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Supporting Legislation to Provide Better, More Cost-Effective Care to Medicare Beneficiaries

June 24, 2004

(Washington, DC): The American College of Physicians enthusiastically applauds the introduction of the "Geriatric and Chronic Care Management Act of 2004." This legislation, sponsored by Senator Blanche Lincoln (D-Ark.), is an important step forward to help improve the coordination and quality of care for patients with multiple chronic conditions, as well as produce savings in the Medicare system.

"We must redesign the Medicare system to provide high-quality, cost-effective care to the growing population of elderly individuals with multiple chronic conditions," said ACP President Charles Francis, MD, FACP, FACC. "This population presents one of the health care system's biggest future challenges."

Dr. Francis cited a number of statistics to underscore the bill's importance:

Fifty percent of Medicare costs can be attributed to five percent of Medicare's most costly beneficiaries, according to the Congressional Budget Office.

Eighty-two percent of the Medicare population has at least one chronic condition, and two-thirds have more than one chronic condition.

The 20 percent of beneficiaries with five or more chronic conditions account for two-thirds of all Medicare spending.

The aging baby boomer generation will soon confront the Medicare system, enormously increasing the number of new beneficiaries and accompanying costs.

Medicare beneficiaries with multiple chronic conditions experience more hospital stays and more multiple physician visits. The current Medicare program penalizes physicians for integrating and coordinating health care because these services are not explicitly recognized and distinctly reimbursed. Instead, physicians are given incentives to provide episodic care and to generate more individual patient visits to the doctor's office and hospital for separately reimbursed tests and procedures. The intent of this legislation is to coordinate the care of these beneficiaries under the supervision of a physician to avoid duplicative and unnecessary care, as well as to ensure patients are treated before their conditions escalate.

"Studies conducted in the United States and internationally show that the delivery of higher quality health care, increased efficiency, and cost-effectiveness are the result of systems in which patients are linked with a personal physician who coordinates their care," said Dr. Francis.

The chronic care model described in Senator Lincoln's legislation includes important elements for managing chronic disease, including a geriatric assessment, which is an assessment of an individual's medical condition, functional and cognitive capacity, primary caregiver needs, and environmental and psychosocial needs. Senator Lincoln's bill also creates a care management payment that includes the following services: (1) development of a care plan; (2) multi-disciplinary team conferences; (3) coordination with other providers; (4) medication management; (5) patient and family caregiver education; (6) self-management services; (7) telephone consultations, including 24-hour telephone availability; (8) management of transitions across settings, including end-of-life care planning; and (9) referral to and coordination with community services.

"We must realign the financial incentives within Medicare as part of a comprehensive system change," said Dr. Francis. "Medicare should be restructured to include a new fee, paid to a personal physician chosen by the patient, to coordinate their health care. This fee would go to the physician to support specific functions and technology that have been shown to improve chronic care."

The bill is cosponsored in the Senate by Harry Reid (D-Nev.), Bob Graham (D-Fla.), John Kerry (D-Mass.), Barbara Mikulski (D-Md.), Jack Reed (D-R.I.), Paul Sarbanes (D-Md.), John Breaux (D-La.), Susan Collins (R-Me.), Mary Landrieu (D-La.), and Patty Murray (D-Wash.).

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include more than 115,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults. According to the 2001 National Ambulatory Medical Care Survey, 40 percent of office visits to internists were by patients over 65 years of age.

Jack Pope, (202) 261-4556, jpope@acponline.org
Jacquelyn Blaser, (202) 261-4572, jblaser@acponline.org

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