by Patrick Droste, MS, MD
Summary of Activity of Michigan Society of Eye Physicians and Surgeons in Relation to the Michigan State Medical Society House of Delegates: Summary of Resolutions with input from Jerome Finkelstein, MD, and Theresa Cooney, MD.
The following is a summary of MiSEPS sponsored resolutions submitted to the Michigan State Medical Society House of Delegates, (MSMS-HOD) between 2007 and 2019. The House of Delegates (HOD) is the policy forming body of the Michigan State Medical Society. The policies represent the official posture of the Medical Society toward issues that affect our patients and profession.
The policies have three purposes 1. Remain within the MSMS as official policy for ten years before expiring (also referred to as a sunset policy, with the possibility of renewal) 2. Be forwarded to the American Medical Society -House of Delegates (AMA-HOD) for deliberation and potential policy formation. 3. Forward to the Michigan Legislature for possible legislation formation.
An example of the latter was a MSMS sponsored Bill for the cessation of smoking in restaurants and public buildings. These Bills usually start in Committee of the Michigan House or Senate, leave committee and have to be approved by both chambers of government and signed by the governor before becoming law. This is no small accomplishment. It takes a lot of work and a lot of capital support.
Until now we never had a MiSEPS resolution become Michigan Law. MiSEPS recently proposed a bill regarding prescription eye drops that has been passed by the legislature and signed into law with immediate effect by the governor in December, it represents MiSEPS first sponsored legislation to become law. This bill was not formulated in the MSMS-HOD but developed by MiSEPS leadership and passed directly to sponsoring legislators with the assistance of our lobbyists. It is now Public Act 139 of 2019 (Effective: 12/05/2019). You can find this Public Act in the MCL.
In May of 2019 MiSEPS sponsored a resolution to support physician input on the research and development of autonomous vehicles. This resolution was written by Dr. Jerome I. Finkelstein. It was written as follows:
Utility of Autonomous Vehicles for Individuals who are Visually Impaired or Developmentally Disabled.
Year 2019: Resolution #8
Action Taken: Approved as amended
Author: Jerome I Finkelstein, M.D.
Sponsor: Jerome I Finkelstein, M.D., on behalf of the Michigan Society of Eye Physicians and Surgeons (MiSEPS).
Committee E (Science and Education Affairs)
RESOLVED that the Michigan State Medical Society (MSMS) in conjunction with the Michigan Society of Eye Physicians and Surgeons (MiSEPS) supports physician input on research into the capability of autonomous or “self-driving” vehicles to enable individuals who are visually impaired or developmentally disabled to benefit from autonomous vehicle technology, and be it further
RESOLVED that the Michigan Delegation to the American Medical Association (AMA) asks the AMA to work with the National Transportation Safety Board (NTSB) to support physician input on the research into the capability of autonomous “self-driving” vehicles to enable individuals who are visually impaired or developmentally disabled to benefit from autonomous vehicle technology.
COMMENT: This resolution was taken by the Michigan Delegation to the American Medical Association in June 2019. The resolution was adopted by the American Medical Association. The resolved clause and final report reads as follows:
RESOLVED: that our American Medical Association with the National Transportation Safety Board (NTSB) to support physician input on research and for the capability of autonomous “self-driving” vehicles to enable individuals who are visually impaired or developmentally disabled to benefit from autonomous vehicle technology.
RESOLUTION 427-Utility for Autonomous vehicles for individuals who are visually impaired or developmentally disabled. The recommended Resolution 427 to be adopted.
Comment: The Reference Committee and American Medical Association had the following comment: “The Reference Committee heard testimony in support of Resolution 427. The testimony now has the potential of fully autonomous vehicles to expand mobility of those who cannot be mobile. It was noted that transportation is a significant barrier for employment among the developmentally disabled and autonomous vehicle technology could expand employment opportunities for this population. It was suggested that the elderly be added to this resolution as well, but your Reference Committee felt that this was outside the scope of the resolution. Therefore, your Reference Committee recommends that Resolution 427 be adopted.”
It is very uncommon that a resolution from the Michigan State Medical Society that is taken to the American Medical Association be adopted without significant amendment. Dr. Finkelstein’s resolution was well written and not only passed by the Michigan State Medical Society House of Delegates but also passed, without amendment, as Resolution 427 American Medical Association. This resolution on Utility of Autonomous Vehicles for Individuals who are Visually Impaired or Developmentally Disabled is now a formal policy for the Michigan State Medical Society and the American Medical Association.
RESOLUTION: Telemedicine Initiatives for Eye Care Delivery
Year: 2019/Resolution #9
Action Taken: Substituted (combined with Resolution 11)
Author: Jerome I Finkelstein, M.D.
Sponsor: Jerome I Finkelstein, M.D., on behalf of the Michigan Society of Eye Physicians and Surgeons (MiSEPS)
Committee: A (Medical Care Delivery)
RESOLVED: that MSMS supports the use of telemedicine pursuant to applicable standards of care, and shall develop policies regarding the ethical practice of telemedicine and improve access through the elimination of barriers, including but not limited to, restrictive originating sight requirements and fees.
RESOLUTION: Approval for Use of Tinted Windows in Motor Vehicles
Year: 2018/Resolution #4
Action Taken: Approved
Author: Jerome I Finkelstein, M.D.
Sponsor: Jerome I Finkelstein, M.D., on behalf of the Michigan Society of Eye Physicians and Surgeons
Committee: B (Legislation)
RESOLVED: that MSMS seeks legislation to amend MCL 257.709 (3) (e) such that the medical exception provision be permitted only upon written documentation of medical necessity by a dermatologist and that the degree of tinting be limited to that as stated in the law.
COMMENT: This was a modified resolution from the previous year, which was disapproved by the Michigan State Medical Society and House of Delegates primarily due to objection from dermatologists.
This resolution has become formal policy of the Michigan State Medical Society. It has been taken by the Legislative Committee of the MiSEPS to the Michigan Legislature with hopes that the ophthalmologist can be removed from the awkward position of approving tinted windows for patients.
RESOLUTION: Surgery for Surgeons
Year 2017/Resolution #34
Action Taken: Approved as amended
Author: Patrick J Droste, M.D.
Sponsor: Patrick J Droste, M.D., on behalf of the Michigan Society of Eye Physicians and Surgeons
Committee: B (Legislation)
RESOLVED: that MSMS oppose any program that permits ocular surgery on patients by a clinician who has not completed an accreditation counsel from a graduate medical education approved residency program and be it further
RESOLVED: that MSMS actively work with legislators to oppose the creation of alternative boards of surgery by organizations representing and credentialing non-physician providers to perform ocular surgery.
COMMENT: This resolution reinforced the previous resolution of Ophthalmic Surgery by Surgeons: Year 2011, Resolution #14, authored by Theresa Cooney, M.D., on behalf of the Michigan Society of Eye Physicians and Surgeons.
RESOLUTION: Tinted Windows on Motor Vehicles
Year 2017/Resolution #55
Action Taken: Approved as amended
Author: Patrick J Droste, M.D.
Sponsor: Patrick J Droste, M.D., on behalf of Michigan Society of Eye Physicians and Surgeons
Committee: D (Public Health)
RESOLVED: That Michigan State Medical Society (MSMS) opposes the tinting of motor vehicle windows except as medically indicated beyond the legally accepted limits and that MSMS work with the appropriate state agencies to enforce the current law as written.
NEW RESOLUTION: Discontinue Physician Statements for the Use of Tinted Windows in Motor Vehicles
Year 2017/Resolution #78
Action Taken: Disapproved
Author: Patrick J Droste, M.D.
Sponsor: Patrick J Droste, M.D., on behalf of the Michigan Society of Eye Physicians and Surgeons
Committee: B (Legislative)
RESOLVED: that MSMS actively support the appeal of Michigan Compiled Law (MCL) 257.709 (3)(e), which allows for a special window treatment or application on a motor vehicle if such treatment is determined necessary by a physician or optometrist, for protection of a person who is photosensitive and the person has in his/her possession a copy of a letter signed by a physician or optometrist indicating a special window treatment or application is medically necessary.
COMMENT: This resolution was disapproved primarily because of objections by dermatologists who felt that certain skin conditions needed UV protection provided by the tinted windows. We modified the resolution and resubmitted it in 2018. The modified resolution (Resolution #4, 2018) was approved by MSMS House of Delegates.
RESOLUTION: Conditions for Mandatory Vision Screening
Year 2016/Resolution #28
Action Taken: Approved as amended
Author: Patrick J Droste, M.D.
Sponsor: Patrick J Droste, M.D., on behalf of Michigan Society of Eye Physicians and Surgeons
Committee: A (Medical Care Delivery)
RESOLVED: That MSMS supports the current State of Michigan Vision Screening Program (VSP) for infants and children, which ensures follow-up and collaboration with local health departments, primary care physicians, schools and the Michigan Department of Health and Human Services and opposes any change to the current vision screening program process that does not demonstrate added value.
RESOLUTION: Third-Party and Ophthalmic Pharmaceutical Pricing
Year 2013/Resolution #41
Action Taken: Approved as amended
Author: Patrick J Droste, M.D.
Sponsor: Patrick J Droste, M.D., on behalf of the Michigan Society of Eye Physicians and Surgeons
Committee: A (Medical Care Delivery)
RESOLVED: That MSMS work with pharmaceutical companies to develop programs such as self-pay discounts for patients who pay out-of-pocket for their ophthalmic medications and also to encourage third-party payers to expand their formularies, thus making the medications affordable to contracted patients/members.
Comment: This resolution was written to encourage self- pay discounts to patients who pay out-of-pocket for ophthalmic medications and to make other medications more affordable. There was testimony to expand this resolutions to involve non ophthalmic medications, but the reference committee decided that this was outside the scope of the resolution and it was not expanded to non-ophthalmic medications.
RESOLUTION: Contractual Risk/Incentive Adjustment of Optometrists versus Ophthalmologists for Blue Cross/Blue Shield of Michigan
Year 2013/Resolution #42
Action Taken: Referred to board (BAR #05-14) who recommended adoption and it was adopted
Author: Patrick J Droste, M.D.
Sponsor: Theresa M Cooney, M.D., on behalf of Michigan Society of Eye Physicians and Surgeons
Committee: A (Medical Care Delivery)
RESOLVED: That MSMS work with Blue Cross Blue Shield of Michigan to apply the “contractual risk adjustment (CRA) referred to as incentive adjustment CO-144 to optometrists as well as ophthalmologists.
Comment: This resolution addressed the unfair practice by Blue Cross Blue Shield to assess a contractual risk adjustment (fee reduction) (CRA) to ophthalmologists but not to optometrists for the same Evaluation and Management Codes. There was some discussion on the HOD Floor and the resolution was referred to the MSMS Board for further evaluation and study. The Board Action Report (BAR #05-14) subsequently recommended the above resolution for adoption. It was adopted by the MSMS-HOD, the following year, 2014
RESOLUTION: Maintaining Residency Positions in Ophthalmology
Year 2013/Resolution #43
Action Taken: Approved as amended
Author: Patrick J Droste, M.D.
Sponsor: Patrick J Droste, M.D., on behalf of the Michigan Society of Eye Physicians and Surgeons
Committee: E (Science and Education Affairs)
RESOLVED: That MSMS work with AMA as well as federal, private and non-private resources to ensure that adequate opportunities for appropriate graduate ophthalmology training exist to meet the increasing patient demand for ophthalmology services both in Michigan and other parts of the United States.
COMMENT: This resolution was heavily contested and originally disapproved by the Reference Committee. The resolution was pulled out of the “consent calendar” and placed before the full House of Delegates on Sunday morning. There was a strong move by primary care physicians to limit residency space for ophthalmologists. There was significant discussion and debate and some final amendments in the verbiage of the resolution. The resolution was passed as written above.
RESOLUTION: Ophthalmic Surgery by Surgeons
Year 2011/Resolution #34
Action Taken: Approved
Author: Theresa M Cooney, M.D.
Sponsor: Theresa M Cooney, M.D., on behalf of Michigan Society of Eye Physicians and Surgeons
Committee: B (Legislation)
RESOLVED: That MSMS continue to support the current accepted standards that all ophthalmic surgery performed are only by appropriately educated and trained, certified allopathic and osteopathic physicians possessing an unrestricted license to practice medicine in the State of Michigan and is overseen by the State of Michigan Board of Medicine. Be it further
RESOLVED that MSMS continue to protect the public by supporting the current restrictions that prevent optometrists from performing ophthalmic surgery.
Comment: This was the first ophthalmic surgery scope resolution submitted to the MSMS-HOD by Dr. Cooney. It was subsequently reaffirmed in 2017 by a similar resolution to keep the support of MSMS for potential scope legislation battles in Michigan and prevent “sun setting” of the 2011 Resolution
RESOLUTION: Vision Screening Programs for Children
Year 2011/Resolution #74
Action Taken: Approved
Author: Patrick J Droste, M.D.
Sponsor: Theresa M Cooney, M.D., on behalf of Michigan Society of Eye Physicians and Surgeons and Dominic R Federico, M.D., on behalf of Kent County Delegation
Committee: E (Science and Education Affairs)
RESOLVED: That MSMS urge state and county governments to continue to support the development of affective vision screening programs in preschool and school age children. Be it further RESOLVED that MSMS encourage county and state governments to continue financial support to maintain improved vision screening programs for preschool and school age children.
RESOLUTION: No Medical Marijuana for Glaucoma
Year 2010/Resolution #42
Action Taken: Approved
Author: Theresa M Cooney, M.D., Joshua Stein, M.D., and Patrick J Droste, M.D.
Sponsor: Theresa M Cooney, M.D., on behalf of Michigan Society of Eye Physicians and Surgeons
Committee: B (Legislation)
RESOLVED: That MSMS pursue legislation that would remove glaucoma as an appropriate indication for medical marijuana usage from Michigan Medical Marijuana Act. In 2008 the State of Michigan approved the use of medical marijuana for treatment of medical conditions. The National Medical Marijuana Act was written in 2008. As a result of this, itinerate physicians were entering Michigan cities and clinics and freely dispensing prescriptions for medical marijuana to treat glaucoma without appropriate testing or procedures.
Comment: This resolution was written by Theresa Cooney, MD and Joshua Stein, MD to oppose the rapid development of for-profit dispensation of Marijuana prescriptions by itinerant physicians/ophthalmologists for the treatment of glaucoma.
RESOLUTION: Truth and Disclosure by Allied Health Professionals in Patient Care
Year 2008/Resolution #96
Action Taken: Approved
Author: Theresa M Cooney, M.D.
Sponsor: Theresa M Cooney, M.D., on behalf of Michigan Society of Eye Physicians and Surgeons
Committee: B (Legislation)
RESOLVED: That MSMS seek legislation limiting the designation “physician”, “medical practitioner” and “surgeon” to only those fields that currently are designated on the Public Health Code Section 170 and 174 and specifically require all other providers to identify themselves as non-physicians or allied health professionals. Be it further
RESOLVED that MSMS seek patient safety legislation that requires all
Non-physician allied health professionals to fully disclose the difference in their education and training compared to physicians at the time patient care services are rendered.