180. Health Care Delivery

180.985 Interference in Patient Counseling

 

CMS vigorously and actively defends the physician-patient-family relationship and actively opposes all state and/or federal efforts to interfere in the content of communication in clinical care delivery between clinicians and patients (new HOD policy

CMS supports litigation that may be necessary to block the implementation of newly enacted state and/or federal laws that restrict the privacy of physician-patient-family relationships and/or that violate the First Amendment rights of physicians in their practice of the art and science of medicine (new HOD policy)

CMS continues to strongly condemn any interference by government or other third parties that compromise a physician’s ability to use his or her medical judgment as to the information or treatment that is in the best interest of their patients.
(RES 2-P, AM 2011; Reaffirmed, BOD-1, AM 2014)

180.986 Advertising Standards

 

ID Requirement for Individuals and Families in Providing Patient Care

CMS supports state legislation on advertising standards that will:

• Provide accurate representation of credentials of a health care professional when that professional is advertising their services.
• Use easily understood language in describing their qualifications when advertising.
• Provide verifiable evidence to statements and testimonials made in advertising.
• Only use titles/initials authorized by their respective Colorado Licensing Board or Registration Act

(RES-3-A/BOD-1, AM 2012; Reaffirmed, BOD-1, AM 2014)

180.987 Patient Safety

 

The Colorado Medical Society considers patient safety a high priority and an important component of health care reform to make Colorado the safest state in the nation in which to receive medical care.
CMS considers patient safety the foundation of our liability reform efforts.
(LATE ADHOC-1, AM 2010; Revised, BOD-1, AM 2014)

180.988 Accountability

 

Colorado Medical Society policy is that physicians should be held accountable only for clinical and administrative factors they can control.

It is inappropriate (and unethical) to hold physicians accountable for decisions made by others. CMS supports only those systems of accountability that appropriately align accountability with responsibility and advocate for change in systems of accountability where there is misalignment.
(RES-18, AM 2007; Reaffirmed, BOD-1, AM 2014)

180.989 Options for Delivery of Medical Care

 

Colorado Medical Society supports various options for the delivery of medical care so long as they meet the quality standards of effectiveness, equity, timeliness, efficiency, patient centeredness and safety as well as increase patient access to care.
(RES-9, AM 2007; Revised, BOD-1, AM 2014)

180.990 Freedom of Practice in Medical Imaging

 

The Colorado Medical Society encourage and support collaborative specialty development and review of any appropriateness criteria, practice guidelines, technical standards, and accreditation programs, particularly as Congress, federal agencies and third party payers consider their use as a condition of payment, and to use the AMA Code of Ethics as the guiding code of ethics in the development of such policy.

The Colorado Medical Society actively oppose efforts by private payers, hospitals, Congress, state legislatures, and the administration to impose policies designed to control utilization and costs of medical services unless those policies can be proven to achieve cost savings and improve quality while not curtailing appropriate growth and without compromising patient access or quality of care.

The Colorado Medical Society actively oppose any attempts by federal and state legislators, regulatory bodies, hospitals, private and government payers, and others to restrict reimbursement for imaging procedures based on physician specialty, and continue to support the reimbursement of imaging procedures being performed and interpreted by physicians based on the proper indications for the procedure and the qualifications and training of physicians regardless of their medical specialty.
(RES-13, AM 2005; Reaffirmed, BOD-1, AM 2014)

180.991 Electronic and Telephonic Communication Guidelines

 

The Colorado Medical Society (CMS) encourages physicians to use proper and adequate written documentation of the problem(s), discussion, and treatment plan/recommendations resulting from the telephonic communication. The CMS has no opinion on the relative value of these services at this time. The CMS believes that telephone services that are reasonable, properly documented and of high quality should be billable services that merit reimbursement by patients and third parties.
(RES-20, AM 2004; Reaffirmed, BOD-1, AM 2014)

180.992 Observation Care

 

(RES-21, AM 2004; Sunset, BOD-1, AM 2014)

180.993 Electronic Communication Guidelines

 

New communication technologies must never replace the crucial interpersonal contacts that are the very basis of the patient-physician relationship. Rather, electronic mail and other forms of Internet communication should be used to enhance such contacts. Patient-physician electronic mail is defined as computer-based communication between physicians and patients within a professional relationship, in which the physician has taken on an explicit measure of responsibility for the patient’s care. These guidelines do not address communication between physicians and consumers in which no ongoing professional relationship exists, as in an online discussion group or a public support forum.

1. For those physicians who choose to utilize e-mail for selected patient and medical practice communications, the following guidelines are adopted.
Communication Guidelines:
1. Establish turnaround time for messages. Exercise caution when using e-mail for urgent matters.
2. Inform patient about privacy issues.
3. Patients should know who besides addressee processes messages during addressee’s usual business hours and during addressee’s vacation or illness.
4. Whenever possible and appropriate, physicians should retain electronic and/or paper copies of e-mail communications with patients.
5. Establish types of transactions (prescription refill, appointment scheduling, etc.) and sensitivity of subject matter (HIV, mental health, etc.) permitted over e-mail.
6. Instruct patients to put the category of transaction in the subject line of the message for filtering: prescription, appointment, medical advice, billing question.
7. Request that patients put their name and patient identification number in the body of the message.
8. Configure automatic reply to acknowledge receipt of messages.
9. Send a new message to inform patient of completion of request.
10. Request that patients use auto reply feature to acknowledge reading clinician’s message.
11. Develop archival and retrieval mechanisms.
12. Maintain a mailing list of patients, but do not send group mailing where recipients are visible to each other. Use blind copy feature in software.
13. Avoid anger, sarcasm, harsh criticism, and libelous references to third parties in messages.
14. Append a standard block of text to the end of the e-mail messages to patients, which contains the physician’s full name, contact information, and reminders about security and the importance of alternative forms of communication for emergencies.
15. Explain to patients that their messages should be concise.
16. When e-mail messages become too lengthy or the correspondence is prolonged, notify patients to come in to discuss or call them.
17. Remind patients when they do not adhere to the guidelines.
18. For patients who repeatedly do not adhere to the guidelines, it is acceptable to terminate the e-mail relationship.

Medicolegal and Administrative Guidelines:
Develop a patient-clinician agreement for the informed consent for the use of e-mail. This should be discussed with and signed by the patient and documented in the medical record. Provide patients with a copy of the agreement. Agreement should contain the following:

1. Terms in communication guidelines (stated above).
2. Provide instructions for when and how to convert to phone calls and office visits.
3. Hold harmless the health care institution for information loss due to technical failures.
4. Waive encryption requirement, if any, at patient’s insistence.
5. Describe security mechanisms in place including the use of a password-protected screen saver for all desktop workstations in the office, hospital, and at home.
6. Never forwarding patient-identifiable information to third party without the patient’s express permission.
7. Never using patient’s e-mail address in a marketing scheme.
8. Not sharing professional e-mail accounts with family members.
9. Not using unencrypted wireless communications with patient-identifiable information.
10. Double-checking all “To” fields prior to sending messages.
11. Perform at least weekly backups of e-mail onto long-term storage. Define long-term as the term applicable to paper records.
12. Commit policy decisions to writing and electronic form.

 

2. Communicate the policies and procedures for e-mail to all patients who desire to communicate electronically.

 

3. Apply the policies and procedures for e-mail to facsimile communications, where appropriate.

(RES-31, AM 2003; Reaffirmed, BOD-1, AM 2014)

180.994 Use of Current Knowledge in Palliative Medicine

 

(RES-10, AM 2000; Sunset, BOD-1, AM 2014)

180.995 Termination of Physician/Patient Relationship Notification

 

(RES-11, AM 1999; Sunset, BOD-1, AM 2014)

180.996 Transition of Care for Patients with Special Needs and Circumstances

 

PREAMBLE

In the process of transitioning of care from one health plan to another, at times it becomes necessary for a patient to leave an ongoing doctor-patient relationship during treatment of a chronic or protracted medical condition and establish a relationship with a new physician. There is great value to the care of the patient in developing a process to facilitate such transfer with minimal disruption to all involved parties.

The recommendations presented herein are designed to recognize the special needs of certain patients with chronic or protracted illnesses who are under the care of either a primary care or specialty care physician at the time of transition. They provide a preferred method by which the patient interacts with the two physicians at both ends of the transition and the new health plan. They provide a framework which is simple and flexible, compensates the transferring physician for the time and effort expended, gives highest priority to concern for patient satisfaction, and promotes an effective vehicle for health plans to transition potentially high cost patients into their plan.

Developed through discussions between the Colorado Medical Society and the Colorado Association of Health Plans, these recommendations are presented to health plans and physicians for their voluntary adoption.

RECOMMENDED ELEMENTS OF TRANSITION

1. Early Notification
Typically a patient who will be changing plans involuntarily will have a time delay between the notice of change and the effective date. The patient should advise the current physician practice as soon as possible. Health plans should make available:
1. A written description of the process used to facilitate transition of care, (customer service, new member nurses, etc.)
2. A written description of its review process of requests to continue services with an existing, non-affiliated provider.

 

2. Identification of Patients with Special Needs and Circumstances

Current physicians are expected to identify patients with unique needs and initiate a process to facilitate their transition to a new provider.

1. Health plans should make available to those patients so requesting, names of available participating providers (primary care and specialty practices) and how to contact them to ease referral and selection.
2. If requested by the patient, it is appropriate for the current physician to suggest a physician to the patient, and then begin communication with that physician.

 

3. Transition Planning Visit

The current physician and patient should schedule a visit in the period before effective date of new plan to plan a smooth transition to the accepting physician’s practice.

4. Transfer of Patient Information

The current treating physician should:

1. Collect and prepare for transfer of adequate medical records to inform accepting physician of patient’s past medical history, treatment modes, medication history, pertinent diagnostic measures, current treatment plan, etc.
2. Create a letter of referral summarizing pertinent historical and biographical data to facilitate accepting physician’s development of rapport with the patient and family.

 

5. Introductory Visit to Accepting Physician

Should be arranged as soon as practical after effective date of new plan. The current treating physician should make a recommendation to the patient regarding the timeliness of scheduling the first appointment. The purpose is to begin development of relationship, ensure pertinent records are available, prescriptions are transferred if necessary and consideration of ancillary needs (durable medical equipment, etc.).

6. Physician-to-Physician Consultation

It may be appropriate for former and accepting physicians to formally consult regarding patient’s unique needs.

7. Compensation

Fair and appropriate compensation should be paid promptly for each of these services by the plan in effect at the time of service.

The following recommendations should also apply when a physician is separating from a health plan:

1. Physician Initiated
When the physician is voluntarily leaving the plan, the physician should initiate the transition process.
2. Plan Initiated
When the plan initiated disaffiliation; the health plan should initiate the transition process.

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

180.997 School-Based Health Centers

 

The Colorado Medical Society (CMS) recognizes school-based health centers as an effective approach to reaching previously inaccessible children and adolescents with medical and mental health care needs. The CMS encourages physicians to participate in the community planning process of school-based health centers. The CMS believes that school-based health centers should, when possible, refer and coordinate care with community-based practitioners.
(RES-50, AM 1994; Reaffirmed, BOD-1, AM 2014)

180.998 Encouragement of Physician Participation in Project USA

 

(RES-67, AM 1994; Sunset, BOD-1, AM 2014)

180.999 Vertical Divestiture in the Health Care System

 

The Colorado Medical Society (CMS) believes that physicians and physician groups are full and equal partners in policy development in vertically integrated structures for health care delivery. The CMS believes that these structures should in no way compromise physician judgment in the provision of health care.
(Revised RES-15, IM 1994; Reaffirmed, BOD-1, AM 2014)