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

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Policy Briefs

College President talks to IOM about lack of health insurance

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

The lack of health insurance has important consequences for both individual patients and the nation, College President William J. Hall, FACP, told the Institute of Medicine in an April 26 speech.

“Medical treatment for the uninsured is often more expensive than for the insured because those without insurance are more likely to seek care from an emergency department than a physician’s office,” Dr. Hall said.

Providing health coverage to the uninsured will not only increase overall access to health care, he explained, but may also substantially help reduce the nation’s total burden of illness.

More information on the College’s efforts to focus attention on the problems of a lack of health insurance is available online at www.acponline.org/uninsured/.

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College: Self-referral rule improved, but still too complex

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

HCFA has streamlined its rule regulating physician referrals to health care entities with which they have a financial relationship, but the rule is still cumbersome.

In an April 30 letter to HCFA’s acting administrator, ACP-ASIM said that the final rule, commonly known as Stark II, has removed barriers to many common types of referrals and financial arrangements physicians use. The letter also stated that because the final rule is still exceptionally lengthy and at times unclear, most physicians will likely have difficulty complying with it.

The letter, however, welcomed the following improvements, which the College had requested in comments on the proposed rule:

  • Services personally performed by referring physicians are no longer considered a referral.

  • Referring physicians do not have to be present to meet the supervision requirement, which allows them to qualify for an in-office ancillary exception.

  • Physicians can now more easily qualify as a group practice.

  • Physicians can refer to entities with which they have a compensation relationship, as long as the resulting compensation does not exceed the amount that would be paid to someone else who is not in a position to refer to the entity.

  • Physicians can receive fair market value payment for referrals for designated health services.

  • Physicians can supply patients with certain durable medical equipment.

For more information, see the full text of the April 30 letter online at www.acponline.org/hpp/physician_referrals.htm.

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Expand Medicaid and SCHIP, but first address problems

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

The College agrees that expanding Medicaid and the State Children’s Health Insurance Program (SCHIP) would help expand access to care, but it says that the government must first address some basic problems in the programs.

In a monograph on whether the government should expand Medicaid and SCHIP, ACP-ASIM concludes that the nation can quickly expand coverage to millions of uninsured Americans by building on its existing programs. The College points out, however, that the government should avoid creating new bureaucracies to reduce start-up costs and avoid further fragmenting the health care system.

ACP-ASIM also says that to successfully expand the two programs, officials must address existing problems such as a lack of uniform eligibility and coverage requirements; inadequate reimbursement to providers; complex enrollment procedures; and excessive administrative hassles.

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Individual health insurance not ready to replace employer-based coverage

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

While a system in which individuals choose and purchase their own health insurance has some appeal, the country is not prepared to abandon the current system of employer-based coverage.

In a policy monograph on individually owned health insurance, the College examines the pros and cons of adopting a system in which individuals purchase their own health insurance. Several organizations like the AMA have recently advocated for a system in which individuals, not employers, choose and purchase their health care coverage.

While ACP-ASIM concludes that such a system could potentially increase health coverage in this country, it also points out that in the current market, individual health insurance is expensive and sometimes unavailable to high-risk individuals. Several options could help encourage a shift to individually owned coverage, such as individual tax credits or subsidies, purchasing pools and medical savings accounts.

Without major changes in federal and state law, however, the College says that Congress should not enact abrupt changes that would discourage employers from providing health insurance coverage to their employees.

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College favors most points in plan to change how training is funded

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

The College has come out in favor of several key aspects of a new plan to change the way graduate medical education (GME) in this country is funded.

In a report issued late last year, the Council on Graduate Medical Education (COGME) recommended that all third-party payers help pay for graduate medical education. Currently, a handful of payers like Medicare, Medicaid and the Veterans Administration pay for the majority of physician training.

In an analysis, the College supports the idea that all health care payers should contribute to the costs of training new physicians. The College also supports recommendations that would fund training activities at nonhospital sites, base total GME payments on the nation’s workforce needs and modify budget cuts to avoid hurting training programs in underserved areas.

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