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

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ACP: Case management, standardized data key to Medicare reform

From the January 1997 ACP Observer, copyright © 1997 by the American College of Physicians.

WASHINGTON—Congress should enact reforms that promote greater use of case management services and should create a federal initiative to collect data on the cost-effectiveness of unproved technologies, procedures or services, according to the College.

Testifying last month before the Physician Payment Review Commission (PPRC), which advises Congress on Medicare and Medicaid, ACP President Christine K. Cassel, FACP, explained why the College opposes "arbitrary funding cuts that are driven only by budget needs rather than health policy." She instead offered a set of recommendations on what internists think it takes to provide high quality and cost-effective care for elderly patients.

"We know that Medicare beneficiaries, particularly those with chronic illnesses, are well served by systems of coordinated care," such as case management, Dr. Cassel said. "We urge the PPRC to consider how Medicare can promote case management services both in fee-for-service reimbursement and capitated settings."

Dr. Cassel also suggested that in return for reimbursement for a new or untested service, Medicare should require providers to report data on costs and outcomes in a standard format. "Multi-site studies of this type could provide data on efficacy and cost-effectiveness of new technologies under clinical conditions prior to widespread diffusion," she said.

Both ACP and the American Academy of Family Physicians, which also spoke at the annual commission hearing, made the case for greater funding for the embattled federal Agency for Health Care Policy and Research to do this kind of essential health services research.

The College was joined by several other physician organizations in calling for Medicare to allow provider-sponsored organizations to compete with HMOs for Medicare business. Representatives of primary care physicians, meanwhile, urged the PPRC to encourage HCFA to proceed with planned implementation of new resource-based practice expenses to correct the historical undervaluation of evaluation and management and other office-based services.

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