College leaders weigh in on upcoming Medicare reform

Regents also approve recommendations for retooling Medicaid and for offering CME online through chapters

From the June ACP Observer, copyright © 2005 by the American College of Physicians.

By Phyllis Maguire

SAN FRANCISCO—ACP's Board of Regents at its April meeting approved several items designed to help protect beneficiaries when the new Medicare prescription drug benefit takes effect next year.

The Regents also approved recommendations for redesigning Medicaid in the face of significant budget deficits. And the Board discussed the College's role in ongoing national quality initiatives, including the growth of pay-for-performance programs, quality improvement activities and health information technology adoption.

Eric B. Larson, FACP, who was then Chair of the Board, pointed out that the College's national efforts on quality initiatives are helping ACP meet its goal of uniting internal medicine, as the College forms partnerships and creates policy to guide national quality improvement efforts.

"Our organization," he said, "stands the tallest for quality improvement."

Drug benefit

In looking forward to the upcoming Medicare drug benefit, the Regents took the following actions:

  • Benefits for "dual eligibles." The Board approved a policy paper on maintaining the

    quality of Medicare benefits for "dual eligibles"—patients who qualify for both Medicare and Medicaid benefits—under the new Medicare prescription drug benefit.

    "These patients may have a hard time understanding the new benefit, and their continuity of coverage may be threatened," said Regent Lynne M. Kirk, FACP, Chair of the Health and Public Policy Committee. "Our recommendations helped ensure that beneficiaries have a smooth transition."

    Among the policy paper's recommendations, the College said that dollar thresholds contained in the new Medicare legislation for appealing prescription reimbursement decisions should be revised or eliminated. According to the paper, dual eligibles should receive drug coverage when they cannot afford a copay. Under the benefit law's current provisions, they would be denied such coverage.

  • Medicare premium support. The Regents also approved a policy monograph on Medicare reform premium support. In the paper, the College expressed its concerns that Medicare managed care plans—now known as Medicare Advantage plans—will cover only healthier beneficiaries, leaving sicker patients to be covered by Medicare fee-for-service and driving up their premiums.

    Among its recommendations, the College is urging the Centers for Medicare and Medicaid Services (CMS) to regularly assess risk adjustment among all Medicare coverage options and to make it easy for different Medicare populations—including those with chronic illness, to compare different Medicare plans.

  • Medicaid redesign. The Board also voted to approve a policy paper that contained recommendations for redesigning Medicaid during an era of federal budget deficits, which are projected to total $2.3 trillion by 2014, the paper noted.

    Among the College's recommendations, ACP said the Medicaid program should be expanded to cover more uninsured patients; that eligibility for the program should be uniform across the country; and that patients with long-term care needs should be allowed to supplement Medicaid coverage with private policies.

    Regent Derrick L. Latos, MACP, pointed out that ACP chapters can use the approved policy to advocate for Medicaid reform in their state.

  • Chapter Web site CME. The Regents also approved working with College chapters to develop continuing medical education (CME) to help members meet state-mandated CME requirements. Chapters would be responsible for developing CME content as well as materials to document members' participation. The content would be available on chapter Web sites.

The Regents also heard that later this year, grants will be available in as many as 25 different television markets to get local input into the Public Broadcasting Service's production of "Remaking American Medicine," a program that will focus on quality improvement in American health care. The College will help coordinate the efforts of ACP chapters to seek grant support.

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