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Regents endorse new performance measures, more

ACP leaders also agree to redefine internists' role and find ways to ensure that EHRs are cost-effective

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

By Janet Colwell

At its July meeting, the Board of Regents endorsed a set of ambulatory clinical performance measures that College leaders hope will boost quality improvement efforts and lead to nationwide, uniform performance measurement standards.

The Regents also approved several resolutions geared to making sure health care information technology options are affordable and cost-effective. The Board also passed measures designed to boost physicians' compensation for cognitive services, as well as a new guideline on hereditary hemochromatosis.

Measuring performance

The set of 26 performance measures endorsed by the Regents were selected earlier this year by the Ambulatory Care Quality Alliance (AQA), a consortium of leading medical organizations, quality groups, employers and health plans. ACP is a founding member of the AQA.

The endorsed set includes prevention measures for cancer screening and vaccinations, as well as measures related to chronic conditions, including coronary artery disease, heart failure, diabetes, asthma and depression. The set of measures may be incorporated into health plan pay-for-performance programs by the beginning of next year. (The set of measures is online.)

Criteria used to select the measures included clinical importance, scientific validity, and relevance to physicians, consumers and purchasers. Most of the measures were also approved in August by the National Quality Forum, a nonprofit public-private partnership dedicated to developing a national strategy for health care quality measurement and reporting.

The Board also heard that, starting this month, ACP will start posting online resources to keep College members abreast of quality improvement and pay-for-performance initiatives. This new section of the ACP Web site will include comprehensive information on quality initiatives, updates on the AQA process, and detailed descriptions of approved and proposed performance measures. The online resource will also give physicians practical tips and tools to implement measures, such as information on setting up a patient registry.

The Regents also discussed taking quality improvement information directly to College members at chapter meetings. Later this month, Board members will address attendees of the Wisconsin and Kansas chapter meetings, while other Board members will visit other chapters in the coming months.

In other actions, the Regents approved the following items:

  • Increased cognitive services compensation. The Board approved a resolution that calls for working to increase physician compensation for cognitive services, a recommendation originally approved by the Board of Governors. The Regents agreed to explore changes to the current payment system and to make recommendations to the Centers for Medicare and Medicaid Services (CMS).

    This new policy is in addition to current College activities, in which the College has asked the CMS to review undervalued evaluation and management services. ACP has also launched several initiatives to urge Congress to fix the current payment system by replacing the flawed sustainable growth rate.

  • Electronic health records (EHRs). The Regents passed several recommendations to help physicians achieve cost effective EHR adoption and use. Approved policies include seeking cost data on using EHRs in different types of practices and working with the AMA and other groups to secure financial support for physicians who install and use electronic systems.

    The Regents also approved asking Medicare to fund research projects aimed at developing EHR standards to satisfy pay-for-performance data collection requirements.

  • Medicare audit charges. The Board adopted policy designed to ensure fair, objective and scientifically sound audits of Medicare charges. The approved recommendation calls for working with the CMS and other third-party payers to make sure that the auditors are board-certified physicians who actually practice the specialty under review. This recommendation was originally approved by the Board of Governors.

    The policy also commits ACP to working to guarantee a clear-cut appeals process, with audit reviewers' compensation based on actual time and effort spent instead of on contingency fees.

  • Hereditary hemochromatosis guideline. The Regents approved a new Clinical Efficacy Assessment Project screening guideline for hereditary hemochromatosis. The guideline has been submitted for publication.

  • The internist's role. The Board approved a revised definition of the role of the general internist. The new definition stresses the internist's role in managing the care of chronically ill patients who have one or more complex illnesses. The updated definition also emphasizes the importance of using health information technology, practicing evidence-based medicine and expanding physicians' medical knowledge base through administration, research and teaching.

  • New Young Physician representative. The Regents passed a resolution adding a representative from the Council of Young Physicians to ACP's Strategic Planning Committee. That committee, which consists of College leaders and staff, sets the College's strategic objectives.

  • Increased Chapter support. The Board approved a resolution to broaden ACP support for College chapters. In 2006-07, this additional help will fund a chapter liaison position on the College's chapter activities staff; restore the chapter development fund and Laureate brochures; and increase support for medical student interest groups. The changes are designed to give ACP Governors more support in implementing national initiatives at the local level.

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