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

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Governors discuss drug switching, Medicare pay, more

From the November ACP-ASIM Observer, copyright 2002 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

QUEBEC—At its fall meeting, the Board of Governors discussed 17 resolutions recommending that the College's Board of Regents to advocate for a wide range of reforms, from prohibiting the sale of physicians' prescribing data to providing uniform reimbursements for inpatient services.

Here is an overview of the issues the Governors addressed:

  • Pharmaceutical practices. Two resolutions dealt with pharmaceutical marketing and profiling practices. One called on the Regents to oppose the sale or exchange of physicians' prescribing data to any company, including drug makers. Janelle A. Rhyne, FACP, Governor for the North Carolina Chapter, recalled how a drug company representative approached her at a children's soccer game and knew exactly what drugs she had and had not been prescribing to patients.

    The Governors also recommended advocating for legislation or regulations to prohibit pharmacists or pharmacy benefit managers from trying to convince patients to change their medications without first talking to their physician. (HHS last month proposed guidelines that would discourage "prescription switching" for financial gain.)

  • Reimbursement and fees. Several resolutions addressed payment issues. One recommended uniform physician payments for hospital services performed by inpatient and outpatient physicians. The Governors heard that some hospitalists are paid more for providing inpatient care than equally credentialed physicians with outpatient practices.

    Another resolution directed the Regents to support legislation or regulations to resolve geographic inequities in Medicare payments to physicians, particularly doctors practicing in rural areas.

    A third called on the Regents to support physicians setting their own fees for all patients, including those covered by Medicare. Virginia L. Hood, FACP, Governor for the Vermont Chapter, spoke against the resolution, saying that setting fees might restrict access to care for less affluent patients. But Joseph W. Stubbs, FACP, Governor for the Georgia Chapter, pointed out that physicians would still have the option of waiving fees for patients who can't afford them, "something we've already been doing for years."

  • Young physicians. The Governors approved a recommendation to delay the implementation of the Clinical Skills Assessment Exam for U.S. medical graduates. (The exam is slated to begin in 2004.) The resolution further directs the Regents to initiate a discussion with the exam's administrators to ensure the exam is evidence-based and cost-effective.

    The Governors supported a resolution on resident loan repayment that recommends advocating for repayment plans that would begin after residents finish training. The resolution also advocated for new loan forgiveness and consolidation programs.

    The Governors also directed the College to investigate ways to offer the print version of ACP Journal Club free to student members. While several Governors expressed concern about printing and mailing costs, Karen Hsu, ACP-ASIM Medical Student Member and Vice-chair of the Council of Student Members, pointed out that print versions were more convenient for students and a good way to introduce them to the College.

    Governors suggested a pilot program that would send several issues to second- or third-year students.

  • Subspecialist members. To increase the number of subspecialist members, the Governors recommended encouraging subspecialists to join both the College and their subspecialty society by possibly offering reduced combined dues.

  • Health care reform. Several resolutions addressed the need for health care reform. One recommended opposing the use of "gatekeeper" referrals for tests and services requested by consulting physicians, particularly when the services are outside the expertise of the designated "gatekeeper."

    Another resolution directed the Regents to investigate how the decision by some insurers to discontinue the use of referral forms has affected patient care.

  • Elder abuse. The Governors called on the Regents to support legislation to facilitate the reporting of elder abuse but protect physicians from liability related to elder abuse reports. Several Governors explained that in California, attorneys are using the issue of elder abuse to threaten physicians with criminal or civil penalties.

  • Nurse educators. The Governors recommended working with the AMA and nursing organizations to support efforts to help relieve the shortage of nurse educators by making those positions competitive with comparable job opportunities.

  • HIPAA. The Governors supported a resolution calling on the Regents to work to ensure that HIPAA confidentiality requirements do not hinder physicians' ability to care for patients unable to identify themselves or to provide consent, particularly during public health emergencies.

  • Tort reform. Several resolutions on tort reform were recommended to be referred for further study. They included calling for alternate systems of medical liability compensation, mechanisms for insuring volunteer physicians and measures to ensure better availability of liability insurance.

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