IOWA OSTEOPATHIC MEDICAL ASSOCIATION
POLICIES AND POSITIONS
ACOFP – Iowa Chapter Funding - 1997
WHEREAS, it has occurred in the past that the Iowa Osteopathic Medical Association (IOMA) has borrowed money from the Iowa Chapter ACOFP to meet short-term cash needs, and these transactions have not appeared in the budget or other financial reporting of either organization, and it is an obligation of the Board of Trustees that they inform the membership of the financial transactions of the association, now therefore be it
RESOLVED, that the executive director of the Iowa Osteopathic Medical Association (IOMA) be allowed to seek short term funding from the Iowa Chapter ACOFP upon the mutual approval of each board and that these transactions appear in the financial reporting of each organization.
REAFFIRMED 5/2002; 5/2007; 5/2012
Area Health Education Center (AHEC) Support – 2010
WHEREAS, Iowa is made up of a large number of rural and underserved communities, and rural and underserved communities have difficulty in recruiting and retaining health care professionals, and Area Health Education Centers (AHEC’s) are created to train and place health care providers in rural and underserved communities, and Des Moines University with the assistance of a federal Health Resources and Services Administration (HRSA) grant, has developed an AHEC within the state of Iowa to place healthcare providers, including osteopathic physicians, into rural and underserved areas in Iowa, now therefore be it
RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) support the mission of the Area Health Education Centers (AHEC’s) in Iowa, and be it further
RESOLVED, that the IOMA advocates for the use of state funds to support and expand the AHEC program throughout Iowa.
Capital Crime Executions - 1995
WHEREAS, it appears that the legislature of the State of Iowa and its Governor are heading to re-imposing the death penalty in the State of Iowa, and unified medicine in general and the Iowa Osteopathic Medical Association in general have specific codes of ethical conduct, and these codes of conduct prevent a physician from “doing any harm” or giving any medication to a patient that would be deemed harmful, now therefore be it
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; 5/2007; 5/2012
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.
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.
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.
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) encourage students to rotate in rural osteopathic physician offices and hospital settings in their clinical years of osteopathic medical school education.
AMENDED AND REAFFIRMED 5/2002; 5/2007; 5/2012
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 requires physicians who treat children to obtain 2 hours of CME on the subject of child abuse detection and reporting every five years; and the state of Iowa requires physicians treating elderly patients to obtain 2 hours of CME on the subject of elder abuse detection and reporting every five years; 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, and that IOMA forward a similar resolution to the American Osteopathic Association.
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
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
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
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.
Cost and Quality Transparency in Healthcare – 2010
WHEREAS, the Iowa Osteopathic Medical Association supports the goal of empowering patients to make informed decisions regarding their healthcare, and legislative bodies, patient advocacy groups, and individual healthcare consumers have called for increased transparency in the cost and quality of healthcare services, and the Iowa legislature has proposed several bills requiring healthcare providers and healthcare institutions to provide cost and quality data, and only one quarter of Iowa physicians and less than one in ten Iowa hospitals use electronic data system capable of producing cost and quality data, and producing cost and quality data without the use of electronic data systems would add significant cost and administrative burden to physician practices, and there are no standardized methods by which to produce, analyze, or present cost and quality data, and this lack of standardization can lead consumers to reach erroneous conclusions about the cost and quality of care a physician provides, now therefore be it
RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) Legislative Committee work with the Iowa Legislature to educate them on the difficulties inherent in producing, analyzing, and presenting cost and quality data, and be it further
RESOLVED, that the legislature be urged to delay implementation of healthcare cost and quality transparency laws until such time as technology has been widely adopted by Iowa physicians and hospitals, and be it further
RESOLVED, that the IOMA work with other appropriate Associations to advocate that when enacted, healthcare cost and transparency laws do not add further cost and administrative burden to physician practices and that physicians have the opportunity to review their data before it is published and that they are permitted to attach comments to any reports produced with the data.
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
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 be it further
RESOLVED, 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; 5/2007; 5/2012
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.
AMENDED AND REAFFIRMED 4/2011
Electronic Health Records - 2005
WHEREAS, the Federal Government will mandate the adoption of Electronic Health Records for all physicians who see Medicare and Medicaid Patients in the near future, and the cost of implementation and the information needed for implementation for the single, small, or rural medical offices will be very expensive, and once these regulations become mandatory, many physicians will not be able to comply with the regulations because of the added expense and additional knowledge required, and will then be unable to continue to see Medicare and Medicaid Patients in rural regions of Iowa, now, therefore be it
RESOLVED, Iowa Osteopathic Medical Association (IOMA) should inform our Federal Representatives of this risk and recommend special consideration for small and rural based physician groups, and these special considerations could include financial inducements or exemptions for these physician groups in the implementation of electronic health records.
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 APPROVED 4/2008; REAFFIRMED 5/2013
FMLA Documentation - 2002
WHEREAS, the Family and Medical Leave Act (FMLA) allows employees to take time off from their job for various reasons, and the FMLA allows employers to require medical certification of illness or disability, and the FMLA sets no standard for this certification, and a wide range of report forms and information is requested for this certification, and it is the opinion of the members of the Iowa Osteopathic Medical Association that some of the employer required reports intrude on the patient’s privacy and require information beyond that needed to establish illness or disability, now therefore be it,
RESOLVED, that the Iowa Osteopathic Medical Association will work with employer trade groups and other similar groups to develop uniform documentation requirements that provide adequate information for employers but protect the patient’s right to privacy.
REAFFIRMED 5/2007; 5/2012
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
Global Fees - 2005
WHEREAS, there exists little if any rules with respect to the delineation of what constitutes a global fee universally, and government agencies, third party payors and other entities require increasing non-compensated health care services and other health care related oversight and management services, and the American Osteopathic Association (AOA) has supported the concept that the imposing of administrative fees is ethical, now, therefore be it
RESOLVED, that the Iowa Osteopathic Medical Association encourage the AOA to collaborate with the American Medical Association (AMA) to delineate each non-compensated service with an appropriate CPT or ICD-9 code, and that the AOA work with the appropriate entities to ensure that implementation of these CPT codes does not economically adversely effect its members.
Health Care Reform - 1993
WHEREAS, Health Care Reform 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 reform 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 reform 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 the medical industry from frivolous litigation, while protecting the patient’s ability to undergo due process to receive compensation for medical error.
• Reduction in the ever-increasing volumes of paperwork 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 availability of affordable medical care for all Americans.
• Though we support the idea of al patients having access to affordable health care insurance, we oppose that individual patients be mandated to purchase health care insurance.
REAFFIRMED 5/2002; 5/2007
AMENDED AND REAFFIRMED 5/2012
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.
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 may it further be
RESOLVED, that IOMA urges its members to use their best efforts to vaccinate their patients in accordance with the ACIP recommendations.
1. http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-acip-color-office.pdf, accessed April 23, 2013
2. http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-acip-color-office.pdf, accessed April 23, 2013
3. 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.
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.
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 appropriate funds for lead screening for uninsured and underinsured patients, and
RESOLVED, that the IOMA ask the Iowa Department of Human Services to provide funding for lead screening as a covered service.
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
Mandatory Coverage of HPV Vaccine, Recommendation of – 2007
WHEREAS, seventy percent (70%) of cervical cancers are caused by the Human Papilloma Virus, Types 16 and 18; and ninety percent (90%) of genital warts are caused by Human Papilloma Virus, Types 6 and 11; and a large number of women are expected to 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
Marijuana for Medical Use – 2010
WHEREAS, medical marijuana has been recognized by the Iowa Board of Pharmacy as a means of management of chronic medical conditions including chronic pain, 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 medical marijuana, now therefore be it
RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) opposes the legalization of marijuana for medical use.
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 reimbursed for their expenses and reasonable profit, and current Medicaid reimbursement levels provide payment at a level that is 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 reimburse 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 reimbursement to meet or exceed the current Medicare reimbursement level.
Medicaid Reimbursement – 2010
WHEREAS, the policy of the Iowa Osteopathic Medical Association (IOMA) with respect to Medicaid reimbursement to it’s member physicians has been established by resolution in 2004 and reaffirmed in 2009, and that policy links Medicaid reimbursement to Medicare reimbursement levels, and Medicaid reimbursement fails on its own merits to adequately reimburse 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 reimburse Iowa’s physicians and hospitals at a fair and equitable rate for providing quality care for the state’s Medicaid recipients.
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) communicate to CMS its concern about the MRAC payment methodology, and that a similar resolution be forwarded to the AOA House of Delegates for their consideration.
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 and re-pricing companies, 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 a reimbursement rate 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, and that a similar resolution be forwarded to the American Osteopathic Association for consideration by its House of Delegates.
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
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.
On-Line Pharmaceuticals - 1997
WHEREAS, the safe prescribing of pharmaceutical agents requires a thorough knowledge of the patient, human physiology and pathology, and the indications, contraindications, and the actions and side effects of medications; and the act of prescribing medications is the practice of medicine; and state licensing boards have held that a physician must be licensed in the state where care is provided; and there has been a proliferation of Internet and 1-800 sites that will prescribe and sell medications to patients without a thorough knowledge of the patient; now therefore be it
RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) encourage its member physicians to warn patients of the dangers of these sites, and that the IOMA provide information on its web site informing the public of these dangers, and that the IOMA work with the proper authorities to prevent the inappropriate prescribing and dispensing of medications, and that any osteopathic physician participating in such an on-line process is participating in an unethical practice of medicine.
REAFFIRMED 5/2002; 5/2007; 5/2012
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.
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; and that IOMA work with the American Osteopathic Association (AOA) to get AOA approval for osteopathic graduates in allopathic programs; and that IOMA work to get residency training programs in the state of Iowa dually accredited by the AOA.
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 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; 5/2007
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.
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) work with payors and physicians to be cautious with enacting Pay-for-Performance initiatives to ensure that patients who do not meet Pay-for-Performance standards maintain access to care.
Pediatric Out of Hospital Do Not Resuscitate (OOH-DNR) – 2012
WHEREAS, terminally ill adults in Iowa can have advance directives from their doctors forbidding life saving interventions outside the hospital, and Iowa law does not allow the same power to similarly situated minors and their parents, and the American Academy of Pediatrics declares that it is ethically acceptable to forgo resuscitation when it is unlikely to be effective or when risks outweigh benefits, and thirty-two states have passed laws to allow individuals under the age of 18 with terminal illnesses to have out-of-hospital do-not-resuscitate orders, now therefore be it
RESOLVED, that the Iowa Osteopathic Medical Association (IOMA) supports amending the current laws and potential changes in the OOH-DNR laws as they apply to individuals under the age of 18 with terminal illnesses.
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 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 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
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) 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 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.
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 be it further
RESOLVED, 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.
1. http://www.statehealthfacts.org/comparemaptable.jsp?ind=689&cat=8, accessed April 7, 2010
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 that IOMA encourages physicians to verify directly with patients that the patient is in need of supplies; and 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.
Preventative Medicine Procedures – 2006
WHEREAS, there is a wide variation in the coverage of preventative medicine services by third party payors, and there is strong documentation to support the use of preventative medicine services to improve patient health and reduce long term costs through early disease detection, now therefore be it
RESOLVED, that the Iowa Osteopathic Medical Association supports and works to promote preventative medicine services for all patients, and that the IOMA works to require preventative medicine coverage and reimbursement by all third party payors in the state of Iowa.
AMENDED AND REAFFIRMED 4/2011
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, and
be it further , that a similar resolution be forwarded to the American Osteopathic
Association House of Delegates.
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 current PLI crisis by exploring the impact and feasibility of additional PLI reforms beyond reform of the tort system.
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.
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.
Publication of Formularies – 2006
WHEREAS, many health insurers, managed care organizations, state and federal government programs and others (entities) have implemented restricted formularies, and in any given week a physician prescribes 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, and that a similar resolution be presented to the American Osteopathic Association House of Delegates.
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, and that a similar resolution be sent to the American Osteopathic Association House of Delegates.
Resolutions – AOA House of Delegates – 2009