Policy Review

305.005 Resident Representation on American Medical Political Action Committees:   The Texas Medical Association supports the appointment of a resident member to the AMPAC Board of Trustees (Res. 28Y, p 217, A-96).

The Board of Trustees has confirmed that AMPAC currently has a position on its board reserved for a resident physician, as mandated by the AMA House of Delegates.  Consequently, there is no need for TMA to retain this policy.  (The Texas Delegation to the AMA concurs.)

Recommendation 1:  Delete.

295.003  Interspecialty Society Providing News of Interest: The Texas Medical Association will provide news of interest to specialty societies for use in their publications and an interspecialty society page will be included on the TMA home page (Interspecialty Society Committee, p 77, A-96).

While TMA does provide news to specialty societies for use in their publications, News of Interest is the actual name of a monthly news sheet sent electronically to county medical society executives and editors, specialty society staff, physician members, and others in the health care field. Also, there is a specialty societies' page on the TMA Web site (not TMA "home page").  For these reasons, the board recommends that this policy be amended as follows simply to clarify the language: 

295.003 Interspecialty Society Providing News of Interest: The Texas Medical Association will provide news of interest to specialty societies for use in their publications and an interspecialty society page will be included on the TMA home page will provide links to Texas specialty societies from the TMA Web site .  (Interspecialty Society Committee, p 77, A-96).

Recommendation 2:   Approve as amended.

295.004 TMA Relevance to Texas Physicians: TMA will (1) continue utilization of ad hoc task forces to facilitate policy debate and development of medicine's positions; (2) enhance interaction on policy development between various TMA policy bodies and trustees through joint meetings and retreat formats.  Appointees to various committees, councils, and task forces should reflect an increasingly diverse membership that is defined less by geography and more by practice environment; (3) expand TMA's successful pilot of retaining designated political operatives in Harris and Dallas County Medical Societies to coordinate local grassroots response, political campaign activities, legislative briefings, and lobby support; (4) investigate a state-of-the-art database to permit personalized direct mail, fax, and Internet communications to physicians, Alliance members, and students cross matched to legislators and other public officials; (5) coordinate TMA communications as a unified 12 to 18 month campaign, including locally adaptable media applications.  Charge the Council on Communication with reorganization of its own and association communication activities centered on key public relations messages established as part of the strategic planning process and timely events, such as legislative or congressional debate, litigation, breaking news events, and emerging public health concerns; (6) establish a Texas Physician Services Organization that will consist of Physician Network Development Assistance Program, Consultant Credentialing Program, Managed Care Education Campaign: Employer/Employee Seminars, Physician Network Investment Program, Physician Credentialing, Quality Assurance/Outcomes Measurement, Managed Care Data Clearinghouse, Standardization of Administrative Procedures, In-office Review, Managed Care Education Campaign: Simplified Managed Care Checkup; (7) endorse concept of a participatory vehicle for medical directors with a detailed implementation plan to be submitted in time for implementation in 1996; (8) offer CME activities, based on identified member needs, at the local level through (a) "on the road" activities and (b) joint sponsorship of programs; (9) investigate producing audiovisual tapes of CME activities; (10) evaluate changing the current annual session format of Thursday through Sunday; (11) at annual session, offer a symposium for primary care specialists on non-primary care topics; target young physicians by offering seminars on managed care and starting a practice.  Seminars for young physicians should be scheduled together so that the physicians would be more likely to attend all seminars; (12) evaluate offering continuing education courses at annual session for medical directors, nurses, office managers, and allied health workers; (13) evaluate charging a nominal registration fee for members who attend the Annual Session; (14) evaluate providing a medical book purchase program as a member benefit; (15) direct the TMA Library to serve as an information resource for computer software; (16)  ask the library to explore providing dial-in access to MEDLINE and other computer databases and to other Library services; (17) ask the library to evaluate establishing a TMA "node" for member access to the Internet; (18) direct the library to establish an electronic clearinghouse on CME courses as a member benefit; (19) ask the library to evaluate its hours of operation; (20) engage in discussions with primary care specialty boards regarding physician retraining to determine what time frame will be required for enhancing the training of specialists interested in obtaining board certification. Also evaluate the feasibility of establishing a program or services to enhance the training of physicians, as identified by the TSBME or PROs, based on an assessment of the individual's need for enhanced medical education; (21) continue to monitor the number of physicians and their specialty mix; (22) provide clinical symposia and educational materials to physicians on major issues of preventive medicine, public health and science through a variety of means:  (a) clinical symposia to bring current information on a wide variety of medical issues to physician membership; (b) educational inserts and articles in Texas Medicine on current trends and issues in science, preventive medicine, and public health; (c) Tuberculosis diagnosis and treatment booklet for primary care physicians outlining detection, treatment, and surveillance guidelines that physicians can apply to their daily practice; and (d) continuation of POEP (Physician Oncology Education Program) symposia and distribution of cancer education materials and resources; (23) provide a patient education/public awareness component for its public health and science initiatives through a variety of methods; (24) serve as an advocate for science education and science-based health care and research through a variety of means, including: (a) a quarterly newsletter containing information on current topics and TMA initiatives in science and public health targeted to the membership of TMA public health and science councils and committees, CMS presidents and executive directors, and attendees of TMA symposia series and POEP conferences; (b) public forums as appropriate (e.g., text book hearings, prevention guidelines drafting, and legislative hearings) to provide science-based testimony on medical and health care issues; (c) science outreach programs to include the development of a mentoring program to encourage youth to become involved with science (based on the AMA mentoring program), and implementation of an awards program for students at the Texas State Science and Engineering Fair; (24) serve as an advocate for preserving the core public health infrastructure in Texas (e.,g., disease tracing); serve as the private sector spokesperson for improving the public health of all Texans; and serve as a liaison between TMA member physicians and the Texas Department of State Health Services to enable public funds to be more effectively spent; (25) prioritize TMA public health and science initiatives based on a comprehensive needs assessment that identifies public health and science issues of greatest impact and concern to physicians; (26) explore the role of TMA in providing services to corporations, e.g., implementation of a corporate program which offers employee wellness information and offers employers managed care information; (27) consolidate and reorganize committees, task forces, ad hoc committees, and other groups in order to provide a more focused effort for addressing public health and science issues: (a) convene experts as needed to address targeted issues on a time-limited basis, then fold issue back into the regular council/committee structure if necessary; (b) sunset the Ad Hoc InterCouncil Committee on AIDS and the Committee on Sexually Transmitted Diseases and appoint a Committee on Infectious Diseases to deal with the issues addressed by these two committees as well as the emergent threats in infectious disease by adding immunizations and tuberculosis to the new committee's purview; and (c) increase the number of private practice physicians on the Council on Public Health; (28) streamline TMA committee and council meetings to assure that TMA's policymaking process is efficient and effective by (a) providing orientation sessions to new committee/council chairs and members so that they understand the process, resulting in committees that are action oriented; and (b) utilize the Coordinating Committee to maximize the coordination of meetings so that planning sessions occur before budgets are designed; (29) develop a program that emphasizes the role of the TMA leadership in carrying messages directly to the membership.  Extend the benefits of this program by increasing the number of physicians who "campaign" for the association; (30) add to a TMA survey questions to gather data on various members' needs for different types of information and also to investigate which media are most effective for delivering that information; (31) conduct a full communications audit of all association publications and of the publications that TMA members receive from other medical organizations to identify ways to strengthen TMA communications and avoid unnecessary duplication; (32) survey other state and national medical associations and use AAMSE data to determine how they expect to fund publications and other media in the future.  Also survey nonmedical associations about their communication funding sources; (33) conduct a full audit of TMA's media relations program.  Based on the findings, strengthen the current program by increasing the amount of contact with the state's major media.  Also, develop a larger group of physicians trained in media contact who can respond on short notice on topics of strategic interest to the association.  The media relations program must dovetail with the needs of the public affairs office, particularly during legislative session, when the rapidly changing atmosphere may require impromptu projects; (34) develop a short- and long-range communication program to address each goal and audience identified by the study of TMA's Relevance to Texas Physicians; (35) continue to focus membership recruitment/retention efforts on narrowly defined target markets such as academics, IMGs, etc., highlighting both the tangible and intangible benefits of membership most important to each group; (36) develop a proactive retention program that will ensure that members are reminded continuously throughout the year of the benefits of membership, as well as TMA's accomplishments on behalf of its members; (37) target membership development of group practice physicians.  Work with other TMA staff to identify and/or develop products/services that will appeal to group practice physicians.  Additionally, in light of the increasing number of physicians practicing in group settings, study the possibility of establishing new membership categories for medical directors and groups, so that they may become better educated about the value of membership in organized medicine; (38) develop a feedback mechanism to ascertain whether TMA is meeting the needs of its existing membership.  In addition, help to educate members, including students and residents, on the procedures for affecting change in TMA policy; (39) continue to encourage county medical societies to promote interaction between students and residents and member physicians through activities/programs; (40) develop a recruitment/retention plan for AMA membership that focuses on the AMA's most recent accomplishments and helps to increase the value of AMA membership in the minds of Texas physicians; (41) direct he Board of Trustees' Finance and Planning Committee to meet in October to review the preliminary TMA operating budget in detail; (42) include building depreciation in the annual operating budget; (43) consider all expenditure requests approved by the board during the year as amendments to the operating budget rather than expenditures from the reserves; (44) establish an annual Capital Equipment Budget for the association that is not to exceed the amount of annual depreciation expense.  A report on actual expenditures is to be prepared for the board on a quarterly basis; (45) continue to evaluate why the Operational Reserve is needed in order to determine an appropriate level to reserve; (46) restate the 50 percent Operating Reserve requirement to be a board goal, consistent with its original intent; (47) combine the Contingency Reserve and the Operating Reserve into one fund identified as the Operating Reserve; (48)  total all liquid reserves (Operational, Contingency, and Capital Equipment Reserves) when determining whether the 50 percent Operating Reserve level has been met; (49)  redefine the basis of the Operating Reserve requirement to be TMA's Operating Expense Budget less depreciation on furniture and equipment; (50) poll county society presidents to devise a formula to motivate attendance (e.g., if a delegate misses both meetings in a single year, replace the delegate); the speakers and Council on Constitution and Bylaws study realignment by district/region rather than by county societies; poll county society presidents to ask (a) should attendance be "forced;" and (b) should TMA continue to have an interim session; (51)  stress more use of ad hoc committees to accomplish business, involve more members; (52)  provide guidelines for Handbook reports for consistency and to encourage more action recommendations; (53)  strengthen TMA/county society relationships by TMA providing more services, support; (54)  study possible "regionalization" of county societies for purposes of sharing costs, administrative support; (55)  refer conclusions (b), (h) and (k) of Report of Task Force on Hospital Medical Staff/County Medical Society Relations to Board of Councilors and Council on Constitution and Bylaws for report to Board of Trustees; (56)  study the possible use of member surveys to give advice to TMA components (including the House of Delegates) and to involve the membership; (57) study the purposes, structure, and activities of Board of Councilors; (58) continue to strengthen TMA/TMAA relationships; (59) support joint meetings with the alliance (e.g., the May 1995 meeting at the Anatole Hotel) are desirable (but not generally feasible due to facility limitations); (60) increase TMA Official Family physicians' spouse membership in TMAA through direct "solicitation" letters signed by the TMA president, president-elect; promote county society presidents' letter campaigns; (61) provide TMA meeting badge identification for physicians whose spouses belong to the alliance; (62) arrange a TMA/TMAA joint board reception annually.  Any overlap or conflict between approved recommendations will be resolved by the Board of Trustees.  Approved projects and programs are to be initiated in 1996, if possible within the framework of the approved 1996 Plan and Budget  (Board of Trustees, p 18, A-96).

This policy was adopted in 1996 when the Board of Trustees completed a two-year, broad-based study of TMA activities and presented 62 recommendations to the House of Delegates.  The board's study had been undertaken to assure that the association was in fact responding to members' needs and could become more attractive to nonmembers. Some of the recommendations presented were not specific; others were to continue or expand a (then) current activity.  Most concerned services or programs.  Several of the recommendations were implemented, but some were dropped completely as the environment changed in ways not envisioned in 1996.

Two years ago, the board initiated another major look at TMA from multiple perspectives and approved TMA 2010, a study to assess the efficiency and effectiveness of the association with respect to structure, process, and outcomes.  The board has adopted vision and mission statements, goals and strategies.  TMA 2010 has developed as a process by which the board continually reviews association programs and measures their value in terms of return on investment and benefits to the membership.  This process assures that TMA's relevance to Texas physicians is monitored constantly.  Therefore, the Board of Trustees believes that Policy 295.004 is outdated and no longer needed.

Recommendation 3: Delete.

TMA House of Delegates: TexMed 2006