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‘Marked Departure’ in Medicare Practice of Paying Physicians Featured in Geriatric Care Improvement Act

American College of Physicians Applauds Change From Only Paying for Episodic and Acute Care, Move to Patient-Centered Medical Home

May 9, 2007 (WASHINGTON) Enactment of the Geriatric Assessment and Chronic Care Coordination Act of 2007 (S. 1340) will represent a marked departure from Medicare’s practice of paying physicians only for episodic and acute care, the Senate Special Committee on Aging was told today by the American College of Physicians (ACP) in a statement submitted for the record. During its hearing on The Future of Medicare: Recognizing the Need for Chronic Care Coordination, Senators were told about the advantages of realigning benefits and payment incentives to support a comprehensive geriatric assessment.

“Ongoing care coordination for patients with multiple chronic diseases and/or dementia is critical,” said ACP President David C. Dale, MD, FACP. “It is essential that the system incorporate several of the key elements of the Patient-Centered Medical Home.”

ACP, which represents 120,000 physicians and medical students, is the largest medical specialty society and the second largest medical organization in the United States. Internists provide care for more Medicare patients than any other medical specialty.

ACP strongly believes that Medicare and other health plans should be reformed to advance the Patient-Centered Medical Home, a model of health-care delivery that has been proven to result in better quality, more efficient use of resources, reduced utilization, and higher patient satisfaction. Congress should also authorize a new Medicare benefit for geriatric assessments of patients with multiple chronic diseases and/or dementia and payment of a care coordination fee to physicians who accept responsibility for such patients.

The Patient-Centered Medical Home: A Model for Improving Care Coordination

In March, 2007, ACP, the American Academy of Family Physicians, American Academy of Pediatrics, and the American Osteopathic Association released a joint statement of principles that defines the characteristics of a patient-centered medical home. These four organizations represent 333,000 physicians and medical students.

The patient-centered medical home incorporates the relationships and systems required to support more effective care coordination for patients with multiple chronic diseases. As defined by the joint principles:

Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Quality and safety are hallmarks of the medical home:

  • Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family.
  • Evidence-based medicine and clinical decision-support tools guide decision making
  • Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.
  • Patients actively participate in decision-making and feedback is sought to ensure patients’ expectations are being met
  • Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication
  • Practices go through a voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.
  • Patients and families participate in quality improvement activities at the practice level.

The patient-centered medical home can improve the quality of care provided to any Medicare beneficiary, but is particularly suited to providing continuous, longitudinal, integrated and coordinated care for patients with multiple chronic diseases and/or dementia.

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 120,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.

Contact:
David Kinsman, (202) 261-4554, dkinsman@acponline.org
Jacquelyn Blaser, (202) 261-4572, jblaser@acponline.org

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