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College warns of looming collapse of nation's primary care

ACP leaders issue sweeping recommendations to safeguard primary care and boost physician workforce numbers

From the March ACP Observer, copyright © 2006 by the American College of Physicians.

In a widely covered national press briefing, ACP leaders proposed far-reaching reforms to resolve what they described as an ongoing crisis within the nation's primary health care system.

In its annual "State of the Nation's Health Care" report, the College said "immediate and comprehensive" reforms were needed to fundamentally change the way primary care is organized, financed and valued.

"ACP has developed a comprehensive plan of action to reverse the downward trend in primary care medicine before it is too late," said ACP President C. Anderson Hedberg, FACP, speaking to reporters.


College President C. Anderson Hedberg, FACP (right), and Council of Associates' Chair Vineet Arora, ACP Member, take questions from reporters at ACP's 'State of the Nation's Health Care' briefing.



According to data presented at the briefing, the country faces a looming workforce shortage being fueled by a dysfunctional payment system and lack of primary care incentives. Without such incentives, young physicians will continue to opt out of primary care careers, according to Vineet Arora, ACP Member, Chair of ACP's Council of Associates.

"If these reforms do not take place, within a few years there will not be enough primary care physicians to take care of an aging population," Dr. Arora said. "The consequences of failing to act will be higher costs, greater inefficiency, lower quality, more uninsured persons, and growing patient and physician dissatisfaction."

Needed reforms

College leaders outlined four recommendations to help avert the collapse of primary care:

  • Establish an "advanced medical home" model. This new practice model would provide for comprehensive care coordinated by a personal physician, working in a practice that uses information technology and other innovations to ensure high quality and access. Practices certified as advanced medical homes would also be eligible for new reimbursement mechanisms to fully compensate them for the enhanced value of services provided to patients.

    Such a model would particularly benefit patients with multiple chronic diseases. According to the ACP report, 60 million Americans already have multiple chronic conditions. Within 10 years, an estimated 150 million Americans will have at least one chronic illness. (For more, see "ACP Regents approve new 'medical home' care model.")

  • Create new relative values for primary care. Currently, the process used to establish relative values under-values primary care office visits and other evaluation and management services, while over-valuing many technological and procedural services. Those values need to be recalibrated to recognize the time physicians spend outside face-to-face office visits in care coordination. Policy-makers also need to reimburse for e-mail and telephone consults.

  • Offer pay-for-performance incentives. Reforms need to include incentives to reward physicians who participate in pay-for-performance practice innovations. According to the report, such reforms should be non-punitive, so that physicians who choose not to participate do not get negative updates. At the same time, incentives need to be sufficient to encourage information technology investment and office redesign innovations.

  • Replace the sustainable growth rate formula (SGR). While the College fought hard to get Congress to end the 4.4% pay cut and reinstate 2005 physician payment levels for Medicare claims, ACP leaders renewed their call to replace the SGR with a more reasonable alternative to provide predictable and fair payment updates.

Enacting such reforms is the only way to stop many established physicians from "finding an 'exit strategy' from primary care," Robert B. Doherty, ACP's Senior Vice President for Governmental Affairs and Public Policy, said at the briefing. "We have clear evidence that the availability of primary care is directly associated with better care at a lower cost. Restoring the value of primary care is the best cure for an ailing health care system."

News items on the ACP report included articles in the Wall Street Journal, the Boston Globe and the Washington Post, and broadcast coverage on CNN as well as on television and radio news in several major metropolitan areas.

More information on the briefing is online. College members are also urged to sign up as a Key Contact to get regular updates on College advocacy efforts and to learn how they can help.

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