Patient -Centered, Physician-Guided Care Must Guide Medicare's Chronic Care Improvement Program Says ACP
Evidence-Based Clinical Decision Support should be a Key Requirement
June 30, 2004
(Washington, DC) The new Medicare Chronic Care Improvement (CCI) pilot program must include at least one demonstration site which focuses on "patient-centered, physician-guided" care, said the American College of Physicians (ACP) in a June 23 letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Mark McClellan, MD.
Congress created the pilot program in recognition of the current fragmented care provided chronically ill Medicare patients under fee-for-service. Under Section 721 of the Medicare Modernization ACT (MMA) the CMS administrator must establish CCI pilot programs in ten different sites. The results of these test programs will be evaluated and ultimately become a permanent part of Medicare.
"The Chronic Care Improvement Pilot creates an important opportunity to implement and evaluate innovative ways to provide better and more cost-effective care to patient with chronic disease. To be successful, however, such programs must recognize and support the critical role that physicians play in managing patient care" said ACP President Charles Francis, MD, FACP, FACC. "Doctors of internal medicine are ideally suited to be the primary or principal care physicians because of their training in caring for the chronically ill."
ACP offered several recommendations to guide CMS in its development of targets for CCI contractors and their physician case managers.
Physician case management of the chronically ill represents a critical service which should be paid from the CCI contractor's administrative fee.
CMS should ensure quality improvement goals for patients are limited to elements of care completely under the physician's control, and the goals need to be adjusted to account for factors such as the complexity of the patients, and patient's who fail to comply with treatment plans.
Physicians must be provided with immediate access to evidenced-based clinical decision support (CDC) tools to help them evaluate different treatment options and make the best clinical decisions for their patients.
ACP strongly endorsed the CCI program's goal to spread the use of health information technology (HIT), especially the requirement for a CDS tool.
"ACP has considerable experience with this type of tool having developed online and PDA versions of the highly regarded real-time, point-of-care CDS tool, the Physicians' Information and Education Resource (PIER)," said Dr. Francis. "PIER aids physicians in the diagnosis and treatment of hundreds of conditions and also offers educational support to patients, with physician-selected print-outs available at the push of a button. The PIER software could be an excellent fit for the CCI program."
ACP urged CMS to provide financial incentives to physicians who use HIT. Most physicians, particularly those in small or solo practices, lack the resources to take financial risks for the outcomes of care provided to chronically ill patients.
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.