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

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Policy Briefs

From the January/February ACP Observer, copyright 2004 by the American College of Physicians.

ACP says interpreter guidelines still too onerous for physicians

While ACP appreciates changes to regulations requiring physicians to provide services to patients who do not speak English proficiently, the requirements still threaten to hurt physician practices—and force some to stop participating in Medicare and Medicaid.

In a Dec. 5 letter to HHS, the College said that it supports efforts to make sure that patients with limited proficiency in English do not receive inadequate care and services because of communication barriers they face.

Recent guidelines from HHS say that health care organizations can take into account costs and resources when determining exactly what they must do to care for patients who don't speak English. In revising existing rules, the new guidance said that small health care entities with limited budgets—like office practices—are not expected to provide the same level of language services as larger organizations.

Despite that flexibility, the College is concerned that physician practices will be financially burdened by requirements to help non-English speaking patients. ACP said it is also concerned that because the guidelines require physicians to take measures to ensure the competency and suitability of interpreters, they will have less time to devote to patient care.

The College called on Medicare and Medicaid to pay for interpreter services and ease the administrative burden of the requirements.

ACP's letter is online.

ACP criticizes report on incorrect payment rates as "preliminary"

The College criticized the release of a recent report on the rate of improper Medicare payments for 2003, saying the data are preliminary and not ready for publication.

In mid-November, the Centers for Medicare and Medicaid Services (CMS) published a press release announcing the rate of incorrect payments for 2003.

In a Dec. 3 letter to Thomas Scully, CMS administrator, the College said the agency should have waited until the report was finalized before releasing data on the rate of improper payments. (The full report was expected in late December.) ACP said that the report that contains those findings does not explain its methodology or expand on aggregate figures.

For example, ACP speculated that the report may inappropriately include claims for evaluation and management services that were determined to be one level too high or too low.

In its letter, the College said that such a determination does not necessarily indicate that an improper payment was made.

The College also said the CMS should acknowledge claims that were actually underpaid and offset the error rate by that number of claims.

ACP's letter is online.

Needed: standards to guide pharmacists on therapeutic substitutions

ACP recently led a group of organizations calling for standards to guide pharmacists who educate physicians and patients about drug alternatives.

In a Nov. 20 letter to six organizations that represent pharmacists, ACP joined eight other organizations in calling for guidelines to help pharmacists decide when a therapeutic substitution is appropriate.

The letter said that such standards should call for pharmacists to contact and secure the prior consent of local physicians when offering such information to patients.

The College's Board of Governors and Board of Regents addressed the topic of unsolicited drug substitutions in a resolution in the fall of 2002. That resolution guided ACP's action on the issue.

The College's letter is online.

College lab testing service wins five-year government contract

The College's Medical Lab Evaluation (MLE) program recently won a five-year contract to test the proficiency of medical labs throughout the U.S. government.

The contract, which was awarded by the General Services Administration, puts the MLE on the list of approved vendors, making it easy for any government entity to use the program's proficiency testing services. Government labs may now use MLE services without going through a lengthy bidding process.

The MLE provides proficiency testing for medical labs in physicians' offices, hospitals and health care systems around the world. Such testing is one of the standards of competency that regulatory inspectors use when examining labs.

The MLE program began in 1973 as part of a collaboration between the American Society of Internal Medicine and the College of American Pathologists.

More information about the MLE service is online.

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