Because service on advisory bodies of health insurance companies by elected officers and board members or appointed council and committee members of TMA has been in the past - and is expected to be in future instances - valuable to TMA and the patients of Texas, contact with and advice to these companies should not be arbitrarily limited or prevented. Instead, the wisdom of the House of Delegates ultimately should prevail in deciding who should represent TMA in these endeavors. Accordingly, the following rules should be made part of the rules of the House of Delegates.
The board proposes that all potential conflicts of interest should be disclosed at the time of campaigns for elections for at-large or ex officio positions on the Board of Trustees. Potential conflicts of interest include employment by or service on a board, advisory board, council, or committee of another organization. Potential conflicts also include remuneration from such an organization except for (1) reimbursement of actual expenses to attend meetings, (2) money earned by the physician in the regular course of his or her practice, e.g., payments made for patient care by an insurance company, or (3) participating in the health insurance company's medical peer review activities.
The board believes that when an outside company contacts TMA about physician representation on a component of the company, the TMA president should endeavor to recommend physicians for these positions who have expertise in those areas of concern and who can faithfully and expertly represent TMA and the patients of Texas (e.g., recommend members of the Council on Socioeconomics or those who have expertise in socioeconomic matters to a physician advisory committee of a health insurance company).
Recommendation 1 : That 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.
Recommendation 2 : That all members of the Board of Trustees (at-large trustees and officers) provide an updated disclosure of affiliations each year at the time of the Winter Conference, and that any new information or change since the time of election be reported to the House of Delegates at its next meeting.
Recommendation 3 : That 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.
Your Board of Trustees also categorized all other "organizational and fiduciary" relationships and reports with respect to their alignment with TMA goals.
Relationships with Vendors
For the purpose of examining "organizational and fiduciary relationships" with external entities, the Board of Trustees defined relationships with vendors as royalties received through endorsements recommended by the Council on Member Services and Committee on TMA Physician Services. The board reviewed a list of companies currently endorsed by Texas Medical Association and royalties received. The board also reviewed (1) the Texas Medical Association Member Service Endorsements process for endorsements approved by the Board of Trustees, February 1998; (2) TMA Policy and Procedures for endorsement of products and services; (3) Texas Medical Association Member Products/Services Evaluation Criteria; and (4) TMA Products/Services Vendor Questionnaire. The Board of Trustees believes these policies and processes appropriately safeguard the association in its relationships with vendors.
The board found that these relationships support two of the association's goals. TMA's royalty program generates non-dues revenue to support TMA activities and programs. This is part of a strategy to ensure a powerful voice through growth in membership and member involvement and the ongoing financial health of the association, and this strategy directly supports the goal of One Voice - enhance the powerful, effective, and unified voice of Texas medicine.
TMA's endorsement program connects members with companies that provide products and services to support and enhance their practices. This is part of a strategy to provide cost effective solutions to improve all aspects of practice management operations, and this strategy directly supports the goal of Practice Viability - protect, improve, and strengthen the viability of medical practices in Texas.
Relationships with Organizations Established by TMA
The Board of Trustees reviewed a list of organizations established by TMA and royalties received from them, as well as a matrix outlining the benefits of TMA's endorsement of the Texas Medical Liability Trust. The board also reviewed actions of the House of Delegates establishing TMLT (May 1978), restructuring the TMA Insurance Trust (November 1988), and establishing Texas Medical Foundation, which has been renamed TMF Health Quality Institute (January 1973). The board also reviewed TMA policy 225.010, Texas Medical Foundation as PRO. The Board of Trustees believes the association's relationships with the organizations it has established are appropriate.
Further, the board found that these relationships support two of the association's goals. TMAIT and TMLT royalties provide non-dues revenue for association programs and services. This is part of a strategy to ensure a powerful voice through growth in membership and member involvement and the ongoing financial health of the association, and this strategy directly supports the goal of One Voice - enhance the powerful, effective, and unified voice of Texas medicine.
TMAIT, TMF Health Quality Institute, and TMLT offer services and products that help physicians run their practices. This is part of a strategy to provide cost effective solutions to improve all aspects of practice management operations, and this strategy directly supports the goal of Practice Viability - protect, improve, and strengthen the viability of medical practices in Texas.
Relationships with Non-Insurance Company Sponsors
For the purpose of examining "organizational and fiduciary" relationships with external entities, the Board of Trustees defined relationships with non-insurance company sponsors as support received from non-insurance company sponsors for specific programs and activities, such as pharmaceutical company sponsorship for TexMed programs. The board reviewed a matrix listing all companies that have provided grants or sponsorships for TMA special events and found these relationships to be appropriate. Further, the board found that these relationships support an association goal. Grants and sponsorships for TMA special events contribute to the financial health of the organization. This is part of a strategy to ensure a powerful voice through growth in membership and member involvement and the ongoing financial health of the association, and this strategy directly supports the goal of One Voice - enhance the powerful, effective, and unified voice of Texas medicine.
Relationships with Exhibitors and Advertisers
The Board of Trustees reviewed a matrix listing all exhibitors and advertisers and income derived, as well as guidelines for acceptance of ads and advertising restrictions. The board believes these policies provide the appropriate safeguards for the association's relationships with exhibitors and advertisers. The board found that these relationships support an association goal. Income derived from exhibits and advertising contributes to the financial health of the organization. This is part of a strategy to ensure a powerful voice through growth in membership and member involvement and the ongoing financial health of the association, and this strategy directly supports the goal of One Voice - enhance the powerful, effective, and unified voice of Texas medicine.
Relationships with Government Entities
The association's only "organizational and fiduciary" relationships with government entities are contractual relationships through the Physician Oncology Education Program and other relationships through the Physician Oncology Education Program. POEP's mission is "To provide Texas physicians, physicians in training, and those in training to become physicians (e.g., medical and undergraduate students) with the knowledge and skills necessary to reduce cancer morbidity and mortality through collaboration among the public, private, and volunteer sectors of the state. This program supports the goal of Trusted Leader - strengthen physicians' trusted leadership role within their communities and the health care team.
Relationships through Related TMA Entities
For the purpose of examining "organizational and fiduciary" relationships with external entities, the Board of Trustees looked at related entities that receive grants and contributions. These included grants received through TMA Special Funds Foundation for physician health and rehabilitation programs, donations received by the Physician Health and Rehabilitation Assistance Fund, and contributions to TMA Foundation. The board reviewed the following policies of TMA Foundation and found them to be appropriate safeguards: Authority to Accept Gifts, Board Member Responsibilities, Conflict of Interest, Donor Disclosure, Donor Bill of Rights, and Solicitation of Gifts.
The board found that relationships through these entities support two association goals. TMA Foundation's mission, "To fund initiatives with the power to help physicians create a healthier future for all Texans," and its funding of many of TMA's public health programs, as well as TMA Alliance and TMA medical student chapter community health programs, is part of a strategy to enhance the public image of TMA-member physicians. This strategy supports the goal of Trusted Leader - strengthen physicians' trusted leadership role within their communities and the health care team. TMA Foundation also encourages member involvement by funding initiatives in which members can become personally involved, such as Hard Hats for Little Heads, Be Wise-Immunize, and many others. This is part of the strategy to ensure a powerful voice through growth in membership and member involvement and the ongoing financial health of the association, which directly supports the goal of One Voice - enhance the powerful, effective, and unified voice of Texas medicine.
Relationships through Sponsorships
Sponsorship is defined as support given by TMA to external entities. Examples of such affiliation are use of TMA's name, use of TMA's logo, use of TMA's financial resources, TMA membership in coalitions (TMA will not serve as a fiscal agent/treasurer for coalitions), TMA member physician participation in coalitions, and TMA staff participation in coalitions.
Sponsorship is distinct from endorsement. Sponsorship may have active participation by TMA; endorsements cannot. (See Relationships with Vendors earlier in this report.)
The board reviewed the sponsorship process it adopted in 1998 and all sponsorships approved by the board in the past two years. All sponsorships approved by the Board of Trustees are reported to the House of Delegates at each meeting. The board found that the process in place provides appropriate safeguards for the association's affiliation with external entities. However, the board was advised by legal counsel that the term "sponsorship" is a well-known tax term and may give the misleading impression that this policy refers to federal taxation of non-profit organizations. The purpose of the sponsorship process is to provide guidelines for TMA's association with other groups and organizations. It was felt that this purpose might be conveyed more clearly if the term "sponsorship" were changed to the term "affiliation," and the board voted to make the change.
The board finds that TMA's affiliation with other groups and organizations to advocate for public health initiatives, promote educational programs, and strengthen legislative initiatives directly supports two strategies: (1) enhance the public image of TMA-member physicians, and reinforce the physician's role as the leader of the health care team; and (2) promote appropriate roles of the professionals on the team. Both of these strategies directly support the goal of Trusted Leader - strengthen physicians' trusted leadership role within their communities and the health care team.
Relationships through Memberships
The board reviewed a list of organizations that TMA has founded and other organizations to which it belongs or contributes, as well as related entities that receive grant support from TMA. These include the Texas Society for Biomedical Research, Texas Civil Justice League, Federation of Texas Psychiatry, Texas Alliance for Patient Access, The Litigation Center of the American Medical Association and the State Medical Societies, and Texans for Lawsuit Reform.
The board believes that TMA's contributions to TCJL, TAPA, and TLR led to the success of Proposition 12, and that TMA's effectiveness in the courts is enhanced through participation in The Litigation Center. These activities directly support the goal of Healthy Environment - ensure continued success in legislative, regulatory, and legal interventions to enhance the statewide environment in which Texas physicians practice medicine.
Relationships through Financial Relationships with Banking and Investment Firms
The board reviewed its financial relationships with banking and investment firms and the related annual expense. The board chooses the association's banking and investment relationships carefully to assure the financial health of the association and reports annually to the House of Delegates. These relationships are part of a strategy to ensure a powerful voice through growth in membership and member involvement and the ongoing financial health of the association, which directly supports the goal of One Voice - enhance the powerful, effective, and unified voice of Texas medicine.
In addition to the impressive array of "organizational and fiduciary" relationships reported here, the Texas Medical Association has many other relationships, including those with medical school presidents, legislators on both sides of the aisle, and business community leaders. These relationships are key to TMA's strength and to its ability to effect positive change on behalf of its members and their patients. Historically, TMA has used these relationships to achieve association goals through formal meetings with governmental and non-governmental bodies and informal meetings with key governmental and powerful non-governmental leaders.
TMA House of Delegates: TexMed 2006