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From the April ACP Observer, copyright © 2005 by the American College of Physicians.

ACP holds Hill briefing on physician payment system

College officials held a briefing on Capitol Hill to present the steps needed to improve the dysfunctional physician payment system and improve the physician-patient relationship.


At a Capitol Hill briefing, College President Charles K. Francis (left) joins other College leaders to discuss problems with current Medicare payment policies.



"Current Medicare payment policies favor episodic treatment of patients with acute illnesses," said College President Charles K. Francis, FACP, "rather than supporting the physician's roles as the patient advocate and coordinator of quality care of patients with chronic diseases."

Dr. Francis, addressing a group of reporters and Hill staffers in the Rayburn House office building in mid-March, also pointed out that payment policies do not encourage use of electronic medical records, evidence-based clinical performance measures and other innovative models of practice innovations intended to improve the effectiveness of physicians' interactions with patients.

ACP called on Congress and the administration to create incentives for physician practice innovation and improvement. Such innovations would include use of electronic medical records and other health information technology to support evidence-based practice improvement; incorporation of clinical decision-support tools at the point of care; and new practice models to improve coordination of care of patients with chronic diseases.

ACP asked Congress to expand existing pilot programs testing new forms of physician payment. The existing programs do not encompass enough physician practices nor give physicians a big enough role in managing treatment for patients who are chronically ill.

More on briefing comments is online.

ACP issues recommendations on retiree drug benefits

Saying that retirees should not lose employer-based drug benefits, the College recently released a monograph with recommendations on retiree drug benefits as they relate to new Medicare reform legislation passed in 2003. The law creates a Medicare prescription benefit that takes effect in 2006.

According to the monograph, employers have been reducing prescription coverage for retirees for several years. The percentage of retirees covered by employer-based prescription benefits has dropped from 66% to 38% between 1988 and 2003.

The College monograph included the following recommendations for the federal government:

  • Monitor the employer subsidy included in the new benefit that would support employer-sponsored benefits. That monitoring should be used to determine whether employers are reducing or dropping coverage.

  • Create a safety net for retirees and employees who lose employer-based coverage.

  • Ensure that employers who receive subsidies for retirees under the new law do not use those funds to pay for coverage for existing employees.

The College monograph can be found online.

College, others, ask for increased QIO funding

The leaders of 10 national medical associations and health care organizations, including ACP, have asked the federal Office of Management and Budget to fund Medicare quality improvement organizations (QIOs) at the level requested by the HHS.

In a letter sent Feb. 25, signatories said they supported Medicare's current plans to increase QIO efforts. They also said they concurred with the initial request made by HHS for an estimated $2 billion to fund QIO efforts between mid-2005 and mid-2008. The letter noted, however, that the $2 billion request has since been scaled back in fiscal budget negotiations.

The $2 billion funding level, the signatories said, would represent a significant down payment on the country's health care quality infrastructure. However, the letter pointed out that the scaled-back amount, which has not been made public, was not enough to adequately fund needed QIO efforts.

The letter was signed by John Tooker, FACP, the College's Executive Vice President, as well as by leaders of the American Academy of Family Physicians, the American Health Quality Association and the National Rural Health Association, among others.

The letter is online.

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