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Policy briefs

From the January-February ACP Observer, copyright 2006 by the American College of Physicians.

ACP Associate presents perspective of young physicians in Congress

Vineet Arora, ACP Associate Member, told federal legislators in November that Congress must act to stabilize Medicare physician payments to avert a looming crisis in primary care.


Dr. Arora



Dr. Arora, who is Chair of ACP's Council of Associates and a member of the College's Board of Regents, testified on the impact that scheduled payment cuts would have had on her career decisions as a young physician. She told the House Energy and Commerce Committee's subcommittee on health that medical students and young physicians are turning away from primary care careers.

"In my own program, I was one of only two of our nearly 30 graduating residents who did not enter a subspecialty training program," said Dr. Arora. Medical students and young physicians, she added, learn early on in their training "that primary care is under-reimbursed compared to other specialties, and that many primary care physicians are struggling financially."

Because of reimbursement issues, she said, attending physicians in training programs often counsel residents not to go into primary care. Dr. Arora told subcommittee members that the Medicare Economic Index estimates that physician costs will rise by 15% between 2006 and 2011.

Dr. Arora also cited data from the Centers for Medicare and Medicaid Services showing that almost half of all Medicare office visit expenditures in 2004 were for services provided by primary care physicians. She said there is growing evidence that shortages are developing among U.S. physicians, particularly in general internal medicine and family practice, at a time when aging baby boomers will increasingly need health care services.

Dr. Arora's testimony is online.

College releases sweeping pay-for-performance guidelines

ACP has issued comprehensive recommendations that would support a fair and transparent pay-for-performance system within both the public and private sectors.

Released last month, the 34-page "Linking Physician Payments to Quality Care" position paper outlines detailed guidance for developing and implementing pay-for-performance programs. The recommendations include:

  • replacing the current physician payment system with new reimbursement methods that reward physicians using evidence-based standards of care. Financial incentives for physicians should be broad enough to encourage quality improvement efforts, the policy states. Incentives should also reward both high performers and those who achieve substantial improvements over time.

  • making sure rewards reflect physicians' quality improvement efforts, which will inevitably differ among physicians across and within medical specialties.

  • basing pay-for-performance systems on valid, reliable clinical measures, data collection and analysis, and reporting mechanisms.

  • recognizing that information technology capabilities, such as electronic health records (EHRs) and decision-support tools, can boost internists' performance on quality measures and enable them to report their progress.

In a press release, College President C. Anderson Hedberg, FACP, noted that Congress would have to restructure Medicare payment policies to support quality improvement as a necessary first step before moving to a pay-for-performance system.

The paper is online.

The ACP press release is also online.

ACP issues recommendations on drug importation

In a newly released monograph, the College has outlined its support for drug importation to relieve the high cost of prescription drugs in the U.S.—as long as the quality and safety of imported drugs can be maintained.

To safeguard drug quality and safety, the College recommends that Congress take several actions before legalizing importation, which include permitting state pilot programs to test the safe implementation of importation programs and creating an independent oversight board within the Food and Drug Administration to handle drug safety issues.

The recommendations also state that importation systems should honor only prescriptions written by a U.S. licensed physician; include tight control and documentation requirements; and be restricted to countries with high assured safety standards. ACP also recommended that certain medications should not be imported, including controlled substances and drugs that have strict temperature requirements.

The monograph also states that drug importation should be only a temporary solution to counter high drug prices. Other solutions, the College said, should include allowing Medicare to negotiate volume discounts with drug companies.

The policy monograph is online.

College comments on payment rules for power mobility devices

ACP has asked the Centers for Medicare and Medicaid Services (CMS) to clarify the type of information physicians must submit to be reimbursed for prescribing power mobility devices.

In the Nov. 25 letter to CMS administrator Mark B. McClellan, FACP, the College said that some of the information the CMS is asking doctors to submit is readily available in physicians' offices. Submitting other required information, however—such as proving that the patient lives in a place where the device can operate—would create an "administrative burden" for physicians, the letter said.

The College also recommended that the CMS work with specialty organizations to create a form listing all the information the agency needs to reimburse physicians for prescribing power mobility devices.

ACP also asked the agency to clear up a data discrepancy. While the CMS estimates that physicians will annually prescribe 187,000 mobility devices, the agency's records indicate that Medicare paid for more than 8 million general wheelchair prescriptions in 2004. The College asked the CMS to explain how projected power mobility device figures relate to that claims data.

The letter is online.

For more information, see "Medicare ramps up coverage of power mobility devices" in the November 2005 ACP Observer.

ACP urges broader "safe harbors" for information technology

The College has asked the Centers for Medicare and Medicaid Services (CMS) to significantly expand a proposed safe harbor rule for electronic prescribing and electronic health records (EHRs). While the proposed rule would establish new safe harbors under federal anti-kickback statutes, ACP said the rule does not provide enough options to facilitate widespread technology adoption.

The CMS has proposed that physicians be allowed to accept information technology donations from specified donors, including large group practices and hospitals. In letters sent Dec. 12 to the CMS and the HHS' Office of Inspector General, ACP urged the CMS to adopt the following recommendations:

  • Modify the CMS requirement that hospitals can donate equipment only to physicians on their medical staff. Donors should be allowed to donate technology to all members of a group practice, ACP said, not just those with admitting privileges. Similarly, group practices should be able to donate technology to independent contractors who are not physicians.

  • Extend the proposed safe harbor to include other categories of donors and recipients, such as nursing homes and community health centers, as well as physician-hospital organizations and regional health information organizations.

  • Expand the types of technology that can be donated to include any equipment, license, software or training service used to develop or facilitate the adoption of information technology.

  • Remove provisions that limit the aggregate fair market value of all donated items and services. Setting any per-physician cap or limit, the College said, would stifle technology implementation.

The College also said that Congress should significantly increase financial incentives for physicians to offset the costs of implementing information technology. Those incentives could take the form of grants, loans, tax credits or Medicare payment add-ons for physicians using technology in their practice.

The letter to the CMS is online.

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