College leaders weigh in on quality payments, more
From the December ACP Observer, copyright © 2005 by the American College of Physicians.
At its October meeting, the Board of Regents considered several issues related to the business of medicine and to the high cost of medical care for patients. Topping the agenda were new policy positions on linking physician payments to better quality care, supporting younger patients' opportunities to buy into the Medicare program and a potential redesign for residency training programs.
Other policy papers approved on pressing issues included the need for nationwide information technology standards and drug importation from other countries.
Quality payments, training redesign
The Regents approved a position paper in support of linking physician payments to care quality. The paper acknowledged the growing interest by private payers and Congress in value-based purchasing programs that utilize performance measurements. It noted that appropriate quality improvement strategies, if done right, will result in higher quality patient care leading to increased physician and patient satisfaction.
Financial incentives should be high enough to motivate physicians to make continuous quality improvements, the paper said. At the same time, programs should not place an excessive financial or administrative burden on physicians, detract from time with patients, or inadvertently penalize physicians who care for sicker or non-compliant patients. Further, physicians should play a key role in determining how data will be collected and reported.
The Board also approved a new position paper advocating a voluntary program in which patients age 55-64 would be able to buy into the Medicare program, regardless of their insurance status. ACP also recommended that the program include premium subsidies for eligible lower income beneficiaries.
The Board also approved the first of two position papers on redesigning residency training. (The second paper will be presented at a later meeting.) The approved paper outlined the forces driving the need for redesign in internal medicine, including concerns that traditional training programs may no longer meet residents' needs, particularly in a changing health care system. The paper also set forth the principles and goals that should provide the framework for training redesign.
Over the next two to five years, the paper stated, the standard three-year training program should include a core educational component that addresses competencies and experiences common to all internists (whether generalists or subspecialists), as well as a customized component directed toward a trainee's specific career goals and eventual scope of practice. Resident training should also include more in-depth instruction in team-based health care; chronic care management, particularly for older patients; and practice management skills.
Other items approved by the Regents included:
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Family counseling reimbursement. The Regents voted to urge the Centers for Medicare and Medicaid Services to separately reimburse for a new code, to be introduced next year, allowing physicians to bill for care plan oversight services—ncluding time spent with a caregiver--for patients not in nursing homes.
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Drug importation. The Regents approved a position paper supporting drug importation to combat high prescription drug costs. The paper stressed, however, that ensuring high quality and patient safety must remain the top priority of any cost-control program. ACP recommends that before legalizing importation, Congress should permit states to run pilot programs to test the safety of imported drugs. The paper also called for a Food and Drug Administration oversight board to handle drug safety issues and for studies on the effectiveness of new technologies to detect prescription drug counterfeiting.
Electronic health record (EHR) standards. The Board approved supporting the adoption of one national standard for pertinent clinical summaries generated from EHRs. The College has actively participated in technical standards discussions with different groups, including Health Level Seven (HL-7), which promotes interoperability.
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Screening mammography guideline. The Regents approved a Clinical Efficacy Assessment Project guideline on screening mammography for women age 40-49. The paper is pending publication.
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Reviewing ethical complaints. The Regents voted to approve changes to the procedure to be used in reviewing an ethical complaint against an ACP member. (See "ACP revises procedures for ethical complaints.")
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New membership figures. The Board heard a report on the growth in College membership to nearly 119,000, the highest ever. Growth was greatest among women, international medical graduates and minorities. According to the report, the College has captured about 42% of the internist and internal medicine subspecialist populations and retained about 92% of its members, not including students.
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