ACP advocates on an exceptionally broad range of issues, making it hard to sum up what we seek to achieve. If you take a look at our advocacy home page on ACP Online, you will see dozens of topics and thousands of related communications to policymakers. The written communications do not tell the whole story: Most ACP advocacy efforts involve meeting with members of Congress, federal regulators, state officials, payers, and other health care organizations to persuade them to support our recommendations.
The breadth and depth of ACP advocacy are the result of its mission, “to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine,” and one of its chief goals, “to advocate responsible positions on individual health and on public policy related to health care for the benefit of the public, patients, the medical profession, and our members.” With this framework, it should be no surprise that ACP takes on so many issues.
Yet for all the depth and breadth of its advocacy, I think there are 11 words that describe what ACP hopes to achieve: Include everyone in health and health care and support their physicians.
Including everyone in health and health care means that everyone should have affordable coverage, without regard to where they live or work, their income and employment status, their health, and their personal characteristics. It means eliminating barriers to health and health care based on race or cultural identity, gender and gender identity, sex and sexual orientation, immigration status, age, disability, literacy and health literacy, incarceration status, and other personal characteristics. It requires that ACP challenge state and federal restrictions that would limit women's access to health, discriminate against LGBTQI persons, or inflict violence and discrimination against a person because of who they are or where they live. It demands equity in COVID-19 vaccine distribution and in distribution and allocation of health care resources and challenges social drivers of health that result in poorer outcomes for some people based on where they live and socioeconomic factors like poverty, often compounded by racism and discrimination.
This idea of a U.S. health care system that is inclusive of everyone is central to ACP's Vision for the U.S. Health Care System, published Jan. 21, 2020, in Annals of Internal Medicine, in which we found that “U.S. health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients' interests; undervalues primary care and public health; spends too much on administration at the expense of patient care; fails to invest and support public health approaches to reduce preventable injuries, deaths, diseases, and suffering; and fosters barriers to care for and discrimination against vulnerable individuals.” In three companion papers, ACP proposed specific policies to overcome these shortcomings.
This vision of an inclusive health care system also pervades ACP's new policy paper, “A Comprehensive Policy Framework to Understand and Address Disparities and Discrimination in Health and Health Care,” published by Annals of Internal Medicine on Jan. 12, 2021, along with three related papers. Based on these policies, ACP lent its support to the American Rescue Plan Act, which will make coverage more affordable and available for millions of Americans, and to many of the Biden administration's actions to roll back barriers to care and promote health equity.
Equally essential to creating a better and more inclusive health care system is supporting physicians, and especially internal medicine specialists and ACP members, in providing their patients with the best possible care. This is also part of ACP's Vision for the U.S. Health Care System. The College's paper on health care delivery and payment system reforms argued that “payment systems must be made to put the interests of patients first, better support primary care, make health care less complex, correct inappropriate disparities in payment levels between complex cognitive care relative to procedures, simplify billing and documentation requirements, and redesign health IT to transform [value-based payment] programs to achieve what matters most to physicians and their patients.” ACP called for “the immediate elimination of unnecessary, inefficient, and ineffective billing and reporting requirements for all health care services, as well as reducing administrative barriers to appropriately paying for and valuing non-face-to-face-based care, such as care management.” ACP's Patients Before Paperwork initiative provides a framework and specific policies to achieve this end.
In addition, support for physicians was central to ACP's advocacy to pay for video and audio phone calls with patients (telehealth) at the same level as in-person visits and to extend the easing of telehealth restrictions beyond the COVID-19 public health emergency, to improve the Medicare Quality Reporting Program, to successfully secure increases in Medicare payments for outpatient office visits and ease documentation requirements for them, to improve electronic health records, and to advocate for physician-led dynamic clinical care teams that recognize and support the unique skills and training of physicians compared to other clinicians.
Next time someone asks you what ACP advocacy is about, here is how to answer: ACP advocates for a U.S. health care system that is inclusive of all and supports physicians in providing the best possible care to them.