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ACP Member Offers Physician's Insight at Congressional Hearing

Testimony gives nod to improved care through new programs but notes added administrative burdens, too

Dec. 1, 2017 (ACP) -- Dr. Louis Friedman, an American College of Physicians member from New Jersey, brought a simple but powerful message to a recent congressional hearing: When it comes to patient care, the Comprehensive Primary Care Plus program (CPC+) is a big plus for the most part and a sign of the power of innovative approaches to physician payment models.

dr louis friedmanUnder CPC+, "we have expanded our ability to analyze and deliver care, and our patients have benefitted in many ways," said Friedman, who's part of a five-clinician practice in Woodbridge, N.J. "We must continue to move forward with value-based, coordinated care -- such as can be found in programs like CPC+, the medical home, and other APMs [Alternative Payment Models] -- and away from the fee-for-service system."

At the invitation of both congressional Democrats and Republicans, Friedman testified Nov. 8 before the House Energy and Commerce Health Subcommittee. He spoke at a hearing regarding the development of value-based options such as APMs under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

"The committee was really looking for feedback about how these programs are working," Friedman said. "Members of both parties in Congress know that the ACP is a respected and knowledgeable voice on medical matters, so they called us in to offer our perspective."

He told the subcommittee about his own experience with the CPC initiative and CPC+, which emphasizes care coordination. It's the only medical home model that's specifically identified as an advanced APM in the Quality Payment Program under Medicare Part B for those in practices with 50 or fewer clinicians.

"The addition of care coordination staff has enabled us to better track our patients who have been discharged from the hospital, reach out to them within 48 hours of discharge and

review medications and determine whether further ancillary services are needed," Friedman told the subcommittee. "Follow-up visits are also arranged at that time, which has helped to limit confusion on the patient's part. We anticipate this will lead to a decrease in readmissions."

In addition, he said, the CPC+ program has allowed his clinic to offer self-improvement programs such as nutrition classes and dietician visits.

Financial incentives from the CPC+ program have made these improvements possible for practices like his, which are small and independent, Friedman said. Thanks to CPC+, he said, his clinic was able to hire nurses and nutritionists and buy software to more effectively track patients.

Friedman's comments before the congressional subcommittee reflect ACP's ongoing support for both MACRA and the shift away from a volume-based payment and delivery system. "ACP believes that all public and private payers should transition their payment systems to support innovative payment and delivery models linked to the value of the care provided," he said.

However, Friedman pointed out that the CPC system still has room for improvement in several areas, especially in regard to the need for extra resources to comply with its requirements.

"Employing a full-time trained accountant and/or project manager who can design a budget and analyze the constant flow of data is not feasible for most small practices, but there is a need for that in a CPC+ practice," he told the committee. "Many physicians have needed to outsource these tasks, thus adding to overhead."

There are other challenges, too, he said, such as the specialized skills needed of care coordinators. "The ideal candidate would be a nurse," he said, "yet most nurses prefer face-to-face clinical contact."

Friedman also told the congressional panel that reporting requirements need to be simplified. And, he said, interoperability of electronic health record software should be encouraged as "this would lead to better electronic communication between medical offices and hospitals."

Still, he sees the overall picture as positive.

"I wanted to get across that this system has certainly improved care in many ways, but it increases administrative burdens as well," Friedman said. "That's the challenge. But with refinement, this model can transform care for patients."

dr louis friedman and others

More Information

The printed text of Dr. Friedman's testimony is available on the ACP website.

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