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College to spend nearly $1 million to make access a campaign issue

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

By Phyllis Maguire

PHILADELPHIA—At its mid-July meeting, the Board of Regents agreed to spend nearly a million dollars to focus attention on universal access, took a stand on physicians' rights to engage in joint negotiations and approved a new position paper on the ethical implications of physicians who sell products from their offices.

The Board approved the allocation of more than $947,000 for "Decision 2000: The Presidential Election and Universal Health Care Coverage," which will work to make access to health care a key issue in the upcoming presidential and congressional campaigns during the next 18 months. To emphasize its commitment to universal coverage, the College plans to hold press events in key primary and caucus states; conduct polls, studies and seminars on the issues; and place print advocacy ads. The College will also send members information on elections and evaluations of individual congressional candidates, and it will distribute pledge cards that internists and their patients can send to candidates to encourage them to make health care access part of their platform. (For more on the campaign, see "Why the College must speak up for the uninsured.")

College President Whitney W. Addington, FACP, told the Regents that he will continue to meet with congressional leaders and seek strategic alliances with other organizations to promote access. "We want to include as much of organized medicine as possible in an attempt to educate the public as well as public officials," he said. Dr. Addington is the chair of the Physicians' Work Group on Universal Coverage, a coalition that includes the College and six other medical organizations. The group announced its plans to raise awareness about the problem of the uninsured at a press conference in June. (For more information, see "Physicians unite for universal coverage" in the July/August ACP-ASIM Observer)

Joint negotiations

The Regents also approved a position paper on physicians and joint negotiations. The paper states that physicians should have the right to negotiate jointly with health insurance plans; that physician membership in a negotiating organization should be voluntary; and that third-party mediators from within academic or organized medicine should be used to help resolve disputes among housestaff. The paper opposes any physician actions that would deny or limit patient services—including strikes, slowdowns or boycotts—or would result in anti-competitive behavior such as price-fixing.

Though he voted to approve the position, W. James Stackhouse, FACP, pointed out that by opposing all forms of work stoppages, the College was not giving any options to members faced with unacceptable terms from health plans or employers. "The physician-patient relationship shouldn't be a club used against our members," Dr. Stackhouse said. Paul F. Speckart, FACP, Chair of the Health and Public Policy Committee, said that the committee will explore options for possible actions in contract disputes and report back to the Board. The paper is currently being prepared for publication.

Product sales from the office

The Board also approved a position paper on the controversial issue of selling products from physicians' offices. While the paper recognizes that selling products from the office raises important ethical issues, it concludes that in limited instances, "Physicians may maintain high ethical standards while affording patients access to products essential to their care." When deciding whether to sell products from the office, the paper says, physicians should consider the urgency of patient needs, whether selling the product would ease a patient's time constraints and whether evidence-based data support the product's use.

The paper also cautions physicians to disclose any financial interests they may have and to encourage patients to explore alternatives to acquire the product when appropriate. The paper is currently being prepared for publication.

Other recommendations

The Regents also approved a new Clinical Efficacy Assessment Program (CEAP) guideline on the pharmacological treatment of acute major depression and dysthymia.

The guideline generated some discussion among the Regents because it states that Saint John's wort "may be considered" for short-term treatment of mild acute depression. The guideline, which reviews the efficacy of all available anti-depressant medications, says physicians need to caution patients that St. John's wort lacks FDA approval and that the amount of active ingredients in products on the market may differ from the substances tested in randomized trials. A number of Regents pointed out that evidence-based data supports the recommendation, and the guideline was approved. The paper is currently being prepared for publication.

The Regents also took the following actions:

  • The Board approved a preliminary position paper that supports establishing a Medicare prescription drug benefit—as long as a reliable funding mechanism can be identified. The position paper states that the highest priority of a prescription drug benefit program should be to help those patients who are most in need. The paper also voices concern about the government's use of formularies, claims that physicians should be able to prescribe covered drugs for accepted off-label uses and maintains that any prescription drug benefit should not require expanded prescribing privileges for non-physician health professionals. The College's Health and Public Policy Committee is expected to develop a more detailed position paper on the issue.
  • The Regents decided to neither endorse nor oppose the Pain Relief Promotion Act of 1999, which was being debated in Congress at press time. Robert B. Doherty, the College's Senior Vice President for Governmental Affairs and Public Policy, said that while the new bill is an improvement over last year's defeated Lethal Drug Abuse Prevention Act, it would not do enough to prevent unjustified investigations into physicians' prescription of narcotics. The Regents directed College staff to work with the AMA and other medical groups to revise the bill's language.
  • The Board developed an official position statement on the NIH's E-biomed proposal, which would post both peer reviewed and non peer reviewed research papers free of charge on the Internet. Frank Davidoff, FACP, Editor of Annals of Internal Medicine, told the Board that he and other journal editors worried that because part of the E-biomed project would bypass quality-control mechanisms established by clinical journals, it could potentially jeopardize patient care. The position statement said that the College is concerned that sweeping, centrally proposed proposals like E-biomed "may cause serious and irreversible damage to the peer review and editing process," and that such restructuring should be undertaken with great caution.
  • The Regents approved a recommendation that board certification should not be a requirement for the American Medical Association Accreditation Program (AMAAP).
  • The Board recommended that the College continue to work with the Office of Inspector General to help reduce unnecessary "hassles" for practicing physicians, and to coordinate efforts to combat actual instances of Medicare fraud and abuse. The Board also recommended that the College continue to explore the use of patient encounter time as a component of evaluation and management (E/M) documentation. Robert D. McCartney, FACP, pointed out that fears about the current E/M documentation guidelines now prompt physicians to consistently undercode.
  • The Regents approved a new Subcommittee on Young Physicians. Membership Committee Chair William J. Hall, FACP, noted that the failure to retain Associates is the College's most significant cause of membership attrition. Other Board members recommended that the Subcommittee not only work to increase membership, but also to improve the College's appeal to younger physicians. Statistics show that most younger physicians devote less time to organized medical groups than their older colleagues.
  • The Regents passed several resolutions from the Board of Governors regarding the integration and reimbursement of medical/surgical and psychiatric services; off-label medication coverage by Medicare; the need for insurers to provide a 24-hour telephone line to provide coverage and benefit information to patients; and physician contracts with Medicare HMO intermediaries.
  • The Regents approved the appointment of the following members of the ACP-ASIM Foundation's Board of Trustees: Board of Regents Immediate Past Chair Robert B. Copeland, MACP, who is serving as Chair; former Regent James L. Borland Jr., FACP, who is serving as Treasurer; ACP-ASIM Executive Vice President Walter J. McDonald, FACP, who is serving as an ex officio Board Member; ACP-ASIM President Emeritus William A. Reynolds, MACP, who is serving as a Board Member; and William D. French, director of medical association alliances for Bristol-Myers Squibb, who is serving as a Board Member.

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