ACP releases State of Nation’s Health Care report 2013


Category : Medical Rants

For transparency, I currently serve on the ACP Board of Regents, was the chair of the Health and Public Policy Committee, and in April become the Chair-Elect of the BOR.  I am very proud of our yearly state of the nation's health statement.  You can access the details here.

Here is the abridged version:

Recommendations to Make the Health System More Effective:
 Renew commitment at both national and state levels to effectively implement the coverage expansion under ACA, particularly ensuring the poorest and most vulnerable have access to affordable coverage. Reach agreement in Congress and in the Administration on a plan to replace sequestration cuts and prevent future disruptions in funding for critical health care, by enacting fiscally- and socially-responsible alternatives to reduce unnecessary health  care spending.
• Eliminate Medicare’s SGR formula and support a transition to new payment models.
• Implement policies to recruit and retain primary-care physicians.
• Reduce firearms-related injuries and deaths by improving access to mental health services, supporting research on the causes and prevention of violence, and enacting reasonable controls over access to firearms that do not infringe on constitutionally protected rights.

Recommendations to Reduce Intrusions on the Patient-Physician Relationship:
•  Payment reforms must allow physicians to spend more appropriate clinical time with their patients.
•  Payment and delivery reforms that hold physicians accountable for the outcomes of care should eliminate the layers of review and second-guessing of clinical decisions made by physicians.
 CMS should harmonize the measures used in different reporting program.
 CMS should provide more clinically relevant ways to satisfy the requirement that physicians must transition to using ICD-10 codes for billing and reporting purposes.
 Congress and CMS should encourage participation in quality reporting programs by reducing administrative barriers, improving bonuses, and broadening hardship exemptions.
 The government, the medical profession, and standard-setting organizations should work with EHR vendors to improve the functional capabilities of their systems.
 Medicare and private insurers should move toward standardizing claims administration requirements, pre-authorization, and other administrative simplification requirements.
 Congress should enact meaningful medical liability reforms including health courts, early disclosure of errors, and caps on non-economic damages.
 State and federal authorities should avoid enactment of mandates that interfere with physicians’ free speech and the patient-physician relationship. 

Often readers of this blog impune the ACP and other national organizations.  They charge that we are not in sync with practicing physicians.  I challenge you to read these positions and say that here.

You may disagree with parts of the ACA, but most of you do want to see broader coverage for patients.  I know that you care about payment and making primary care a more desirable option.

You have told me often that government is intruding into our practices, and I contend that the ACP's positions should be most agreeable.

We are proud of our agenda.  We believe that most internists will agree with the majority of our positions.  We wish the Congress and their staffs, the White House and state legislatures would pay attention.  We can improve health care AND spend less money.  We can decrease physician burnout without harming quality.

And please note my favorite point – one that readers of this blog will recognize:

Payment reforms must allow physicians to spend more appropriate clinical time with their patients. 


Comments (9)

Looks very good at first glance, much better than anything we've gotten from the AAFP. When you get a chance, could you clarify the ICD-10 statement, and, if possible, indicate why the ACP did not sign on to the AMA's letter regarding this? Thanks
(It's impugn, not impune. I always get tricked up on that one)

Of course, reasonable control over access to firearms could not include any assault weapon ban, or registration, or gun free zone, or capacity limitation. None of those have ever been shown to prevent violence, and the third actually appears to enhance violence. They also all infringe on constitutionally protected rights. I would like to hear just what sort of "reasonable controls" the ACP is referring to here. Last time I saw a paper authored by Christine Cassel the suggestions were ludicrous, with the first position being that fully automatic weapons be registered. This was 64 years after the US government required registration of all fully automatic weapons.
If the ACP were to recommend that gun free zones be abolished unless enforced by metal detectors (as in courthouses and airports) and shall issue permits become standard in states that still discriminate, such as Massachusetts, New York, Illinois, and California, I would reconsider my opinion that the ACP's position is just a politically correct vision of the anointed, with no acceptance of responsibility or culpability for past failed policies.

So ACP has a variety of recommendations, and you focus only on the firearms section. ACP has had this policy since 1995, not a new idea. We are developing a new policies that will address both firearm types and the problems of identifying those who cause violence.

But please look at the policies as a group – you give no comment on the remainder.

Thanks for the spelling lesson – I need all the help I can get!

I do not remember our difference with the AMA letter. We are concerned about the unintended consequences of ICD-10 and do not think it is the best solution.

The most important thing here is that we are very concerned about how well-meaning laws impact the physician-patient relationship, and particularly the impact on primary care physicians and hospitalists.

Shouldn't it be "to spend clinical time more appropriately" with their patients?
 If I understand it correctly, you want them to use their time better, not to make special hours, right? 

Cory you are correct and that is the intent. I believe the long version makes that clear.

The AMA letter in December asked CMS to halt plans for ICD-10 implementation in outpatient medicine. I was surprised that the ACP was not one of the 40 medical groups co-signing the letter.
ICD-10 could well be the final straw for many small practices. Not only is it needlessly complex, requiring large amounts of time and money to implement, but will inevitably result in major payment problems that many practices will not be able to weather. 

I can't wait to see the difference in time spent with patients, it really needs to happen.  Thanks for sharing!

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