REPORT OF BOARD OF TRUSTEES
BOT Report 2-A-07
Subject: Potential Conflicts of Interest, Disclosure of Affiliations, and TMA Relationships with Business Entities
Presented by: C. Bruce Malone, MD, Chair
In May 2006, the House of Delegates adopted Board of Trustees Report 18-A-06 as amended to read as follows: that (1) any candidate for at-large trustee or any office that includes an ex officio seat on the Board of Trustees (president, president-elect, secretary/treasurer, and speaker and vice speaker of the House of Delegates) provide full disclosure of affiliations on a form developed by the speaker of the House of Delegates for that purpose; (2) all members of the Board of Trustees (at-large trustees and officers) provide full disclosure of affiliations each year at the time of the Winter Conference, and that full disclosure be reported to the House of Delegates in the Handbook for Delegates, on the TMA Web site, and by any other method deemed appropriate by the Board of Trustees; and (3) when a health insurance company or HMO requests recommendations for appointment to a physician advisory committee or any other component, the TMA president shall recommend for appointment individuals who best represent TMA's position, and the names of those individuals recommended by TMA and subsequently appointed by the health insurance company or HMO will be reported to the House of Delegates for information at its next meeting.
The house also adopted Resolution 106-A-06 as amended to read as follows: that (1) the Texas Medical Association foster exemplary relationships with all business entities in order to expedite better communications regarding quality, operations, global payment processes, transparency, and other issues unrelated to fees; and (2) the TMA Board of Trustees and members of TMA standing councils restate the policy of full disclosure of all financial remuneration from any business entity as that relationship could be considered a conflict of interest when these members represent the membership of the Texas Medical Association.
Candidate Disclosure
The speakers of the House of Delegates have approved the "Disclosure of Affiliations and Statement of Compliance with the Conflicts of Interest Policy of the Texas Medical Association" as the form to be used by candidates for the Board of Trustees to provide full disclosure of affiliations. The form was developed at the direction of the Board of Trustees, which has used it since 2005, and the speakers believe a single form should be used association wide. A listing of the affiliations disclosed by candidates for the Board of Trustees at this meeting is published in the Handbook for Delegates .
Disclosure by Members of Board of Trustees
A listing of the affiliations disclosed by all members of the Board of Trustees is distributed to all board members at each meeting. A listing of those affiliations is attached to this report and published on the TMA Web site, where access is limited to members only. New affiliations and changes in affiliations will be self-reported annually at the time of the TMA Winter Conference.
Appointments to Physician Advisory Committees or Other Components of HMOs and Health Insurance Companies
These appointments are reported to the House of Delegates by the President.
Exemplary Relationships with Business Entities
In its report to the House of Delegates in May 2006 (BOT Report 18-A-06), the Board of Trustees examined "organizational and fiduciary" relationships with external entities, including but not limited to health insurance companies. The board's report discussed relationships in the following categories: vendors, organizations established by TMA, non-insurance company sponsors, exhibitors and advertisers, government entities, related TMA entities, sponsorships, memberships, and financial relationships with banking and investment firms. The report also mentioned other relationships, including those with medical school presidents, legislators on both sides of the aisle, and business community leaders, and noted that these relationships are key to TMA's strength and to its ability to effect positive change on behalf of its members and their patients.
In addition to this impressive array of business and organizational relationships, TMA meets regularly with the major commercial managed care plans and public payers such as Medicare (through Medicare Part B contractors), Medicaid, and TriCare (the CHAMPUS managed care activity). In a typical year, there are 20 or more of these meetings organized by TMA's Payment Advocacy Department and involving both staff and member/leader physician participation and preparation.
These information/dispute resolution meetings lead to the gathering, analysis, and reporting of various types of claim and patient data which are used for advocacy, representation, and member service activities. The best example of the use of those data is the Hassle Factor Log program, which is among TMA's best known and most credible information sources. In addition to the regularly scheduled meetings with major carriers, TMA meets on an on-going or ad hoc basis with several health plans to address major policy issues in contention.
These meetings are used to expedite better communications regarding quality, operations, global payment processes, transparency, and other issues unrelated to fees. Regular reports of these meetings are provided to the Council on Socioeconomics and Board of Trustees.
Disclosure by Members of the Board of Trustees and Members of Councils
Disclosure of affiliations by members of the Board of Trustees is described above. In accordance with House of Delegates' action to include "members of TMA standing councils," in September 2006 each member of each of the nine TMA councils was asked to complete the "Disclosure of Affiliations and Statement of Compliance with the Conflicts of Interest Policy of the Texas Medical Association." Beginning with meetings held during the TMA Winter Conference in February, a listing of the affiliations disclosed by all members of an association council will be distributed to all members of that council at each meeting.
TMA House of Delegates: TexMed 2007