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


Policy briefs

From the May ACP Observer, copyright 2006 by the American College of Physicians.

ACP leaders call for revamping health care

Health care leaders must come together now to overhaul the nation's health care system, ACP leaders warned at an Annual Session press conference on practice redesign. If not, the cracks in the current system will grow too wide to be effectively repaired.

Outgoing Regent Chair Donna E. Sweet, MACP, talks to reporters about needed health care reforms.

"The College is offering a comprehensive vision of reform that is centered on patient needs," said outgoing Board of Regents Chair Donna E. Sweet, MACP. "The health care system needs to recognize the critical role of internal medicine in meeting these needs."

ACP released new papers at Annual Session that recommend far-reaching changes to American medicine. The papers—which lay out ways to reform the dysfunctional payment system and redesign internal medicine training—recommend overhauling physician payments, working to find ways to reduce student debt and tailoring the third year of residency training.

Those changes, while enhancing internal medicine subspecialties, should boost reimbursement and professional satisfaction for general internists. "Ambulatory care is the poor stepchild," said Steven E. Weinberger, FACP, Senior Vice President for Medical Education and Publishing, who spoke about training redesign. "Inpatient care has always been the focus."

The training redesign paper is online.

College, others, comment on 'medically unbelievable' program

ACP has told CMS officials that the agency's proposal to create a medically unbelievable edits (MUE) program will require much more time to review before that program can be implemented.

The CMS initially designed the MUE program to prevent payment of Medicare claims that contain obvious errors or gross fraud. The proposal has grown to include more than 10,000 edits that review claims for anatomic appropriateness and frequency on individual patients.

The College joined more than 90 other medical societies in signing an April 10 letter to the CMS administrator. The letter applauded the CMS' decision to push back implementation of the MUE program to no sooner than Jan. 1, 2007, instead of July 1, 2006, as was previously proposed.

But the letter lodged several serious reservations concerning the CMS' planned MUE rollout. Problems noted included:

  • A confusing review process. The sheer number of edits, the letter said, will require a very lengthy review process. The CMS wants to implement two review processes, with the first review deadline this June and the second this fall. The College, however, is asking the CMS to implement only one review process with a Sept. 15 deadline.

  • Lack of transparency in rationale and frequency data. The letter urged the CMS to make available the rationale and frequency data behind the MUEs, saying that initial comments from specialty societies suggest the units assigned contradict current evidence-based practices.

  • The lack of modifiers and of an appeals process. Both modifiers and an appeals process are essential, the letter said, to put a workable edits process in place.

The letter is online.


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