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Regents approve new policies on angina, Medicare access

From the March 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

At its February meeting, the Board of Regents adopted several new College policies and approved a number of position papers on topics ranging from Medicare reform to health care access.

The Regents unanimously endorsed a chronic stable angina guideline submitted by the College's Clinical Efficacy Assessment Project (CEAP). It is the first CEAP guideline to be developed through collaboration with other organizations, which included the American College of Cardiology and the American Heart Association. The guideline will appear in an upcoming issue of the Journal of the American College of Cardiology.

The Regents also approved position papers on the following topics:

  • Medicare. Medicare should not be converted to a defined contribution program, which would limit the government's share of health care contributions and likely raise out-of-pocket expenses for patients. The paper states that a defined contribution model would eliminate affordable health care coverage for many elderly, a problem that already swells the ranks of the uninsured among younger Americans.

    While the position paper opposes raising the age for Medicare eligibility, it supports a sliding scale for premiums that would have wealthier Americans pay more for their Medicare coverage. The College also favors modest tax increases to financially bolster the Medicare program. (The full text of the paper, which was sent to the National Bipartisan Commission on the Future of Medicare, is available in the "Where We Stand" section of ACP-ASIM Online at

  • Drug abuse. In another position paper approved by the Regents, the College recommends that federal efforts regarding drug abuse be shifted from the criminal justice system to treatment and education programs. The College's position also urges health care professionals and the public to consider drug abuse as a biologically-based illness rather than a character weakness.
  • Uninsured. The Regents approved a report from an ACP-ASIM/American Board of Internal Medicine task force that supports local physician efforts to aid the uninsured. The paper urges medical leadership to convene conferences on the problem of coverage for the uninsured and calls for medical groups to participate in broad-based national coalitions to improve health care access. The paper also recommended that the College encourage physician efforts to overcome cultural and educational barriers to health care and to form partnerships between concerned public and private sector groups. (For more on the College's stance on health care coverage for the uninsured, see "College unveils new plan to care for the uninsured,".)
  • Sanctions. In a position paper approved by the Regents on the effects of sanctions and embargoes, the College supports exempting food and other humanitarian goods. The College also recommends providing medical supplies and services to countries targeted by sanctions.

In another action, the Regents adopted work group recommendations to help physicians prepare for biological and chemical terrorism, a concern originally expressed in a Board of Governors resolution. The College will promote educational efforts on treating terrorist events, including articles in College publications, possible presentations at Annual Session and a bibliography.

A number of other resolutions that originated from the Board of Governors were also adopted. Those included resolutions that call on the College to work on federal legislation to regulate the appeals process when health plans deny medical care; to endorse patients' voluntary choice of inpatient physicians; and to re-examine the role of national pharmacies, restricted formularies and therapeutic substitutions for Medicare beneficiaries.

The Regents also adopted policies on the following topics:

  • Patient age. A new policy states that internists should not be automatically excluded from caring for teenagers. A number of health plans have adopted the American Academy of Pediatrics' policy that pediatricians are responsible for the care of patients through age 21, excluding internists from caring for some teenagers and young adults.
  • IMGs . Due to concern about the fairness of the Clinical Skills Assessment program administered by the Education Commission for Foreign Medical Graduates, the Regents directed the College's Education Committee to examine how the clinical skills of all residency candidates are currently assessed. Some have expressed concern that the program may pose an undue burden on international medical graduates, which is administered once a year in Philadelphia.
  • End-of-life care. The Board received two papers from the College's End-of-Life Care Consensus Panel. "Dying Patients in the ICU: Forgoing Treatment, Maintaining Care" and "Pain Management in Patients with Advanced Cancer" will be submitted to the Annals of Internal Medicine for consideration. The papers are the third and fourth in a proposed series of 12 papers that address end-of-life care issues in clinical situations.
  • Year 2000. The Regents approved a number of new College efforts to help members with year 2000 computer issues. Over the next month, College staff will put together resource materials on how to update computer systems for Y2K compliance. (For more on year 2000 computer issues, see "Will the Y2K bug force you to replace your computer? ".)
  • Online advertising. The College's Web site, ACP-ASIM Online, will now accept ads from pharmaceutical companies, physician-support services, medical device and equipment suppliers, and employment agencies and other organizations interested in hiring physicians. The guidelines prohibit the College from accepting advertising for tobacco products, non-FDA approved drugs or diagnostic tests and products or services not directly relevant to medical practice.

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