Internists issue 2-pronged plan to improve health care system

A report from the American College of Physicians on the State of the Nation's Health Care

(Washington) "Continued improvement in the health care system to expand coverage and reduce unnecessary costs is imperative," David L. Bronson, MD, FACP, president of the American College of Physicians (ACP), said at today's annual State of the Nation's Health Care briefing. "Such efforts will not succeed in ensuring patient access to high quality medical care if the current assault on the patient-physician relationship continues unabated."

In yesterday's report, ACP noted that in some ways it is the best of times for U.S. health care, because the Affordable Care Act will soon make affordable coverage available to nearly all legal U.S. residents—for the first time in history—accompanied by a record slowdown in health care cost increases. But ACP also warned of vulnerable patients being left behind in states that refuse to cover their poor under Medicaid; the threat to public health and access if an across-the-board budget cut (sequestration) is allowed to occur; the continued obstacles to high quality care created by Medicare's flawed SGR formula; and the unacceptable toll of deaths and injuries from firearms. A growing shortage of primary care physicians for adults will increase costs and reduce access. And, ACP noted that many physicians report that it is the worst of times when it comes to intrusions on the hallowed patient-physician relationship.

ACP's two-pronged plan

includes specific and achievable proposals to continue to advance the progress being made in expanding affordable coverage, lowering costs, recruiting and retaining primary care physicians, and reforming physician payment systems.
reduces barriers to the patient-physician relationship to accomplish the only genuine purpose of health reform, which is to put the interests of patients first.

"It simply is unacceptable that the political divisions in Washington have caused a recurring series of wholly unnecessary budget impasses that imperil the health and safety of the American people," said ACP's Senior Vice President of Governmental Affairs and Public Policy Bob Doherty.

ACP's recommendations to make the health system more effective:

ACP calls for a renewed commitment at both the national and state levels to effectively implement the coverage expansions and related policies under the ACA, with particular attention to ensuring the poorest and most vulnerable patients have access to affordable coverage.
ACP urges Congress and the administration to reach agreement on a plan to replace across-the-board sequestration cuts and future potential future disruptions in funding for critical health care and instead enact fiscally- and socially-responsible alternatives to reduce unnecessary health care spending.
Congress must enact legislation to eliminate Medicare's SGR formula and support the medical profession's commitment to transition to new payment models.
ACP calls for policies to recruit and retain primary care physicians.
A reduction of firearms-related injuries and deaths must result 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.

ACP's recommendations to reduce intrusions on the patient-physician relationship:

Public and private policymakers and payers must ensure that any payment reforms have, as an explicit goal, allowing physicians to spend more appropriate clinical time with their patients.
Payment and delivery reforms that hold physicians accountable for the outcomes of care (measurable performance on quality, cost, satisfaction and experience with care) should concurrently eliminate the layers of review and second-guessing of the clinical decisions made by physicians.
CMS should harmonize (and reduce to the extent possible) the measures used in the different reporting programs, work toward overall composite outcomes measures rather than a laundry list of process measures.
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 consider working with physicians to encourage participation in quality reporting programs by reducing administrative barriers, improving bonuses to incentivize ongoing quality improvements for all physicians, and broadening hardship exemptions. If necessary, Congress and CMS should consider delaying the penalties for not successfully participating in quality reporting programs, if it appears that the vast majority of physicians will be subject to penalties due to limitations in the programs themselves.
The government, the medical profession, and standard-setting organizations should work with EHR vendors to improve the functional capabilities of their systems, to improve the ability of those systems to report on quality measures and to ensure that those systems improve rather than adding to workflow inefficiency.
Medicare and private insurers should move toward standardizing claims administration requirements, pre-authorization, and other administrative simplification requirements even in advance of, and in addition to, the simplification rules included in the ACA.
Congress should enact meaningful medical liability reforms including health courts, early disclosure errors, and caps on non-economic damages.
State and federal authorities should avoid enactment of mandates that interfere with physician free speech and the patient-physician relationship.

"System-wide efforts to improve the health care system won't succeed on their own in improving access and quality if the physicians that the system is counting on to deliver are over-hassled, over-stressed, harried, hushed and rushed," noted Dr. Bronson. "ACP views necessary strategic health reform improvements and results not from a partisan or ideological perspective, but from the standpoint of what the evidence tells us will be the most effective course of action."

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The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 133,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

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