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Physician payment issues top Regents' summer meeting agenda

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

By Jennifer Kearney-Strouse

At its July meeting, the Board of Regents approved actions dealing with physician payment and reimbursement, along with a resolution concerning support of teaching faculty, an item on tax deductions for living organ donors, a new guideline on screening mammography, and revisions to existing College guidelines and policies.

The following were among the issues that the Board addressed:

  • Reimbursement reform. The Regents approved two resolutions dealing with physician reimbursement, both previously approved by the Board of Governors. The first was a resolution to explore alternative models of payment for comprehensive primary care services, including the retainer model. The second promoted development of ACP policy to help internists receive appropriate reimbursement for complex ongoing medical care. The College has already completed several relevant initiatives in this area, such as a position paper calling for reform of the current payment system and the Advanced Medical Home policy monograph, which were approved by the Board of Regents in April 2006 and January 2006, respectively. Also, ACP is currently developing a position paper evaluating new systems of payment.

    The College has also been working to secure increased payments from the Centers for Medicare and Medicaid Services (CMS) for evaluation and management services, which are undervalued in the existing payment system. In June 2006, CMS announced plans to implement higher work relative value units (RVUs), the numerical value that represents the amount of physician work for these activities, which would significantly increase payments for many of these services. The new values are currently undergoing a mandatory public comment period and, if adopted, are scheduled to take effect in January 2007.

  • Increased teaching faculty. The Regents voted to encourage medical schools to increase the number and support of clinician educator teaching faculty through academic advancement for clinical teaching and provision of protected time for education-related activities. This resolution furthers a goal outlined in a position paper approved by the Board of Regents in January 2006 and published in the June 20, 2006 Annals of Internal Medicine, which noted the need to provide “sufficient time; financial remuneration; academic status; and institutional recognition for teaching, evaluating, supervising, and mentoring trainees.”

  • Tax-deductible expenses for living organ donors. The Board approved a resolution to support tax deductions for living organ donors that would apply to transplant-related expenses, that is, travel costs and lost wages. This action was based on a report from the Health and Public Policy Committee, with input from the Ethics and Human Rights Committee, on a resolution previously passed by the Board of Governors. The Committee found that indirect, retrospective compensation, such as tax deductions, for living organ donors’ expenses is in keeping with the College’s ethical standards. It recommended that the Board of Regents support HR 2474, the Living Organ Donor Tax Credit of 2005, which has been introduced in the U.S. House of Representatives.

  • Guideline for use of screening mammography in women 40 to 49 years of age. The Board approved a Clinical Efficacy Assessment Project guideline on screening mammography for women between age 40 and 49 years. The guideline has been submitted for publication.

  • Revised endorsement guidelines. The Board approved the first endorsement guidelines for ACP chapters. The guidelines stress that any positions or statements a chapter endorses must also agree with official College positions and standards. Governors of chapters should discuss potential endorsements with their chapter liaisons to determine whether the necessary criteria are met.

  • Addendum to ACP position paper. The Board approved an addendum to the ACP 2001 position paper on correctional medicine. The addendum endorses the medical treatment model of using opium replacement therapy, along with counseling and other medical services, to treat incarcerated persons who are addicted to opiates.

  • ACP Adult Immunization Advisory Board. The Regents approved a recommendation that the ACP Adult Immunization Advisory Board have a formal reporting relationship to the Education Committee. The Advisory Board requested this change to strengthen its position with such groups as the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and to more effectively educate ACP members on pending immunization issues.

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