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Regents discuss recertification, position papers

By Phyllis Maguire

At its July meeting, the Board of Regents revisited the contentious issue of recertification, which has been a major concern for the past year. The Board also approved funding for marketing materials and several position papers on physician performance assessment and physicians' relations with industry.

Here is an overview of the topics the Regents debated:

Recertification

After hearing an update from the College's representatives to the Joint Committee on Recertification, the task force made up of College officials and members of the American Board of Internal Medicine (ABIM), the Regents approved a list of negotiating positions. They include the following:

  • Make the proposed patient-peer assessment component of the ABIM's continuous professional development program optional
  • .
  • Allow internists to substitute MKSAP and other educational resources for the ABIM's self-assessment study modules.
  • Find alternate ways to evaluate clinical performance in lieu of the ABIM's practice improvement modules.

The Regents also discussed alternate courses of action if an accord could not be reached regarding recertification. The Regents also planned several meetings to address recertification. In late July, College leaders met with representatives from other internal medicine groups such as the Council of Subspecialty Societies and the Academic Alliance, which includes the Association of Professors of Medicine and the Association of Program Directors in Internal Medicine, to discuss the issue.

And in August, College President William J. Hall, FACP, and Regent Chair Bernard M. Rosof, FACP, met with ABIM representatives. The results of both meetings will be presented to the Board of Governors later this month. Marketing

In other business, the Regents approved funding for the Marketing and Communications Committee to help increase awareness of the College's programs and positions among health care professionals and the public. The funds will be used to strengthen public relations support for chapter meetings and individual members, and to produce monthly video news segments on internal medicine topics for distribution to the broadcast media.

Physician performance

The Board approved a position paper from the Medical Services Committee, titled "Assessing Individual Physician Performance by Managed Care Organizations." The paper states that programs that measure and evaluate physician performance can, when properly implemented, improve health care quality and cut costs.

According to the paper's principles, physician assessment should be confidential and nonpunitive; focus on clinical effectiveness and patient satisfaction, not cost; involve physicians at all levels of development and implementation; and not contain physician-specific identifiers when performance data are released to the public.

Physician-industry relations

The Regents approved a two-part position paper on physician-industry relations submitted by the Ethics and Human Rights Committee. The paper, which revises a 1990 College publication, acknowledges the increasing potential for conflicts of interest and ethical problems posed not only by drug companies' growing promotional efforts, but also by emerging biotechnology, disease management and electronic-products industries.

The paper strongly discourages physicians from accepting individual gifts and states that physicians should disclose all financial relationships regarding medical facility ownership or office-based research. The paper also states that industry support for medical education programs should not lead to any control of program planning, content or delivery.

The two-part paper is being submitted for publication.

Workforce and GME

The Board approved a policy monograph prepared by the Health and Public Policy Committee evaluating the recommendations of the Medicare Payment Advisory Commission (MedPAC) on physician workforce and graduate medical education financing.

The monograph states that while the College approves of some MedPAC recommendations, it cannot support the commission's proposal to combine direct and indirect medical education cost payments. The monograph says that a combined payment would substantially reduce graduate medical education funding.

The College also disagrees with both MedPAC's proposal to eliminate current differentials in direct cost funding and its position that Medicare payment policies should not provide incentives to affect the supply, specialty mix or geographic distribution of health care professionals. The College instead believes that physician training should try to achieve a balance between generalists and specialists and that the numbers of nonphysicians should be considered and adjusted.

Ethical principles on managed care

The Board endorsed a report, "Ethics in Practice: Managed Care and the Changing Health Care Environment," prepared by the ACP-ASIM Center for Ethics and Professionalism in partnership with the Harvard Pilgrim Health Care Ethics Program. The report, which includes the principle that health plans need to support physician-patient relationships, is being submitted for publication.

Medical professionalism

The Regents also endorsed the Physician Charter on Medical Professionalism, a joint project of the ACP-ASIM Foundation, the ABIM Foundation and the European Federation of Internal Medicine. (For more on the charter, see the July/August 2001 issue of ACP-ASIM Observer at www.acponline.org/journals/news/jul01/professionalism.htm.) College Executive Vice President and CEO Walter J. McDonald, FACP, who served on the charter project committee, pointed out that the document calls on physicians to help justly distribute scarce resources while maintaining the primacy of individual patients' welfare.

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