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Business, quality issues dominate Governors' meeting

Leaders debate ways to boost physician payments, redesign primary care practices and retool audit procedures

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

PROVIDENCE, R.I—Challenges facing the business of medicine—including reimbursement issues and new payment models—topped the agenda at the Board of Governors' fall meeting. Governors debated different innovations in practice design to help improve patient care and secure better reimbursement.

They also approved a full slate of policy recommendations that has been passed onto the Board of Regents for consideration. Those resolutions ranged from alternative payment methods for comprehensive care to subsidizing chapter activities geared toward medical student and Associate members.

Quality improvement

Elliott S. Fisher, MD, a professor of community and family medicine at Dartmouth Medical School in Hanover, N.H., spoke to the Governors about his research findings on regional quality variations found across the country.

"The more money that is spent, the worse the care," Dr. Fisher said. "As per capita spending goes up, the quality of the care goes down."

Quality improvement was also an issue addressed by Charles M. Kilo, FACP, the chief executive officer of GreenField Health in Portland, Ore.

Dr. Kilo spoke about the need to retool the health care system, from how physicians are paid to how patients are treated. However, he underscored what he said is the biggest problem facing medicine today: the American public can't agree on what health care in this country should cost.

"Without that [agreement], it's difficult to move forward" to implement information technology and redesign physician practices, he said. "Cost is the big elephant in the room."

Physician reimbursement

The Governors approved two resolutions directly related to physician reimbursement. The first asks Regents to develop policy to help internists achieve appropriate reimbursement for complex and ongoing medical care. The Governors' resolution covers all medical care, not just for specific chronic care conditions.

The second resolution urges Regents to explore a retainer model as well as alternative payment models where insurers would pay physicians for comprehensive primary care services. According to Allan H. Goroll, FACP, the Governor for the Massachusetts Chapter, which sponsored the approved resolution, "We are asking the College to look at fundamental reform."

Other approved resolutions include:

  • Claims audits. The Governors passed a resolution related to claims audits. The recommendation asks the Regents to work with the Centers for Medicare and Medicaid Services and other stakeholders to ensure that all insurers seek out and report underpayments with the same incentives as audits for incorrect payment.

    The recommendation also would allow physicians notified of underpayment to have the same amount of time to apply for reconsideration as with any other form of claims appeal.

  • Disaster relief. The Governors approved two measures prompted by Hurricane Katrina. The first urges Regents to appoint a task force to explore ways to help ACP members volunteer for disaster relief. The second calls on Regents to waive College dues for an unspecified period of time for ACP members affected by a national disaster.

  • Medical student and resident activities. One recommendation passed by the Governors asks Regents to encourage ACP chapters to include student activities at their scientific meetings, while another called for developing medical student member categories at chapters' abstract competitions.

    A third recommendation urges Regents to increase subsidies for chapter activities that support and engage medical student and Associate members. The Governors also approved a resolution asking the College to encourage chapters to schedule regional chief residents' meetings.

  • Drug marketing. The Governors approved two recommendations related to pharmaceutical promotions. One asks Regents to develop policy regarding the ethical role of drug companies that don't test drugs alone or don't market those as standalone drugs. The other recommendation calls on Regents to support strengthening existing Food and Drug Administration regulations on direct-to-consumer advertising.

  • College dues. The Governors approved two resolutions dealing with national and chapter dues. The first asks Regents to eliminate the automatic dues reduction when members reach age 65. Retired members over age 60, the recommendation states, could request "emeritus" status and not pay national dues in return for not receiving College publications. Alternatively, they could pay a nominal dues rate to include publications.

    The second recommendation urges Regents to approve mandatory membership dues at the national and chapter levels.

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