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Advocacy tops busy agenda of a College president

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

By Lynn Kirk, FACP

It's been an exciting and hectic past few months in my tenure as ACP President. From trips to Capitol Hill to testify against Medicare fee cuts to travels overseas to meet with our European colleagues, my calendar has been full. As I prepared my quarterly report for the Board of Regents meeting in October, I was struck by the diverse activities in which the College is involved and the areas where we are making an impact. Following are some of the highlights of my report.

During the fall, advocacy activities to avert the projected 5.1% Medicare fee cut for 2007 reached a frenzied pace. With very little time left for Congress to act, our Washington office is working closely with Congressional staff and representatives of other physician organizations to enact legislation that rescinds the proposed cuts. ACP's ultimate goal is to have Congress change the formula for Medicare updates, which are based on the sustainable growth rate (SGR), and adopt long-term payment system reform. In July, I testified about these issues before the Health subcommittee of the House Energy and Commerce committee. Lawmakers were sympathetic, but perceived significant fiscal constraints impeding a permanent fix for the SGR.

The advocacy response of ACP's members on this issue has been robust. I sent an email letter to the membership in late August outlining the need to contact their Congressional representatives to avert the Medicare fee cut. By Sept. 1, almost 2000 of our members had sent letters to Congress and over 48 had sent us stories about the adverse impact of the fee cut on their practices and their patients. Over 300 had contacted the Washington office to get more information and to volunteer their help.

In early September, I attended the Polish Society of Internal Medicine's 100th anniversary held in conjunction with the European Federation of Internal Medicine's meeting in Krakow. It was once again apparent that the ACP is held in high esteem by our sister international organizations. I also learned that many of our concerns are universal--declining numbers of students choosing internal medicine (especially general internal medicine) and the challenges of providing health care with limited resources. In the past I have naively assumed that access to health insurance for all Americans would solve many of our problems. Clearly, that is important, but those countries with national health insurance continue to grapple with constrained resources. We can all learn from each other.

John Tooker, FACP, ACP Executive Vice President, Yul Ejnes, FACP, Chair of the Board of Governors, and I took a field trip to visit the Louisiana Chapter in mid-September (including a 360 mile drive across the state). We were graciously hosted by ACP members in Shreveport and New Orleans. It is clear that the devastation from Hurricane Katrina continues to be a challenge throughout the state. We visited with members from a hospital 50 miles outside of New Orleans that no longer has resources to refer patients for secondary and tertiary care because those facilities were destroyed by the flood. They had to act quickly to develop alternative resources locally for their patients. Overall I was impressed by the optimism of the members we met. Despite their losses, many were able to perceive new opportunities to rebuild a better health care system from the ground up. They continue to need our help and support.

The College's patient-centered medical home model, which proposes rewarding primary care physicians for managing and coordinating care, continues to engender widespread interest. I spoke about it before the House Energy and Commerce subcommittee on Health. Mark McClellan, the outgoing administrator of CMS, and an internist, had outlined the components of a medical home in his remarks preceding mine. Payers and consumer groups, such as AARP, are very interested in the concept and its potential to improve patient care at less cost. ACP's Washington staff is working closely with several groups to develop demonstrations of the model.

Besides the immediate issues connected with physician reimbursement and payment reform, the College continues to work on other priorities, such as improving health care access and medical education. We are working closely with other organizations to improve internal medicine graduate medical education. The goals of these efforts are to:

  • define and organize residency training around a core of internal medicine competencies
  • base evaluation on these competencies and advancement on achievement of them
  • allow flexibility for more personalized and career-oriented training

We continue to work with the American Board of Internal Medicine on recertification to assure minimal redundancy with physicians' other practice improvement activities and to identify relevant practice areas in order to increase its educational value.

As I represent the College around the world, I continue to be impressed with the time and expertise our members are willing to devote to ACP. They actively participate at both the local and national levels to carry forward the goals of the College and the interests of internal medicine. They clearly perceive, as do I, that the work of the College will help us to continually improve the care we provide to our patients.

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