-skilled providers and advocates across the state, and many hospitals and psychiatric emergency medical partners.

Details of the Governor’s budget request include:

• $13 million to provide services to 809 additional people with developmental disabilities, including an increase of 576 funded waiver slots to eliminate the Children’s Extensive Services Waiver Program waiting list. Currently 2,400 individuals are on the wait list to access Developmental Disability services. The Governor’s budget proposal reduces that wait list by 30%.
• $1.8 million in continuing funds to provide Early Intervention and Case Management services for children from birth to 2 years of age.
• $17.7 million for strengthening Colorado’s Behavioral Health system including $10.3 million for expansions of the behavioral health crisis response system; $4.8 million for improving behavioral health community capacity; and $2.1 million for increasing access to civil beds for those defendants determined incompetent to proceed with their trials.
• $6.8 million for County Administration Food Assistance, including $2 million to cover county administrative costs associated with a projected increase in caseload with implementation of health care reform.
• $15.5 million for a 1.5% rate increase in provider rates.
• $1.3 million to compensate for increasing utility costs.
• $3.8 million to provide services for elderly adults in needs, including a 1.7% Cost of Living increase for Old Age Pension recipients.
• $860,000 to modernize Departmental data and IT systems.
• $5 million as a legislative set aside for the estimated costs of the recommendations of the Elder Abuse Task Force to increase protections for vulnerable seniors. These costs will fund a system of mandatory reporting of instances of exploitation or mistreatment of seniors.

(Motion of the Board, January 2013; Reaffirmed, BOD-1, AM 2014)

 

325.977 Body Art

The Colorado Medical Society requests that the Colorado Board of Health make inspections of body art facilities in accordance with 6CCR 1010-22, basic public health services required of all public health departments, and implement a registration program for body art facilities.
(RES-2, AM 2009; Reaffirmed, BOD-1, AM 2014)

 

325.978 Disaster Communication/Preparedness

The Colorado Medical Society supports a secure, statewide, noncommercial, disaster preparedness database dedicated to the singular purpose of recording participating physicians’ contact preferences during disasters, with access strictly limited to authorized officials.
(RES-9, AM 2008; Reaffirmed, BOD-1, AM 2014)

 

325.979 National Immunization Registry

The Colorado Medical Society supports a national immunization registry. Any required physician participation and data entry or maintenance shall be appropriately compensated.
(RES-7, AM 2008; Reaffirmed, BOD-1, AM 2014)

 

325.980 Childhood Vaccinations

The Colorado Medical Society (CMS) supports increased efforts to achieve herd immunity in Colorado for childhood vaccine preventable diseases through improved outreach to parents, encouraging the use of on-site school nurses, and through increased provider usage of the Colorado immunization registry. CMS opposes exemptions from childhood immunizations based on personal beliefs while maintaining exemptions for medical reasons and religious beliefs.
(RES-6, AM 2008; Reaffirmed, BOD-1, AM 2014)

 

325.981 Opposition to Importation of Radioactive and Toxic Waste Materials

Colorado Medical Society opposes the importation of nuclear and or toxic waste material from any other state or nation to the State of Colorado.
(RES-40, AM 2004; Reaffirmed, BOD-1, AM 2014)

 

325.982 Firearm Safety

(Motion of the Board, March 2004; Reaffirmed, RES-6-P, AM 2011; Reaffirmed, BOD-1, AM 2014; Sunset, replaced by 325.972)

 

325.983 Impaired drivers

The Colorado Medical Society recommends that:

1. Physicians increase their awareness of the medical conditions, medications, and functional deficits that might impair an individual’s driving performance, and
2. Physicians familiarize themselves with community resources such as formal driver assessment programs and driver rehabilitation services, and refer when appropriate, and urge physicians to know and adhere to Colorado’s reporting statutes for medically at-risk drivers, and
3. Physicians utilize the Physician’s Guide to Assessing and Counseling Older Drivers, a valuable tool available through the American Medical Association.

Formerly Policy 110.999
(Late RES-35, AM 2003; Reaffirmed, BOD-1, AM 2014)

 

325.984 Medical and Dental Care for Persons who are Developmentally Disabled

The Colorado Medical Society (CMS) entreats healthcare professionals, parents and others participating in decision-making to be guided by the following principles:

• All people with developmental disabilities, regardless of the degree of their disability, should have access to appropriate and affordable medical and dental care throughout their lives.
• An individual’s medical condition and welfare must be the basis of any medical decision.

The CMS American Medical Association (AMA) Delegation will submit a similar resolution to the AMA for consideration.
(RES-3, AM 2003; Reaffirmed, BOD-1, AM 2014)

 

325.985 Protective Headgear

The Colorado Medical Society (CMS) encourages recreational and competitive sports organizations and facilities to mandate the use of protective headgear during participation in sporting activities with the risk of head injury, including, but not limited to, skiing, snowboarding, bicycling, inline skating, skate boarding, roller skates, scooters, go-peds, horseback riding, hang gliding, and parachuting. The CMS supports legislation to mandate the use of protective helmets for children under the age of 14 who are participating in these activities.
(RES-20, AM 2002; Reaffirmed, BOD-1, AM 2014)

 

325.986 Support for Colorado Coalition for the Medically Underserved

The Colorado Medical Society supports the goals and work of the Colorado Coalition for the Medically Underserved.
(RES-22, AM 2001; Reaffirmed, BOD-1, AM 2014)

 

325.987 Elimination of Tuberculosis in the United States

The Colorado Medical Society supports tuberculosis screening for active and latent infection of all individuals seeking to enter the United States and for high-risk groups in Colorado such as prison inmates, homeless persons, intravenous (IV) drug abusers, and people infected with human immunodeficiency virus (HIV).
(RES-11, AM 2000; Reaffirmed, BOD-1, AM 2014)

 

325.988 Statewide Immunization Tracking System

The Colorado Medical Society supports the creation of an electronic statewide immunization tracking system or registry for all children, birth through age 18, at the earliest possible date.
(RES-20, AM 2000; Revised, BOD-1, AM 2014)

 

325.989 Immunization of Children, Adolescents and Adults

The Colorado Medical Society supports and encourages the immunization of children, adolescents and adults based on national standards.
(Substitute RES-27, IM 1996; Reaffirmed, BOD-1, AM 2014)

 

325.990 Rocky Flats Environmental Technology Site

(RES-9, AM 1991; Sunset, BOD-1, AM 2014)

 

325.991 Family Planning

The Colorado Medical Society (CMS) recognizes the existing problem of the rapidly proliferating population and supports efforts for voluntary limitation of family size and the dissemination of family planning material and information to everyone. The CMS opposes efforts that may potentially interfere with the delivery of needed family planning health services in our communities that have met all requirements of the law.
(RES-20-A, IM 1990; Reaffirmed, BOD-1, AM 2014)

 

325.992 Health Promotion

The Colorado Medical Society (CMS) recognizes the huge socio-economic impacts on the community and individuals of unhealthy lifestyle practices. The CMS supports health promotion and disease prevention by both physicians and patients.
(RES-29, IM 1990; Reaffirmed, BOD-1, AM 2014)

 

325.993 Routine Screening of Newborn Infants

The Colorado Medical Society supports the screening of all newborn infants of Colorado to include those diseases screened by the Colorado Department of Public Health and Environment that is supported by appropriate funding.
(RES-53, AM 1986; Reaffirmed, BOD-1, AM 2014)

 

325.994 Asbestos Abatement in Public Buildings and Schools

In the past asbestos was used in the construction of public places, including schools. If the asbestos is already sealed in and no demolition or remodeling is required, the Colorado Medical Society (CMS) recommends that no action be taken. If remodeling or demolition of buildings containing asbestos is to be done for reasons other than the asbestos content, the CMS recommends that the work be done by a firm approved for such work by the Colorado Department of Public Health and Environment.
(Motion of the Board, March 1985; Reaffirmed, BOD-1, AM 2014)

 

325.995 Joint Statement Regarding Smoking

The Colorado Medical Society (CMS) adopts the statement below prepared jointly by the CMS, the Colorado Hospital Association and the Colorado Department of Public Health and Environment.

Because smoking is the single most preventable cause of illness and early death, health care providers have a responsibility to take a leadership role to reduce smoking, to encourage non-smoking, and to protect the rights of the non-smokers. We recognize our role as exemplars in influencing the smoking behavior of the general public, and our responsibility in educating the community at large regarding the health hazards of smoking. We are particularly concerned with the dangers of smoking, and address this subject as a high priority issue. Exposure to cigarette smoke not only adversely affects the health of the smoker but increases the health risk and discomfort of patients who are already at risk for medical complications. Therefore, it is incumbent upon health care professionals to eliminate smoking in all health facilities. Because we, as health care providers, professionals and educators, are in a unique position to support the aims of all smoking-reduction activities, we unite our voices in a joint statement to recommend that smoking ultimately be eliminated from all health facilities in the state of Colorado.
(RES-17, AM 1984; Reaffirmed, BOD-1, AM 2014)

 

325.996 Indoor and Outdoor Air Pollution

In the interest of preserving public health the Colorado Medical Society supports efforts to reduce indoor and outdoor air pollution.
(Motion of the Board, March 1984; Reaffirmed, BOD-1, AM 2014)

 

325.997 Mandatory Seat Belt Use

The Colorado Medical Society (CMS) supports and encourages seat belt usage in automobiles and primary enforcement of the seat belt statutes. Further, CMS supports the increase in fines for a violation of the statute to be commensurate with other traffic violations of a like class.
(RES-3, IM 1984; Reaffirmed, BOD-1, AM 2014)

 

325.998 Nuclear Power Generation

The Colorado Medical Society (CMS) recognizes and stresses the great differences between nuclear warfare and the generation of nuclear power. The CMS believes that these two issues are essentially unrelated and should be considered independently. The CMS supports the further safe development and use of nuclear energy for electricity generation and energy independence, while pursuing research and development of alternative sources of energy.
(Motion of the Board, December 1982; Reaffirmed, BOD-1, AM 2014)

 

325.999 Motorcycle Helmet Law

The Colorado Medical Society supports requiring helmets for motorcycle riders.
(RES-25, AM 1980; Reaffirmed, BOD-1, AM 2014)

330. Quality of Care

 

330.999 Restricting Communication Between Physicians and Patients

The Colorado Medical Society strongly condemns any interference by the government or other 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.
(RES-43, AM 1991; Reaffirmed, BOD-1, AM 2014)

335. Research

 

335.999 Biomedical Research and Animal Activism

The Colorado Medical Society (CMS) supports the establishment of a uniform method to assure a prompt, unbiased review by scientific peers of federally funded research projects before grant or contract monies can be withheld from any investigator or institution. The CMS opposes legislation that inappropriately restricts the choice of scientific animal models used in research. The CMS supports the Facilities Protection Act (S-544 and HR-2407), which makes it a federal crime and similar legislation at state levels to make it a felony to trespass and/or destroy laboratory areas where biomedical research is conducted. The CMS supports education of the public and policy makers regarding the need for medical research.
(RES-65, AM 1991; Reaffirmed, BOD-1, AM 2014)

340. Rural Health

 

340.998 Rural Health

The Colorado Medical Society (CMS) supports and encourages rural training track residency programs in order to assist rural physicians and rural medicine and to increase the number of well-trained, broadly skilled rural physicians.. The CMS encourages other primary care specialties, along with Family Practice, to develop similar training programs. The CMS also encourages the improvement of training in traditional residency sites to teach broad-based skills to better qualify residents for rural practice. The CMS encourages the cultivation of an educational environment more supportive of rural primary care by:

1. Promoting changes at the medical school, which include consideration of a rural rotation for all first year residents and students, and encouraging faculty visits to rural areas;
2. Working with the Medical Student Component of CMS to mobilize students to work for a more favorable environment for the training of rural physicians;
3. Promoting the medical students’ mentor program to encourage and facilitate rural physician participation; and
4. Utilizing the CMS network of physicians to develop rural sites for use in conjunction with the medical education in an effort to get students out to rural areas and increase their interest in rural primary care. In an effort to improve the financial situation for rural physicians so as to encourage more physicians to choose rural practice and retain those currently in rural Colorado, the CMS encourages public and private payers to eliminate fee differentials, which result in reduced payment in rural fee schedules.

(RES-51, AM 1994; Reaffirmed, BOD-1, AM 2014)

 

340.999 Support of Colorado Rural Outreach Program

(RES-51, AM 1992; Sunset, BOD-1, AM 2014)

345. Surgery

 

345.998 Laser Surgery

(RES-32, AM 1991; Sunset, BOD-1, AM 2014)

 

345.999 Post-Operative Care

The Colorado Medical Society believes that patient postoperative medical management is the responsibility of the operating surgeon, and must be provided by the operating surgeon, or with the patient’s knowledge be delegated to another licensed physician.
(RES-58, AM 1989; Reaffirmed, BOD-1, AM 2014)

350. Technology

 

350.996 Telemedicine-Health

Advances in telemedicine and technology are rapidly transforming today’s medical practice. Telemedicine and telemedicine technologies can enable physicians to enhance access to care safely, improve care quality, reduce costs and improve patient and physician satisfaction. While these advances offer opportunities to improve the delivery of health care, they also present a number of risks and challenges to physicians and patients. The following policy provides guidance and a basic roadmap for physicians to consider as it relates to telemedicine.

These guidelines, which are based upon model policy from the Federation of State Medical Boards1 and peer-review literature, focus on physician-to-patient communications using telemedicine within established or new physician-patient relationships. These guidelines are not meant as legal advice and physicians are encouraged to bring any specific questions or issues related to online communication to their legal counsel. This policy provides guidelines and does not establish a standard of care for physicians practicing through telemedicine.

These guidelines are intended to address some of the patient safety challenges inherent to telemedicine, including but not limited to:

• Determining when a physician-patient relationship is established;
• Assuring privacy of patient data;
• Guaranteeing proper evaluation and treatment of the patient; and
• Limiting the prescribing and dispensing of certain medications.

Physicians who provide medical care, electronically or otherwise, are expected to maintain the highest degree of professionalism and should:

• Place the welfare of patients first;
• Maintain acceptable and appropriate standards of practice;
• Adhere to recognized ethical codes governing the medical profession;
• Properly supervise non-physician clinicians; and
• Protect patient confidentiality.
Definitions

“Telemedicine” means the practice of medicine using electronic communications, information technology or other means between a licensed health care provider in one location, and a patient in another location with or without an intervening healthcare provider. It typically involves the application of secure videoconferencing or store and forward technology to provide or support health care delivery by replicating the interaction of a traditional, encounter in person between a physician and a patient. Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation, or fax, although the use of such technology may be appropriate where there is an existing physician-patient relationship.

“Telemedicine technologies” means technologies and devices enabling secure electronic communications and information exchange between a physician in one location and a patient in another location with or without an intervening health care provider.

Licensure

The practice of medicine occurs where the patient is located at the time telemedicine technologies are used. Physicians and other health care providers who treat or prescribe through online services sites are practicing medicine and must possess appropriate licensure in all jurisdictions where patients receive care.

Establishing the Physician-Patient Relationship

The health and well being of patients depends upon a collaborative effort between the physician and patient. The relationship between the physician and patient is complex and is based on the mutual understanding of the shared responsibility for the patient’s health care.  It may be difficult in some circumstances to precisely define the beginning of the physician-patient relationship, particularly when the physician and patient are in separate locations, it tends to begin when an individual with a health-related matter seeks assistance from a physician who may provide assistance. However, the relationship is clearly established when the physician agrees to undertake diagnosis and treatment of the patient, and the patient agrees to be treated, whether or not there has been an encounter in person between the physician (or other appropriately supervised health care practitioner) and patient.

The physician-patient relationship is fundamental to the provision of acceptable medical care.  A physician is discouraged from rendering medical advice and/or care using telemedicine technologies without:

• Fully verifying and authenticating the location and, to the extent possible, identifying the requesting patient;
• Disclosing and validating the provider’s identity and applicable credential(s); and
• Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telemedicine technologies.

An appropriate physician-patient relationship has not been established when the identity of the physician may be unknown to the patient. Where appropriate, a patient must be able to select an identified physician for telemedicine services and not be assigned to a physician at random.

Where an existing physician-patient relationship is not present, a physician must take appropriate steps to establish a physician-patient relationship, and, while each circumstance is unique, such physician-patient relationships may be established using telemedicine technologies.

Evaluation and Treatment of the Patient

A documented medical evaluation and collection of relevant clinical history commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.

Informed Consent

Evidence documenting appropriate patient informed consent for the use of telemedicine technologies must be obtained and maintained. Appropriate informed consent to help establish a physician-patient relationship should include the following terms:

• Identification of the patient, the physician and the physician’s credentials;
• Types of transmissions permitted using telemedicine technologies (e.g. prescription refills, appointment scheduling, patient education, etc.);
• The patient agrees that the physician determines whether or not the condition being diagnosed and/or treated is appropriate for a telemedicine encounter;
• Details on security measures taken with the use of telemedicine technologies, such as encrypting data, password protected screen savers and data files, or utilizing other reliable authentication techniques, as well as potential risks to privacy notwithstanding such measures;
• Hold harmless clause for information lost due to technical failures; and
• Requirement for express patient consent to forward patient-identifiable information to a third party.
Continuity of Care

Patients should be able to seek, with relative ease, follow-up care or information from the physician (or physician’s designee) who conducts an encounter using telemedicine technologies. Physicians solely providing services using telemedicine technologies with no existing physician-patient relationship prior to the encounter must make documentation of the encounter using telemedicine technologies easily available to the patient, and subject to the patient’s consent, any identified care provider of the patient immediately after the encounter.

Medical Records

The medical record should include, if applicable, copies of all patient-related electronic communications, including patient-physician communication, prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telemedicine technologies. Informed consents obtained in connection with an encounter involving telemedicine technologies should also be filed in the medical record. The patient record established during the use of telemedicine technologies must be accessible and documented for both the physician and the patient, consistent with all established laws and regulations governing patient healthcare records.

Privacy and Security of Patient Records and Exchange of Information

Physicians should meet or exceed applicable federal and state legal requirements of medical/health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy, confidentiality, security, and medical retention rules.

Written policies and procedures should be maintained at the same standard as traditional face-to-face encounters for documentation, maintenance, and transmission of the records of the encounter using telemedicine technologies. Such policies and procedures should address:

1. Privacy;
2. Health-care personnel (in addition to the physician addressee) who will process messages;
3. Hours of operation;
4. Types of transactions that will be permitted electronically;
5. Required patient information to be included in the communication, such as patient name, identification number and type of transaction;
6. Archival and retrieval; and
7. Quality oversight mechanisms. Policies and procedures should be periodically evaluated for currency and be maintained in an accessible and readily available manner for review.

Sufficient privacy and security measures must be in place and documented to assure confidentiality and integrity of patient-identifiable information. Transmissions, including patient e-mail, prescriptions, and laboratory results must be secure within existing technology (i.e. password protected, encrypted electronic prescriptions, or other reliable authentication techniques). All patient-physician e-mail, as well as other patient-related electronic communications, should be stored and filed in the patient’s medical record, consistent with traditional record-keeping policies and procedures.

Disclosures and Functionality of Online Services:

Online services used by physicians providing medical services using telemedicine technologies should clearly disclose:

• Specific services provided;
• Contact information for physician;
• Licensure and qualifications of physician(s), associated physicians and other qualified health care providers;
• Fees for services and how payment is to be made;
• Financial interests, other than fees charged, in any information, products, or services provided by a physician;
• Appropriate uses and limitations of the site, including emergency health situations;
• Uses and response times for e-mails, electronic messages and other communications transmitted via telemedicine technologies;
• To whom patient health information may be disclosed and for what purpose;
• Rights of patients with respect to patient health information; and
• Information collected and any passive tracking mechanisms utilized.

Online services used by physicians providing medical services using telemedicine technologies should provide patients a clear mechanism to:

• Access, supplement and amend patient-provided personal health information;
• Provide feedback regarding the site and the quality of information and services; and
• Register complaints, including information regarding filing a complaint with the applicable state medical and osteopathic board(s).

Online services must have accurate and transparent information about the website owner/operator, location, and contact information, including a domain name that accurately reflects the identity.

Advertising or promotion of goods or products from which the physician or other qualified health care provider receives direct remuneration, benefits, or incentives (other than the fees for the medical care services) may raise conflict of interest issues. Online services may provide links to general health information sites to enhance patient education and physicians should limit potential conflicts of interest, minimize the risk of brand endorsement and ensure a focus on benefits to patients by disclosing the nature of their financial arrangement and informing patients about the availability of a product elsewhere.

Prescribing

Telemedicine technologies, where prescribing may be contemplated, must implement measures to uphold patient safety in the absence of traditional physical examination. Such measures should guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical evaluation and resulting prescription is maintained. Measures to assure informed, accurate, and error prevention prescribing practices (e.g. integration with e-prescription systems) are encouraged. Issuing a prescription via electronic means will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings.

Prescribing medications, in-person or via telemedicine, is at the professional discretion of the physician. The indication, appropriateness, and safety considerations for each telemedicine visit prescription must be evaluated by the physician in accordance with current standards of practice and consequently carry the same professional accountability as prescriptions delivered during an encounter in person. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, physicians may exercise their judgment and prescribe medications as part of telemedicine encounters.

Parity of Professional and Ethical Standards

There should be parity of ethical and professional standards applied to all aspects of a physician’s practice.

A physician’s professional discretion as to the diagnoses, scope of care, or treatment should not be limited or influenced by non-clinical considerations of telemedicine technologies, and physician remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes (i.e. a prescription or referral) or the utilization of telemedicine technologies.
(BOD-1, AM 2014)

 

350.997 Support for Telemedicine

The Colorado Medical Society supports the modernization of C.R.S. 10-16-123, including removal of the 150,000 person county or smaller limitation on payers for telemedicine services.

No health care provider shall be required to document a barrier to an in-person visit for health benefit plan coverage of services provided via telemedicine. Nothing shall require the use of telemedicine when in-person care by a participating provider is available to a covered person within the carrier’s network and within the member’s geographic area, when the health care provider has determined that it is not appropriate.
(RES 3-P, AM 2014)

 

350.998 Statewide Master Patient Index

The Colorado Medical Society supports a statewide secure and accessible network for sharing clinical data by encouraging adoption of a dedicated, secure, master patient index† to improve care and reduce ambiguity during electronic record exchange between dissimilar hospitals.
(RES-11, AM 2006; Reaffirmed, BOD-1, AM 2014)

†MPI: “Master Patient Index,” is a data retrieval strategy whereby a guarded set of unique patient identifiers allows authenticated queries to securely “point” to the correct hospital and internal identifier (medical record number, account number, etc), thereby generating a probabilistic “match list” for review by a credentialed requestor. Data remains decentralized and does not reside in any single statewide repository. The Internet and banking systems have used this strategy for over a decade.

 

350.999 Office Automation

(RES-1, IM 1995; Sunset, BOD-1, AM 2014)

355. Tobacco and Other Nicotine Products

 

355.992 Smoking Ban

Colorado Medical Society strongly and actively supports both state and local efforts to prohibit smoking in the following places:

1. All enclosed areas of worksites and public places owned, rented, leased or otherwise under the control of the State of Colorado including motor vehicles.
2. Restrooms, lobbies, reception areas, hallways and any other common-use areas.
3. Buses, taxicabs, and other means of public transit under the authority of the State of Colorado, and ticket, boarding, and waiting areas of public transit depots.
4. All restaurants and bars.
5. Service lines.
6. Retail stores.
7. All areas available to and customarily used by the general public in all businesses and non-profit entities patronized by the public, including but not limited to, banks, laundromats, hotels and motels.
8. All areas of galleries, libraries and museums.
9. Any facility which is primarily used for exhibiting any motion picture, stage, drama, lecture, musical recital or other similar performance, except performers when smoking is part of a stage production.
10. Sports arenas.
11. Convention halls.
12. Public and private meeting facilities.
13. Every room, chamber, place of meeting or public assembly, including school buildings under the control of any board, council, commission, committee, including joint committees, or agencies of the State of Colorado or any political subdivision of the State of Colorado, to the extent such location is subject to the jurisdiction of the State of Colorado.
14. Waiting rooms, hallways, wards and semi-private rooms of health facilities, including, but not limited to, hospitals, clinics, physical therapy facilities, doctors’ offices, and dentists’ offices.
15. Lobbies, hallways, and other common areas in hotels, motels, multiple-tenant office buildings and malls, apartment buildings, condominiums, trailer parks, retirement facilities, nursing homes, and other multiple-unit residential facilities.
16. Eighty percent (80%) of hotel and motel rooms rented to guests.
17. Airplanes.

(RES-32, AM 2004; Reaffirmed, BOD-1, AM 2014)

 

355.993 Display of Tobacco Advertisements

The Colorado Medical Society opposes the display in patient areas of periodicals and printed materials containing tobacco advertisements.
(RES-24, AM 2000; Reaffirmed, BOD-1, AM 2014)

 

355.994 Tobacco Settlement

(RES-13, AM 1999; Sunset, BOD-1, AM 2014)

 

355.995 Tobacco Related Research

The Colorado Medical Society supports a restriction on tobacco industry funding for tobacco related research in any state-supported institution.
(RES-44, AM 1996; Reaffirmed, BOD-1, AM 2014)

 

355.996 State Excise Taxes on Tobacco Products

The Colorado Medical Society supports and encourages the passage of increased excise taxes on tobacco products and that these proceeds support educational cessation, prevention activities and increase patient access to medical services.
(RES-64, AM 1992; Reaffirmed, BOD-1, AM 2014)

 

355.997 Smoke-Free Colorado Medical Society

Smoking is prohibited at all Colorado Medical Society (CMS) functions. Smoking is prohibited in the offices of the CMS.
(Motion of the Board, January 1982, Substitute RES 67, AM 1990; Reaffirmed, BOD-1, AM 2014)

 

355.998 Youth Vaping and Tobacco Use

Public health crisis

• CMS recognizes youth vaping and tobacco/nicotine use as a public health crisis.
• CMS recognizes more research is needed to help direct regulatory standards on youth vaping.

Regulation of youth vaping and tobacco/nicotine use

• CMS supports the enactment of reasonable laws that seek to regulate the sale and distribution of tobacco/nicotine products in order to protect youth and restrict youth access to vaping/tobacco/nicotine.
• CMS supports enforcement of existing tobacco/nicotine/vaping control laws.
• CMS supports eliminating advertisements of tobacco/nicotine and vaping products targeted specifically at youth, designed to promote youth initiation of vaping and progression to traditional tobacco/nicotine use.
• CMS supports eliminating added flavors to vaping solutions that can be appealing to youth and promote initiation or continued youth use.
• CMS promotes requiring vaping containers be in child resistant packaging to prevent accidental ingestion and exposure.

Screening/education and awareness

• CMS encourages all health care providers to screen all youth specifically for vaping as well as other tobacco/nicotine use, and have subsequent discussions of smoking cessation and referral to developmentally appropriate nicotine cessation treatment if needed.
• CMS recommends screening patients for other high-risk behaviors, including alcohol use, other drug use, and risky sexual behaviors if the youth is vaping.
• CMS supports educational efforts designed to increase awareness, especially among youth, about the dangers of vaping/smoking and to reduce tobacco/nicotine use in our society.

(RES-41, AM 1990; Reaffirmed, BOD-1, AM 2014; Amended BOD May 17, 2019)

 

355.999 Limitation on Distribution of Tobacco

The Colorado Medical Society (CMS) opposes the sale of tobacco products in vending machines. The CMS opposes the free distribution of tobacco products as a promotional tool of the tobacco manufacturers.
(RES-31, AM 1988; Reaffirmed, BOD-1, AM 2014)

360. Violence and Abuse

 

360.996 Violence in Society

CMS urges our community leaders to support the creation of a comprehensive and accessible network of mental health services and crisis intervention capabilities in order to divert emotionally or mentally disturbed individuals from violence to a support system that can identify and address their potentially harmful actions.
(RES-6-P, AM 2012; Reaffirmed, BOD-1, AM 2014)

 

360.997 Colorado Medical Society Condemns Terrorism

The Colorado Medical Society stands with the United States Government, and all concerned people everywhere, to condemn those who commit terrorism and cause loss of human life.
(Late RES-24, AM 2001; Reaffirmed, BOD-1, AM 2014)

 

360.998 Domestic Violence

The Colorado Medical Society supports efforts to change existing laws and regulations regarding domestic violence to:

1. Improve immunity for physicians;
2. Mandate that the plaintiff cover legal fees for physicians acting in good faith;
3. Protect physicians from ethical complaints for breaking physician/patient confidentiality when reporting domestic violence;
4. Clarify the duty to report in a manner that recognizes the need for flexibility and protection for reasonable failure to report; and
5. Refine the definition of what is to be reported.

(RES-42, AM 1993; Reaffirmed, BOD-1, AM 2014)

 

360.999 Domestic Abuse

The Colorado Medical Society encourages and supports the education of physicians about proper ways to recognize, report, treat and refer domestic violence victims.
(RES-8, IM 1993; Reaffirmed, BOD-1, AM 2014)

365. War

 

365.999 Condemning the Use of Children as Soldiers and Weapons of War

The Colorado Medical Society condemns the use of children as soldiers or weapons of war.
(Late RES-25, AM 2001; Reaffirmed, BOD-1, AM 2014)

370. Women

 

370.999 Female Genital Mutilation

The Colorado Medical Society (CMS) condemns the practice of female genital mutilation, as defined by the American College of Obstetrics and Gynecology as a medically inappropriate procedure that has no scientific basis. The CMS considers it a form of physical abuse subject to the same criminal sanctions and reporting requirements as any other type of physical abuse.
(Late RES-12, IM 1998; Reaffirmed, BOD-1, AM 2014)

900. Administration and Organization

 

Colorado Medical Society Principles on External Funding Relationships

1. GUIDELINES FOR COLORADO MEDICAL SOCIETY (CMS) EXTERNAL FUNDING RELATIONSHIPS. The following principles are based on the premise that in certain circumstances CMS should enter into mutually-beneficial cooperative relationships with corporations, organizations and other entities when guidelines are met. These relationships must further CMS’s core strategic focus, retain CMS’s independence, avoid conflicts of interest, and guard its professional values.
2. OVERVIEW OF PRINCIPLES. CMS’s principles to guide these relationships have been organized into the following categories: General Principles that apply to most situations; Special Guidelines that deal with specific issues and concerns; Organizational Review that outlines the roles and responsibilities of the Board, and CMS management and staff. These guidelines should be reviewed over time to assure their continued relevance to the policies and operations of CMS and to its business environment. The principles should serve as a starting point for anyone reviewing or developing CMS’s relationships with outside groups.
3. GENERAL PRINCIPLES. CMS’s mission, values statement, and strategic focus provide guidance for all externally funded relationships. All relations must support or at least not be in conflict with the mission and values of CMS. Relations not motivated by the association’s mission threaten CMS’s ability to provide representation and leadership for the profession.
   • CMS’s mission, values and strategic focus ultimately must determine whether a proposed relationship is appropriate for CMS. CMS should not have relationships with organizations or industries whose principles, policies or actions obviously conflict with CMS’s mission and values. For example, relationships with producers of products that harm the public health (e.g., tobacco) are not appropriate. CMS will proactively choose its priorities for external relationships and collaborate in those that fulfill these priorities.
   • The relationship must preserve or promote trust in CMS and the medical profession. To be effective, medical professionalism requires the public’s trust. Relationships that could undermine the public’s trust in CMS or the profession are not acceptable. For example, no relationship should raise questions about the scientific content of CMS’s health information publications, CMS’s advocacy on public health issues, or the truthfulness of its public statements.
   • The relationship must maintain CMS’s objectivity with respect to health issues. CMS accepts funds from external entities only if acceptance does not pose a conflict of interest and in no way impacts the objectivity of the association, its members, activities, programs, or employees. For example, exclusive relationships with manufacturers of health-related products marketed to the public could impair CMS’s objectivity in promoting public health policy. CMS’s objectivity with respect to health issues should not be biased by external relationships.
   • The activity must provide benefit to the public’s health, patients’ care, or physicians’ practice. Public education campaigns and programs for CMS or its members are potentially of significant benefit. Externally-supported programs that provide financial benefits to CMS but no significant benefit to the public and/or direct benefits to CMS or CMS members are not acceptable. In the case of member benefits, external relations must not detract from CMS’s professionalism.

4. SPECIAL GUIDELINES. The following guidelines address a number of special situations where CMS cannot utilize external funding. There are specific guidelines already in place regarding advertising in publications.

   • CMS will provide health and medical information, but should not involve itself in the production, sale, or marketing to consumers of products that claim a health benefit. Marketing health-related products (e.g., pharmaceuticals, home health care products) undermines CMS’s objectivity and diminishes its role in representing healthcare values and educating the public about their health and healthcare.
   • Activities with corporate funding should be funded from multiple sources whenever possible. Activities funded from a single external source are at greater risk for inappropriate influence from the supporter or the perception of it, which may be equally damaging. For example, funding for a patient education brochure should be done with multiple sponsors if possible. For the purposes of this guideline, funding from several companies from different and non-competing industry categorys (e.g., one pharmaceutical manufacturer and one health insurance provider), does not constitute multiple-source funding. CMS recognizes that for some activities the benefits may be so great, the harms so minimal, and the prospects for developing multiple sources of funding so unlikely that single-source funding is a reasonable option. Even so, funding exclusivity must be limited to program only (e.g., asthma conference) and shall not extend to a therapeutic category (e.g., asthma). The Board should review single-sponsored activities prior to implementation to ensure that: (i) reasonable attempts have been made to locate additional sources of funds (for example, issuing an open request for proposals to companies in the category); and (ii) the expected benefits of the project merit the additional risk to CMS of accepting single-source funding. In all cases of single-source funding, CMS will guard against conflicts of interest.
   • The relationship must preserve CMS’s control over any projects and products bearing the CMS name or logo. CMS retains editorial control over any information produced as part of a externally funded arrangement. When a CMS program receives external financial support, CMS must remain in control of its name, logo, and CMS content, and must approve all marketing materials to ensure that the message is congruent with CMS’s mission and values. A statement regarding CMS editorial control, as well as the name(s) of the program’s supporter(s), must appear in all public materials describing the program and in all educational materials produced by the program. (This principle is intended to apply only to those situations where an outside entity requests CMS to put its name on products produced by the outside entity, and not to those situations where CMS only licenses its own products for use in conjunction with another entity’s products.)
   • Relationships must not permit or encourage influence by the external partner on CMS policies, priorities, and actions. For example, agreements stipulating access by external partners to the Board or access to CMS leadership would be of concern. Additionally, relationships that appear to be acceptable when viewed alone may become unacceptable when viewed in light of other existing or proposed activities.
   • Participation in a sponsorship program does not imply CMS’s endorsement of an entity or its policies. Participation in sponsorship of a CMS program does not imply CMS approval of that entity’s general policies, nor does it imply that CMS will exert any influence to advance the entity’s interests outside the substance of the arrangement itself. CMS’s name and logo should not be used in a manner that would express or imply a CMS endorsement of the entity, its policies and/or its products.
   • To remove any appearance of undue influence of external relationships on its affairs, CMS should not depend on funding from external relationships for core governance activities. Funding core governance activities from external sponsors, e.g., receiving external financial support for conduct of the Board, Council or Committee meetings, could make CMS become dependent on external funding for its existence or could allow an external entity, or group of entities, to have undue influence on the affairs of CMS.
   • Funds from external funding relationships must not be used to support political advocacy activities. A full and effective separation should exist, as it currently does, between political activities and external funding. CMS should not advocate for a particular issue because it has received funding from an interested entity. Public concern would be heightened if it appeared that CMS’s advocacy agenda was influenced by external funding.

5. ORGANIZATIONAL REVIEW. Every proposal for a CMS external funding relationship must be thoroughly screened prior to staff implementation. CMS activities that meet certain criteria requiring further review are forwarded to a committee of the Board for a heightened level of scrutiny.

   • As part of its annual report on CMS performance, activities, and status, the Board will review a summary of CMS’s external funding arrangements.
   • Every new CMS external funding relationship must be approved by the Board, or through a procedure adopted by the Board. Specific procedures and policies regarding Board review are as follows: (i) The Board routinely should be informed of all CMS external relationships; (ii) Upon request of two dissenting members of senior staff, any dissenting votes within the senior staff, and instances when the senior staff and the Board committee differ in the disposition of a proposal, are brought to the attention of the full Board; (iii) All externally supported activities directed to the public should receive Board review and approval; (iv) All activities that have support from only one entity (except patient materials linked to CME), within an industry should either be in compliance with ACCME guidelines or receive Board review; and (v) All relationships where CMS takes on a risk of substantial financial penalties for cancellation should receive Board review prior to enactment.
   • The CEO is responsible for the review and implementation of each specific arrangement according to the previously described principles. The CEO is responsible for obtaining the Board authorization for externally funded arrangements that have an economic and/or policy impact on CMS.
   • CMS senior staff reviews externally funded arrangements to ensure consistency with the principles and guidelines; (i) CMS senior staff is the internal, cross-organizational group that is charged with the review of all activities that associate CMS’s name and logo with that of another entity and/or with external funding; (ii) The review process is structured to specifically address issues pertaining to CMS policy, ethics, business practices, corporate identity, reputation, and due diligence. Written procedures formalize the committee’s process for review of external funding arrangements; (iii) All activities placed on the senior staff review agenda have had the senior manager’s review and consent and following senior staff approval will continue to be subject to periodic review by the CMS Board or the Partners in Medicine Committee.
   • CMS senior management in consultation with legal counsel, as necessary, will review and approve all marketing materials that are prepared by others that bear CMS’s name and/or corporate identity. All marketing materials will be reviewed for appropriate use of CMS’s logos and trademarks, perception of implied endorsement of the external entity’s policies or products, unsubstantiated claims, misleading, exaggerated, or false claims, and reference to appropriate documentation when claims are made.

6. ORGANIZATIONAL CULTURE AND ITS INFLUENCE ON EXTERNALLY FUNDED PROGRAMS.

   • Organizational culture has a profound impact on whether and how CMS external relationships are pursued. CMS activities reflect on all physicians. Moreover, all physicians are represented to some extent by CMS actions. Thus, CMS must act as the professional representative for all physicians, and not merely as an advocacy group or club for CMS members.
   • As a professional organization, CMS operates with a higher level of purpose representing the ideals of medicine. Nevertheless, non-profit associations today do require the generation of non-dues revenues. CMS should set goals that do not create an undue expectation to raise increasing amounts of money. Such financial pressures can provide an incentive to evade, minimize, or overlook guidelines for fundraising through external sources.
   • Every staff member in the association must be accountable to explicit ethical standards that are derived from the mission, values, and focus areas of the Society. In turn, leaders of CMS must recognize the critical role the organization plays as the largest representative professional association for physicians in Colorado. CMS leaders must make programmatic choices that reflect a commitment to professional values and the core organizational purpose.

(Motion of the Board of Directors, April 24, 2022)

 

900.975 Spring Conference

Statement of Purpose

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

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

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

 

900.976 Strategic Plan

Colorado Medical Society Strategic Plan

 

900.977 Policy Manual

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

 

900.978 Investment Guidelines

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

 

900.979 Mileage Reimbursement

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

 

900.980 Funding Requests from Outside Entities

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

 

900.981 In-State Travel

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

 

900.982 Out-of-State Travel

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

 

900.983 Participation in the Provider Coalition

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

 

900.984 Conduct of Representatives of the Colorado Medical Society

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

 

900.985 Use of Dues Monies

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

 

900.986 Requests for Money, Time or Endorsements

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

 

900.987 Gender Neutrality

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

 

900.988 Exhibit Space

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

 

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

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

 

900.990 Relationship with the University of Colorado School of Medicine

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

 

900.991 Spending from the Reserve Fund

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

 

900.992 Antitrust Guidelines

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

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

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

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

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

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

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

Antitrust Problem Areas of Activity

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

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

Topics of Discussions to be Avoided:

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

Meeting Procedures:

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

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

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

(Motion of the Board, April 1987; Reaffirmed, BOD-1, AM 2014)

 

900.993 Expense Report Submission

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

 

900.994 Registration Fees

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

 

900.995 Sources of Non-Dues Revenue

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

 

900.996 Budget Recommendations

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

 

900.997 Budget Information

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

 

900.998 Member Representatives

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

 

900.999 Evaluation of Chief Administrative Officer

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

905. Board of Directors

 

905.994 Medical Student Representation

There shall be four student representatives on the CMS Board of Directors, two from the University of Colorado and two from Rocky Vista University, each with full voting privileges at the Board and House of Delegates. Furthermore, student representation in the House of Delegates shall be no fewer than 20 delegates and may be increased to a ceiling of 12% of the voting seats in attendance at the start of business of the annual meeting of the CMS House of Delegates. The medical student component will make every effort to fill the delegate seats with upper-class students who have attended previous CMS meetings.
(RES 5-A, AM 2011; Reaffirmed, BOD-1, AM 2014)

 

905.995 Presentations to the Board of Directors

(Motion of the Board, September 1996; Sunset, BOD-1, AM 2014)

 

905.996 Attendance at Board of Directors Meetings

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

 

905.997 Proxy Voting by Members of the Board of Directors

The use of proxy votes for members of the Board of Directors is denied.
(Motion of the Board, May 1992; Reaffirmed, BOD-1, AM 2014)

 

905.998 Minutes of Board of Directors Meetings

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

 

905.999 Business of the Board of Directors

(Motion of the Board, June 1979; Sunset, BOD-1, AM 2014)

910. Councils and Committees

 

910.994 Finance Committee

The Finance Committee will add a sixth member, who may or may not be a CMS member, who has specific knowledge and expertise in finance and investments.

 

910.995 General Guidelines/Working Principles in Forming CMS Committees and Task Forces

General Guidelines

• Committees should only be formed when it is apparent that issues are too complex and/or numerous to be handled by the entire CMS Board of Directors.
• For ongoing, major activities, establish standing committees; for short-term activities, establish Task Forces that cease when the activities are completed.
• Ensure that the committee has a specific charge or set of tasks to address and a timeline for completion; committees are a great way to delegate different kinds of work but they work poorly if they are not well defined before they begin.
• Annually review the list of standing committees and re-consider whether each of them is necessary. Simply because the topic/issue of the committee is important does not mean that a standing committee is the best way to do the work.
• Form a committee only for a specific reason – design a committee to fill the organization’s needs and help CMS realize its goals in an exciting and dynamic way.  Committees will quickly become plagued by a lack of interest, or scope creep, if they aren’t really doing anything.
• Committees assist the organization with the work of the Board; therefore, the committees’ charge should be developed by the Board with some fine tuning once the committee is in place.
• Discontinue any committee if it is not making a contribution.
• CMS committee meetings are open to all members, and members are encouraged to participate even if they are not members of the committee. Notification of all committee meetings, including how to participate in person or remotely, will be sent out to the entire membership via existing communication channels. Members attending meetings have the right to address the committee within the rules of the Standard Code of Parliamentary Procedure. Once the committee has had a chance to discuss an issue, the floor will be opened to CMS member comment. Members may be required to submit their intent to speak on an agenda topic in advance of the discussion. If this process is being used, it must be clearly stated to all members at the beginning of the meeting. CMS member comments will be limited to three minutes per individual.

Functions of CMS Committees:

• Conduct preparatory work leading up to BOD decisions, such as developing policy options and recommendations regarding CMS programs/initiatives and operations.
• Carry out tasks as assigned by the BOD.
• Serve as a training ground for future CMS leaders.

The Committees and Task Forces of CMS consist of:

• Standing Committees – Study problems/issues within an assigned area and provide specialized assistance and advice to the Board on an ongoing basis.
• Work Groups – May be created as subgroups of an existing committee with a defined charge related to the function of the existing committee.
• Task Forces – Formed to handle a specific charge that falls outside of the assigned function of an existing standing committee. It is automatically dissolved 90 days after the initial charge is completed.

ESTABLISHING CMS COMMITTEES AND TASK FORCES

Things to consider before establishing a committee or task force:

• Specify each committee’s Charge: a definitive statement which clearly describes the purpose of the committee; time frame; membership composition; authority; and major areas of responsibility.

Guidelines in Appointing Committee Chairs and Members

Committee Chairs and Vice-Chairs:

• Must be thoroughly acquainted with the mission/goals of CMS and the part that the committee plays in the achievement of these goals.
• Must be skilled in chairing meetings and preferably an expert in the subject matter for which the member will be appointed chair.
• Must be trained in CMS parliamentary procedure and all technical tools utilized by CMS to ensure equal access and participation of all members in a meeting.
• Will serve one three-year term. Upon completion of a full term, the Chair is ineligible to be reappointed to the Committee for two years. The Vice-Chair is eligible to become the Chair at the completion of their term.
• A Chair may be extended for an additional full or partial term, per bylaws, with a majority vote of the BOD.

Committee Members:

• Committee members must have a clear view of the committee’s goals and have an awareness of the skills brought by each committee member to assist in the achievement of these goals.
• Effort should be made to ensure diversity of Committee Members, including gender, age, sexual orientation, race, religion, practice type, practice specialty and geography.

Guidelines on Committee Size and Terms:

• Committees should generally have no fewer than seven (7) members and no more than nine (9) members.
• Task Forces and Work Groups should generally have no fewer than five (5) members and no more than seven (7) members.
• Committee Members serve staggered three-year terms so that approximately 1/3 of the Committee is eligible for renewal or replacement every year.
• Members shall be able to serve up to two (2) consecutive terms on a Committee before they are ineligible for renewal unless they are becoming a Chair or Vice-Chair.
• Members who leave a committee due to term limits may be eligible to rejoin the committee after two years.
• A committee member may be removed from that committee if they fail to meet minimum attendance standards (two consecutive meetings missed, or 20% of meetings missed in an association calendar year), or if their behavior is determined to be in violation of the CMS Code of Conduct. If a Chair believes that a member needs to be removed from a committee based on one of the above criteria, they must make that recommendation in writing to the CMS President and CMS CEO. The President must meet with the member, staff, Chair or others to determine if the removal is warranted. The President may make the recommendation to the Executive Committee to remove the member. The member may appeal that decision to the Executive Committee. The determination of the Executive Committee is subject to approval of the entire board.

Review and Appointment Process:

• The CMS Staff will present a report to the President-elect no more than 60 days prior to the annual meeting. This report shall include a summary of the activities of each Committee/Task Force. It will also include information on term status, attendance, and other information as needed.
• The President-elect, in conjunction with staff and the Executive Committee, will decide which committees/task forces need to be continued, dissolved, or merged with another relevant committee.
• The President-elect will make appointments to Committees prior to the first regularly scheduled Board Meeting following their inauguration as President. These appointments must be approved at that meeting by the Board per bylaws.
• Committee members must have a clear view of the committee’s goals and have an awareness of the skills brought by each committee member to assist in the achievement of these goals.

Recruitment Process:

• CMS will actively promote and solicit members interested in participation in CMS Committees via standard communication channels at least 90 days prior to the annual meeting.
• CMS will actively search for ways to promote participation in CMS Committees to groups who are currently under-represented.

(Motion of the Board, July 10, 2020)

 

910.996 Training of chairs of CMS Committees and other groups

All Committee (Task Force, etc.) chairs shall receive training on optimal committee functioning including the use of the parliamentary procedure currently used by the Board and effective use of digital communication tools (eg: Zoom) to ensure all members are actively engaged.

(Motion of the Board, July 10, 2020)

 

910.997 Meeting Attendance

The Presiding Chair of each Board, Council and Committee shall file an attendance report in the Executive Office within one week after each called meeting of the body over which he/she has presided. Each Chair shall have the authority, subject to review by the body concerned, to excuse any member from a meeting for due cause. Unexcused absence from one-third of the called meetings within any six-month period if such called meetings number four or more, or unexcused absence from any two consecutive meetings, may on the recommendation of the Presiding Chair of each Board, Council or Committee, serve as cause for requesting the resignation of the member from the body concerned.
(Motion of the Board, February 1980; Reaffirmed, BOD-1, AM 2014)

 

910.998 Approval of Council Recommendations

1. The Board of Directors will approve or disapprove all Council recommendations as reported by Council Chairs.
2. In the event the Board of Directors cannot meet, the Council’s recommendations will be approved or disapproved by the Executive Committee.
3. In the event the Executive Committee cannot meet, Colorado Medical Society (CMS) staff will act with concurrence of Council Chair (e.g., Legislative Chair). The Council’s recommendations will be approved or disapproved by the President or President-elect.
4. In the event the President or President-elect is unavailable, CMS staff will act with concurrence of the Council Chair.

(Motion of the Board, February 1980; Reaffirmed, BOD-1, AM 2014)

 

910.999 Minutes of Council Meetings

(Motion of the Board, April 1979; Sunset, BOD-1, AM 2014)

920. Membership and Dues

 

920.996 Medical Student Support–Rocky Vista University

(RES-23, AM 2007; Sunset, BOD-1, AM 2014)

 

920.997 Medical Student Support

The Colorado Medical Society Board of Directors’ annual budget will include enough funds for four-year student memberships in both the Colorado Medical Society Medical Student Component and American Medical Association.
(RES-23, AM 2002; Revised, BOD-1, AM 2014)

 

920.998 Processing of Membership Applications

(Motion of the Board, May 1996; Sunset, BOD-1, AM 2014)

 

920.999 Medical Society Jurisdiction

(Motion of the Board, July 1994; Sunset, BOD-1, AM 2014)

925. Nomination, Election and Tenure

 

925.996 Campaign Reform

Colorado Medical Society assumes the responsibility for arranging a candidates’ reception at the annual meeting.
(RES-3, IM 1998; Revised, BOD-1, AM 2014)

 

925.997 American Medical Association Delegation

Candidates for the positions of American Medical Association (AMA) Delegate and Alternate Delegate will present their viewpoints during the general membership meeting at the Colorado Medical Society (CMS) Annual Meeting. A forum will be held at the Annual Meeting for the CMS Delegation to the AMA to present issues and obtain input from members.
(RES-6, IM 1996; Revised, BOD-1, AM 2014)

 

925.998 Distribution of President-elect Resumes

(RES-3, IM 1992; Sunset, BOD-1, AM 2014)

 

925.999 Implied Resignation

A Delegate or Alternate Delegate to the American Medical Association (AMA) who misses two consecutive meetings of the AMA House of Delegates should be considered to have tendered his/her resignation.
(Motion of the Board, March 1988; Reaffirmed, BOD-1, AM 2014)

930. Political Action

 

930.996 Unified Position of Colorado Medical Society and its Component Medical Societies

Component medical societies should be encouraged to lobby legislators in a manner which is consistent with a position taken by the Colorado Medical Society (CMS), or its Council on Legislation. Individual physicians may lobby legislators on the same issue in any direction, for or against, that they see fit. The CMS will maintain a process by which the leadership of all component societies:

1. May consider, in advance of meeting of the Council on Legislation, any proposed legislation as well as staff recommendations on the issue;
2. Give timely constructive feedback prior to any final decision.

(RES-5, AM 2001; Reaffirmed, BOD-1, AM 2014)

 

930.997 Colorado Medical Society Leadership

The Colorado Medical Society Leadership shall be encouraged to join the Colorado Medical Political Action Committee (COMPAC) and the American Medical Political Action Committee (AMPAC) at any level of membership.
(RES-37, AM 1996; Reaffirmed, BOD-1, AM 2014)

 

930.998 Political Effectiveness

The Colorado Medical Society (CMS) promotes political effectiveness through the utilization of the legislative staff for Colorado Medical Political Action Committee (COMPAC) activities, the encouragement of membership in COMPAC by all CMS and CMS Connection members, and the use of in kind services provided by the CMS to enhance COMPAC’s support of candidates favorable to medicine.
(RES-36, AM 1996; Revised, BOD-1, AM 2014)

 

930.999 Support Priorities

(Motion of the Board, October 1983; Sunset, BOD-1, AM 2014)