Joint Letter in Support of Removing Cost-sharing Obligations from the Chronic Care Management Code

Joint Letter in Support of Prohibition of Menthol Cigarettes

Joint Letter Supporting Primary and Behavorial Health Care Access Act

Joint Letter Supporting Medicaid and CHIP Continuous Eligibility Provisions in Reconciliation Package

Joint Letter Supporting Humanitarian Standards for Individuals in Customs and Border Protection Custody Act

Joint Letter in Support of H.R. 2474, the Strengthening Medicare for Patients and Providers Act

Joint Letter Supporting Gun Violence Prevention Research Funding in Fiscal Year 2025 from Medical and Public Health Organizations to Congressional Appropriators

Joint Letter Supporting Fiscal Year 2025 Funding for Title VII Health Professions Programs

Joint Letter Supporting Funding for Health Care Priorities in FY2023 Appropriations Legislation

Joint Letter Supporting Funding Allocation 302(b) for DOL and HHS for 2020 Appropriations Bill

A History of American Legal Barriers to Gender-Affirming Care

The last 5 years in the United States have witnessed a flurry of policies attempting to limit access to gender-affirming care (GAC), with state and federal authorities instituting restrictions on care for transgender and gender-diverse (TGD) adolescents and attempting to limit funding for treatment costs. Although many have decried these policies as an unprecedented assault on GAC, there is actually a long history of attempts to limit access to GAC in the United States through the creation of restrictive policies directed at patients, clinicians, and payers. Even amid such restrictions, TGD people have demonstrated a remarkable ability to access GAC, often finding new ways to obtain this care. These have included shifts in tactics deployed by advocates of GAC as hostile policymakers attempted to limit the expansion of access. The current landscape of restrictive policies represents the culmination of a longstanding regulatory evolution, integrating various legislative approaches that have been used over almost a century. This article discusses how TGD communities have navigated several iterations of hostile legislative environments to access such care.

Asheville, North Carolina: The Origin of the American Tuberculosis Sanitarium Movement

The digitization of academic publications and newspapers from the 1800s has permitted identification of several authoritative sources that credit Dr. Joseph W. Gleitsmann with establishing the first successful tuberculosis sanitarium in the United States in Asheville, North Carolina, in 1875, antedating by 9 years the Trudeau Sanatorium in Saranac Lake, New York. The facility used German climatological methods and a defined medical treatment program. Gleitsmann's Mountain Sanitarium for Pulmonary Diseases had a 30-bed occupancy and published outcomes data from 5 years of clinical experience by 1880. By 1910, Asheville had become a tuberculosis care “colony,” with 25 private tuberculosis sanitaria with a national referral base. Asheville was a key driver of the development of climatotherapy in the treatment of tuberculosis and other respiratory ailments in the preantibiotic era. From 1870 to 1930, medical, mental health, and wellness tourism largely drove the population growth (1500 to 50 000) of Asheville, a previously remote Appalachian town. The stigmatization of tuberculosis sufferers is illustrated by restrictive municipal regulations that led to the demolition of almost all tuberculosis sanitaria within Asheville city limits by the 1920s. The Von Ruck Research Laboratory for Tuberculosis produced more than 50 papers from 1890 to 1930, published mostly in the Journal of the American Medical Association and the Journal of Immunology. These included pioneering immunotherapy studies with tuberculin variants and the first robust description of the antigenic profile of Mycobacterium tuberculosis. Tuberculosis was both incurable and a leading cause of death, and thus perseverance with fractionated tubercle bacillus products and subunits by so many is understandable in the context of the times. By analogy, public health now seems more ready to accept disease-specific immunotherapy agents and vaccines that save lives even if they are substantially less than 100% effective.

Ethical Issues in Organ Transplantation: A Position Paper From the American College of Physicians

Recent developments and controversies in organ transplantation necessitate the reaffirmation and application of foundational ethical norms as the laudable goal of increasing viable organs for transplantation is pursued. The physician’s primary duties are to individual patients under the physician’s care. For physicians of prospective donor-patients, the “bright line” between serving the best interests of donor-patients and their families and serving potential recipient-patients and the public interest can become blurred in ethically problematic ways. This paper provides ethical guidance for clinicians involved in organ transplantation as well as for patients, families, the public, policymakers, and others to help maintain trust and encourage participation in this life-saving enterprise. It clarifies the duties and roles of care teams of prospective donor-patients, recipient-patients, and organ procurement teams, reaffirming that end-of-life decision making for prospective donor-patients must center on the best interests of donor-patients and their families independent of organ donation potential. It also emphasizes the importance of truly informed consent for organ donation and advocates for prioritizing equity and transparency in transplantation processes.

Quality Indicators for Screening and Surveillance of Colorectal Cancer in Adults: A Review of Performance Measures by the American College of Physicians

Colorectal cancer is the second leading cause of cancer-related deaths for both men and women. Screening for colorectal cancer is an effective strategy to reduce morbidity and mortality, but uptake remains suboptimal. Several performance measures for colorectal cancer screening and surveillance are currently used in pay-for-performance, public reporting, and/or accountability programs. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care. The ACP believes that a performance measure must be methodologically sound and evidence-based to be considered for inclusion in payment, accountability, or reporting programs. These principles are critical given the potential effect to physician administrative work and reputation and reimbursement and to prevent unintended consequences on patient care. The ACP’s Performance Measurement Committee (PMC) reviews performance measures using a validated process to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. This article aims to present a review of current performance measures for colorectal cancer screening and surveillance to inform physicians, payers, and policymakers in their selection and use of performance measures and make recommendations for measures that could be developed. The PMC appreciates the importance of colorectal cancer screening in the prevention and early detection of colorectal cancer and supports performance measures based on strong recommendations. The PMC reviewed 5 performance measures for colorectal cancer screening relevant to internal medicine and supports 1 performance measure (“Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy”) for use.

Identifying Core Clinical Topics and Recommending Core Performance Measures for Internal Medicine Physicians: A Position Paper From the American College of Physicians

Internal medicine physicians are specialists who promote health, emphasize disease prevention, manage complex acute and chronic conditions in adults, and receive extensive training in the diagnosis and treatment of diseases affecting all systems of the human body. As a result, internal medicine performance measures (PMs) target several topics. Many PMs are not based on high-certainty evidence of at least moderate net benefit and are burdensome, with low or no value to patient care. The American College of Physicians (ACP) wants to provide a national focus to improve the quality of health care in the United States. The ACP is a leader in the evidence-based world, being the only physician organization designated as a GRADE (Grading of Recommendations Assessment, Development and Evaluation) Center, an Appraisal of Guidelines for Research and Evaluation (AGREE) Center, and a member of the Cochrane U.S. Network. Using a structured, stepwise, evidence-based approach, ACP identified the most important clinical topics evaluated and treated by internal medicine physicians. The ACP is also actively working toward recommending essential PMs for each core clinical topic that can be used to evaluate and improve patient care. This position paper describes ACP’s method and results of identifying core clinical topics. It also offers a blueprint for defining core PMs and illustrating the principals through application to 2 core clinical topics. The ACP plans to apply this method on PMs for other core clinical topics.

Bolstering the Medication Supply Chain and Ameliorating Medication Shortages: A Position Paper From the American College of Physicians

The U.S. health care system is experiencing numerous supply chain disruptions, including for important medications. Prescription drug shortages have been at record levels and have affected more drugs in recent years, especially generic sterile injectables and other low-margin medications. These shortages arise from a confluence of factors, including the complexity of the entire production and delivery supply chain, quality issues, outdated manufacturing facilities and practices, drug purchasing policies that prioritize lowest price over reliable production, changes in prescribing and usage patterns, geopolitical constraints, and market concentration, among other factors. When prescription drugs are in shortage, patients face negative health outcomes due to being unable to obtain necessary treatments, the stress associated with securing medications, and adverse effects from alternative treatments. Physicians also face substantial burden in navigating drug shortages because they must expend time and resources in identifying alternative treatment options and obtaining prior authorization for the coverage of alternative drugs, negatively affecting the patient–physician relationship. Policymakers, regulators, manufacturers, health systems, health professionals, and other relevant entities must collaborate to further efforts to ameliorate drug shortages and promote equitable access to treatments. In addition to short-term measures to address the immediate effect of drug shortages, policymakers, manufacturers, and drug purchasers should also undertake efforts to prevent future drug shortages by investing in, strengthening, and diversifying prescription drug supply chains and incentivizing procurement practices that emphasize reliable and sustainable production practices. Such efforts must be undergirded by policies to improve monitoring of and transparency into the prescription drug supply chain.

There Is No Substitute for Primary Care Physicians: A Response to the Association of American Medical Colleges’ Workforce Model

Quality Indicators for Diabetes in Adults: A Review of Performance Measures by the American College of Physicians

Type 1 and type 2 diabetes are prevalent chronic illnesses, are leading causes of mortality and morbidity, and result in substantial public health burden. Timely identification and appropriate management of diabetes can help reduce adverse consequences of diabetes. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care but believes that a performance measure must be methodologically sound and evidence-based in order to be considered for inclusion in payment, accountability, or reporting programs. These principles are critical given the potential impact on physician administrative work, reputation, and reimbursement and to prevent unintended consequences for patient care. To help improve performance measurement and reduce burden, the ACP Performance Measurement Committee (PMC) reviews performance measures using a rigorous process to recognize high-quality measures and address gaps and areas for improvement. In this article, the PMC presents its review of 14 current performance measures for diabetes that are relevant to internal medicine. The PMC supports kidney health evaluation at the individual and group practice levels, hemoglobin A1c control at the health plan level, eye examination at the health plan level, and angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker therapy at the individual physician level.

Optimizing Ethical Care, Quality, and Safety in Long-Term Services and Supports: A Position Paper From the American College of Physicians

Long-term services and supports (LTSS) in the United States have faced substantial and enduring challenges. They encompass services for persons who can no longer independently care for themselves because of cognitive decline, functional limitations, chronic illness, or the sequelae of such conditions. These services are delivered in institutional and noninstitutional settings, such as nursing homes, assisted living facilities, and home- and community-based programs. This position paper by the American College of Physicians examines the ethical implications of current LTSS business models and practices and their effect on vulnerable persons receiving care in these settings. These models and practices include approaches to staffing, resource allocation, health equity, and attention to patient preferences and patient-centered care, as well as business strategies that focus on profit rather than patient care and ownership structures that can lack transparency and hinder accountability. Addressing these challenges necessitates a collaborative approach among policymakers, health care systems, researchers, physicians and other health care professionals, LTSS facility and agency owners, patients, and caregivers. By embracing shared goals through a collaborative approach, an LTSS system can be cultivated that optimizes ethical care, quality, and safety, ensuring respect for all individuals across their lifespan.

Breaking the Silence: Restoring Justice in Academic Medicine