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From the September 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

ACP-ASIM urges House to pass stronger patient protections

ACP-ASIM is urging the House to pass a strong patients' bill of rights containing important patient protections that were excluded from the bill the Senate passed July 15.

"We believe that it is still possible to craft a bill that will provide the necessary protections to all insured Americans without causing an increase in premium costs that could result in more uninsured persons," said ACP-ASIM President Whitney W. Addington, FACP.

ACP-ASIM is calling for Congress to approve legislation that:

  • Applies to all insured Americans, not just those in ERISA plans.
  • Provides enrollees with timely access to a review process, one that includes opportunities for review by an independent physician if service is denied.
  • Requires that physicians, rather than health plans, determine medical necessity and appropriate treatment.
  • Offers all managed care plan enrollees point-of-service options so they can receive care from providers outside their plan.
  • Holds all health plans—including those exempted under ERISA—legally accountable for medical decisions that result in a patient's death or injury.

Medicare drug benefit must address costs, other issues

ACP-ASIM is supporting the addition of a prescription drug benefit under Medicare—as long as a number of key points are addressed.

In an Aug. 5 letter to Congress, ACP-ASIM Associate Executive Vice President Alan R. Nelson, FACP, noted that patients who lack prescription drug coverage are significantly less likely to comply with a physician's prescribed drug therapies. He also pointed out that with the cost of prescription drugs rising rapidly, legislation must balance the need for the benefit with the expense of providing it. According to Dr. Nelson's letter, an effective prescription drug program must address a number of issues:

  • The program's costs must be offset by revenue to ensure that the solvency of Medicare is not threatened.
  • The highest priority should go to providing prescription drug benefits to those most in need: low-income beneficiaries who lack access to drug coverage under other plans.
  • The program should not require the use of formularies.
  • Physicians should continue to be able to prescribe covered drugs for accepted off-label uses.
  • Only health professionals trained in diagnosing and selecting treatments should be given prescribing privileges.
  • A national policy emphasizing "A" rated drugs should be implemented to deal with generic or therapeutic drug substitution.

College comments on Medicare reform proposal

In a July 1 statement, ACP-ASIM outlined its views on proposals to reform Medicare. College President Whitney W. Addington, FACP, said that the College was concerned about how reforms will affect patients' access to care, particularly those of lower means. "We will support only those reforms which honor the commitment to provide all beneficiaries with access to affordable health care, regardless of income or health status," he said.

While the College has concerns about parts of President Clinton's Medicare reform plan, including the proposals to charge a 20% copayment for laboratory services and to index the Part B deductible to inflation, it supports many of the administration's proposals. Specifically, the College supports:

  • The concept of making the traditional fee-for-service program competitive, by adopting techniques used in the private sector to purchase supplies and negotiate payments.
  • The administration's position that Medicare should not be converted to a defined contribution program.
  • The proposal to eliminate cost-sharing for preventive benefits, to initiate a smoking cessation demonstration project and to launch a new initiative on health promotion for Americans over age 50.
  • Changes to correct excessive cuts in reimbursements mandated by the Balanced Budget Act of 1997 that could ultimately limit beneficiaries' access to services if physicians refuse to participate in Medicare.

ACP-ASIM supports changes to Stark II

ACP-ASIM is supporting legislation introduced by House Ways and Means Health Subcommittee Chairman Bill Thomas (R-Calif.) that would clarify and simplify the provisions of Medicare's "Stark Law" prohibitions on physician referrals.

In an Aug. 4 letter to Mr. Thomas, ACP-ASIM Associate Executive Vice President Alan R. Nelson, FACP, said the bill includes an important measure that would eliminate the need for physicians to always be physically present when their staff performs laboratory tests. This would make it easier for solo practitioners or physicians in small groups to share equipment, rental space and personnel, Dr. Nelson said.

The College is also supporting the provision in the Thomas bill that would repeal the prohibition of referrals based on compensation arrangements. Under current law, physicians are not permitted to distribute income from ancillary services based on the volume or value of referrals made by the members of a group practice.

Four College leaders elected to AMA positions

At the AMA's House of Delegates meeting this summer, four College leaders—two Regents and two Governors—were elected to AMA councils. Here are the four individuals and their newly elected positions:

  • Regent Cyril M. (Kim) Hetsko, FACP, was re-elected to AMA's council on medical service.
  • Regent Cecil B. Wilson, FACP, was re-elected to AMA's council on constitution & bylaws.
  • Governor for the Illinois Northern Chapter John F. Schneider, FACP, was elected to the AMA's council on scientific affairs.
  • Governor for the Southern California Region II Chapter Mel L. Sterling, FACP, was elected to the AMA's council on scientific affairs.

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