Governors lobby to increase fees for cognitive services
From the June ACP Observer, copyright © 2006 by the American College of Physicians.
By Janet Colwell
PHILADELPHIA—At their spring meeting, ACP’s Board of Governors tackled critical issues facing internal medicine, including the need for payment reform and a pay-for-performance appeals system.
Yul D. Ejnes, FACP, BOG Chair, says payment reform must include 'a reallocation' of funds.
Governors representing more than a dozen chapters co-sponsored a resolution to reallocate funding from specialty procedures to case management and cognitive services. “We have to make sure this is a reallocation, not just a reduction,” said Yul D. Ejnes, FACP, Governor for the Rhode Island Chapter and incoming Board Chair.
In approving the recommendation, Governors said the College should adopt the policy in spite of its potential to cause division between general internist and subspecialist members. Several governors pointed out that it does not make sense to pay more for overvalued diagnostic tests than for ongoing coordination of care.
Another recommendation approved by the Governors would increase oversight of “minute clinics,” which are now being established in large retail stores and chain pharmacies. Concerned about the rapid growth of such clinics, the Governors voted to urge the Board of Regents to provide materials that would help chapters ensure that such clinics meet quality and safety standards.
Changing the system
The Governors heard from several speakers who said that the current crisis in internal medicine calls for system-wide reform, encompassing quality improvement, payment reform and new approaches to training.
“The system is bad because it’s oriented toward acute care,” said guest speaker Edward H. Wagner, FACP, director of the MacColl Institute for Health Care Innovation at Group Health Cooperative in Seattle. “We’re focusing on symptoms and lab results, not the long-term issues.” Dr. Wagner helped spearhead the widely adopted chronic care model, which underlies ACP’s “advanced medical home” concept. The advanced medical home would promote patient-centered care and reimburse primary care physicians for coordinating chronic care.
Recent studies have shown that physicians provide evidence-based care less than 60% of the time, noted speaker Kevin B. Weiss, FACP, director of the Institute of Healthcare Studies at Northwestern University’s Feinberg School of Medicine and an expert on health care quality measurement and improvement. While physicians set out to provide the best care, they are hindered by such barriers as lack of awareness and/or time to read new guidelines, lack of comfort with new procedures and clinical inertia.
To improve care, doctors need to work in teams and make use of new tools, such as reminders at the point of care and computerized decision support, said Dr. Weiss, who is also a Regent.
Training redesign
Redesigning medical training is a major piece of system reform, said Steven E. Weinberger, FACP, the College’s Senior Vice President for Medical Education and Publishing. Internal medicine once attracted the best and brightest, he said, but that’s changed drastically over the past decade. In 1998, a survey of third-year residents found that 54% of seniors planned to go into general internal medicine--but by 2005, that had dropped to 20%.
Training programs have not kept pace with major changes occurring in the health care system, said Dr. Weinberger, a lead author of ACP’s 2006 position paper on training redesign. The paper proposes several solutions, including dividing the three-year residency training period into two years of core training and one year of customized training.
Pay-for-performance appeals
Other resolutions approved and sent to the Board of Regents included:
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Pay-for-performance appeals. The resolution urges the College to advocate for systems that would allow physicians to complain about the inappropriate application of pay-for-performance criteria.
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Formulary requests. The resolution would promote the use of a single, universal form to be used by all insurers, including Medicare, for administrative processes.
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Industry relationships. The recommendation asks the Regents to ensure that agreements with industry reflect ACP’s core principles for external funding.
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Teaching professionalism. The recommendation urges the Regents to adopt a policy that would leave the evaluation of professional behavior to medical schools and residency programs.
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Malpractice immunity. The resolution would promote legislation to hold physicians immune from malpractice litigation when they volunteer their services.
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