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Policy Briefs

College comments on final privacy rule

From the May 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

ACP–ASIM weighed in on the HHS’ final rule on patient privacy in late March, suggesting changes to the regulation. The rule was issued by HHS in December 2000 and implemented by the Bush administration in mid-April.

In comments submitted to HHS on March 30, the College stated that the final rule fails to address all of its concerns and includes some proble­matic new provisions. ACP–ASIM recommended the following changes:

  • HHS should re-examine some of the rule’s administrative requirements, particularly as they would apply to small physician offices. Small physician practices should be exempted from specific requirements that would impose an unreasonably heavy administrative burden on their practices.

  • All covered entities, not just health care providers, should be required to obtain patient consent before using or disclosing protected health information for treatment, payment or health care operations.

  • HHS should redefine “quality improvement” so that the definition does not preclude or inhibit quality improvement activities designed to produce generalized knowledge to improve patient care.

  • HHS should recommend that Congress enact a comprehensive federal privacy law.

ACP–ASIM also expressed concerns about the rule’s provisions that require physicians to provide patients, upon request, specific information about all parties that have had access to their protected health information. The College explained that this requirement is unworkable, particularly for small physician practices.

While the Bush administration implemented the rules on April 14, administration officials said they will issue new modifications and guidelines to address criticisms of the final rule before its provisions become fully effective. College officials also said that they would continue to work with the administration to achieve modifications before the rule’s provisions are fully implemented.

Physicians have two years to comply with the regulation.

A copy of the College’s comments is available online at


ACP–ASIM releases third paper on lack of health coverage

From the May 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

The College released a third paper as part of its series, “No Health Insurance? It’s Enough to Make You Sick,” during a March 14 press conference in Washington.

The report, “Uninsured Women at Risk,” focuses on the health risks faced by women without health coverage. The report presented the following information:

  • Uninsured women with breast cancer have a higher adjusted risk of death than women with health insurance. Uninsured women 35 to 49 years old have a 57% higher adjusted risk of death, and uninsured women between 50 and 64 have a 43% higher adjusted risk of death.

  • Uninsured women are 2.3 times more likely than insured women to have never had a mammogram, 2.4 times more likely to have never had a clinical breast exam and 2.7 times more likely to have never had a Pap test.

  • Women between 18 and 64 who had been uninsured for more than one year were 5.3 times more likely than insured women to report being unable to see a physician when needed in the past year.

After releasing the report, the College held a Congressional briefing hosted by U.S. Reps. Shelley Moore Capito (R-W.Va.) and Louise Slaughter (D-N.Y.), who also serve as co-chairs of the Congressional Caucus on Women’s Health. More than 50 health care organizations attended the briefing.

The paper is available online at


College supports Senate bill giving tax credits to uninsured

From the May 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

The College announced its support for the Relief, Equity, Access and Coverage for Health (REACH) bill in a March 14 letter to Sen. James M. Jeffords (R-Vt.).

The bill proposes helping low and moderate-income working Americans purchase health insurance through tax credits. The College proposes a similar approach to make health insurance available to all Americans.

ACP–ASIM supports provisions in the REACH bill that would do the following:

  • Provide assistance to those who face the greatest financial barriers to getting health care, such as Americans in low-wage jobs that do not offer health insurance. A refundable credit will help eligible individuals regardless of their income tax liability.

  • Provide an advance payment option, which will allow individuals to get the benefit of a tax credit through their employer. This option helps people when insurance premiums are due, not after they file their taxes.

The College believes that Congress should continue to examine the level of tax subsidy necessary to make coverage affordable for low-wage workers. ACP–ASIM is encouraging Congress to expand the tax credit if necessary.

A copy of the College’s letter to Sen. Jeffords is available online at


Medicare’s complaint process for beneficiaries: rusty valve?

From the May 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

ACP–ASIM submitted comments concerning the Office of Inspector General’s (OIG) draft inspection report, “The Medicare Beneficiary Complaint Process: A Rusty Safety Valve.”

In a March 7 letter to HHS, the College said it agreed that an effective Medicare beneficiary complaint process can be a vital element in assuring quality of care. College officials disagreed, however, with the OIG’s contention that physician review organizations (PROs) intentionally under-prioritize addressing complaints as a way to win favor with the medical community.

The College also believes it is crucial that PROs retain their focus on education and quality improvement, and not endanger that role by giving enforcement activities a higher priority, as the OIG suggests.

ACP–ASIM believes the beneficiary complaint process can be improved in a number of ways that do not compromise the trust that currently exists between physicians and PROs. The College recommended expanding beneficiary awareness of the complaint process and making the process more accessible and easy to use; offering an informal PRO complaint resolution process; and specifying precisely which types of information can be released pursuant to a PRO investigation while ensuring this information is responsive to beneficiary needs.

These improvements would also complement the burgeoning array of national patient safety initiatives, as data on systemic sources of errors will be easier for PROs to collect when protection of physician confidentiality is not an issue.

A copy of the College’s letter to the OIG is available online at


ACP–ASIM joins statement on latest IOM report

From the May 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

ACP–ASIM joined the American Academy of Family Physicians, the American College of Surgeons and the AMA in issuing a March 1 statement on the Institute of Medicine’s (IOM) latest report, “Crossing the Quality Chasm: A New Health System for the 21st Century.”

The new IOM report examined flaws in the nation’s health care delivery system. Instead of criticizing physicians’ lack of training or expertise, however, the report criticized the structure of America’s health care system.

“Our organizations call on Congress to enact legislation to make it possible for physicians to identify, diagnose, report and correct potential system problems that undermine quality—with assurances that they will not be penalized for doing the right thing by identifying and reporting such problems,” Walter J. McDonald, FACP, the College’s Executive Vice President and Chief Executive Officer, said in the joint statement.

“Further, we call on President Bush and Congress to include sufficient funding to support efforts by the Agency for Healthcare Research and Quality to conduct research on ‘best practices’ to improve quality and to provide a vital link between health care professionals, their patients and biomedical research findings,” he said.

The IOM called on Congress to establish a $1 billion fund over the next three to five years to finance improvements to the health care system. The report followed the IOM’s 1999 study, “To Err is Human: Building a Safer Health System,” which examined patient safety issues.

The College’s response is available online at


College supports patients’ rights bill

From the May 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

The College endorsed the Bipartisan Patient Protection Act of 2001, which was introduced by Sens. John McCain (R-Ariz.) and Ted Kennedy (D-Mass.) and Reps. Greg Ganske (R-Iowa) and John Dingell (D-Mich.).

In a March 1 letter to 17 Senate and 70 House cosponsors of the bill, ACP–ASIM endorsed the measure as the only proposal designed this session that gives patients the full measure of legal protections they deserve.

The bill includes key elements ACP–ASIM has long advocated, including:

  • An effective and timely appeals mechanism for patients who are denied access to needed services;

  • Individuals’ right to hold managed care plans accountable in a court of law for decisions that have harmed them or their family members;

  • An assurance that health plans determine medical necessity based on professional standards of appropriateness that use clinical evidence, rather than a health plan’s own criteria; and

  • Guaranteed choice of physician and access to specialty care.

The letter is available online at College members can help by sending letters to lawmakers urging support for the bill. Tips on sending a letter to Congress are available on the College’s Web site at


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