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

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Policy briefs

From the July-August ACP Observer, copyright 2004 by the American College of Physicians.

ACP comments on CMS' chronic care pilot programs

Saying that internists are best suited to oversee the care of chronically ill patients, the College has issued recommendations to the Centers for Medicare and Medicaid Services (CMS) on its launch of pilot chronic care improvement programs.

In written testimony sent in May, the College urged the CMS to designate internists as the leaders of pilot care management teams and to give team leaders increased payments for coordinating patient care. In addition, the College said that physician leaders should receive incentives to produce better outcomes and lower costs in chronic care.

The College also noted that the chronic care pilot program requires each participant to oversee as many as 150,000 Medicare beneficiaries, making it impossible for small physician practices to participate in any of the 10 pilot sites. The CMS needs to make sure that practicing physicians "are fully vested in all the care models," the testimony stated, to ensure better outcomes and reduced costs.

The College applauded the CMS for attempting to improve the cost-effectiveness and quality of chronic care. The testimony, which was submitted to the Subcommittee on Health of the House Ways and Means Committee, noted that Medicare patients with five or more chronic conditions represent 20% of the Medicare population, but account for 66% of all Medicare spending.

The College's testimony is online.

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College endorses recommendations to expand physician workforce

The College has voiced its support for several recommendations that would expand the physician workforce over the next 15 years.

The recommendations were included in a report issued last year by the Council on Graduate Medical Education (COGME). In a letter sent to COGME in May, College President Charles K. Francis, FACP, said the College endorsed several of the report's recommendations, including:

  • expanding the number of physicians entering residency training from approximately 24,000 in 2002 to 27,000 in 2015;

  • increasing by 15% the number of students enrolled in U.S. medical schools by 2015;

  • expanding the J-1 visa waiver and Conrad 30 programs to alleviate the workforce shortage in critically underserved areas;

  • increasing the scope of the National Health Service Corps and other programs under Title VII of the Public Health Service Act designed to improve health care access in medically underserved areas; and

  • offering low-interest loans with service obligations to encourage medical graduates to pursue careers in primary care and to serve in shortage areas.

ACP's letter is online.

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ACP supports debt relief for geriatricians in training

The College has lent its support to a Senate bill that would provide debt relief for residents specializing in geriatric care.

The Geriatricians Loan Forgiveness Act of 2004 (S. 2075) would count each year of fellowship training in geriatric medicine or geriatric psychiatry as a year of obligated service under the National Health Service Corps Loan Repayment Program.

In a letter sent in late May to Senate Majority Leader Bill Frist, ACP applauded the effort to encourage physicians to pursue geriatric training by extending loan forgiveness.

The letter noted that by 2030, one-fifth of all Americans will be over age 65, with a growing proportion above age 85. While voicing College support of the bill, Dr. Francis also noted that all internists are trained to care for older patients and that more internists are needed to serve the aging population.

The College's letter is online.

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