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


On ACP's policy agenda: Medicare fees, access, more

From the July-August ACP Observer, copyright 2004 by the American College of Physicians.

As the nation begins to focus on the presidential election, international affairs understandably loom larger than domestic concerns. Despite extensive evidence pointing to problems in the safety and quality of U.S. health care, health issues are simply not a top priority.

While the political climate may not favor health care legislation, College members continue to focus legislators on the challenges that face American health care. In May, for example, ACP brought more than 200 internists in from 41 states to attend the annual Leadership Day events. (See "College members arrive in force to lobby on Capitol Hill.")

The participation of so many internists is particularly notable because significant legislation is unlikely to be passed before the November election. The willingness of busy internists to take the time to come to Washington and deliver the College's message to Congress is evidence that ACP members view advocacy as a key to enhancing the quality and effectiveness of patient care.

Along with other ACP efforts, Leadership Day helps the College advocate for progressive health care policy in the next congressional session. During their visits, internists helped lay the groundwork to advance legislation on a number of ACP's top legislative issues.

Here is an overview of those issues, with a look at the College's recommendations.

Medicare fee schedule

Last fall, the College played a pivotal role in reshaping the Medicare Prescription Drug Improvement and Modernization Act. That legislation replaced a planned cut of 4.5% in the Medicare fee schedule with a positive increase, or "update," of at least 1.5% in 2004 and 2005.

Unfortunately, that reprieve may prove to be temporary. The Medicare program continues to link Medicare fees to the sustainable growth rate (SGR) formula.

If implemented as scheduled, that formula would cut physician reimbursement by 5% a year from 2006 through 2012. Internists would see their overall Medicare compensation slashed by more than 30%.

ACP is asking lawmakers to take the following actions to make sure that all physicians receive fair reimbursement from Medicare:

  • Ask the Centers for Medicare and Medicaid Services (CMS) to make interim administrative changes in the SGR, including removing the cost of physician-administered drugs from the formula.

  • Support legislation that would create Medicare fee schedule updates that are more closely linked to increases in the actual costs of medical practice.

Access to care

ACP's seven-year plan—released in 2002—to cover Americans who don't have insurance now serves as the basis for legislation introduced in both the House and Senate.

The HealthCARE Act of 2003 (S. 1030/H.R. 2402) would help expand access to care through several mechanisms, including tax credits and purchasing pools to help businesses find affordable coverage. Businesses with two to 100 employees would be able to purchase coverage through an arrangement that gives them access to the same kinds and variety of affordable health plans that are now offered to federal government employees.

The legislation would give states flexibility in administering Medicaid and the State Children's Health Insurance Program. It also calls for a bipartisan commission to advise Congress on further measures to expand coverage.

ACP is asking lawmakers to take the following actions: co-sponsor the HealthCARE Act and make the issue of expanding health insurance a top legislative priority.

Liability reform

While several high-risk specialties have been affected by the liability crisis, internal medicine has been especially hard hit.

The Congressional Budget Office, for example, recently reported that between 1993 and 2002, internists saw the highest rate of increase in medical liability premiums. Our colleagues saw higher rate increases than either general surgeons or ob/gyns.

As premiums rise, many physicians are finding that liability insurance is no longer available or affordable. In some states, physicians are being forced to limit services, retire early or move to other states with a more stable medical liability structure.

Last year, the House passed legislation that would reform the tort system to allow greater access to care, give more money to injured patients and resolve claims more quickly. The Senate has to date failed to adopt the broad reforms included in the House legislation, or even targeted reforms aimed at capping damages for ob/gyn and emergency services.

ACP is asking senators to pass legislation that would safeguard patient access to care through reforms that include caps on noneconomic damages, a sliding scale limit on contingency fees and periodic payment of future damages.

Health information infrastructure

ACP agrees with calls from the Institute of Medicine and President Bush to bring information technology advances to all health care sectors, underwritten with federal support and leadership.

According to an October 2003 Government Accounting Office study, information technology can improve quality of care, reduce errors, allow more complete documentation, facilitate more accurate capture of codes and charges, and improve communication among providers.

There are several obstacles to achieving this goal. Besides cost, the U.S. health care system lacks common medical terminology and communications software that will let the many elements of health care communicate electronically.

As a result, ACP is asking lawmakers to support legislation that encourages the creation of interoperable health information networks by taking the following steps:

  • Facilitate pilot testing of industry standards on interoperability.

  • Provide financial resources, including grants and loans, to help physicians, particularly those in smaller practices, acquire health information technology.

  • Fund demonstration projects that give physicians financial incentives to acquire electronic health records and other technology. The College believes that incentives, not mandates, are the best route to a national interoperable infrastructure.

Patient safety

The College concurs with many of the recommendations made in the Institute of Medicine's 1999 "To Err is Human" report. Among other conclusions, the report found that instead of punishing individuals for errors, U.S. health care needs to embrace wide reforms.

To make sure that adverse events that don't actually hurt patients are reported and acted upon, the report calls for measures to guarantee the confidentiality of those reports. Health care professionals must be able to report adverse incidents without worrying that their cooperation will lead to lawsuits or other sanctions. ACP is asking lawmakers to take the following actions:

  • Urge Senate leaders to allow a vote on pending patient safety legislation (S. 720) similar to the House-passed Patient Safety and Quality Improvement Act (H.R. 663). That bill calls for voluntary reporting with confidentiality protections and limits on "discoverability" in liability lawsuits. A Senate version of the bill was voted on in the Senate Committee on Health, Education, Labor and Pensions in July 2003, but the full Senate has not yet scheduled a vote on it.

  • Establish a national patient safety database to acquire basic knowledge on what errors are occurring and how to prevent them.

  • Support adequate and secure overall funding for the Agency for Healthcare Research and Quality to support the mission of the agency, including support for the Center for Quality Improvement and Patient Safety.

The bigger picture

The ability to "walk the halls" of Congress and talk to legislators and their staff gives College members a unique opportunity to affect this country's medical policy-making. We can't overestimate the value—and the thrill—of meeting with members of Congress.

Our Leadership Day activities, however, represent just one part of ACP's overall advocacy strategy. We can't forget that the grassroots efforts of College members in the Key Contact program, along with the day-to-day activities of chapter Governors and the Washington office, account for much of ACP's success in advocating for important health care legislation and public policy.


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