IOWA OSTEOPATHIC MEDICAL ASSOCIATION
POLICIES AND POSITIONS

Blue Ribbon Commission Report – 2014

WHEREAS, the Blue Ribbon Commission for the Advancement of Osteopathic Medical Education has produced a report with its recommendations for its vision of the osteopathic physician in the 21st century including a suggested competency-based training model over the current model of time-based training which would, in theory, produce primary care physicians in a shorter time frame; and several states are already involved in scope of practice legislative issues with non-physician clinicians and maintain a position that physicians have significantly more clinical training than NP/PA’s; and altering the training model for osteopathic primary care would create a perceived inferiority of an osteopathically trained resident versus an allopathic trained resident; and the number of competencies in primary care have increased rather than decreased with Medical Home/ACO as well as ever changing quality expectations and technologic advances making a shortened training time even more challenging; and less training by primary care physicians may result in increased referral to specialists, increased hospitalizations, increased ordering of ancillary tests, and in essence, drive health care costs up instead of down; and there are several other ways to motivate osteopathic medical students to consider primary care including loan forgiveness or repayment; and the Iowa Osteopathic Medical Association (IOMA) members are extremely concerned about the implementation of such significant educational change; now therefore be it;

RESOLVED, that Iowa Osteopathic Medical Association (IOMA) opposes the implementation of the Blue Ribbon Commission Report as written, and be it further

RESOLVED, that IOMA requests that the American Osteopathic Association (AOA) continue to study the impact of the Blue Ribbon Commission’s recommendation before taking any action to implement it; and be it further

RESOLVED, that IOMA requests that the AOA directly involve all specialty colleges including students and residents in their continued study of the impact of the Blue Ribbon Commission’s recommendations; and be it further

RESOLVED, that IOMA requests that the AOA appoint a Steering Committee with representation from all specialty colleges and other affected parties including students and residents whose purpose is to direct the further study and/or implementation of the Blue Ribbon Commission’s recommendations; and be it further

RESOLVED, that IOMA requests that the AOA set up a mechanism by which input can be gathered from members if a plan is formulated to test this concept; and be it further

RESOLVED, that any action taken, before being implemented, must be presented to and voted in the affirmative by a 2/3rds majority at the AOA House of Delegates.


Capital Crime Executions - 1995

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) deems it an unethical act for any of its members or licensed osteopathic physicians to supervise or participate in any form of execution including lethal injection for the purpose of execution in capital crimes.

AMENDED AND REAFFIRMED 5/2002; REAFFIRMED 5/2007; 5/2012; AMENDED AND REAFFIRMED 5/2017

Centers for Medicare and Medicaid Services (CMS) Electronic Prescribing – 2009

WHEREAS, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate incentive program to entice electronic prescribing by eligible professionals, and the MIPPA incentives are in addition, and unrelated to the Physician Quality Reporting Initiative (PQRI), and the enticement program under MIPPA began on January 1, 2009 and provides financial incentives for "successful e-prescribers", these incentives are intended to allow "successful e-prescribers" to recover a portion of the costs associated with the implementation of electronic health systems, and it takes both a sender and receiver to make a successful electronic transfer, and there is no requirement that pharmacies be required to accept electronic prescriptions, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) requests that the American Osteopathic Association (AOA), through the appropriate means and actions, requests that the Center for Medicare and Medicaid Services (CMS) ensure that pharmacies utilize e-prescribing systems in compliance with standards established pursuant to the Part D Electronic Prescribing Program under Section 1860 D-4 of the SSA.

REAFFIRMED 4/2014

Centers for Medicare and Medicaid Services (CMS) Electronic Prescribing Data Mining – 2009

WHEREAS,  the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate incentive program to entice electronic prescribing by eligible professionals, and the MIPPA incentives are in addition, and unrelated to the Physician Quality Reporting Initiative (PQRI), and the enticement program under MIPPA began on January 1, 2009 and provides financial incentives for "successful e-prescribers", these incentives are intended to allow "successful e-prescribers" to recover a portion of the costs associated with the implementation of electronic health systems, and CMS requires the use of their E-prescribing software which must display the least expensive medical therapeutics, and our obligation as osteopathic physicians is to give our patients the most effective medical therapy in a cost effective manner which may not be the least expensive, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) support a program of CMS electronic medical prescribing which stresses superior patient care rather than programs designed to put financial interest first.

REAFFIRMED 4/2014

Chronic Interventional Pain Management - 2009

WHEREAS, the Iowa Osteopathic Medical Association (IOMA) adopted in 2006 the American Osteopathic Association’s (AOA) 2005 Statement on “Non-Physician Clinicians”, and the National Uniform Claims Committee defines chronic interventional pain management as the diagnosis and treatment of pain-related disorders primarily with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain1, and allied health care practitioners, including certified registered nurse anesthetists and others, do not possess the medical training or, therefore, the requisite knowledge or equivalent skills to independently perform chronic interventional pain management in a safe and competent manner, IOMA recognizes the service of Certified Registered Nurse Anesthetists (CRNAs) for pain treatment procedures under the supervision of a prescribing physician, including epidural steroid injections under fluoroscopy, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) concludes that the practice of independent chronic interventional pain management, including the use of fluoroscopy, is the practice of medicine and is not within the scope of practice of other health care professionals, including a Certified Registered Nurse Anesthetists.

REAFFIRMED 4/2014

Clinical Rotations for Osteopathic Medical Students - 1990

WHEREAS, Iowa is a rurally oriented state which has the benefit of Des Moines University –College of Osteopathic Medicine with osteopathic physicians and students being trained in hospitals and clinics throughout the state; and Iowa realizes a shortage of physicians in rural communities and exposure to medical practice in a rural setting would give the student and physician a broadened scope of expertise and rural awareness; and the rural exposure would assist in the recruitment of new physicians to rural areas, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) petition Des Moines University to encourage students to rotate in rural osteopathic physician offices and hospital settings in their clinical years, and be it further

RESOLVED, that IOMA encourage its members to become preceptors for osteopathic medical students.

AMENDED AND REAFFIRMED 5/2002; REAFFIRMED 5/2007; 5/2012; AMENDED AND REAFFIRMED 5/2017

Code of Leadership for IOMA House of Delegates – 2003

WHEREAS, membership in any organization looks to the action of its leadership as a guide to their own actions; and delegates are selected by their peers to represent them and the entire osteopathic profession at the Iowa Osteopathic Medical Association (IOMA) House of Delegates’ meeting; and the opportunity to serve as a leader in the IOMA carries a variety of responsibilities, and members of the Board of Trustees recognize their solemn responsibility to the osteopathic profession by adopting a Code of Leadership for the Board of Trustees (see attached); and the Board of Trustees believes that members of the House of Delegates should also recognize that they too have a solemn responsibility to the osteopathic profession; now, therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) House of Delegates adopts the attached “Code of Leadership for the House of Delegates.”

REAFFIRMED 5/2008; 5/2013

CME Mandatory Course Requirements – 2004

WHEREAS, medical knowledge is expanding rapidly, requiring physicians to continuously seek continuing medical education (CME) in all areas of their practice; and the state of Iowa currently requires physicians who provide primary health care to children and adults to periodically obtain CME on the subject of child and dependent adult abuse detection and reporting; and the state of Iowa currently requires physicians who provide primary health care to patients in Iowa to periodically obtain CME on the subject of chronic pain management and end-of-life care; and some states have additional specified CME requirements for physicians providing certain services or treating certain patient populations; and the increasing requirements of state mandated CME decreases the amount of time and resources available to physicians to obtain other equally important CME; and each individual physician is in the best position to know which CME courses would be of benefit to his/her patients and practice; now, therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) oppose any attempts in the State of Iowa to impose additional specific CME course requirements.

REAFFIRMED 5/2009; AMENDED AND REAFFIRMED 4/2014

Complementary and Alternative Medicine – 2011

WHEREAS, the national center for complementary and alternative medicine defines complementary and alternative medicine as "a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.  Conventional medicine (also called western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The boundaries between cam and conventional medicine are not absolute, and specific cam practices may, over time, become widely accepted." 1 and according to the National Center for Complementary and Alternative Medicine, 38% of adults and 11.8% of children used complementary or alternative medicine in 2007 2, and before applying any therapy, a proper diagnosis must be established, and establishing a proper diagnosis requires a level of knowledge, training, and skill possessed by a physician, now therefore be it,

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) encourages its members to become knowledgeable about complementary and alternative medicine, and be it further

RESOLVED, that the IOMA encourages its members to discuss the use of complementary and alternative medicine with their patients in a non-judgmental manner that is personally respectful and culturally sensitive, and be it further

RESOLVED, that the IOMA encourages the continued performance of well-designed, evidence-based research on the efficacy and safety of complementary and alternative medicine, and be it further

RESOLVED, that the IOMA opposes all attempts to permit non-physician providers to gain or expand their scope of practice to include complementary and alternative medicine practices.

REAFFIRMED 4/2016

Credentialing – 2006

WHEREAS, many insurance companies, HMOs, PPOs and other entities require physicians to complete lengthy credentialing forms, and physicians must periodically re-credential in many cases providing the same information on the same lengthy form that was used in the initial credentialing process, and completion of these forms is time consuming and redundant, now therefore be

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) work with other medical associations to encourage payors and other entities requiring credentialing information to agree to a single credentialing form which may be submitted electronically.

REAFFIRMED 4/2011; 4/2016

Des Moines University-College of Osteopathic Medicine Support - 1993

WHEREAS, the Iowa Osteopathic Medical Association (IOMA) is a society of osteopathic physicians interested in the osteopathic care of Iowa residents; and the future osteopathic care of Iowa residents must be perpetuated by the next generation of well-trained osteopathic physicians the administration at the Des Moines University-College of Osteopathic Medicine (DMU) continue communication and cooperation between the osteopathic physicians, hospitals, alumni, students, and the administration; now therefore be it

RESOLVED, that the Iowa Osteopathic Association (IOMA) stands ready and eager to assist the Des Moines University (DMU) administration in opening all lines of cooperation and communication between the osteopathic components within this state; and be it further

RESOLVED, that the IOMA will continue to support the DMU-COM students, faculty and administration in their quest for quality osteopathic medical education; and that the IOMA will continue to support DMU in the constructive advancement of osteopathic health care for the residents of this State.

AMENDED AND REAFFIRMED 5/2002; REAFFIRMED 5/2007; 5/2012; 5/2017

Driving Evaluation and Training - 2006

WHEREAS, health insurance programs in companies have traditionally denied coverage for driving evaluations and training, and Iowa has limited public transportation resources, and independence for quality of life in the Iowa community has its basis on the ability to drive safely, and vocational opportunities and health care for the disabled are limited due to transportation problems for those who cannot drive, and the Iowa Academy of Physical Medicine and Rehabilitation supports health insurance coverage for driving evaluations and training in appropriate citizens; therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) work with the Iowa Legislature to develop and implement programs to evaluate citizens for safe driving in the community, and re-training to help patients to regain their lost skills for safe driving and return to productive lives and to improve their access to appropriate health care.

RESOLVED, that the IOMA develop programs to educate members on the responsibilities of physicians in evaluation of their patients for safe driving as well as effective techniques to perform such evaluation.

AMENDED AND REAFFIRMED 4/2011: AMENDED AND REAFFIRMED 4/2016

Electronic Health Records – 2016

WHEREAS, the use of  Electronic Health Records (EHR) by Osteopathic physicians has become  widespread since the  implementation of the Health Information Technology for  Economic and Clinical  Health  Act (HITECH Act, Title XIII of the American for Recovery and Reinvestment Act), and physicians noted important negative effects of current EHRs on their patient’s care.  EHR usability does not match clinical workflows, is time-consuming data entry, interferences with face-to-face patient care, and has created overwhelming numbers of electronic messages and alerts, (1) and physicians in a variety of specialties reported that their EHRs require them to perform tasks that could be done more efficiently by clerks and transcriptionists, and the inability of  varying  EHRs to communicate electronically, as well as the potential for misuse of template-based  medical notes and initial expenditures greater than expected have also been frustrations, and physicians have been under a universal mandate to adopt a new technology before its effects are fully understood, and before the technology has reached a level of usability that is acceptable to its users, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) use whatever efforts it can to advocate for EHR systems that build usability and functionality of  their products in response to the needs of physicians, and assist its member physicians to be better purchasers of EHR systems, and be it further

RESOLVED, that IOMA work with state and federal regulators to slow the pace of additional mandates related to use of EHR and in particular meaningful use requirements.

Epinephrine – 2017

WHEREAS, the population of Iowa has a rising incidence of anaphylaxis, and there exists in Epinephrine an effective medication that can buy time to get a patient to definitive help, and current Epinephrine auto-injectors are out of the financial reach of many Iowans, and the cost of Epinephrine in single use aliquots is more affordable and we trust and train people with failing eyesight, peripheral neuropathy, cardiac failure, etc. to self-draw and administer a much more dangerous medication such as insulin, and Epinephrine has a wide margin of safety, and providing physicians with liability protection for making a much lower cost solution to a life-saving intervention will encourage adoption, now therefore be it

RESOLVED, that Iowa Osteopathic Medical Association (IOMA) advocate for statutory protection on evaluation for and prescribing of Epinephrine for allergic and anaphylactic reactions when used outside a medical setting regardless of the form of Epinephrine used, and be it further

RESOLVED, that IOMA send a similar request to the American Osteopathic Association House of Delegates for national action.

Ethics of Administrative Fees - 2003

WHEREAS, there have been significant increases in the amount of administrative work physicians are asked to perform, and insurance and other reimbursements have not kept pace with the cost of these services, and some physicians are considering charging fees for certain administrative tasks such as completing forms, giving telephone and e-mail advice, consulting with patient’s family, and other indirect patient care activities, and the AOA Bureau of Ethics has determined that this is an ethical practice, now therefore, be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) House of Delegates reaffirms the ethics of Osteopathic physicians ability to charge for administrative tasks.

AMENDED AND REAFFIRMED 4/2008; REAFFIRMED 5/2013

Formulary Changes – 2002

WHEREAS, it has become a common practice for health insurers and managed care plans to utilize a restricted pharmaceutical formulary, and it is also common for the pharmaceutical agents on the formulary to be changed, and it is common for financial criteria to be used in determining which agents are available on the formula, and these frequent changes in the formulary require patients to be switched from one medication to another, and at times it may not be medically advisable for the patient’s medication to be

changed, and it may be dangerous for patients to change medications for example in the case of antidepressants, psychotropic medications, and other narrow therapeutic window drugs, now therefore be it,

RESOLVED, that the Iowa Osteopathic Medical Association educate healthcare insurers and managed care companies on the dangers of formulary changes.

REAFFIRMED 5/2/2007; 5/2012

Health Care Legislation - 1993

WHEREAS, Health Care legislation is a positive political topic at both the state and federal government; and the Iowa Osteopathic Medical Association (IOMA), as a group, is interested in the possible ramifications of this legislation on our patients’ ability to obtain affordable health care; and osteopathic physicians, for a number of years, have strive to maintain a position as our patients’ advocate; and this Association must represent our membership as health care continues to evolve, now therefore be it

RESOLVED, that the IOMA as policy, believes that any meaningful health care legislation must incorporate the following items:

  • Osteopathic health care be available to all patients.
  • Patient freedom to choose a personal physician.
  • A strong emphasis on primary care physicians as the core of the medical care system.
  • Tort reform to protect medical professionals and institutions from frivolous litigation, while protecting the patient’s ability to undergo due process to receive just and fair compensation for medical error.
  • Reduction in the ever-increasing volumes of documentation demanded by third party payers.
  • Patient responsibility to once again become the true purchaser of medical services.
  • Access to preventative medical services for all patients.
  • The accessibility of affordable quality medical care for all Americans.

REAFFIRMED 5/2002; 5/2007; AMENDED AND REAFFIRMED 5/2012; AMENDED AND REAFFIRMED 5/2017

Health Insurance Company Code of Conduct – 2010

WHEREAS, a significant proportion of healthcare expenses are paid by private healthcare insurance companies, and physicians often contract to provide care to patients covered by these private health insurance companies, and physicians have little negotiating power to alter the terms of the contracts offered by these companies, and patients also have little negotiating power to alter the terms of the benefits offered by these companies, and this imbalance of power in favor of insurance companies has resulted in physicians and patients being severely disadvantaged in their dealings with these companies, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) supports legislation that requires fair operating policies by insurance companies that include requirements for transparency and accountability in health insurance cancellation and rescission, the calculation of premium quotes, the calculation of the medical loss ratio, for unregulated secondary networks, in physician rankings and in claims processing; and be it further

RESOLVED, that this legislation should require insurers to operate in a consumer friendly manner.

REAFFIRMED 4/2015

Immunization Practices – 2013

WHEREAS, the Advisory Committee on Immunization Practices (ACIP) is an advisory group of the United States Center for Disease Control and Prevention; and the ACIP provides recommendations to the CDC on immunization practices for U.S. citizens of all ages; and the recommendations of the ACIP are based upon vaccine research, scientific data related to vaccine effectiveness and safety, clinical trial results, manufacturer’s labeling or package insert information, and outbreaks of vaccine-preventable disease or changes in vaccine supply1; and the recommendations of the ACIP are endorsed by the American Academy of Pediatrics and the American Academy of Family Medicine and various other medical organizations2, and the American Osteopathic Association supports the work of the ACIP by appointing a liaison to the ACIP3, now therefore be it

RESOLVED, the Iowa Osteopathic Medical Association endorses the recommendations of the United States Center for Disease Control and Prevention Advisory Committee on Immunization Practices as from time to time amended; and be it further

RESOLVED, that IOMA urges its members to use their best efforts to vaccinate their patients in accordance with the ACIP recommendations.

http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-acip-color-office.pdf, accessed April 23, 2013
http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-acip-color-office.pdf, accessed April 23, 2013
http://www.cdc.gov/vaccines/acip/committee/members.html, accessed April 23, 2013

Internet Access at Conventions – 2004

WHEREAS, an increasing amount of business is being conducted over the internet; and an increasing number of physicians are computerizing their offices; and many hospitals now offer physicians on-line access to patient information; and many osteopathic physicians continue to conduct business while attending convention activities; and many convention site hotels offer high-speed internet service, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) should attempt to negotiate with convention hotels free high-speed, (including where available wireless), internet access for convention registrants who stay at the designated convention hotel.

REAFFIRMED 5/2009; 4/2014

Interstate Compact for Medical Licensure – 2014

WHEREAS, the interstate compact for medical licensure seeks to expedite licensing processes for physicians applying for licensure in multiple states at the same time; and interstate compact licensure is viewed as a mechanism for facilitating telehealth delivery and licensure portability; and interstate compact licensure is strictly voluntary; and physicians practicing under an interstate compact are bound to comply with the statues, rules and regulations of each compact state wherein he/she chooses to practice; jurisdiction over licensees and the practice of medicine within the boundaries of each state continues to vest with each state’s medical licensing board, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) will work with the Iowa Board of Medicine on legislative language if the Iowa Board of Medicine votes to move forward.

Iowa ACGME Training Programs – 2017

WHEREAS, the resident training will no longer be accredited by the AOA after July 2020, and ACGME will be certifying residency programs, and osteopathic practice and principles will be needed to be integrated into residency training to insure the future of our profession, and now therefore be it

RESOLVED, that Iowa Osteopathic Medical Association (IOMA) encourages all Iowa ACGME residency programs to apply for osteopathic recognition, and therefore be it

RESOLVED, that IOMA be a resource for ACGME programs achieving osteopathic recognition.

Iowa Medicaid Managed Care – 2016

WHEREAS, the State of Iowa is transitioning its Medicaid Agencies (Iowa Medicaid            Enterprise) by contracting with Managed Care Organizations (MCO’s), to provide and pay for certain health care services. It is estimated by the Iowa Governor’s Office that this transition will save $51 million in costs the first year alone, although the methodology to calculate this savings has been called into question, and Osteopathic Physicians care for many of Medicaid beneficiaries.  Medicaid covers about 600,000 Iowans at a cost of approximately $4 to $5 billion, and Iowa Medicaid Managed Care Organizations are currently signing up members and providers, and providers had until March 1, 2016 to contract with one or more of the MCO’s, or face a 10% decrease in Medicaid reimbursement, and the provider contracts have been deemed by many to be incomplete or unclear as to reimbursement rates, utilization oversight, as well as case management and care coordination, and

RESOLVED, that the Iowa Osteopathic Medical Association advocate for accessibility to quality care, transparency of administrative costs, transparency of cost savings, and limitation of undue burdens for physicians/providers under the Iowa Medicaid Managed Care transition.

IOMA Support of TOMA Opposition to TCOM MD Option – 2012

WHEREAS, the University of North Texas and the President of the University of North Texas Health Science Center (UNTHSC) have initiated a study of the feasibility of offering an MD degree at the school.  A study group organized by the Chancellor and the President of the UNTHSC has recommended further study and development of details in a business plan for further consideration of this option, which has been directed by the Board of Regents to be accomplished.  Any need for such an MD degree in the UNT System remains undefined and of questionable validity.   Many of the discussions concerning this proposal appear to be centered on:  1) a ‘need” of Fort Worth to have such a program; and 2) the desire of the UNT System to generate additional research dollars, both of which remain unsubstantiated.   The State of Texas statutes prohibiting the UNT Board of Regents from awarding a MD degree are still in effect.  The creation of an MD degree at the UNTHSC would be detrimental to the growth and levels of excellence being obtained by TCOM.   The creation of an MD degree at the UNTHSC would have a negative impact on TCOM’s ability to continue providing a disproportionately higher share of well-trained primary care physicians for the State of Texas.  The rationale for creating the MD degree at the UNTHSC gives credence to those who believe only an MD degree can be first-rate, despite all the evidence to the contrary.  The state and national osteopathic associations are in agreement that such a concept is ill-formed, untimely, and without demonstrated need; now therefore be it

RESOLVED, that Iowa Osteopathic Medical Association supports the Texas Osteopathic Medical Association’s efforts to oppose the development of an MD degree program at the University North Texas Health Science Center (UNTHSC) and its opposition to any change in the state statute prohibiting the University of North Texas (UNT) Board of Regents from awarding an MD degree.

Lay Midwives – 2010

WHEREAS, Iowa Osteopathic Medical Association (IOMA) supports the goal of providing consumers with a choice in who provides their healthcare, and Iowa patients have access to a rich variety of licensed healthcare providers offering obstetrical services, and in recent years, a variety of individuals and groups have sought the legitimacy of state licensure in an effort to prove to the public that they have the knowledge, training, and skill to safely care for the citizens of Iowa, and licensure by the state implies to the public that the holder of the license possesses a certain level of skill, knowledge and expertise, and one of the groups recently seeking the legitimacy of state licensure is the lay midwives, and lay midwife education generally consists of correspondence course work and an apprenticeship under the guidance of another lay midwife, and current Iowa law permits a woman the complete freedom to choose where they give birth and who is in attendance at the birth, and licensing lay midwives would imply to the public that they possess a level of skill, knowledge and expertise comparable to that of other healthcare providers who provide care to pregnant women, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association opposes the licensing of lay midwives; and be it further

RESOLVED, that the IOMA urges the Iowa Legislature to exercise great caution in creating new licensed professionals.

REAFFIRMED 4/2015

Lead Screening – 2011

WHEREAS, childhood lead poisoning has significant effects on the health of children, and lead has adverse effects on nearly all organ systems in the body and is especially harmful to the developing brains and nervous systems of children under the age of six years, and although lead poisoning can cause serious health problems, including death, most lead-poisoned children demonstrate no visible symptoms which makes it important to have effective programs to prevent childhood lead poisoning, and in 2007 the Iowa Legislature passed a law requiring all children entering kindergarten to be tested for lead poisoning, and in 2008, parents of Iowa children entering kindergarten must show proof of a blood lead test, and Iowa Medicaid adopted the Medicare NCDs and LCDs in October 2010, and the Medicare LCD does not allow for screening, and Iowa now has in place a mandated service without funding, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) work with other associations to encourage the state legislature to continue to appropriate funds for lead screening for uninsured and underinsured patients, and be it further

RESOLVED, that the IOMA ask the Iowa Department of Human Services to provide funding for lead screening as a covered service.

AMENDED AND REAFFIRMED 4/2016

Legislation Dictating the Practice of Medicine – 2017

WHEREAS, the practice of medicine and the practice thereof are best defined by the medical profession, and many non-physician entities attempt to have legislation introduced and passed which address the standard of care, and these legislative attempts are not aligned with evidence-based guidelines, and well intended legislation may have unintended consequences such as interference with the physician-patient relationship and patient harm, now therefore be it

RESOLVED, that Iowa Osteopathic Medical Association (IOMA) is opposed to the legislature defining the standard of care in medicine, interfering with medical decision making, or interfering with the physician-patient relationship.

Limiting Patient Autonomy in Emergency Situations – 2013

WHEREAS, the Iowa Osteopathic Medical Association (IOMA) supports patient autonomy and the patient’s right to accept or reject medical care by an osteopathic physician; and the patient invoking the right may be inadvertently and unintentionally placing themselves in danger should be unforeseen life threatening emergency arise, now therefore be it

RESOLVED, that any Osteopathic physician practicing in this state, who responds to a patient experiencing a life threatening event, even though that patient had previously expressed a desire that that particular physician not participate in their care, that the physician acting in that manner is acting ethically and humanly; and be it further

RESOLVED, that the Iowa Osteopathic Medical Association will promote policy at the state and national level to ensure protection of Osteopathic physicians who are following the dictates of their Osteopathic Oath.

Managed Care System - 1994

WHEREAS, the current delivery system of health care is rapidly being converted to a managed care system, and managed care products, according to insurance industry proponents demand that provider panels be restricted in order to obtain discounts from providers, and their restricted panels often exclude osteopathic specialists and independent primary care providers, D.O., M.D. and others, and these exclusions limit the patient choice of provider and often cause patients to change their source of health care services, and healthcare purchasers an payers have been unwilling to provide patients with plan choices that allow them the freedom to remain with their own provider or choose the provider they feel best meets their healthcare needs, and the osteopathic profession has accepted the responsibility of patient advocacy as on of its principles regarding health care delivery, now therefore, be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) will continue to work with other health care providers to ensure that “any willing provider” and/or “patient freedom of choice” language is inserted into any health care reform legislation considered by the Iowa legislature.

REAFFIRMED 5/2002; 5/2007; 5/2012; 5/2017

Mandatory Coverage of HPV Vaccine, Recommendation of – 2007

WHEREAS, the majority of cervical cancers are caused by the Human Papilloma Virus; and a majority of genital warts are caused by Human Papilloma Virus; and a large number of women may die from cervical cancer; and this vaccine is approved for males and females ages nine to twenty-six; and therefore be it,

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) recommends to the appropriate state agencies and legislative bodies, that the HPV vaccine be included in the mandatory vaccine list and/or be made available to general public through the state department of health; and consistent with U.S. Preventative Services Task Force.

AMENDED AND REAFFIRMED 5/2012; AMENDED AND REAFFIRMED 5/2017

Marijuana for Medical Use – 2010

WHEREAS, in February 2010, the Iowa Board of Pharmacy voted 6-0 to recognize marijuana’s medical value and to recommend that the legislature reschedule marijuana to schedule II; and legislation has been introduced to reclassify marijuana from a scheduled I controlled substance to schedule II controlled substance which would allow a physician to issue a prescription for marijuana; and there is a high potential of patient misrepresentation of their medical condition; and there is a high potential of abuse by patients in the use of controlled substances including marijuana for medical use, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) opposes the legalization of smoked marijuana for medical use; and that the IOMA opposes the reclassification of marijuana for medical use without additional study and consideration of scientific evidence on its safety and efficacy.

AMENDED 4/2014

Medicaid – 2004

WHEREAS, recent reports indicate that the number of patients eligible for Medicaid benefits is increasing, and physicians strive to serve all patients in need of medical care, and in providing services to patients, physicians and their practices incur significant expense, and for physicians to continue to provide service to patients, physicians must be paid for their expenses and reasonable profit, and current Medicaid payment levels are below the physician’s cost of providing care, and the State of Iowa does not currently fund the Department of Human Services at the level needed to appropriately pay physicians and hospitals for the care they provide to Medicaid recipients, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) make as one of its top legislative priorities the adequate funding of the Medicaid program at a level that will allow physician payment to meet or exceed the current Medicare payment level for all medical specialties.

REAFFIRMED 5/2009; AMENDED 4/2014

Medicaid Payment – 2010

WHEREAS, the policy of the Iowa Osteopathic Medical Association (IOMA) with respect to Medicaid payment to it’s member physicians has been established by resolution in 2004 and reaffirmed in 2009, and that policy links Medicaid payment to Medicare payment levels, and Medicaid payment fails on its own merits to adequately pay physicians for services rendered, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) supports the state of Iowa upholding its obligation to pay Iowa’s physicians and hospitals at a fair and equitable rate for providing quality care for the state’s Medicaid recipients.

REAFFIRMED 4/2015

Medicare Medical Necessity Certification Requirements – 2016

WHEREAS, in 2015, 55.5 million Americans were covered by Medicare1, and 2014 Medicare expenditures totaled $618.7 billion1, and The Center for Medicare and Medicaid Services estimates that waste, fraud, and abuse accounted for up to 10% of total Medicare spending1 , and to combat this waste, fraud, and abuse, CMS has implemented a more robust medical certification process to ensure the goods and services paid for are medically necessary, and as a result of these measures, physicians who prescribe durable medical equipment and medical supplies for their patients are required to complete and submit forms and documentation from the medical record in order for patients to receive the prescribed DME or medical supplies, and when patients have an ongoing need for medical supplies such as diabetes testing strips and supplies, CMS requires completion of a new certificate of medical necessity every six (6) months, and when patients need certain medical assistive devices such as walkers, wheelchairs, braces, etc. CMS requires multiple forms and highly specific documentation in the medical chart, and for many items, CMS also requires a patient to be seen on the date the DME or medical supply prescription was issued even when the patient has been recently seen, and these medical certification processes implemented to rightly combat waste, fraud and abuse add unnecessary costs, create a heavy administrative burden on physician practices, delay the availability of the DME or supply, and act as a barrier to patients receiving medically necessary DME and supplies, now therefore be it

RESOLVED, that Iowa Osteopathic Medical Association (IOMA) supports reasonable efforts to prevent Medicare waste, fraud, and abuse, and be it further

RESOLVED, that IOMA calls on the Center for Medicare and Medicaid Services (CMS) to evaluate its medical necessity certification requirements including the amount of waste fraud and abuse detected and prevented by such measures, the administrative burden imposed on physician practices, and the rate of denial of legitimate medical supplies and equipment, and that IOMA calls on CMS to reform its medical necessity certification processes to minimize the administrative burden placed on physician practices, and that IOMA submit a similar resolution to the 2016 AOA House of Delegates.


Medicare Recovery Audit Contractors - 2005

WHEREAS, the Iowa Osteopathic Medical Association, (IOMA) supports the proper coding and payment of claims, and the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) required the Centers for Medicare and Medicaid Services, (CMS) to carry out a demonstration project using Medicare Recovery Audit Contractors, (MRAC), and the purpose of this demonstration project is to retrospectively review payment of claims for accuracy, and the MRAC is required to review claims for both underpayment and overpayment, and CMS has based payment to the MRAC only on the value of overpaid claims found, and this creates a clear incentive for the MRAC to find overpaid claims and ignore underpaid claims, now, therefore, be it,

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) continue to support the American Osteopathic Association (AOA) efforts to work with the CMS on MRAC payment methodology.

REAFFIRMED 4/2010; AMENDED 4/2015

Membership Campaign – 2017

WHEREAS, at their mid-year meeting, the American Osteopathic Association (AOA) Board of Trustees passed resolution B-12, Osteopathic Continuous Certification Component 5, and when implemented, this resolution will end the requirement that AOA board certified physicians maintain AOA membership, and a frequent excuse cited by physicians for not being members of the Iowa Osteopathic Medical Association (IOMA) is the cost of AOA dues, and the decoupling of AOA certification from AOA membership provides an opportunity for IOMA to increase its membership, now therefore be it

RESOLVED, that Iowa Osteopathic Medical Association (IOMA) House of Delegates directs the IOMA Board of Trustees and staff to design and implement a major membership marketing plan directed toward all osteopathic physicians practicing in Iowa, but especially targeting those physicians who are American Osteopathic Association (AOA) Board certified, and be it further

RESOLVED, that the implementation of this membership marketing campaign be timed to coordinate with the date set by the AOA to officially decouple AOA membership from AOA board certification.

Membership Dues Increase – 2016

WHEREAS, the Iowa Osteopathic Medical Association (IOMA) is the primary organization that represents, advocates and educates all osteopathic physicians in the state of Iowa; and these matters are important as our profession attempts to maintain its leadership status in times of constant change; and membership in all professional organizations shows a decline; and this decline places all professional organizations in a difficult financial position; and the IOMA Board of Trustees recognizes its fiduciary liability and the necessity to keep the IOMA in a strong financial position; and the IOMA has not changed or increased its dues in twenty years (1996); now therefore be it

RESOLVED, that the IOMA Finance Committee and Board of Trustees will review this resolution prior to the House of Delegates in 2017; and, that in order to sustain fiscal responsibility to its members, dues shall be $525 beginning the 2016-2017 fiscal year.

Mental Health Reform – 2017

WHEREAS, patients lack access to adequate mental health care, and the closure of Iowa’s mental health institutes has worsened access to mental health services, and there continues to be a severe shortage of mental health professionals especially residency trained psychiatrists practicing in Iowa, and patients requiring in-patient mental health care are often unable to find a facility with an open bed or have to travel hundreds of miles from home and family to find a facility with a bed, and now therefore be it

RESOLVED, that comprehensive mental health reform shall be a legislative priority of the Iowa Osteopathic Medical Association.

Mergers and Buy-Outs of Third Party Payers – 2004

WHEREAS, physicians contract with some but not all insurance companies, health maintenance organizations, preferred provider organizations, third-party administrators, accountable care organizations, re-pricing companies, and other health care expense payers, and there are several thousand of these entities operating in Iowa; and there are frequent mergers and buy-outs among these entities; when an entity with which a physician contracts is the subject of a merger or buy-out, the purchasing entity often automatically enrolls the physician in all products of the purchasing company even though the physician has not contracted with the purchasing entity, and this forces physicians to provide services to patients for whom he/she has not contracted at payment rates to which he/she has not agreed, now therefore be it,

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) work with the appropriate state agencies and the legislature to prevent acquiring entities from automatically enrolling physicians in all products of the acquiring company.

REAFFIRMED 5/2009; AMENDED 4/2014

Naloxone – 2017

WHEREAS, the United States is seeing an unprecedented rise in deaths from opioids resulting in a public health crisis, and opioids have an effective antidote (Naloxone), and Naloxone has no adverse effects if administered to a person not on opioids, and the cost of Naloxone is predominantly in the auto-injectors, and persons with poor eyesight, neuropathy, renal failure, etc. are trusted to possess, self-draw and self-administer a much more dangerous drug, such as insulin, and Naloxone can be dispensed in unit-of-use aliquots, and physicians are reluctant to prescribe Naloxone as a self-drawn medicine, and Good Samaritan laws do not protect the physician in routine or emergency situations, and a public health crisis permit altered standards, therefore be it

RESOLVED, that Iowa Osteopathic Medical Association (IOMA) work with legislators to give statutory protection in evaluation for and prescribing of Naloxone regardless of route of administration; and be it further

RESOLVED, that IOMA send a similar request to the American Osteopathic Association House of Delegates for national action.

Non-Physician Clinicians – 2006

WHEREAS, non-physician health care providers are granted medical privileges by various agencies (public and private), and there medical privileges imply a health care quality which may not be substantiated in fact, therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) adopt the American Osteopathic Association’s 2010 statement on “Non-Physician Clinicians”.

AMENDED AND REAFFIRMED 4/2011; REAFFIRMED 4/2016

Non-Physician Health Care Providers – 2016

WHEREAS, the term “health care provider” is widely used; and the term as used fails to denote whether the health care provider has a restricted or non-restricted license; and this term leads to confusion as to the credentials the “health care provider” has; and this confusion in some instances leads patients to obtain services from a “health care provider” that may not have credentials that the patient finds desirable; now therefore be it

RESOLVED, that Iowa osteopathic Medical Association (IOMA) will request of the Iowa Legislature and regulatory bodies that the title “health care provider” not be used in favor of the title “physician and non-physician provider; adopts the policy of the American Osteopathic Association titled “Use of the Term Doctor” H324-a/14; and be it further

RESOLVED, that a similar resolution if approved be forwarded to the American Osteopathic Association (AOA) House of Delegates.

On-Call Physician Services – 2010

WHEREAS, the recognition of adequate rest and balanced lifestyle is crucial for the health of physicians, and the commitment to payment for an on-call physician to be available for emergencies during traditional non-business hours has long been neglected, and on-call physician services are often required by hospitals in order to be on active staff, and these services are often provided under demanding and challenging circumstances, exposing physicians to additional liability without compensation, and compensation to on-call physicians will ensure adequate, highly trained physician services will be available to their communities on a consistent basis, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) encourage hospitals to compensate physicians for on-call time during weekends, holidays and after hours.

REAFFIRMED 4/2015

Osteopathic Organizations – 2006

WHEREAS, osteopathic medicine is a separate and distinct branch of the healing arts, and it is recognized that some issues facing the practice of osteopathic medicine today are unique to the osteopathic profession, and the Iowa Osteopathic Medical Association (IOMA) has effectively represented the osteopathic physicians of Iowa for more than 100 years, and IOMA represents osteopathic physicians engaged in all specialties of osteopathic medicine, now therefore be it

 RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) House of Delegates proclaims that the Iowa Osteopathic Medical Association is THE voice of all osteopathic physicians in Iowa representing their specific needs.

REAFFIRMED 4/2011; 4/2016

Osteopathic Pledge of Commitment  - 2003

WHEREAS, the American Osteopathic Association (AOA) started the Unity Campaign; and one of the main goals that campaign was to unify osteopathic medicine; and the AOA realizes that there is a period of time in physician’s training that they may lose their commitment to the osteopathic family; and there is no standard pledge to instill commitment and loyalty to the profession; and the AOA Board of Trustees has approved a pledge that they would like all osteopathic physicians to take, therefore, be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) adopt and promote the attached pledge.

REAFFIRMED 4/2008; 5/2013

Osteopathic Post-Graduate Training - 2005

WHEREAS, osteopathic physicians graduating from Des Moines University-College of Osteopathic Medicine (DMU) have limited available post-graduate osteopathic programs in the state of Iowa, and many osteopathic graduates are now entering allopathic post-graduate programs in order to remain in the state of Iowa, and the Iowa Osteopathic Medical Association  (IOMA) would like to encourage osteopathic graduates to remain in the state of Iowa, to practice in the state of Iowa, and to become members of IOMA, and it would be in the best interest of DMU to improve post-graduate opportunities in the State of Iowa; now, therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) in conjunction with Des Moines University (DMU) work to support existing osteopathic residency programs and improve the availability of osteopathic training programs in the state of Iowa.

REAFFIRMED 4/2010; AMENDED 4/2015

Osteopathic Primary Care Training - 1994

WHEREAS, the Iowa Osteopathic Medical Association submitted a resolution to the AOA House of Delegates calling for increased training of osteopathic primary care physicians; and the 1993 AOA House of Delegates approved this IOMA sponsored resolution; and there has been an increasing level of communication and cooperation between IOMA and the Des Moines University – College of Osteopathic Medicine in Des Moines; now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) commends Des Moines University (DMU) on its commitment to train osteopathic primary care physicians and requests DMU to continue to strengthen this goal and, be it further

RESOLVED, that the IOMA House of Delegates directs the IOMA executive director, IOMA Board of Trustees, and IOMA officers to assist the DMU administration in their efforts to stress the importance of primary care training.

AMENDED AND REAFFIRMED 5/2002; REAFFIRMED 5/2007; 5/2012; 5/2017

Osteopathic Medical Student Rotations Support - 2013

WHEREAS, the Iowa Osteopathic Medical Association (IOMA) and its members have been strong advocates of osteopathic medical education as well as collaborative partners with Des Moines University; and the University of Iowa increasing medical school class size may negatively impact the availability of clinical rotations within Iowa for DMU osteopathic medical students; and foreign/international medical students competing for clinical rotation sites may also negatively impact the availability of clinical rotations within Iowa for DMU osteopathic medical students; now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association strongly encourage its members to continue supporting Des Moines University osteopathic medical students through providing quality clinical rotation sites, consider providing new opportunities for clinical rotations for DMU students, and be open to other avenues of collaboration regarding clinical medical education with DMU.

Pay-for-Performance -2005

WHEREAS, Pay-for-Performance initiatives are being considered by many payors, and the Iowa Osteopathic Medical Association (IOMA) recognizes that these initiatives are designed to improve patient care, and patient compliance or non-compliance, formulary restrictions, the ability to afford medications and other factors outside the physician's control may affect measurable outcomes, and physicians may feel it necessary to discharge patients who do not meet Pay-for-Performance standards for financial reasons, now, therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) continues to oppose outcome-based pay-for-performance initiatives that may affect patient access to care.

REAFFIRMED 4/2010; AMENDED 4/2015

Physical Medicine and Rehabilitation – 2006

WHEREAS, it is detrimental to the public health for the citizens of Iowa to have one of the lowest numbers of practicing physiatrists (ranked 49th) in the state with one of the highest  proportion of elderly citizens (ranked 5th), many of whom have chronic musculoskeletal and neurological conditions, and although all osteopathic physicians are trained in osteopathic manipulative medicine there is not a physical medicine and rehabilitation residency program in Iowa, and it is in the best interest for the public health of Iowans and those with neuromuscular or musculoskeletal disease or injury to have improved access to physicians knowledgeable about and specifically trained in rehabilitation, now therefore be it

RESOLVED, that the Iowa Osteopathic Medicine Association (IOMA) recognizes the lack of physical medicine and rehabilitation physicians currently practicing in Iowa, and be it further

RESOLVED, that IOMA encourage Iowa medical schools to increase training in management of chronic disabling conditions, including clinical rotations with physicians trained in physical medicine and rehabilitation, and be it further

RESOLVED, that the Iowa Osteopathic Medicine Association support effort to improve patient access to physical medicine and rehabilitation physicians in the state of Iowa.

AMENDED AND REAFFIRMED 4/2011; REAFFIRMED 4/2016

Physician Competency – 2016

WHEREAS, Osteopathic physicians are accountable to licensing boards, specialty boards,

peer review, and other regulatory agencies that monitor competency, and there is no mandatory retirement age for osteopathic physicians, and it is well known that memory, cognitive skills, completion of complex tasks, as well as motor skills, hearing, and vision can all be adversely affected by age, and it is estimated that approximately 1 in 4 physicians in the United States is age 65 or older (1), and more than one physician organization has advocated inclusion of physical and mental competency as part ofMaintenance of Certification (MOC) and/or licensure, and the American Medical Association acknowledges there has been no identifiable link between physician age and patient safety (1), now be it therefore

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) is opposed to any mandatory retirement age for osteopathic physicians, and be it further

RESOLVED, that IOMA urges more study before any age related neurocognitive testing be used to evaluate physician competency for licensure and/or certification.

Physician Notification of Pending Drug Withdrawal/Recall – 2005

WHEREAS, from time to time, pharmaceuticals agents are withdrawn or recalled from the market, and current Security and Exchange Commission rules prohibit pharmaceutical companies from notifying physicians of pending withdrawals/recalls prior to notification of the general public, and these SEC rules prevent physicians from having a full knowledge of the concerns that prompted the withdrawal/recall, and this lack of information interferes with clinical decision making regarding the appropriate care of patients taking the withdrawn/recalled pharmaceutical agent thereby further endangering patients’ safety, now, therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) continue to call upon the American Osteopathic Association (AOA), through its Washington office, to communicate to the SEC and the Food and Drug Administration its concern for this problem, and be it further

RESOLVED, that the IOMA call upon the AOA to work with these and other regulatory agencies and/or Congress to develop regulations which would allow pharmaceutical companies to communicate to physicians pertinent clinical information regarding a pharmaceutical agent which is about to be withdrawn/recalled from the market prior to notification of the general public.

REAFFIRMED 4/2010; AMENDED AND REAFFIRMED 4/2015

Physician Workforce – 2010

WHEREAS, Iowa has approximately 2.6 physicians per 1000 patients1, and this is significantly below the Unites States average of 3.2 physicians per 1000 patients1, and Iowa's physician workforce is aging, and both of these facts indicate a need to increase the number of physicians caring for patients in Iowa, and Des Moines University has been a reliable source of high quality physicians for Iowa for over 100 years, and it has been shown that most physicians practice in close proximity to the hospitals where they train, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) supports efforts to expand Iowa’s health workforce through workforce incentives and forgivable loans; and that the IOMA supports the use of State funds, either directly or through scholarships, for DMU as a mechanism to increase the number of DMU graduates practicing in Iowa; and be it further

RESOLVED, that the IOMA supports state funding in the form of grants and low interest loans to hospitals and other entities willing to start new residency training programs where none exist.

http://www.statehealthfacts.org/comparemaptable.jsp?ind=689&cat=8, accessed April 7, 2010

REAFFIRMED 4/2015

Post Graduate Education – 2008

WHEREAS, there is a profound need for more osteopathic postgraduate medical education in the State of Iowa, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) supports the Des Moines University College of Osteopathic Medicine and other entities’ efforts to accredit osteopathic postgraduate medical education programs in the State of Iowa.

AMENDED AND APPROVED 5/2013

Pre-filled Medical Necessity Form – 2008

WHEREAS, many patients now receive durable medical equipment (DME), medications, and other medical supplies from national medical supply companies; and many of these companies aggressively market their products and services directly to patients; and this aggressive direct to consumer marketing often neglects to inform patients of Medicare and other insurance’s medical necessity criteria and leads patients to believe they have an absolute right to the product or service being advertised; and some companies make frequent and repeated contact with physicians requesting that the physician sign pre-filled forms certifying medical necessity for the products and services the company offers; and these practices increase the overall cost of patient care through the sale of unnecessary goods and services, the wasting of duplicate supplies, and additional administrative costs to physicians, now, therefore be it,

RESOLVED, that the Iowa Osteopathic Medical Association believes that supplying a pre-filled medical necessity form to a physician is unethical; and be it further

RESOLVED that IOMA encourages physicians to verify directly with patients that the patient is in need of supplies; and be it further

RESOLVED, that a similar resolution be forwarded to the American Osteopathic Association House of Delegates and that said resolution also request the AOA to work with federal regulators and Congress to require that direct to consumer marketing for DME, medical supplies and medications contain a disclosure regarding medical necessity and making it illegal for supply companies to provide physicians with medical necessity certification forms on which the quantity or indication of a need for a product is pre-filled.

REAFFIRMED 5/2013

Prior Authorization – 2016

WHEREAS, Osteopathic physicians strive to provide high quality cost effective care to their patients, and Osteopathic physicians often are required to perform Prior Authorizations for prescription medications and/or advanced imaging and/or procedures to effectively diagnose and treat their patients, and a study published in 2013 in the Journal of the American Board of Family Medicine put the mean annual projected cost per full-time equivalent physician for prior authorization activities between $2,161 and $3,430. The study’s authors concluded that “preauthorization is a measurable burden on physician and staff time.”1, and while prior authorizations are often cumbersome and inconvenient for the physician, it can be harmful to the patient who is experiencing a delay in diagnosis and/or treatment, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) advocate for transparency and accountability to payors practices and that no care may be denied on the grounds that it is not “medically necessary” except by a physician qualified by education, training  and expertise to evaluate the patient’s specific clinical issues”, and that IOMA advocate for eliminating complexity and confusion from payors’ prior authorization processes and communications, and that those processes and communications be minimized and streamlined, and that IOMA advocates for public contact information for the payor’s medical director.

Prior Authorization – 2017

WHEREAS, medical claims payers and pharmacy benefit managers have for years used prior authorization requirements, allegedly to control costs of medical care and pharmaceutical agents, and the use of prior authorization has in recent years greatly expanded to include requirements for prior authorization of diagnostic testing, medical procedures, and pharmaceutical agents, including even some generic medications, and this expansion of prior authorization now greatly interferes with, prohibits, and or delays patient access to medically indicated and necessary diagnostic and therapeutic services and agents, and the expansion of prior authorization requirements has added substantial uncompensated costs to medical practices and to the healthcare system, and many claims payers and pharmacy benefit managers refuse to disclose the criteria they use to make decisions on prior authorization requests, make decisions contrary to their published policies, render decisions which are arbitrary and capricious, and or fail to disclose information on how to contact them, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) will seek legislation in the Iowa legislature which would require insurance claims payers and pharmacy benefit managers to:

  • Disclose in sales, promotional materials and advertising that their products utilize a prior authorization process which may result in a delay in or denial of diagnosis and or treatment which may be detrimental to the patient's health or well being
  • Require contracts with healthcare providers to include hold harmless clauses indemnifying healthcare providers against financial loss due to injury to a patient as a result of their failure or refusal to timely grant a prior authorization request
  • Include a correct phone number and web address on the patient identification card for initiating the prior authorization process
  • Make all forms used in the prior authorization process readily available to healthcare providers
  • Publish and make available to the public all requirements for prior authorization and follow those published policies
  • Provide sufficient knowledgeable staff to ensure that healthcare providers are able to contact medical claims payers and pharmacy benefit managers without average hold times exceeding 10 minutes
  • Compensate medical practices and healthcare providers for the cost of time spent on inappropriately denied prior authorization requests
  • The Medical Director of the payor/claim adjudicator shall be identifiable and shall be held accountable for the result of their decisions

And, be it further

RESOLVED that a similar resolution shall be submitted to the American Osteopathic Association House of Delegates.

Prior Authorization for Payment of Medical Services – 2006

WHEREAS, the cost of medical health insurance is rising faster than the rate of inflation, and some payors, have adopted procedures which require physicians to receive authorization from the payor for certain procedures before the procedure is performed, and these prior authorization procedures are costly and time consuming for physicians to administer, and the criteria for approval are often unknown by the physician or fail to follow recognized diagnostic and treatment guidelines, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) adopts the attached statement of principals for prior authorization, and that IOMA communicate these principals to major payors implementing prior authorization programs in Iowa.

REAFFIRMED 4/2011; AMENDED AND REAFFIRMED 4/2016

Professional Liability Insurance Reform – 2004

WHEREAS, professional liability insurance reform has been a top legislative priority for both the Iowa Osteopathic Medical Association (IOMA) and the American Osteopathic Association (AOA); and there are many factors contributing to the current PLI crisis, such as ineffective or nonexistent insurance rate oversight and control; and the crisis in PLI is great enough that it warrants that all aspects of reform be explored; and to date, most efforts to affect the PLI crisis have been directed at tort reform, now therefore be it,

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) and American Osteopathic Association (AOA) broaden their efforts to address the PLI issue by exploring the impact and feasibility of additional PLI reforms beyond reform of the tort system.

AMENDED 4/2015

Professional Organization Choice - 2005

WHEREAS, some employers pay professional association dues as a part of the employment benefits for their physician employees, and in many cases the employer chooses to pay the dues for the physician in the allopathic medical associations and does not give the physician their choice of medical associations, many osteopathic physicians would prefer to belong to an osteopathic medical association instead of an allopathic medical association, and in essence this is requiring the physician to belong to an association against their choice as a condition of their employment, and these osteopathic physicians wish to have their osteopathic association dues paid to their respective medical alliance the same way as that of their allopathic colleagues, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) supports all physicians having the right to choose which medical associations they join, even when the employer is paying the membership fees, and that the Iowa Osteopathic Medical Association provide physicians with a letter template stating their desire to have dues paid to an osteopathic medical association.

REAFFIRMED 4/2010; REAFFIRMED 4/2015

Provider Tax – 2010

WHEREAS, recently the State of Iowa has struggled with significant budgetary issues, and a significant portion of the state budget is dedicated to payment for medical services, and the Medicaid program is a joint state and federal program in which the state receives $2.00 in federal funds for every $1.00 it spends, and some have proposed that the state impose a tax on healthcare providers and use these funds to pay for additional healthcare services thus drawing down additional federal funds, and part of this proposal would prohibit physicians and other healthcare providers from passing along the cost of this tax to patients, and physician payment rates are set unilaterally by government agencies and insurance companies, and imposing additional costs on medical practices while limiting their ability to recoup those costs would inflict a significant financial burden on physicians leading some to retire or relocate their practices out of state, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association opposes any effort by the state or federal government to impose a provider tax of any type.

REAFFIRMED 4/2015

Publication of Formularies – 2006

WHEREAS, many health insurers, managed care organizations, state and federal government programs and others (entities) have implemented restricted formularies, and physicians prescribe medications for patients on dozens of formularies, and many formularies are not published or made available to physicians, and this significantly interferes with the ability of physicians to efficiently care for patients, now therefore be it,

RESOLVED, that the Iowa Osteopathic Medical Association work for legislation requiring all entities in Iowa using formularies to provide regularly updated plan specific formulary information to physicians, and that this legislation requires entities to provide patients with an identification card which includes all information needed to identify the specific formulary the patient may utilize.

REAFFIRMED 4/2011; AMENDED AND REAFFIRMED 4/2016

Reimbursement of State and Federal Disease Prevention and Control Recommendations -2006

WHEREAS, Iowa has recently experienced outbreaks of communicable diseases such as mumps and pertussis and is at risk for additional public health threats, and the Iowa Department of Public Health (IDPH) in cooperation with the United States Center of Disease Control and Prevention has issued recommendations to physicians on the diagnosis, the determination of immunity of patients exposed, and the treatment and isolation of patients diagnosed with communicable diseases, and these guidelines and recommendations are made to care for individual patients and to prevent the spread of disease within the general population, and Medicare, Medicaid and private insurers have not altered their payment policies to coincide with the recommendations of the IDPH, and this results in a significant financial burden for the patient and/or providers, and this creates a barrier to patients receiving needed evaluation and treatment, increase the risk to individual patients and endangers the public health, now therefore be it

RESOLVED, that the Iowa Osteopathic Medicine Association (IOMA) meet with the IDPH and the Iowa Department of Human Services and others to discuss and work to find solutions which allow payors to rapidly adjust their payment policies to coincide with state and federal disease prevention and control recommendations.

REAFFIRMED 4/2011; REAFFIRMED 4/2016

Resolutions – AOA House of Delegates – 2009

WHEREAS, the Iowa Osteopathic Medical Association (IOMA) is a divisional society of the American Osteopathic Association (AOA), and as a divisional society, IOMA is entitled to submit resolutions to the AOA House of Delegates, and IOMA does not currently have a policy on the identification of issues or how resolutions are selected for presentation to the AOA House of Delegates, now, therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) House of Delegates adopts the attached policy entitled AOA House of Delegates Resolution Submission Policy.

REAFFIRMED 4/2014

Scope of Practice – 2011

WHEREAS, the Iowa Osteopathic Medical Association supports the goal of providing consumers with a choice in who provides their healthcare, and Iowa patients have access to a rich variety of licensed healthcare providers such as physicians; podiatrists; psychologists; nurse practitioners, including nurse midwives; physician assistants; chiropractors; dentists; pharmacists; physical, occupational, and speech therapists, and in recent years, a variety of individuals and groups have sought the legitimacy of state licensure in an effort to prove to the public that they have the knowledge, training, and skill to safely care for the citizens of Iowa or have sought an expansion of their current scope of practice, and licensure by the state implies to the public that the holder of the license possesses a certain level of skill, knowledge and expertise, and IOMA believes that all healthcare providers should practice within their level of knowledge, training, and skill, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) adopts the American Osteopathic Association position paper entitled NON-PHYSICIAN CLINICIANS as adopted by the 2005 AOA House of Delegates and reaffirmed by the AOA House of Delegates in 2015.

AMENDED AND REAFFIRMED 4/2016

Sunsetting Policies – 2012

WHEREAS, the House of Delegates is the policy making body of the Iowa Osteopathic Medical Association (IOMA), and the Board of Trustees is the administrative body of the IOMA, and resolutions passed by the House of Delegates are forwarded to the Board of Trustees for implementation and action, and each policy approved by the House of Delegates automatically sunsets in five years and is subject to review by the House of Delegates, and to facilitate an effective review of sunsetting policies, the House of Delegates requires information about the policy being reviewed, and it is not the intent of the House of Delegates to create an undue burden on IOMA staff in the implementation of this policy but rather to promote a thorough and expeditious review of policies by the House, now therefore be it

RESOLVED, that for all policies due for sunset review, the Iowa Osteopathic Medical Association (IOMA) House of Delegates shall be provided a brief policy summary to include all of the following:  the actual policy being reviewed, what action the IOMA has taken to implement the policy and the results of that action.

REAFFIRMED 5/2017

Term – Healthcare Provider - 2005

WHEREAS, the term “health care provider” has expanded to include many different disciplines, and the term “health care provider” is confusing to the public since it does not describe the person’s level of expertise, and the term “health care provider” fails to define the training, education or responsibility of the individual, and the Iowa Osteopathic Medical Association (IOMA) and American Osteopathic Association (AOA) have historically done everything in its power to accurately reflect its members credentials and accomplishments to the public, now, therefore be it

RESOLVED, that the IOMA refuse to accept the term “health care provider” for its members, and that the IOMA inform state government, third party payers and the media of its decision, and that the IOMA endorse the term “osteopathic physician” when anyone internally or externally refers to its members.

REAFFIRMED 4/2010; 4/2015

Unified GME Accreditation System - 2014

WHEREAS, for more than a year, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) have been engaged in negotiations with the Accreditation Council for Graduate Medical Education (ACGME) in an attempt to reach an agreement on a framework for creating a single unified system for the accreditation of graduate medical education in the United States; and from the outset of the negotiations, the AOA/AACOM outlined five "non-negotiable items" that included, 

  • The discussion is limited to GME and does not extend backward to undergraduate medical education or forward to licensing or certification.
  • The osteopathic medicine licensing examination (COMLEX-USA) remains in place and viable.
  • Osteopathic board certification remains in place and viable.
  • Osteopathic physicians must be given an equal opportunity to participate in all training programs under any unified accreditation system.

Any unified accreditation system must not adversely affect primary care programs in community-based settings; and at the 2013 AOA House of Delegates meeting, the AOA announced it had rejected a Memorandum of Understanding (MOU) stating that it failed to satisfactorily address several of the AOA's non-negotiable items; and on February 26, 2014 the AOA announced that it had reached agreement with the ACGME on the terms of a MOU to create a single unified system for the accreditation of GME in the United States; and the full contents of this new MOU have yet to be publically disclosed; and members of the Iowa Osteopathic Medical Association have raised serious concerns regarding the concept of a single unified GME accreditation system; and the ramifications of the implementation of a such a system are far reaching and have the potential to significantly impact the future of the osteopathic profession; and at its March 2014 meeting, the American College of Osteopathic Family Physicians (ACOFP) Congress of Delegates passed a resolution expressing similar concerns and calling for all of the following:

  • For the American Osteopathic Association (AOA), the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) to immediately release to the osteopathic community (if not released prior to the 2014 AOA House of Delegates) the entire Memorandum of Understanding (MOU);
  • For the AOA to affirm to its membership that it will withdraw from the MOU by December 31, 2015 if any of the principles listed below that are considered to be non-negotiable items are not included in the MOU, or by an amendment to the MOU;
  •  A requirement that all Graduate Medical Education (GME) programs recognize the Comprehensive Osteopathic Medical Licensure Examination of the United States (COMLEX-USA) results as equivalent to meet examination criteria for admission into the new consolidated and unified Graduate Medical Education (GME) programs
  • That graduates of Colleges of Osteopathic Medicine accredited by the AOA Commission On Osteopathic College Accreditation (COCA) will remain eligible for entry into all ACGME programs on an equal basis with U.S. and Canadian graduates of Colleges of Medicine accredited by the Liaison Committee on Medical Education (LCME) or the Committee on Accreditation of Canadian Medical Schools (CACMS),
  • A requirement that if osteopathic physicians in the new unified GME accreditation programs take osteopathic board certification examinations, those osteopathic board certification examinations be recognized as equivalent to the American Board Of Medical Specialties (ABMS) certification examinations and be counted equally with allopathic certification toward  the required certification examination pass rate in the Basic Residency Standards,
  • That the new unified GME accreditation programs recognize AOA Board Certification on an equal basis with ABMS certification for the positions of program director, director of medical education, and designated institutional officer without  requiring an exception be  granted by the applicable Residency Review Committee (RRC); and,

that IOMA communicate its support to the ACOFP and its agreement to sign on to the ACOFP Resolution to be presented to the 2014 AOA House of Delegates, now therefore be it

RESOLVED, that Iowa Osteopathic Medical Association (IOMA) expresses its support for the American College of Osteopathic Family Physicians Resolution 13, AOA/AACOM Unified Residency Accreditation System; and that IOMA communicate its support to the ACOFP and its agreement to sign on to the ACOFP Resolution to be presented to the 2014 AOA House of Delegates.

Vaccine Administration – 2013

WHEREAS, the United States healthcare system is rapidly adopting the medical home model of healthcare delivery; and the medical home model of health delivery recognizes and values the unique knowledge and expertise each member of the healthcare team contributes to the care of the patient; and optimum care is delivered when each member of the healthcare delivery team practices within the scope of knowledge, training, and skill; and pharmacists are valued members of the healthcare team who have specialized training in the biochemical mechanisms of action of drugs, drug uses and therapeutic roles, side effects, potential drug interactions, and monitoring parameters mated to education in anatomy, physiology, and pathophysiology; and disease prevention and wellness have long been a focus of the osteopathic profession; and one component of disease prevention is the proper use and administration of vaccines; and to ensure the patient’s whole disease prevention and wellness needs are met, vaccines are best administered in conjunction with a comprehensive patient wellness evaluation, especially in pediatric patients; and physicians are the members of the healthcare delivery team who possess the necessary knowledge, training and skill to complete this exam, now therefore be it

RESOLVED, that Iowa Osteopathic Medical Association solely supports the independent ordering and/or administration of vaccines by healthcare practitioners licensed to prescribe vaccinations in the state of Iowa.

Vaccine Distribution – 2006

WHEREAS, physicians are the best qualified to assess which of their patients are at the highest risk for developing complications of infectious diseases, and  physicians’ offices appears to be last in the priority list for distribution of influenza vaccine, while vaccines are provided to pharmacies, grocery stores, malls, and other non-physician entities, and this current distribution practice may be harmful to the most vulnerable of our patients, now therefore be it

RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) will meet with the Iowa Department of Public Health, and other interested physician associations, to require the priority distribution of infectious disease vaccinations (especially influenza) to physician offices, and that IOMA will submit a similar resolution to the American Osteopathic Association to deal with this issue at a National level.

REAFFIRMED 4/2011; REAFFIRMED 4/2016