American College of Physicians: Internal Medicine — Doctors for Adults ®

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ACP Regents approve new 'medical home' care model

Regents also weigh in on disaster relief resources for College members and practice tools for geriatric patients

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

A far-reaching new model of patient care was the subject of a new position paper approved by the Board of Regents at its January meeting.

The new policy calls for linking patients with a personal physician and for a new national reimbursement model to pay physicians for coordinating patient care. The Regents also approved a new disaster-response system to help College members affected by a disaster or emergency, as well as new guidelines on reducing perioperative pulmonary complications.

Care, payment reform

ACP's "Advanced Medical Home" position paper envisions a partnership between physicians and patients, where doctors would help patients navigate the health care system instead of acting as gatekeepers.

In this model, patients will have a personal physician working with a team of health care professionals in a practice that is organized according to advanced medical home principles. For most patients, the personal physician would be a primary care physician. However, that physician could be a specialist or subspecialist for patients requiring ongoing care for certain conditions, including severe asthma, complex diabetes, complicated cardiovascular disease, rheumatologic disorders and malignancies.

The paper strongly advocates for changes in training policies to ensure an adequate supply of primary care physicians. It also calls for national pilot testing of the model. Other model features include:

  • using evidence-based medicine and point-of-care clinical-decision support tools.
  • following the principles of the chronic care model as promulgated by the Group Health Cooperative's MacColl Institute for Healthcare Innovation in Seattle.
  • using telephone, e-mail and other communication vehicles in addition to office visits.
  • measuring quality indicators to gauge improvements in care.
  • using technology to promote safety, security and information exchange.
  • participating in programs that give feedback on performance.

According to the new policy, physician practices that qualify as advanced medical homes could participate in a revised reimbursement model. College staff is now working on a follow-up paper that will propose specific mechanisms for implementing a new payment system.

The new policy also calls on the Centers for Medicare and Medicaid Services (CMS) to conduct a national pilot program in primary care offices next year to determine the feasibility, cost-effectiveness and impact on patient care of the advanced medical home concept.

The pilot program would help determine how practices would qualify as advanced medical homes and would test different payment options. The approved position paper is online.

Geriatric management

The Regents also heard about a new College collaboration with the RAND Corp. and the University of Rochester in Rochester, N.Y., to develop a practice model for treating geriatric conditions. The three-year, $2 million project is funded by a grant from The Atlantic Philanthropies, an international foundation that is dedicated to bringing about lasting changes in the lives of disadvantaged and vulnerable people.

The project aims to help internists redesign their practices to improve their management of falls, urinary incontinence and heart failure. The project team is now working to identify five active and five control physician practices to participate in a redesign pilot program. (For more information, see "Practices wanted for geriatric redesign pilot.")

Other items approved included:

  • Disaster-response resources. The Board approved new disaster-response policy guidelines to enable ACP to respond more quickly to members' needs in a disaster or emergency. The College has established an internal disaster work group to ensure that needed resources reach affected College members as quickly as possible via e-mail and ACP Online, the College Web site. As part of those resources, the College would assist members interested in volunteering and would also encourage them on how to become certified by disaster response agencies.

  • Training redesign. The Regents approved the second position paper on redesigning internal medicine training. The paper has been submitted for publication.

  • Perioperative guidelines. The Board approved revised Clinical Efficacy Assessment Project guidelines on risk assessment and strategies to reduce perioperative pulmonary complications. The guidelines have been submitted for publication.

  • Chronic kidney disease. The Regents voted to urge the Centers for Disease Control and Prevention to add chronic kidney disease to its list of priority chronic diseases. The recommendation recognizes the importance of interventions to slow the progression of kidney disease, which affects an estimated 20 million Americans and is a key risk factor for cardiovascular disease.

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