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Redesigning Dysfunctional Physician Payment Policies Would Improve Patient Quality of Care Says ACP

March 18, 2005

(Washington, DC): The dysfunctional payment system and excessive paperwork requirements employed by Medicare and other payers deprive physicians and patients of the time required to develop and sustain the level of communication, trust and confidence needed to deliver optimal care, said American College of Physicians President Charles Francis, MD, FACP, FACC at a briefing on Capitol Hill today.

ACP held the briefing to present a legislative program designed to improve the physician payment system and improve the physician-patient relationship.

ACP called on Congress and the administration to create incentives for physician practice innovation and improvement. Such innovations would include use of electronic medical records and other health information technology to create:

  • evidence-based practice improvement;
  • incorporation of clinical decision support tools into daily practice at the point of care; and
  • new practice models to improve coordination of care of patients with chronic diseases and overall efficiency.

Current Medicare payment policies favor episodic treatment of patients with acute illnesses, rather than supporting the physician's roles as the patient advocate and coordinator of quality care of patients with chronic diseases.

The emphasis on the treatment of acute illnesses has led to a systematic undervaluation of cognitive primary care services, according to ACP. Dr. Francis cited it as one of the key factors behind the rapid and troubling decline in the number of physicians choosing internal medicine, family practice, or pediatrics.

Current payment policies also do not encourage use of electronic medical records, evidence-based clinical performance measures, and other innovative models of practice improvement that are intended to improve the effectiveness of physicians' interactions with their patients.

The Centers for Medicare and Medicaid Services (CMS) are, however, conducting demonstration projects to test new models for physician payment that potentially could result in improved quality of patient care.

"The most important element of the health care system is the physician-patient relationship," emphasized Dr. Francis. "For example, a physician typically knows from personal experience that one patient is extremely conscientious about adherence to a prescribed course of medical treatment. But for another patient, you may know equally well that considerable follow up is crucial to making sure the treatment plan is being followed. This knowledge will never fit neatly into any kind of database. It can only be derived from the unique relationship that grows between a patient and a primary care physician over time. The unique physician-patient relationship must be preserved at all costs."

The attendees also heard presentations from Robert Doherty, ACP senior vice president, Government Affairs and Public Policy and Michael S. Barr, MD, MBA, ACP vice president of Practice Advocacy and Improvement.

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 116,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.


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

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