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Regents discuss recertification, assisted suicide, the independence of pharmacists and access

From the December 2000 ACP-ASIM Observer, copyright © 2000 by the American College of Physicians-American Society of Internal Medicine.

Phyllis Maguire

Philadelphia—At its October meeting, the Board of Regents heard an update on the College's efforts to address internists' concerns about the recertification process. The Regents also approved new positions on issues including physician-assisted suicide, pharmacists' scope of practice and access to care.

Recertification

Bernard M. Rosof, FACP, Chair-elect of the Regents, reported on the first meeting of a new recertification task force made up of officials from the College and the American Board of Internal Medicine (ABIM).

Dr. Rosof explained that the task force discussed internists' concerns that the recertification self-evaluation components are redundant because physicians already meet similar requirements for regulatory agencies and managed care companies. Task force members from both the College and the ABIM agreed that the ABIM should continue to set the standards for component modules of the recertification process, Dr. Rosof reported. ABIM officials indicated that they may be willing to allow internists to use self-evaluation tools from other organizations to complete the recertification process.

Dr. Rosof said that the task force also addressed the need to separate the roles of education and evaluation in the recertification process. The College has traditionally been the provider of educational material to meet members' needs. College officials have also said that it is a conflict of interest for an organization that evaluates physicians to be supplying their educational materials.

Dr. Rosof reported that ABIM officials said they are willing to have the College develop educational elements of the recertification process.

After the report, the Regents drafted a resolution supporting recertification processes that benefit patients and physicians and are "clinically relevant" and "minimally burdensome" to recertifying physicians. The Regents are expected to vote on the resolution at their January meeting. (For more on the recertification process, see the November issue of the ACP-ASIM Observer on the Web at www.acponline.org/journals/news/nov00/recertification.htm.)

Physician-assisted suicide

The Regents approved a new position paper on physician-assisted suicide from the Ethics and Human Rights Committee. The paper outlines the College's opposition to the practice and concludes that it should remain illegal. The new paper is currently being submitted for publication.

Pharmacists' scope of practice

The Regents approved a paper clarifying the College's position on pharmacists' scope of practice. The new paper opposes giving pharmacists the right to independently prescribe and initiate drug therapies. However, it supports physician/pharmacist collaborations in patient education and hospital rounds, and it supports having pharmacists provide immunization information and administer immunizations as allowed by state law. The paper is being submitted for publication.

Access

The Regents approved a new position paper from the Health and Public Policy Committee on access to coverage. The paper's dozen policy principles endorse concepts like affordable health coverage for all and patient choice of physicians. The paper is the College's first effort in 10 years to formulate its key health care reform principles. The paper may be submitted for publication.

Other business

The Regents also took action on the following issues:

  • Associate voting privileges. The Board approved voting privileges for Associates after two years of Associate membership, subject to the approval of the revised College Bylaws at the Annual Business Meeting.
  • Adult immunization initiative. The Board approved a new adult immunization program that will be funded by grants from drug companies. The campaign will give internists information about best practices in adult immunization and provide practice management tools to help implement those practices.
  • Med-peds pilot project. The Regents approved a pilot program for physicians who specialize in both internal medicine and pediatrics. The College will collaborate with the American Academy of Pediatrics (AAP) to help maintain a med-peds database and newsletter. The College will also add a med-peds section to the College's Web site. Both the College and the AAP will offer reduced dues for physicians who join both societies.
  • Physician workforce. The Regents voted to adopt eight principles concerning the physician workforce and graduate medical education (GME). The principles include recommendations to reduce U.S. medical school enrollment and increase GME funding to sufficiently support teaching hospitals, which provide a disproportionate amount of indigent care. The principles can be found at www.acponline.org/hpp/pospaper/physician_workforce.htm.
  • PIER. The Regents approved a new business model for the Physician's Information and Education Resource (PIER), an electronic product that will give physicians instant access to cutting-edge clinical information. (PIER is expected to be released in 2001.) The College will set up a separate for-profit company funded by investors to develop and market PIER. The College will own all PIER content and receive royalties on all sales of the product.
  • Physicals. The Regents agreed to urge HCFA and Congress to pass legislation to cover the cost of annual physicals for Medicare patients.
  • Managed care hassles. The Regents agreed to urge insurers to rescind policies that require physicians to provide supporting documentation for all level 4 or 5 evaluation and management codes. They also agreed to update College policy to limit the punitive use of drug formularies such as prescription profiling and penalties for not using formularies.
  • File identifiers. The Regents voted to oppose the use of physicians' Social Security numbers as file identifiers by CME providers and certification boards.
  • Youth violence prevention. The Regents approved a report from the Commission for the Prevention of Youth Violence, a group that includes representatives from the College, the AMA and nursing and public health organizations. The report recommends increased access to health and mental health care services and reduced access to firearms and exposure to media violence. The report will be released later this month.
  • End-of-life care. The Regents received an end-of-life care consensus panel paper, "Strategies for Culturally Effective End-of-Life Care," which is being submitted for publication.

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