American College of Physicians: Internal Medicine — Doctors for Adults ®


Washington briefs

From the January 1996 ACP Observer, copyright 1996 by the American College of Physicians.

ACP resolutions adopted by AMA

WASHINGTON, D.C.--The AMA House of Delegates voted in favor of a resolution introduced by ACP that calls on the AMA, in conjunction with state and county medical societies, to monitor the impact of Medicaid managed care plans on patients' access to medical care and on the quality of that care.

Specifically, the College urged the AMA to help promulgate uniform criteria for monitoring changes in Medicaid programs.

That resolution was one of two submitted by ACP at last month's semiannual meeting of the AMA. The second College resolution urged the AMA and all parties involved in the financing of health care and/or graduate medical education (GME) to develop recommendations by which all third-party payers would equitably share in the financing of GME.

The delegates adopted a modified version of that resolution. It commits the AMA "to undertake a comprehensive study of the options for financing GME and develop recommendations to provide a stable, rational, adequate and feasible system for financing GME, including mechanisms to implement an all-payer system, the use of vouchers, payment for training in non-hospital settings and appropriate allocation of the training component of the [Medicare] Average Adjusted Per Capita Cost (AAPCC)."

Single conversion factor delayed

Staff from ACP and other primary care physician groups met last month with Clinton administration representatives to express extreme disappointment that a two-year transition period to a single conversion factor was included in the president's budget proposal. The groups attending the meeting have been working for months to promote a single conversion factor to replace the three categories now in effect for surgery, primary care, and "other nonsurgical" services. Immediate implementation of a single conversion factor was included in both the Balanced Budget Act of 1995 (the budget bill approved by Congress) and in the conservative Democratic coalition's budget alternative. HCFA staff said the transition period was included as a matter of equity.

College discusses PSOs with HCFA

ACP representatives met with HCFA Administrator Bruce Vladeck, PhD, and representatives from HCFA's office of managed care last month to express support for the concept of provider-sponsored organizations (PSOs).

During the debate over Medicare reform, the College has recommended that networks of providers be authorized to contract directly with HCFA to provide care to Medicare beneficiaries. The legislation approved by Congress establishes PSOs but creates a state-based regulatory structure that is burdensome and biased in favor of traditional, insurer-sponsored health plans. ACP staff told HCFA officials that the legislation's regulatory structure is unworkable and that the College instead recommends a streamlined process with federal oversight.

ACP testifies to PPRC

ACP Deputy Executive Vice President John Tooker, FACP, told the Congressional Physician Payment Review Commission at its annual hearing last month that increased enrollment in Medicare and Medicaid managed care plans demands federal standards for quality, access and benefits.

Although research shows that the quality of care provided in managed care systems is comparable to that offered in fee-for-service settings, he said, most existing managed care plans have had little or no experience with the elderly.

The College is concerned, he said, that many managed care plans "may not be able to adapt their structures to care for [an older population]." Dr. Tooker suggested the College's recently developed set of quality standards for Medicare managed care could serve as a model for federal oversight in this area.

Dr. Tooker also urged the commission to explore in depth the issues related to proposed cuts in Medicare funding for graduate medical education (GME), particularly those that would harm subspecialty training programs, which "could have unintended ramifications for the nations future supply of physicians."

The College, he told the commission, supports the idea of using Medicare trust funds as the foundation for building a financing system for GME that would draw on contributions from all health care payers, not just Medicare.

Dr. Tooker's testimony also addressed ACP's grave concern about Congressional initiatives to "reform" Medicaid, including the funding cutbacks proposed and the plan to turn over all control to the states.

In return for substantial federal funding, states should be accountable to standards set by the federal government, on such issues as "eligibility, minimum uniform benefits, financial solvency, quality, open processes and marketing," Dr. Tooker said.

The PPRC advises Congress on physician payment and related issues. The full text of ACP's testimony is available from the College's Washington, D.C. office: 800-633-9400.

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