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The resolutions that will come before the House of Delegates in three days have been published today. Because many of you have written and commented, I am going to post them here for your perusal. There are three resolutions in total being sent to the House for consideration.

EMERGENT RESOLUTION #1:
Support the restriction of access to protected health information to properly credentialed individuals and actively advocate for mandatory credentialing.
BE IT RESOLVED THAT the Association for Healthcare Documentation Integrity will:
(a) Support the position that access to protected health information be restricted to properly credentialed individuals, and
(b) Actively advocate for mandatory credentialing with regulatory bodies and organizations of influence, such as the Centers for Medicare and Medicaid, Joint Commission, the American Medical Association, the American Hospital Association, and the American Health Information Management Association.

What this one will do, as I read it, is start working on requiring credentialing for anyone who has access to protected health information. With the addition of the words “properly credentialed individuals,” it would appear we will be seeing some new credentialing programs come from this. For example, will we see one for SRT editors? And the way this is written, it would mean we could also pursue credentialing for health information clerks, medical assistants, all kinds of positions. The rationale, however, only seems to speak the work that medical transcriptionists currently do:

“Rationale: To ensure patient safety and the integrity of patient records, all persons involved in creating, editing, organizing, or transmitting protected health information should be formally trained and hold credentials relevant to those duties. To that end, AHDI should move forward with the support of its leadership in actively advocating for mandatory credentialing by whatever means that can be accomplished, whether working with employers to promote preferential hiring practices that create an implied requirement for credentials in the marketplace or by working with regulatory organizations such as CMS or organizations of influence like the AMA to require credentials in order to access protected health information.”

I have always been a supporter of credentialing. What I see missing here may be an effort to also work with employers to acknowledge credentials with a financial differential. The last time I saw any numbers, we had just over 3,000 CMTs in the entire world. With estimates that have said there are perhaps 250,000 or more medical transcriptionists out there, it appears we could be looking at only a little over 1% that are currently credentialed. Adding those who hold the RMT credential would move that number up slightly. This would also mean the credentials would have to match work settings. Will an RMT be enough, for example, to do acute care work? Will an additional credential be required to do speech recognition editing? Will yet another credential be required if you want to do quality assurance? Who knows what the future will hold there. The discussion should be interesting.

EMERGENT RESOLUTION #2

Tabling of BGG/Restructuring Plan initiative until ACE 2011.
BE IT RESOLVED THAT With complete regard and appreciation for the efforts put forth by BGG and HOD leadership to conduct numerous webinars and town-hall meetings to explain all the possibilities of the Blueprint for Great Governance, but with grave concern that there is a critical lack of support for the BGG at this point among the grassroots which could cause a loss of members, but which could also probably be dispelled by spending further focused time in discussions with members and components, and with further concern that there are still many questions that remain unanswered about the future of AHDI, its members, and its component associations under the proposed governance restructuring plan, we move that all official actions of the HOD and the BOD pursuant to moving ahead with the BGG or any other restructuring plan be tabled (postponed) until at least ACE 2011.

This one is the one we talked briefly about the other day. It simply asks that Resolution #3 below not be voted on at this meeting until there is a firm, well-defined plan for what things will look like.

This lists the issues or rational as: “The currently proposed BGG plan has been in development since 2009; however, only recently have many critical issues been decided and presented to the members and delegates. At present with less than one week before a vote, no resolution has been presented to the House of Delegates. With such a critical and massive restructuring of the Association, it is in the best interest of the members and the Association to ensure transparency and allow each member and delegate ample time to discuss the resolution as well as offer alternatives and additions such as potentially allowing the proposed district Board of Directors to become the new House of Delegates as suggested at some town hall meetings. Additionally, no plan is in place for our international members indicating that the proposed structure is incomplete and not ready for voting.”

EMERGENT RESOLUTION #3
Approval to move forward with restructuring AHDI and its membership apportionment to better facilitate the business of the association.
BE IT RESOLVED THAT the 2010 HOD approve moving forward with restructuring the AHDI Board of Directors and House of Delegates into a National Leadership Board and that the local chapters, state and regional associations have a representative voice through one of six district representatives serving on the National Leadership Board. Local chapters, state and regional associations will maintain distinct identities in the association and sign an affiliation agreement to promote and further initiatives in the areas of credentialing, education, member development, and advocacy to advance the profession and to ensure the professional association remains relevant and a visible proponent for the contributions documentation professionals make to patient care delivery.
As part of this resolution, the House of Delegates will elect a 6 person steering committee before the HOD adjourns, to define the plan, create a timeline, revise bylaws and policies and procedures to effect the new structure. The steering committee will report to the HOD quarterly on their progress and have the plan completed and ready to implement by ACE 2011. In the meantime, an additional 6 person steering committee will be elected by the HOD, before it adjourns, to oversee the strategic work plan developed during the National Leadership Summit agreed upon by components, to further credentialing, education, member development, and advocacy. The steering committee will report to the HOD quarterly on progress made and challenges overcome to create successful programs at the Local, State, and Regional levels.

The rationale, or issue, on this is listed as:
“It is believed that our current structure of the association is not meeting the current needs and purpose of the association. The 2010 House of Delegates is urged to create a 21st Century structure that:
• Supports the changing needs of our members
• Facilitates better communication and coordination
• Successfully manages projects at all levels of the association
• Attracts new members
• Creates powerful member engagement
• Improves leadership succession planning
• Creates greater alignment of the governance structure among all stakeholders”

While this originally proposed in the webinars that were offered as something that would be simply to “explore” a new structure, clearly the committee has revised that. What is also a change is that it states the State/Regional and local chapters will continue to exist independent of the districts. That would call into question how the districts will be funded? In maintaining State/Regionals does we create yet an additional layer of governance that members will have to figure out how to fund? While the representative to the national board (one person from each district would hold a seat on the national board of directors) from each district would be funded by AHDI, that’s still members. How would district activities be funded? And what would they be if the other structures remain in place?

It also appears here that this vote will be taken this year. While a 6-member steering committee will work to define the plan, with the final plan to be ready for implementation by the ACE in 2011, it also says at the end that the bylaws changes are expected to be voted on by the 2010 House of Delegates. In essence, that would dissolve the House of Delegates, and create a transition team, as stated: “The transitional period of one year would be lead by smaller leadership teams to address specific portions of the plan, comprised of delegates, current leaders, national directors, and staff, to work toward implementation of the new governance model by ACE 2011.”

This resolution also includes a map with what “COULD” be the district divisions. One thing to note here is that it includes the country of Canada, yet no other countries are included. That one bothers me personally. No matter how one feels about offshore or near shore transcription, it’s here and there are thousands of medical transcriptionists working on healthcare records in other countries. We allow them to pay dues, we celebrate when they adopt the Knowledge Base as a tool (and thus are given Associate Membership in AHDI), and yet we have not included them in this new form of representative governance. We allow them to come and exhibit at our meetings, all of that bringing revenue to our organization. There was a time when we changed our name from the “American Association for Medical Transcription” to AHDI. A big part of the rationale there was that we wanted to create standards for US healthcare documentation, no matter where it was created. If that is still the case, those MTs who make a choice to belong to the organization should not be left out. If it’s not, then perhaps we need to identify ourselves as an American association.

This resolution, in its bare bones, really says, to me, let’s dissolve the House of Delegates and have a 13-member national Board of Directors, with six of those people being elected by the members in their district, however that district is defined. Maintaining the current structure of the State/Regionals and local chapters does not accomplish the original goals that this task force was charged with, streamlining the “work” that components and volunteers must to do operate. It is also concerning to me that the work of the current House of Delegates, which I believe is about 30 people, would now be done by six? So far, my own state has had no real discussion on these changes, and I’ve heard the same from many members. If 30 can’t communicate well with the membership, how do we think six will do it better? Last, with no firm plan designed, as stated in the resolution itself, I still believe a vote is premature and would stand by my signing of Resolution #2. I’m frankly not convinced that we still need a House of Delegates. I AM convinced that we need to have membership input into major changes in the structure of a membership organization. It is my hope that this is not voted on until we see what those changes look like.

If you are interested in reading the Resolution Committee Report in full, I have linked it here for you. You can then read through it in its entirety as well as see the proposed map of districts. I am also linking a copy of the BGG Frequently Asked Questions that my board partner had shared with us last week.

Okay, there you have it. What are your thoughts? I look forward to hearing them and hope those of you who have delegates will also let them hear from you in the next two days.

UPDATE: Earlier today in reading over the 2009 Audit Report for the association, I believed it said we had a $424,064 loss for the year. That is actually the “members’ deficit” and not the actual loss for the year. I received an email from Peter Preziosi clearing that up this afternoon. Here’s how it works: We had a total loss prior to the “extraordinary event” of $536,283. The “extraordinary event” is the revenue received as a result of AHDI managing the funds from class action settlement, where the association was given the settlement payment to be used to fund programs for the benefit of MTs and the medical transcription industry. Because of the way accounting principles work, we only get to claim a portion of that as revenue in 2009, with the rest being moved to 2010 to cover the expenses incurred this year for that program. So, for 2009, we added $604,725 to our revenue, which actually offset the loss and left us with a INCOME for the year of $68,442. What happens with member equity, as it is called, is that every year it is offset by whatever profit or loss you have in the organization. That means that the members’ deficit (because it is in the red) actually went down (well, really it went up as it’s not as much in the red) from $492,506 to $424,064 for this past year. So because we had that income from the class action suit, we made money this last year.

It was never my intent to post incorrect information and I apologize for that. I’m generally pretty good at reading financial reports and audit reports as I have many years of experience doing that. I know many folks have a problem wading through these things and sure didn’t mean to cause any confusion. Because of this and to hopefully avoid any more confusion with it, I am going to remove the comments below related to the audit. I know you guys will understand that rationale.

It is my hope that next week’s discussions will be good ones and be done with respect for each other. We are a passionate group and I often feel we have a tough time agreeing to disagree. In my early days in the association one of the best lessons I learned came from Claudia Tessier, our then CEO. It was quite simple: Always assume goodwill. I hope we can remember that in these discussions and welcome everyone’s thoughts equally.

Related posts:

  1. AHDI Meeting: House of Delegates, Day One
  2. AHDI Proposes Blueprint for Great Governance
  3. AHDI Ballots are Out, Let’s Have Some Discussion
  4. Online Association of AHDI Announces Student Week
  5. How do the Proposed AHDI Changes Impact You?

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