Letters
From the November ACP Observer, copyright © 2006 by the American College of Physicians.
ABIM defends position on P4P
In his letter in the September 2006 ACP Observer, John Paty, Jr., FACP, chides ABIM for "supporting pay for performance."
ABIM does not "support" pay for performance. ABIM's arrangements with health plans are intended to reduce the burden of redundant requirements and allow physicians to use their Maintenance of Certification activities for credit in other arenas. Many experts believe that current strategies for paying for health care do not promote high quality—and that finance reform is essential to creating a more effective and efficient system.
Pay for performance has yet to prove itself as a mechanism to improve quality of care. However, there is clear evidence that it is a reality for physicians. As long as that is true, we will look for ways to make measurement less intrusive to, and burdensome for, practicing physicians.
Physicians who are measuring their performance through ABIM's Maintenance of Certification program can now receive credit for doing so from many health plans. In an environment in which practicing physicians so often feel beleaguered, we are glad that we have done something that may make their lives easier!
Christine Cassel, MACP
President and CEO, ABIM
More on P4P
I would like to express my agreement with Dr. Paty's letter in the September ACP Observer regarding your article, "Health plans partner with ABIM on incentive programs" (ACP Observer Weekly, July 11, 2006). I, too, think that the ACP should be our advocate against further unnecessary intrusion into our professional lives. The ABIM recertification itself, I concede, is necessary and good for us and for our patients. However, this pay for performance seems to be another devious way of holding up, obstructing or reducing our reimbursement. I agree that ABIM and the College should not support this pay for performance scheme at all.
David W. Swift, ACP Member
Grand Island, Neb.
Personal health records at odds with privacy
Your article, "Wave of the Future: Personal Health Records on the Web?" (July/Aug. 2006 ACP Observer) should be read with caution.
It is dangerous, from medical and legal perspectives, for both patients and doctors to manipulate their personal health records (PHRs) on the Internet. Once entered, these records absolutely should not be changed. If a mistake has been made, or pertinent information left out, it should be noted and additions/corrections added at the end.
Your article suggested that privacy would be protected by a "secure internet server," but patients will have no protection from those using the information (obtained either directly or indirectly) in a discriminatory manner—employers, insurance companies, competitors in business, etc.
Records are only as good as the quality of the data. They can contain outdated or incomplete information or information could be entered into the wrong patient's file. Any of these errors has the potential to affect decisions of multiple doctors who rely on those records as, "the last (and latest) word."
As PHRs become more common, patients will not have a choice about granting full or partial access to physicians, hospitals, insurers or others.
Patients will be forced to choose between privacy (if they refuse to use a PHR) and medical care (if they agree to use a PHR). And what is a patient going to do with "raw" test results without the benefit of a doctor's interpretation and ability to incorporate them into a management plan?
Frances Parisi, ACP Member
Lancaster, N.Y.
Take stronger stand on universal health care
It is very sad that that ACP does not take a more definitive stand on the "health care crises."
If we are to enable the patients in the U.S. to get the care that is provided in the rest of the Western World, is it not time for ACP to formally liaison with Physicians for a National Health Care Program? I am a retired old codger with time to review the alternatives, and find that psychological denial is not an option. We must face the fact that American medicine is prostituted to the insurance and pharmaceutical industries.
I worked for five years in a Free Clinic and was ashamed how we had to cut corners with patient care. We were forced to practice Third World medicine. Where is the honor, the compassion, the ethics of the medical "profession"?
Stephen R. Keister, ACP Member
Erie, Pa.
ACP's Washington office responds: ACP has been consistent its strong support of health insurance coverage for all. In 2002, the College developed a step-by-step proposal that included specific recommendations,including expanding public programs, , allowing federal premium subsidies, creating purchasing pools and instituting waivers that would allow states to test alternative health care reforms. More recently, ACP endorsed the bipartisan Health Partnership Act, which will provide states with federal dollars to develop and test a wide range of models, from single payer to pluralistic approaches that maintain private health insurance as long as they achieve measurable gains in coverage. ACP believes that supporting such state innovation may be the most politically achievable way to expand coverage, later leading toward a consensus on the most successful state programs.
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