Ten Year Review

WHEREAS,            the policy making procedure for implementation and utilization of the Policy Compendium of the Medical Society of Virginia was adopted by the Board in September 1992, and

WHEREAS,            the procedure requires that 10 years after the adoption of each policy action, the Speakers and MSV Staff will present to the House of Delegates a “Ten Year Policy Review Report,” encouraging appropriate consideration of each item, and that unless each such policy is acted upon by the subsequent House of Delegates, it will cease to be policy to the MSV and will be placed in the archives section of the Compendium, and

WHEREAS,            consideration by the House of Delegates to add, amend or archive additional policies prior to ten years after their adoption may be included in the review as deemed appropriate by the Speakers and MSV Staff, and

WHEREAS,            upon review, it is evident that some items in the Policy Compendium should be removed or revised based on their relevance or timeliness, therefore be it

RESOLVED,   that the Medical Society of Virginia adopt the recommendations in the enclosed report.

WHEREAS, the policy making procedure for implementation and utilization of the Policy Compendium of the Medical Society of Virginia was adopted by the Board in September 1992, and updated in 2019, and

WHEREAS, the procedure requires that 10 years after the adoption of each policy action, the Speakers and MSV Staff will present to the House of Delegates a “Ten Year Policy Review Report,” encouraging appropriate consideration of each item, and that unless each such policy is acted upon by the subsequent House of Delegates, it will cease to be policy to the MSV and will be placed in the archives section of the Compendium, and

WHEREAS, consideration by the House of Delegates to add, amend or archive additional policies prior to ten years after their adoption may be included in the review as deemed appropriate by the Speakers and MSV Staff, and

WHEREAS, upon review, it is evident that some items in the Policy Compendium should be removed or revised based on their relevance or timeliness, therefore be it

RESOLVED, that the Medical Society of Virginia adopt the recommendations in the enclosed report.

Recommendation Reaffirm

10.2.01- Children’s Health Insurance Issues

Date: 11/4/2000

The Medical Society of Virginia will work with other health care advocacy groups to promote improvements in Family Access to Medical Insurance Services (FAMIS) including basic eligibility requirements, expedited receipt of benefits and other measures which will enhance delivery of medical care for children in the Commonwealth through these programs.

Reaffirmed 10/24/2010

Recommendation: Reaffirm

10.7.10- Medicare Prescription Drug Benefits

Date: 11/4/2000

  The Medical Society of Virginia supports prescription drug coverage for Medicare recipients in the context of overall Medicare reform.

Reaffirmed 10/24/2010

Recommendation: Reaffirm

30.7.03- Physician Profiles and Health Care Data Collection

Date: 10/31/1998

The Medical Society of Virginia:

1) Urges local medical societies, specialty societies, hospital medical staff, and individual physicians to seek active involvement in the development, implementation, and evaluation of physician profiling initiatives;

2) Encourages research to develop improved data sources, methods, and feedback approaches to physician profiling initiatives;

3) Opposes the use of profiling procedures that do not meet AMA principles for the credentialing or termination of physicians by managed care plans;

4) Opposes physician profiling data being used for economic credentialing purposes;

5) Believes that any disclosure or release of physician profiles shall follow strict conformance to the Medical Society of Virginia and AMA policy on the use and release of physician-specific health care data (AMA Policy H-406.996); and

6) Will monitor the use of profiling procedures related to physician profiling.

The Medical Society of Virginia:

1) Continues to advocate that health care data collected by government and third party payers be used for education of both consumers and providers; and

2) Believes that government, third party payers and self-insured companies should make physician specific utilization information available to medical societies.

Reaffirmed 10/24/2010

Recommendation: Reaffirm

40.23.03- Corporal Punishment of Foster Children by Foster Parents

Date: 11/4/2000

The Medical Society of Virginia opposes the use of corporal punishment by foster parents.

Reaffirmed 10/24/2010

Recommendation: Reaffirm

55.2.07- Honorary Membership to Outgoing Past President

Date: 1/22/2000

The Medical Society of Virginia will grant honorary Society membership to the outgoing president.

Reaffirmed 10/24/2010

Recommendation: Reaffirm

Recommendation Reaffirm as Amended

15.2.07- Tort Reform

Date: 11/8/1997

The Medical Society of Virginia believes that malpractice issues should be resolved in an efficient, fair and less costly manner. Therefore, the Medical Society supports:

1. Alternative dispute resolution proposals such as capped binding arbitration processes, including mediation and arbitration, that are designed to divert claims from the civil justice system and resolve them more quickly and more cost effectively;

Uniform standards for medical liability claims, including:

a. Mandatory periodic payment of damage awards exceeding $250,000;

b. mandatory offsets for collateral sources, such as health insurance.; and

c. Limitation of contingency fees based upon a sliding scale

Filing an affidavit by an expert witness Requiring an expert witness certification stating that the standard of care was violated or that malpractice has occurred prior to filing serving a medical malpractice lawsuit.

4. Preserve equal access to the treating physicians and their health records for the plaintiff’s and the defendant’s attorneys.

5. That evidence with respect to a punitive damage claim be heard separately from the main suit.

6. That Virginia’s “I’m Sorry” legislation should allow  statements expressing “apology, sympathy, commiseration, condolence, compassion, or a general sense of benevolence” so that physicians are not inhibited from communicating with their patients regarding their medical care.

5. Procedural and evidentiary legislation that better enables fairness and equity in the defense of a medical liability case, which may include legislative initiatives from the following:                

a. Amending the “dead man’s statutes” to clarify that a treating physician may testify as 

           to the health care and professional services rendered to a deceased patient;

            b. Amending Va. Code §8.01-399 regarding physician communications to eliminate the 

            requirement that documentation must be contemporaneously entered in the patient’s        

            chart during the course of treatment;

            c. Clarifying venue statutes to create a preference that medical malpractice cases have   to be filed in the jurisdiction where the care is rendered;

            d. Requiring that medical malpractices cases be served within one year of the date they    

           are filed in Court or else they are dismissed with prejudice;

            e. Limiting the exceptions to the statute requiring expert witness certification so they only apply to retention of foreign bodies and wrong site surgeries;

            f. Amending the “habit and customs dead man’s statute” to clarify create an exception so that a defendant physician may rely on this introduce evidence of habit and custom when lacking documentation in defense of a wrongful death action;

            g. Requiring a pre-trial scheduling order and in a medical malpractice case requiring a     plaintiff to designate expert witnesses soon after serving the motion for judgment as

            opposed to 90 days prior to trial; and

            h. Amending the “expert witness statute” to give trial court judges the ability to review the  

            expert witness certification obtained by plaintiff’s counsel,

8. Pilot programs that allow privileged early disclosure of adverse medical outcomes.

Furthermore, the Medical Society of Virginia opposes adoption of a comparative negligence doctrine, and believes that in a claim for contributory negligence, the negligence of the plaintiff does not have to coincide in time with that of the defendant.

Reaffirmed 10/24/2010

Speakers comment:  15.2.07 was reviewed by Counsel.  Counsel recommended amending item 4 as equal access to the treating physicians is unlikely to be passed by the general assembly.  Counsel recommended deleting items 2 and c and 5 d and e for the same reason. 

30.2.01- Economic Credentialing

Date: 9/16/2000

In Accordance with AMA policy 230.975 and 230.976, the Medical Society of Virginia:

1) Adopts the following definition of economic credentialing: economic credentialing is defined as the use of economic criteria unrelated to the quality of care or professional competency in determining an individual’s qualifications for initial or continuing hospital medical staff membership or privileges;

2) Strongly opposes the practice of economic credentialing; opposes the use of economic criteria not related to quality to determine an individual physician’s qualifications for the granting or renewal of medical staff membership or privileges;

3) Affirms its support for the principle of open staff privileges for physicians, based on training, experience, and demonstrated competence.

4) Believes that physicians should continue to work with their hospital boards and administrators to develop appropriate educational uses of physician hospital utilization and related financial data and that any such data collected be reviewed by professional peers and shared with the individual physicians from whom it was collected;

5) Believes that physicians should attempt to assure provision in their hospital medical staff bylaws of an appropriate role for the medical staff in decisions to grant or maintain exclusive contracts or to close medical staff departments;

6) Will communicate its policy and concerns on economic credentialing on a continuous basis to the American Hospital Association, Federation of American Health Systems, and other appropriate organizations.

7) Encourages state medical societies to review their respective state statutes with regard to economic credentialing, and as appropriate, to seek modifications therein;

7) Will explore the development of draft model legislation that would acknowledge the role of the medical staff in the hospital medical staff credentialing process and assure various elements of medical staff self-governance; and

8) Will study and address the issues posed by the use of economic credentialing in other health care settings and delivery systems (CMS Rep. B, I-91)

Reaffirmed 10/24/2010

Current Policy

30.2.02- Economic Credentialing Criteria

Date: 9/16/2000

In accordance with AMA Policy 230.976, the Medical Society of Virginia opposes the use of economic criteria not related to quality to determine an individual physician’s qualifications for the granting or renewal of medical staff membership or privileges (Res. 2, A-91).

Reaffirmed 10/24/2010

30.2.03- Encouragement of Open Hospital Medical Staffs

Date: 9/16/2000

In accordance with AMA Policy 230.976, the Medical Society of Virginia affirms its support for the principle of open staff privileges for physicians, based on training, experience, and demonstrated competence.

Reaffirmed 10/24/2010

Recommendation: Reaffirm as amended 30.1.01. and archive 30.2.02 and 30.2.03

Speakers comment:  the policies overlap and can be consolidated into one policy.

 

Recommendation to Archive

 

10.10.01- Financial Incentives/Under or Overutilization

Date: 11/11/1989 

The Medical Society of Virginia supports the concept of appropriate utilization i.e., that any medical professional reimbursement system that rewards underutilization or overutilization with greater profits is contrary in the Commonwealth, to the best interests of patients and detrimental to the professional ethical behavior of physicians.

Reaffirmed 10/24/2010

Recommendation to Archive

Speakers Comment:  This policy conflicts with current practice and does not offer a solution.  Capitation and Global fees reward underutilization while fee for service rewards overutilization. We should support the ethical and professional judgement of physicians to put patient and public health interests first and provide the best care for our patients regardless of the financial impact to the physician. 

Addressing Racial and Ethnic Health Disparities Through Data Collection and Research

WHEREAS,  Racial and ethnic minorities experience a wide variety and multitude of health and healthcare disparities, and many of these disparities have widened over past decades (1); and

WHEREAS,  African Americans and Hispanics in Virginia were significantly more likely to report unsafe neighborhoods, and research has associated perceived unsafe neighborhoods with poorer physical health, mental health, and reduced social connections (2); and

WHEREAS,  There is strong evidence for poor health among socioeconomically disadvantaged, racial, and ethnic minority populations in Virginia, and African Americans in Virginia live 3-5 fewer years than Whites on average (2); and

WHEREAS,  The higher mortality and infection rates seen in communities of color during the COVID pandemic has drawn attention to these disparities nationally and locally (3); and

WHEREAS,  The reporting of race during the collection of COVID-19 data in Virginia has been partial and inconsistent, thereby making it difficult to estimate the true impact of the pandemic on communities of color within the state (4);

WHEREAS,  Many states have established health equity task forces within state health departments to identify vulnerable populations and address the health disparities underpinning the susceptibility of these communities to COVID (5)[i];

RESOLVED, The MSV supports the Virginia Department of Health in collecting data that accurately captures rates of disease prevalence, diagnosis, treatment, morbidity, and mortality among varying demographics, and supports continued research into the social determinants of health in the Commonwealth.

 

i1. National Center for Health Statistics (US. “Health, United States, 2015: With special feature on racial and ethnic health disparities.” (2016).

2. Virginia Department of Health, 2012. Virginia Health Equity Report 2012. Richmond.

3. 2020 The Covid Tracking Project. Racial Data Dashboard. CovidTracking.com

4. Yancy CW. COVID-19 and African Americans. JAMA. 2020;323(19):1891–1892. doi:10.1001/jama.2020.6548

5. National Academy for State Health Policy. (July 2020). How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities. Retrieved from: https://www.nashp.org/how-states-report-covid-19-data-by-race-and-ethnicity/#tab-id-3

Promoting Health Equity and Medical Workforce Diversity

WHEREAS,  Racial and ethnic minorities experience a wide variety and multitude of health and healthcare disparities, and many of these disparities have widened over past decades (1); and

WHEREAS,  African Americans and Hispanics in Virginia were significantly more likely to report unsafe neighborhoods, and research has associated perceived unsafe neighborhoods with poorer physical health, mental health, and reduced social connections (2); and

WHEREAS,  There is strong evidence for poor health among socioeconomically disadvantaged, racial, and ethnic minority populations in Virginia, and African Americans in Virginia live 3-5 fewer years than Whites on average (2); and

WHEREAS,  The higher mortality and infection rates seen in communities of color during the COVID pandemic has drawn attention to these disparities nationally and locally (3); and

WHEREAS,  Many states have established health equity task forces within state health departments to identify vulnerable populations and address the health disparities underpinning the susceptibility of these communities to COVID (5)[i]; and therefore be it that 

RESOLVED, The Medical Society of Virginia through its delegation to the American Medical Association supports efforts to promote health equity within communities of color, including increasing medical workforce diversity.

 

i1. National Center for Health Statistics (US. “Health, United States, 2015: With special feature on racial and ethnic health disparities.” (2016).

2. Virginia Department of Health, 2012. Virginia Health Equity Report 2012. Richmond.

3. 2020 The Covid Tracking Project. Racial Data Dashboard. CovidTracking.com

4. Yancy CW. COVID-19 and African Americans. JAMA. 2020;323(19):1891–1892. doi:10.1001/jama.2020.6548

5. National Academy for State Health Policy. (July 2020). How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities. Retrieved from: https://www.nashp.org/how-states-report-covid-19-data-by-race-and-ethnicity/#tab-id-3

 

A Resolution to Amend Policy 40.1.04 – Medically Underserved Areas

WHEREAS,  MSV Policy 40.1.04 states “The Medical Society of Virginia shall continue its current efforts and initiate other appropriate efforts to attract physicians to the medically underserved areas of Virginia, and

WHEREAS,  Racial and ethnic minorities experience a wide variety and multitude of health and healthcare disparities, and many of these disparities have widened over past decades (1); and

WHEREAS,  African Americans and Hispanics in Virginia were significantly more likely to report unsafe neighborhoods, and research has associated perceived unsafe neighborhoods with poorer physical health, mental health, and reduced social connections (2); and

WHEREAS,  There is strong evidence for poor health among socioeconomically disadvantaged, racial, and ethnic minority populations in Virginia, and African Americans in Virginia live 3-5 fewer years than Whites on average (2); and

WHEREAS,  The higher mortality and infection rates seen in communities of color during the COVID pandemic has drawn attention to these disparities nationally and locally (3); and

WHEREAS,  Many states have established health equity task forces within state health departments to identify vulnerable populations and address the health disparities underpinning the susceptibility of these communities to COVID (4)[i];

RESOLVED, that the Medical Society of Virginia amend Policy 40.1.04 to be the following:

The Medical Society of Virginia shall continue its current efforts and initiate other appropriate efforts to attract physicians to the medically underserved areas of Virginia, including expanding access to health care services for the low-income and underinsured populations, and communities of color.

 

i1. National Center for Health Statistics (US. “Health, United States, 2015: With special feature on racial and ethnic health disparities.” (2016).

2. Virginia Department of Health, 2012. Virginia Health Equity Report 2012. Richmond.

3. 2020 The Covid Tracking Project. Racial Data Dashboard. CovidTracking.com

4. Yancy CW. COVID-19 and African Americans. JAMA. 2020;323(19):1891–1892. doi:10.1001/jama.2020.6548

5. National Academy for State Health Policy. (July 2020). How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities. Retrieved from: https://www.nashp.org/how-states-report-covid-19-data-by-race-and-ethnicity/#tab-id-3

 

A Resolution to Amend Policy 05.4.01 Access Without Discrimination and Reducing Barriers to Effective Diagnosis and Treatment

WHEREAS,    MSV Policy 05.4.01 states, “The Medical Society of Virginia believes that all citizens of Virginia should have access to medical services without discrimination based on race, religion, age, social status, income, sexual orientation or perceived gender”, and

WHEREAS,  Racial and ethnic minorities experience a wide variety and multitude of health and healthcare disparities, and many of these disparities have widened over past decades (1); and

WHEREAS,  African Americans and Hispanics in Virginia were significantly more likely to report unsafe neighborhoods, and research has associated perceived unsafe neighborhoods with poorer physical health, mental health, and reduced social connections (2); and

WHEREAS,  There is strong evidence for poor health among socioeconomically disadvantaged, racial, and ethnic minority populations in Virginia, and African Americans in Virginia live 3-5 fewer years than Whites on average (2); and

WHEREAS,  The higher mortality and infection rates seen in communities of color during the COVID pandemic has drawn attention to these disparities nationally and locally (3); and

WHEREAS,  The reporting of race during the collection of COVID-19 data in Virginia has been partial and inconsistent, thereby making it difficult to estimate the true impact of the pandemic on communities of color within the state (4);

WHEREAS,  Many states have established health equity task forces within state health departments to identify vulnerable populations and address the health disparities underpinning the susceptibility of these communities to COVID (5)[i];

RESOLVED, that the Medical Society of Virginia amend Policy 05.4.01 to the following:

The Medical Society of Virginia believes that all citizens of Virginia should have access to medical services without discrimination based on race, religion, age, social status, income, sexual orientation or perceived gender, and be it further resolved

That the MSV recognizes racial and ethnic health disparities as a major public health problem and that racial and ethnic bias or personal prejudice is a barrier to effective medical diagnosis and treatment. The MSV affirms strategic interventions to bolster the health of marginalized populations adversely affected by racial, ethnic, or cultural prejudice in the healthcare system.

 

i1. National Center for Health Statistics (US. “Health, United States, 2015: With special feature on racial and ethnic health disparities.” (2016).

2. Virginia Department of Health, 2012. Virginia Health Equity Report 2012. Richmond.

3. 2020 The Covid Tracking Project. Racial Data Dashboard. CovidTracking.com

4. Yancy CW. COVID-19 and African Americans. JAMA. 2020;323(19):1891–1892. doi:10.1001/jama.2020.6548

5. National Academy for State Health Policy. (July 2020). How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities. Retrieved from: https://www.nashp.org/how-states-report-covid-19-data-by-race-and-ethnicity/#tab-id-3

 

Standing With Our Communities Against Racism and Police Violence

WHEREAS,  the Center for Disease Control reports that fatalities from use of lethal force by on-duty law enforcement are disproportionately black, with a fatality rate 2.8 times higher than whites, and 

WHEREAS,  people with disabilities and other historically marginalized communities, including LGBTQ+ individuals, immigrants, and those experiencing homelessness are significantly more likely to be criminalized and targets of police violence2, and

WHEREAS,  between 2013 and 2019, 99% of killings by police did not result in officers being charged with a crime3, and

WHEREAS,  several investigations by the Department of Justice have concluded that police departments practice violent policing with hyper surveillance, harassment, and excessive use of force4, and

WHEREAS,    persons who experience high levels of discrimination have a 21% increased risk of death compared to those at the 50th percentile, after adjustment for age, gender, race, and lifetime socioeconomic status6, and

WHEREAS,  those who had experienced negative encounters with police had higher levels of mistrust of the healthcare system when compared to those who had not experienced such encounters7, and   

RESOLVED, the Medical Society of Virginia supports efforts to eliminate instances of police brutality, as well as improve oversight and independent investigations to hold individual law enforcement officers and police departments accountable, and

RESOLVED, the Medical Society of Virginia supports investments in public health research and community-based safety initiatives that are proven to reduce the disparate impact of police brutality and use of force on the historically marginalized.

1. DeGue, S., Fowler, K. A., & Calkins, C. (2016). Deaths Due to Use of Lethal Force by Law Enforcement. American Journal of Preventive Medicine, 51(5), S173–S187. https://doi.org/10.1016/j.amepre.2016.08.027

2. New York City Anti-Violence Project, Hate Violence Against Transgender Communities Fact Sheet (May 28, 2020) https://avp.org/wp-content/uploads/2017/04/ncavp_transhvfactsheet.pdf

3. “Mapping Police Violence,” (May 28, 2020), https://mappingpoliceviolence.org/

4 Moughty, S. (2011, September 20). 17 Justice Dept. Investigations Into Police Departments Nationwide. Retrieved from https://perma.cc/X94C-A5U2

5 Alang S. M. (2019). Mental health care among blacks in America: Confronting racism and constructing solutions. Health services research, 54(2), 346–355. https://doi.org/10.1111/1475-6773.13115

6 Barnes, L. L., de Leon, C. F. M., Lewis, T. T., Bienias, J. L., Wilson, R. S., & Evans, D. A. (2008). Perceived Discrimination and Mortality in a Population-Based Study of Older Adults. American Journal of Public Health, 98(7), 1241–1247. https://doi.org/10.2105/AJPH.2007.114397

7  Alang, S. , McAlpine, D. , McCreedy, E. , & Hardeman, R. (2017). Police brutality and Black health: Setting the agenda for public health scholars. American Journal of Public Health, 107(5), 662–665. doi:10.2105/AJPH.2017.303691