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

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Chronic care, performance measures, top BOR agenda

From the December ACP Observer, copyright © 2004 by the American College of Physicians.

By Janet Colwell

At its October meeting, ACP's Board of Regents took several actions on key issues for internists. The Regents approved a policy paper that details a comprehensive, physician-led model of chronic care, as well as a new clinical guideline for treating patients who are obese.

They also considered a framework for determining upcoming College recommendations on performance measures, approved a new ACP marketing plan and voted for a resolution that calls for more regulation of herbal supplements.

Chronic care

The Board approved a policy paper that presents a far-reaching model of chronic care. That model relies on chronic care teams led by physicians who, the paper states, should receive financial incentives and case management fees for improved quality, outcomes and patient satisfaction.

Noting that current care for the chronically ill is fragmented and costly, the paper recommends that physicians have access to health information technology and point-of-care decision-support tools as essential elements of providing chronic care.

Among other recommendations, the paper calls for large-scale testing of a patient-centered, physician-guided chronic care model.

The paper also states that ACP is advocating for incentives to encourage physicians to adopt electronic tools to be used in chronic care management. A link to the new policy paper is online.

Performance measures

Kevin B. Weiss, FACP, Chair of the College's Performance Measures Subcommittee, presented an update on performance measures that will serve as a framework for the College to prepare formal recommendations on those measures.

There is an urgent need for uniform measures, said Dr. Weiss, to replace the many performance reporting systems being devised by different health plans and purchasers. Conflicting measures for the same overall standard of care create confusion among the public and hassles for physicians, who may have to juggle several different insurer programs that are tied to different payment scales.

Dr. Weiss laid out the principles that will inform College decisions on measure recommendations. Those principles include the following:

  • There is an urgent need for uniform measures.

  • The medical community must move forward to demonstrate progress on performance measure standardization within a relatively short time frame.

  • Quality measures must demonstrate the basis of evidence for their scientific validity.

  • Once implemented, performance measures need to be continuously reviewed to determine their intended and unintended consequences.

An important focus of the subcommittee's efforts is that it will consider only measures for ambulatory care.

To identify priority conditions for performance measures, the subcommittee will use the Institute of Medicine's list of priority areas. Once the subcommittee has consensus on priority conditions, it will see which measures for those conditions are reported in the National Quality Measures Clearinghouse (NQMC).

After reviewing the NQMC measures, subcommittee members will then see if the AMA Physician Consortium for Performance Improvement has developed measures for those conditions.

Finally, the subcommittee will check to see what measures for those conditions have been vetted by the National Quality Forum, the national body responsible for assessing performance measures for uniform use.

The subcommittee will assess for possible recommendation only those measures that have been reported, developed and vetted by all of the other three organizations.

At their fall meeting, the Regents also took the following actions:

  • Obesity guideline. The Regents approved a new Clinical Efficacy Assessment Subcommittee guideline on the pharmacological and surgical management of obesity. The guideline has been submitted for publication.

  • Obesity coverage. The Board approved a resolution supporting a government study on how individual payment vs. insurance coverage influences the effectiveness of weight loss treatment programs. If such studies show that coverage is cost effective, the resolution states that the Regents will advocate for insurance coverage of obesity treatment.

  • Revitalization initiative. The Board approved a communications plan aimed at communicating the value of internal medicine.

    The objectives of the plan include increasing medical student interest in internal medicine careers; increasing patient preference for internists; increasing the demand for internists among physician employers; and conveying the impact of a shortage of general internists on an aging U.S. population.

  • Herbal supplements. The Regents passed a resolution to work with the AMA to support placing warning labels on over-the-counter herbal supplements that are known to have potentially harmful side effects.

    The Regents also support initiating an information program to educate physicians and the public about the health risks of some supplements and calling for testing programs to ensure supplement safety.

  • VA prescription coverage. The Board approved a resolution calling for the College to advocate for legislative and regulatory changes to allow non-Veterans Affairs (VA) physicians to write prescriptions that will be filled for eligible patients at VA facilities.

  • Malpractice surcharges. The Regents voted to monitor whether there is a problem of liability insurer surcharges being imposed on physicians who have privileges at hospitals that serve under- and uninsured patients.

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