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

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Letters

From the September 1998 ACP-ASIM Observer, copyright © 1998 by the American College of Physicians-American Society of Internal Medicine.

Private contracting

We are appalled at the poor decisions being made by ACP-ASIM leadership, which appears to love government regulation. ("New ACP paper: private contracting threatens Medicare," May ACP Observer,) Years ago, the College came out in favor of the incredibly bureaucratic Clinton health care plan. Then, in a more recent position paper on private contracting, the College argued that one of the main reasons it does not support private contracting is to keep finances out of the physician-patient interaction.

Do our leaders feel it is reasonable for our patients to spend $375 for three months of Rezulin when they pay us only $62 over three months to manage their diabetes? In an era when most businesses are trying to increase efficiency by pursuing government deregulation, we seem to be pursuing more regulation.

Furthermore, we have seen little ACP-ASIM response to HCFA's audits of evaluation and management (E/M) documentation. A Medicare consultant in our area who represents physicians has stated that HCFA had planned to audit up to 40% of the practicing doctors in South Florida and assess fines of between $10,000 and $500,000. While "honest" coding errors would not subject physicians to prosecution, monetary penalties would still be enforced for "up-coding." This process has been slowed, but not stopped, by the recent E/M guideline revision fiasco. Every day, we hear stories about physicians being fined big dollars for so-called fraud and abuse. Of course, these fines must be paid first before an appeal can be made. This is clearly an attempt to scare physicians into "down-coding."

I have not seen any ACP-ASIM position paper about the fairness of these audits. We fail to see any recognition by the ACP-ASIM leadership that private contracting could put an end to an honest physician's risk of being audited. After all, a contract between a patient and physician would usurp HCFA authority. Once any new guidelines have been instituted, these audits will begin again in full force.

Marc S. Frager, FACP;
Timothy W. Valk, FACP
Boca Raton, Fla.

Drug policy

Harold C. Sox, FACP, has written a very thoughtful and long overdue editorial concerning drug use in the United States. ("The national war on drugs: build clinics, not prisons," June ACP Observer.)

To the majority of Americans, it is apparent that the "war on drugs" has failed. While the government has spent an estimated $100 billion annually, the problem continues. Substance abuse is a medical and public health problem, and, as Dr. Sox stated, prisons, war and violence are not the appropriate answers.

We need good clinical research into appropriate medical methods that will minimize harm to all members of society. The Dutch have been able to keep their consumption of cannabis to half of what is consumed in the United States, and the Swiss have been able to cut crime through medically supervised heroin maintenance. The HHS recently acknowledged that needle exchange works to prevent HIV infection without encouraging IV drug use, but for political reasons it cannot fund a needle exchange program.

We need to make sure that decisions regarding drugs and health care are made by compassionate physicians and other health care experts who have no political baggage about appearing "soft on crime." Decisions made by politicians and the Drug Enforcement Agency seldom have any scientific validity or compassion. The war on drugs does not belong in the exam room.

Richard E. Bayer, FACP
Portland, Ore.

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