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

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Regents discuss revitalizing internal medicine, more

ACP leaders look at action on practice hassles, medical student debt and reimbursement for telephone care

From the September ACP Observer, copyright 2003 by the American College of Physicians.

At its July meeting, the Board of Regents addressed an issue that is of concern not only to ACP, but internal medicine as a whole: how to revitalize the specialty.

College leaders took several steps to give internal medicine a boost by not only attracting more medical students, but by enhancing the careers of practicing internists. Along those lines, the Regents approved recommendations addressing topics including medical student debt, physician reimbursement and practice hassles.

The Regents also approved recommendations designed to help reverse health care disparities for racial and ethnic groups, to advocate for pay for care provided over the phone, and to delay a new clinical skills assessment exam for medical students.

Revitalizing internal medicine

The Regents approved two position papers on the revitalization of internal medicine. Together, the two papers propose an ambitious public policy and advocacy agenda to help reverse the decline in the number of medical students choosing internal medicine as a career, and to boost the satisfaction of physicians already in the specialty.

(Internal medicine is not alone in its efforts to boost the morale of its physicians. Groups representing pediatricians, family physicians and ob-gyns are also examining the issue.)

One of the two papers gives an overview of problems in internal medicine and rising educational debt. The paper discusses recent changes in medical practice that are driving students away from internal medicine careers, including growing administrative hassles and regulatory requirements, problems with inconsistent drug formularies, and rising medical school debt.

The second paper approved by the Board addresses physician payment and practice hassles. Recommendations include proposed solutions to problems with reimbursement and the practice environment that are discouraging physicians from entering internal medicine and causing dissatisfaction among internists.

The Regents approved the following recommendations to help revitalize medicine:

  • Payment issues. The Board approved recommendations that call on ACP to advocate for an overhaul of the outdated Medicare benefits package. Changes should include physician reimbursement for preventive and screening services, geriatric assessments and coordinating the care of elderly patients.

    The Regents also approved recommendations stating that codes for new technologies and benefits should not be subject to budget-neutrality adjustments. College leaders agreed that Medicare should not pay for new benefits by draining money used to pay for existing services.

    The Regents also approved recommendations to properly fund the Medicare fee schedule. College leaders called on the government to restore physician payments to 2001 levels, change the formula Medicare uses to calculate physician pay, and restore fees that physicians have already lost because of errors in that formula.

  • Practice hassles. The Regents called on all payers to reduce practice hassles through a broad array of reforms that include the following: paying all "clean" claims within 30 days; requiring a review before downcoding physician services; making coding "edits" available to physicians; and giving physicians easy access to detailed compensation information like fee schedules, capitation arrangements, relative values and conversion factors.

    The Regents also approved a recommendation calling for insurers to maintain a 24-hour service (via telephone or computer) to give physicians information on patient health insurance and benefits. Payers who don't provide around-the-clock information, the Regents said, should have to pay for all services physicians provide when that information is not available—even if the patient's benefits have lapsed.

    To help reduce paperwork, the Regents directed ACP to advocate for standard credentialing and recredentialing forms to be used by all health plans and hospitals. The Regents also called for the creation of other uniform insurer forms to cover patient encounters and formulary requests.

  • Medical school debt. College leaders approved a series of recommendations designed to attract more students to internal medicine by alleviating medical school debt.

    College leaders recommended that ACP work with other groups to expand federal and state assistance, and to advocate for more scholarships, loan forgiveness programs and low-interest loans for programs that require participants to serve in programs like the National Health Services Corps and the U.S. Armed Forces. Efforts should also ensure more streamlined application processes for those programs and loans.

    The Regents also approved a recommendation that calls for the College to create publications that explain the advantages of payback scholarships and loan programs, as well as different options for debt repayment. These publications could be posted on the College's Web site.

Other actions

On issues not directly related to ACP's efforts to revitalize internal medicine, the Regents approved the following recommendations:

  • Telephone care reimbursement. The Board approved a position paper that calls for physicians to be reimbursed for care they provide via the phone. The paper is the second in a series on reimbursing physicians for care that does not occur in a face-to-face setting.

    (The first paper in the series, on computer-based care reimbursement, was approved at the Regents' April meeting. That paper is online.)

    The paper calls for payers to work with physician groups to draw up guidelines for phone care reimbursement. The paper emphasizes that payers should not pay for telephone care by diverting funds currently used to pay physicians for evaluation and management services.

  • Racial and ethnic disparities. The Regents approved a series of recommendations designed to reduce racial and ethnic health care disparities. Those recommendations will help address problems—such as the difficulties different ethnic groups have communicating with physicians—identified in the College's "Racial and Ethnic Disparities in Health Care" position paper approved by the Regents in April. (That paper is online.)

    The new recommendations call for exploring ways in which College chapters can enhance public programs to work with minority communities to prevent chronic disease. The Board also directed the College to review the content of its educational products and meetings to make sure all materials help physicians improve their ability to deliver culturally competent care.

    The College will also consider posting Spanish translations of article descriptions on ACP Online.

  • Clinical skills assessment exam. The Regents called on ACP officials to ask the National Board of Medical Examiners to delay implementing its proposed clinical skills exam until the test's financial impact on medical students can be minimized.

    The test, which is scheduled to become mandatory for graduating medical students in the spring of 2004, costs $995. Because the test is given at only five sites, however, most students will have to spend considerably more on travel expenses. These costs will add to the significant educational debts of most medical students.

    The Regents said the test should be delayed until scientific evidence proves it is valid and beneficial.

  • Lipid management guideline. The Regents approved a new Clinical Efficacy Assessment Project (CEAP) guideline on controlling lipids in type 2 diabetics. The guideline stresses the importance of lowering lipids to prevent cardiovascular morbidity and mortality in patients with the condition. The new guideline has been submitted for publication.

  • Other business. The Board approved a recommendation to accept certification by the American Osteopathic Board of Internal Medicine for internists applying for College membership.

    The Regents also approved re-naming the Annual Session Learning Center The Herbert S. Waxman Learning Center. Dr. Waxman, former Senior Vice President of Education for the College, died earlier this year.

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