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


Policy briefs

From the March ACP-ASIM Observer, copyright 2002 by the American College of Physicians-American Society of Internal Medicine.

College calls on president to boost health care budget

ACP-ASIM officials are concerned that the president's proposed budget is cutting too much money for training programs funded under the Public Health Service Act and doesn't go far enough to protect the nation's health security.

In a Feb. 8 press release, the College protested what it called "dramatic cuts" to training programs covered by the Public Health Service Act. ACP-ASIM President William J. Hall, FACP, said that proposed cuts to Title VII and VIII of the act would cut training programs by 70%. Those programs train providers who serve in rural and underserved areas, which have a significant shortage of health care professionals.

ACP-ASIM commended the budget's expanded funding for the National Health Service Corps, nursing school loans and scholarships, and more community health centers. But Dr. Hall noted that establishing more community centers "will do little good" if there are no physicians to staff them.

In another press release issued after the state of the union address, the College commended the president's plan to beef up national security but urged him to do more to meet the nation's health security. Dr. Hall said the budget should allocate money to meet the following goals:

  • Provide adequate funding to train health providers and systems to prepare for bioterrorism.
  • Fund a health insurance tax credit to make coverage affordable to all low-income Americans.
  • Give Medicare more funding so it can continue to offer high-quality services, and halt reimbursement cuts.
  • Fund a Medicare prescription drug benefit, especially for low-income seniors.
  • Eliminate unnecessary Medicare paperwork and regulatory burdens.
  • Publish final rules on administrative simplification, privacy and security requirements from the Health Insurance Portability and Accountability Act to ease paperwork requirements and protect patient privacy.

Both press releases are online at


ACP-ASIM urges patients, health plans to continue mammography

In the renewed controversy over mammography screening, ACP-ASIM has urged patients to continue undergoing mammograms and health insurers to continue paying for the service.

In January, a National Cancer Institute advisory board announced it had found insufficient evidence that mammography helps prolong life. The advisory board reviewed seven major studies of mammography to reach its conclusion.

In response, the College joined nine other medical groups and signed a letter published in the Jan. 31 New York Times. The letter stated that evidence supports the use of mammography and urged women to follow their physicians' advice.

In a follow-up Feb. 4 letter, ACP-ASIM urged health insurers to continue to pay for mammography screening.

In letters sent to the Blue Cross and Blue Shield Association, the American Association of Health Plans and the Health Insurance Association of America, ACP-ASIM President William J. Hall, FACP, said that mammography has contributed to the early detection of breast cancer and to fewer deaths from the disease since 1990. Dr. Hall also emphasized the College's position that mammography is a vital weapon in the war against breast cancer that health plans should continue to cover as a patient benefit.

The Feb. 4 letter is online at www.acponline.org


HHS must take leadership role to help ease drug shortages

The federal government needs to take a leadership role in addressing distribution issues and shortages of drugs, vaccines and diagnostic agents.

In a Jan. 28 letter to HHS Secretary Tommy G. Thompson, the College noted that in recent years, drug shortages have increased. As an example, it pointed to delays in the distribution of flu vaccines during the past two flu seasons.

In the letter, ACP-ASIM President William J. Hall, FACP, called for a task force to explore the causes of drug shortages. The College also urged HHS to identify solutions that address issues such as liability, reimbursement and the availability of products to vulnerable populations.

The College's letter is online at www.acponline.org


CMS responding to internists' concerns, but more is needed

While ACP-ASIM applauds recent efforts to make Medicare more responsive to internists' concerns, it is troubled by several proposed policy changes.

HCFA, now known as the Centers for Medicare and Medicaid Services (CMS), established the physicians regulatory issues team (PRIT) to address physician concerns. The team met with College representatives last month.

In a Jan. 22 letter, ACP-ASIM said that the team had implemented solutions to a number of issues affecting internists. These include reimbursement for pre-operative assessments; the "Women with Medicare" booklet that explains beneficiaries' financial responsibility for Medicare-covered Pap smears and pelvic/breast exams; and a plan to implement new Medicare regulations quarterly with advanced notification for physicians.

In its letter, however, the College also asked CMS to focus on several new issues. For example, ACP-ASIM noted concerns about a rule that requires physicians to use a new modifier to indicate that they have submitted a claim for a service not covered by Medicare, as well as a modifier that indicates the service does not meet Medicare's "reasonable and necessary" criteria. The College also asked CMS to publish Medicare regulations online so physicians can search the regulations by topic.

Finally, ACP-ASIM voiced concerns about proposed reductions in the number of medical directors at Medicare carriers, as well as plans to allow carriers' advisory committees to seek less input from practicing physicians.

More about the College's work with CMS and the PRIT is online at www.acponline.org


ACP-ASIM concerned about loopholes in privacy regulations

ACP-ASIM is worried that regulations designed to protect the privacy of medical information contain loopholes that might compromise private patient information.

During recent testimony, College President William J. Hall, FACP, said that privacy regulations might actually encourage health care organizations to use patient information to market services. Dr. Hall testified before a Jan. 24 meeting of the Privacy and Confidentiality Subcommittee of the National Committee on Vital and Health Statistics.

Under new regulations, health care organizations will be allowed to use patient information to market their products and services without patient consent when any of the following conditions are met:

  • There is a face-to-face encounter with patients. The regulations allow face-to-face encounters between patients and door-to-door salespeople or even telemarketers. In addition, the regulations do not limit the types of services that can be marketed.

  • Items or services of "nominal value" are presented. The College believes this definition is too vague and may allow health care organizations to market all kinds of products and services.

  • Items or services in question come from the health care organization—and the organization discloses certain information to patients. Under this exemption, organizations must identify themselves, state whether they have received any remuneration for the service or item they are presenting, and allow patients to opt out of future communications. Dr. Hall explained that the exception contains many loopholes that health care organizations could exploit.

For more information, the College's testimony is online at www.acponline.org


In light of Supreme Court case, U.S. needs federal patient rights

ACP-ASIM urged the president and Congress to pass strong patient rights legislation to offset industry efforts to undercut existing patient protections.

In a Jan. 18 letter to President Bush and congressional health care leaders, the College pointed to the Supreme Court's decision to hear oral arguments about patient rights laws. The insurance industry is asking the Supreme Court to invalidate an Illinois law that gives patients the right to an independent medical review when HMOs deny care.

ACP-ASIM said the case represents a legal maneuver to invalidate state laws that give patients the right to appeal an HMO's denial of medical care. The College fears that if the Supreme Court finds in favor of insurance companies, similar laws in 40 other states would be struck down.

ACP-ASIM urged Congress and the president to agree on a federal bill of rights law to ensure patients' rights. While the House and the Senate have passed similar versions of patient rights legislation, they have not agreed on compromise legislation.

The College's letters are available online at www.acponline.org


ACP-ASIM releases position paper on correctional care

In a new position paper on correctional care, the College identifies trends in the growth of the U.S. prison population and health care issues affecting inmates and their physicians.

The paper, which updates a previous 1992 College position, focuses on issues for internists, including corrections and public health, diseases like tuberculosis and HIV, qualifications of practitioners in correctional settings, special prison populations and the accreditation of correctional health care.

The paper is online at www.acponline.org


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