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

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Policy Briefs

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

ACP President-elect outlines access problems for legislators

At a recent meeting in Washington, ACP President-elect Charles K. Francis, FACP, said that a problem hurting the health care of minorities—a lack of access to primary care—is showing signs of affecting all Americans.

At the 2003 Congressional Black Caucus (CBC) Annual Legislative Conference on Sept. 25 and 26, Dr. Francis described how the falling number of primary care physicians is hurting American health care. He explained that these trends are being exacerbated by several factors, including the reduced number of medical students matching to primary care careers. In addition, the number of Americans without access is starting to climb again after dropping slightly over the last several years.

To highlight potential solutions, Dr. Francis detailed ACP's seven-year plan, which aims to make health insurance available to all Americans by the end of the decade by expanding choices, competition and financial incentives for small employers, insurers and individuals. More on ACP's seven-year plan is online.

Dr. Francis also described the College's position paper on eliminating racial disparities in health care that, in part, calls for a diverse health care workforce to address the needs of minorities. ACP's paper on racial disparities is online.

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College calls for an end to mandatory hospitalist policies

ACP has asked a national insurance group to oppose the practice of some health plans to require inpatient care to be overseen by a hospitalist.

In an Oct. 3 letter to the National Association of Insurance Commissioners, the College said that such a requirement can hurt quality and continuity of care, as a patient's longtime provider is most familiar with a patient's medical history and needs.

ACP said that patients must have the right to select the physician they believe is best suited to oversee their care. The College also said that all physicians charged with the responsibility of overseeing and managing inpatient care should be paid on an equal basis, regardless of whether patients elect to use their own physician or a hospitalist.

The letter is online.

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ACP expresses concern about final rule on emergency medical care

While recent revisions to the Emergency Medical Treatment and Labor Act (EMTALA) clear up some confusion about the rules regulating emergency care, the College is concerned that relaxed requirements for on-call specialists may reduce the number of physicians available to see patients.

In an Oct. 1 letter to the Centers for Medicare and Medicaid Services (CMS), ACP said that the final EMTALA rule, which was published on Sept. 9, addresses the roles and responsibilities of hospitals and on-call physicians involved in treating emergency cases.

The letter, however, expressed concern that the final rule's relaxation of requirements for specialist physicians may threaten timely access to emergency care by depleting the ranks of specialists available to treat emergency patients. That situation, the letter said, could be most serious in rural areas that already suffer from a shortage of specialists, forcing internists to handle emergencies for which they have not been trained.

The letter is online.

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College urges Medicare to pay physicians' costs of administering drugs

ACP is calling on the government to make sure that physician reimbursement for Medicare drugs doesn't suffer under a new proposal to recalculate how the federal program pays for drugs administered by physicians.

In a Sept. 30 letter to the Centers for Medicare and Medicaid Services, the College urged the government to address several proposals to revamp Medicare drug reimbursements. Medicare currently pays some physicians more than their purchase costs for drugs. The College pointed out that physicians use this difference to pay for the costs of storing, preparing and administering those drugs.

The College urged Medicare to make sure that revised drug payments cover physicians' costs of purchasing drugs. It also said that any reduction in payments for the drugs themselves must be accompanied by increases in what Medicare pays physicians to administer these drugs. ACP also said that increases in payments for administering drugs should not trigger cuts in other Medicare services.

The letter is online.

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College asks for oversight on Rx data sales, deceptive practices of some DME suppliers

In an Oct. 6 letter to the Office of Inspector General (OIG), ACP outlined problems with the sale of physician prescribing information and with deceptive practices in the area of durable medical equipment.

The College expressed concern about drug makers who financially entice pharmacists to sell information about physicians' prescribing habits. Drug makers can use this information to tailor how they market their drugs to physicians.

The College urged the OIG to investigate and identify abuses related to the sale of physician-specific prescribing information, and to promulgate regulations that will protect the confidentiality of this information.

The College also voiced concern about the deceptive marketing practices employed by some suppliers of Medicare durable medical equipment (DME).

To limit abuses by DME suppliers, ACP urged the OIG to require DME suppliers to include explicit Medicare guidelines for coverage and to monitor advertising to make sure it meets those requirements.

The College's letter is online.

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