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ACP Issues Recommendations for Healthcare Reform

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Raptor:
ACP Issues Recommendations for Healthcare Reform


February 3, 2009 (Washington, DC) — Officials from the American College of Physicians (ACP) presented comprehensive recommendations for addressing the US healthcare crisis at the group's annual State of the Nation's Health Care briefing here yesterday. These recommendations included measures to increase access to both affordable healthcare and primary care physicians.

ACP President Jeffrey P. Harris, MD, FACP, emphasized that an expansion of medical coverage alone would do little to address the US healthcare crisis if the number of primary care physicians is not increased as well. "Giving all Americans an insurance card will not guarantee that everyone will have access to care," Dr. Harris explained. "There are not enough primary care physicians to care for them." In fact, an analysis by the Institute of Medicine (IOM) revealed that the United States needs an additional 16,000 primary care physicians to provide adequate care for currently underserved areas. This shortage is expected to more than double as the US population continues to age.

Dr. Harris stressed that there is an urgent need to enact reforms to expand the primary care physician workforce. "Given the fact that it takes a minimum of 7 years to train a primary care physician, the US cannot afford to delay implementation of policies to attract more new physicians to primary care and to sustain those already in practice," he said.

Increasing Number of Primary Care Physicians Improves Quality

There is increasing evidence that augmenting the number of primary care physicians improves quality and lowers the cost of medical care. For example, recent studies indicate that communities with a greater proportion of primary care physicians have fewer hospital admissions, fewer emergency department visits, and fewer surgeries. Furthermore, a 5% decrease in the rate of hospital admissions could result in a healthcare savings of up to $1.3 billion.

Robert B. Doherty, senior vice president of government affairs and public policy at the ACP, outlined several initiatives that the ACP believes would improve US healthcare. "We are calling for comprehensive reforms that will lead to affordable coverage for all Americans. And, we are calling on all agencies of government to enact reforms to grow the primary care workforce capacity at the same time as coverage is expanded," said Mr. Doherty.

The 2009 annual report of the ACP endorses several legislative initiatives designed to increase access to primary care. These include the extension and subsidization of the Consolidated Omnibus Budget Reconciliation Act (COBRA) health coverage as well as additional Medicaid funding. The members also support measures to reauthorize the State Children's Health Insurance Program and to enact a comprehensive plan which would guarantee affordable healthcare for all Americans.

Reforms to Primary Care Payment Policies Needed

The annual report recommends reforms to the primary care payment policies that would enable primary care physicians to achieve market competitiveness with other specialties. The disparity between the salary range of primary care physicians and non–primary care physicians is a large factor in the declining number of medical students deciding on careers as general internists or family physicians.

"Medicare and all other payers would need to increase their payments to primary care physicians by 7.5% to 8% per year over a 5-year period, above the baseline for all other specialties, to bring the average of the median earnings for primary care physicians to 80% of those for all other specialties," explained Dr. Harris.

In addition, other incentives should be adopted to increase the number of medical students and young physicians who choose to join the primary care workforce. The ACP proposes scholarships for medical students selecting primary care careers and programs to eliminate the student debt of physicians who specialize in primary care.

Expansion of Patient-Centered Medical Home

During the briefing, the ACP also called for an expansion of the Patient-Centered Medical Home (PCMH). In this team-based model of care, a personal physician is responsible for providing continuous healthcare and coordinating with other professionals to ensure that the patient receives appropriate care throughout the duration of the patient's lifetime. The PCMH practice provides preventive services, treatment for acute and chronic illnesses, as well as end-of-life care. This approach has been shown to maximize positive health outcomes.

The ACP closed the briefing by asking President Barack Obama to consider issuing an executive order on increasing primary care workforce capacity.

"This order would ensure that all federal agencies are working together seamlessly to design, implement, measure, and evaluate programs to increase primary care workforce capacity," said Mr. Doherty. "A presidential executive order would send a powerful signal to young physicians and medical students, as they are about to make lifetime career decisions, that the federal government is serious about making primary care an attractive and competitive career choice."

Raptor:
AAFP President Urges Cooperation in Seeking Payment Increases for Primary Care Physicians

By James Arvantes
2/4/2009



A recent editorial by AMA Board of Trustees Chair Joseph Heyman, M.D., has led AAFP President Ted Epperly, M.D., of Boise, Idaho, to emphasize the importance of the AMA working with primary care physicians to ensure they are fairly and adequately paid for the services they provide to patients with Medicare coverage.
 Heyman's editorial, which was posted Jan. 26 to American Medical News online and published in the Feb. 2 print version of the publication, urges payment increases for primary care physicians, but he emphasizes that the AMA would not support such increases if it means there would be corresponding reductions in subspecialists' payments.

"Payments to primary care physicians must increase," said Heyman, an OB-Gyn. However, he added, the AMA "absolutely opposes applying budget-neutrality rules that confine offsets to the physician payment pool."

"Congress should not rob Dr. Peter, the surgeon, to pay Dr. Paul, the primary care physician," said Heyman.

The AAFP and the AMA should act together to speak with a unified voice to support Medicare payment increases for primary care physicians, said Epperly. Ideally, payment increases for primary care physicians should not come via shifting payments from subspecialists, he added.

"We are disappointed that Dr. Heyman chose to use an example that pits (sub)specialists against primary care," Epperly told AAFP News Now. "It would have been more appropriate to speak of the need to think more broadly of applying budget neutrality and that the AMA would oppose solutions that pit any specialties against each other," he said.

"The AAFP is not necessarily advocating that other physicians receive less so (primary care physicians) get paid more," said Epperly. "We don't want this to become a war amongst (physicians). We cannot 'circle the wagons' and point the guns internally and start shooting at each other. It is much better if we circle the wagons together and collectively demand new payment modes that value the important work that family physicians and other primary care physicians perform."
It is important, Epperly added, to go outside of Medicare part B when looking at this issue.

"We must go across the Medicare silos and look at other parts of Medicare -- A, B and D, as well as other sources for this payment increase," said Epperly.

In November, Senate Finance Committee Chair Max Baucus, D-Mont., unveiled a call to action that relies heavily on primary care and preventive services as a way to reform the nation's health care system. Baucus unveiled the health care blueprint during a Capitol Hill press conference in which he said increased payments for primary care physicians might require a shift in resources that results in reduced payments for subspecialists.

In the final analysis, family physicians may be faced with a situation where payment reductions to subspecialists are the only way to finance increased payments for primary care physicians. In this situation, Epperly said he would support shifts in Medicare physician payments to adequately compensate primary care physicians.

"If it comes to this being the only way (increases would) be paid for, I would say, '(Primary care physicians) need to be paid more, and (subspecialists) need to be paid less,'" Epperly said. "But I hope we can avoid going down that path.

"We need to reframe the discussion to focus on paying family physicians more for the important role they perform in integrating and coordinating health care, and all physicians need to work together with a unified voice to accomplish that goal."


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