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

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Regents recommend ways to avert primary care 'collapse’

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

By Christine Bahls

PHILADELPHIA—In its ongoing efforts to help guide key health care reforms, the Board of Regents at its April meeting approved several position papers targeting physician workforce, payment and care delivery issues. In approving the new ACP position papers, the Regents noted that widespread reforms are needed to turn around growing challenges to the delivery of primary care, and to reverse a growing exodus of primary care physicians.


Regent Richard L. Neubauer, FACP, endorses sweeping payment reforms.



In discussing paper details, College staff said they deliberately chose the word “collapse” to characterize the magnitude of problems facing primary care. Regent Richard L. Neubauer, FACP, commented that "the use of the word ‘collapse’ was brilliant”—and apt.

Here’s a look at papers the Board approved:

  • Payment reform. The approved paper calls for the overhaul of the current payment system and recommends that the Centers for Medicare and Medicaid Services increase relative value units (RVUs) for evaluation and management services. The paper also recommends that Medicare pay physicians for coordinating and managing complex care, as well as for e-mail and telephone patient encounters. The paper also states that Medicare should provide add-on payments for care facilitated through the use of information technology.

    The Regents discussed the fact that more equitable payment would go a long way to solving many of the problems in primary care. "We hear over and over,” said Regent Joseph W. Stubbs, FACP, who chairs the Medical Service Committee, “that for primary care physicians, the problem is one of payment."

  • Internal medicine workforce. The approved paper on creating a new national workforce for internal medicine contained several recommendations, including changing medical education to expose medical students and residents to well-functioning office-based primary care practices and providing relief from high levels of student debt. The paper emphasizes that action is needed to reverse the impending collapse of primary care medicine, and calls for increasing the number of physicians trained in internal medicine prepared to practice in new care models.

The Board also took action on a number of other issues. Those included:

  • Influenza pandemic. The Board approved a position paper outlining ACP recommendations to prepare for an influenza pandemic. The approved policy states that primary care physicians should play a key role in developing strategies for addressing a pandemic or other public health crises. The policy also calls for local providers to have access to two-way communications with public health authorities and to information technology, and endorses the stockpiling of vaccine and antiviral medications.

  • Venous thromboembolism guidelines. The Regents approved new Clinical Efficacy Assessment Project guidelines on the diagnosis and management of venous thromboembolism in primary care. The guidelines, which were developed jointly by ACP and the American Academy of Family Physicians, have been submitted for publication.

  • Health courts in malpractice cases. The Regents approved a policy to support the use of demonstration projects to determine the effectiveness of health courts in adjudicating medical liability cases. The paper stressed that such alternative resolution methods were not a substitute for needed comprehensive tort reform.

  • Direct-to-consumer (DTC) ad regulations. The Board voted for a policy paper stating that DTC advertising is "an inappropriate practice" that adversely affects the physician-patient relationship. The policy calls on the federal government to strengthen DTC advertising regulations by, among other provisions, enacting a two-year moratorium on DTC ads for newly approved drugs.

  • Personal health records (PHRs). The Regents approved new policy regarding the use of PHRs. ACP supports the use of PHRs as a mechanism to create patient-centric repositories of clinical information—as long as the information contained in the PHRs remains secure and adheres to current privacy and security standards. The policy recommends features that should be included in PHRs and spells out physician responsibilities. It also states that physicians should be paid for time spent creating, updating and reviewing a PHR.

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