American Medical Association Organized Medical Staff Section (AMA-OMSS) 2008 Interim Meeting Summary

1. American Medical Association Organized Medical Staff Section (AMA-OMSS) 2008 Interim Meeting Summary November 6-8, Marriott Orlando World Center

2. Summary of Actions • The AMA-OMSS held its 52nd Assembly. • The Section considered 15 resolutions and 6 reports for a total of 21 items of business. • Of the initial 21 items, four were adopted, eight were adopted as amended, three were referred, four were not adopted, and one was adopted in lieu of another • Final OMSS and House of Delegate (HOD) actions are available on the AMA-OMSS Web site at www.ama-assn.org/go/omss (See I-08 AMA-OMSS Assembly, “Disposition of Actions”).

3. Key OMSS Actions, HOD Policies and Directives Behaviors that Undermine Safety: Due to the potential impact of alleged “disruptive behavior” on physicians, quality and patient safety and the profession of medicine, the OMSS made specific recommendations concerning this issue. These recommendations included a requirement for both the medical staff and the hospital to adopt and implement its own code of conduct. At I-08, the HOD adopted policy supporting these recommendations. • At I-08, the HOD adopted policy supporting these recommendations.

4. Key OMSS Actions, HOD Policies and Directives Behaviors that Undermine Safety (excerpt): RESOLVED, That our American Medical Association (AMA) adopt the following policies: A. The Medical staff The medical staff shall develop and implement its own code of conduct in the medical staff bylaws which includes, but not be limited to the following provisions: • The medical staff in consultation with independent medical staff legal counsel defines what constitutes disruptive behavior; • The medical staff defines the behavior and its nexus to quality medical care. • The medical staff provides a mechanism whereby instances of possible alleged disruptive behavior are recorded; • The medical staff develops a process whereby the physician accused of disruptive behavior is notified at the time of the event and provided an opportunity to respond within the confines of the organized medical staff; • The medical staff, in consultation with independent medical staff legal counsel, develops bylaw language that allows for freedom of expression by physicians when describing flaws within the hospital;

5. Key OMSS Actions, HOD Policies and Directives Behaviors that Undermine Safety (Continued): • The medical staff, in consultation with independent medical staff legal counsel, develops bylaws language that protects from retribution physicians who speak about quality concerns; • The medical staff establishes a process to investigate and assess, in a timely fashion, reports of alleged disruptive behavior; • The medical staff develops corrective actions that are commensurate with the reported behavior; • The medical staff bylaws contain procedural safeguards that protect due process; • The medical staff code of conduct shall identify, by position, which members or committee will be involved in the various stages of the process for reviewing reports, informing physicians and monitoring conduct; and • The medical staff shall develop processes for the protection of confidentiality.

6. Key OMSS Actions, HOD Policies and Directives Clarification of the Title of “Doctor” in a Hospital Environment: In a hospital there are many professionals who have received doctorate degrees, who are not MDs or DOs. Due to the importance of providing patients with the best care, it is crucial that there is no confusion on the part of the patient, their family, or staff when communications or other interactions occur. The AMA-OMSS made recommendations that called for The Joint Commission to implement identification standards for those who have achieved a Doctorate, to be required to appropriately identify themselves and visibly display their specific type of Doctorate on their person. Therefore, only those who fall under the AMA definition of a doctor will be identified as a MD or DO, and other professionals in a hospital environment would be required to indicate and display their appropriate credentials, distinguishing themselves from physicians. At I-08, the HOD adopted the Section’s recommendations. • At I-08, the HOD adopted policy supporting these recommendations.

7. Key OMSS Actions, HOD Policies and Directives Rescind the 48 Hour Rule: According to Medicare regulations when a verbal order is given it must be authenticated within 48 hours. No data has been published to support the benefit of the federal government’s 48 hour authentication requirement, despite the AMA’s request for such information. In response to these federal regulations, AMA-OMSS made several recommendations to our AMA; such as requesting that the AMA pursue working with other physician, hospital, and specialty organizations, to create a stronger voice in opposition to the 48 hour rule, and encouraging states to adopt legislation that requires a more appropriate timeline for authentication. At I-08, the HOD adopted positions supporting these recommendations. • At I-08, the HOD adopted policy supporting these recommendations.

8. CME Education Programs • Organized Medical Staff Peer Review Done Right • S. Jay Jaysankar, MD; Elizabeth A. Snelson, Esq., Counsel to Medical Staff; Robert A. Wise, MD, Vice President, Division of Standards and Survey Methods, The Joint Commission • Physicians as Targets and How to Avoid Being One • Michael J. Schoppmann, Esq., Kern Augustine Conroy & Schoppmann P.C. • Organized Medical Staffs & Disruptive Behavior • Michael J. Schoppmann, Esq., Kern Augustine Conroy & Schoppmann P.C.; Elizabeth A. Snelson, Esq., Counsel to Medical Staff; Robert A. Wise, MD, Vice President, Division of Standards and Survey Methods, The Joint Commission • Health System Reform • Jeremy A. Lazarus, MD, Speaker, House of Delegates, AMA; Robert Scher, MD • Health Insurance, Medical Inflation and the Patient-Physician Relationship • Richard B. Warner, MD • Medical Home Model: Recognizing and Strengthening the Value of Primary Care (Co-Sponsored with The Advisory Committee on Group Practice Physicians) • Paul Grundy, MD, Director, Healthcare Transformation, IBM Corporation; Donald Klitgaard, MD; Dave Weber, MD (Moderator)

9. CME Education Program Webcasts • Select CME programs from the 2008 Interim Meeting will be available as Webcasts at www.ama-assn.org/go/omss in early 2009.

10. Luncheon Education Programs • Joint Section and Special Groups Program on “Leadership” • Donald J. Palmisano, MD, JD, Former AMA President • Washington Update • Richard A. Deem, Senior Vice President, The Advocacy Group, AMA

11. Save the Date • AMA-OMSS 2009 Annual Meeting held at the Hyatt Regency Chicago in Chicago, IL, June 11-13, 2009. • More information is available at: www.ama-assn.org/go/omss