Sunday, August 9, 2009

Disappointing statement from the president of the American College of Physicians

A statement sent to the American College of Physicians members from its president, Joseph Stubbs. It has some good points, but all in all still physician-centered and not advocating for the best interests of patients (even though it pretends to do so), as demonstrated by his support for physician-negotiated reimbursement rates and not discounted Medicare's rates, which are most likely more efficient and cheaper for patients.

Also find it funny that he advocates for "increased Medicare and Medicaid payments to primary care internists and other primary care physicians, funded in a way that does not cut payments to other internal medicine specialists." I wonder where he thinks that money should come from.


Dear Colleague,

Today, I write to you in my role as President of the American College of the Physicians, but first, let me tell you a little bit about my "day job." When I am not traveling around the country to represent your views as ACP President, I spend my time taking care of patients in a general internal medicine practice in rural Albany, Georgia, as I have done for the past 30 years. Like you, I take enormous professional pride and satisfaction in keeping my patients healthy, helping to heal them, and providing comfort and relief when they are nearing the end of life.

I also share the frustrations with a health care system that often is stacked against patients and their doctors. Too many of my patients can't find affordable health insurance because they have a "pre-existing condition" -- as the insurance companies like to call it. Some of them have lost their jobs -- and their insurance -- during these economic hard-times. Rising premiums and out-of-pocket expenses have brought some to the brink of bankruptcy. At the same time, patients and doctors alike are drowning in a sea of red tape, rules and regulations we cannot understand.

We physicians struggle to provide our patients with the best care possible, even as payment systems reward rushed, episodic care over spending time with patients on prevention and care coordination. Regrettably, few young physicians are choosing internal medicine or other primary care fields, and as a result, we are facing a shortage of tens of thousands of primary care physicians. All of these are barriers to our ability to provide our patients with the care they need.

All of these are barriers that health reform legislation can help overcome. This is why ACP believes that health reform cannot wait. Not just any kind of health reform, but health reform that does at least the following:

1. Provide all Americans with access to an affordable health insurance plan that does not exclude or discriminate against those with pre-existing conditions. We believe that people who can't afford coverage should be provided with help, in the form of tax credits, to buy coverage. We believe the public should have a wide choice of health plans. We believe that health plans should compete based on innovations to improve patient care, not on cherry-picking out the young and healthy. We advocate that all insurers cover preventive services and other essential benefits. We believe that if a public plan option is included, physician and patient participation in the plan must be completely voluntary, the public plan should compete on a level playing field with private insurers (no unlimited access to federal funds) and it should pay competitively -- and not base its payments on Medicare's discounted rates.

2. Create incentives to increase the numbers of general internists and other primary care physicians. We support providing medical students with loan forgiveness and scholarships if they go into general Internal Medicine or another primary field. We advocate for increased Medicare and Medicaid payments to primary care internists and other primary care physicians, funded in a way that does not cut payments to other internal medicine specialists. We support funding and pilot-testing, on a national basis, of paying internists for the work involved in care coordination through a qualified Patient-Centered Medical Home.

3. Put an end to the annual cycle of Medicare payment cuts due to the flawed Sustainable Growth Rate (SGR) formula. Year after year, Congress has used the SGR to threaten physicians with cuts, and then it ends up passing a short-term fix that makes the cuts in future years even worse. This must stop.

4. Reform the medical liability system and reduce the administrative burdens imposed by health insurers. We advocate for caps on non-economic damages and testing of new models -- like health courts, which would have cases heard by an expert panel rather than by a lay jury. We call for standardization of insurance credentialing, quality reporting, and patient eligibility verification, and other reforms to simplify and reduce administrative costs.

As ACP evaluates pending bills, we lend support when they are consistent with the above priorities, and call for changes when they are not. For instance, although we support provisions in the current bills that would make health insurance coverage more affordable by providing subsidies to help people buy coverage from qualified plans, we expressed strong concern about a new public plan that would pay doctors based on below-market Medicare rates. The House has since agreed with us and decided to change its bill so that a public plan would have to negotiate its payment rates with doctors and hospitals, up to prevailing private sector rates.

Congress has decided that it will not take a vote on legislation until after the August recess, which began on August 7. Congress will return after Labor Day. The recess gives us an opportunity to continue to influence the bills so they meet our priorities, as described above. To get the changes we want, ACP needs to continue to participate in the process -- being insistent in supporting the policies we like and seeking changes when they do not. We can't move the ball toward our policy goal posts if we walk off the playing field.

Now, I know that some of you are concerned about ACP lending its support to particular bills. ACP represents a diverse membership of 129,000 internal medicine physicians and medical student members, and no two internists will agree on every issue. Some of you are deeply conservative and distrustful of any reforms that involve a larger role for government, and you especially object to a public insurance option. Some of you are deeply liberal and favor a single payer system and oppose any plan that would cover people through private insurance and eliminate a public plan option. Many of you, like me, are somewhere in-between.

Still, we are all internists who share a passion for patient care and the desire to make sure that health reform meets our patients' needs. As internists, we must be unified in our quest for health care reform that delivers on the priorities I've described above – priorities that came from ACP's members and that are supported by most of us. While unity is important, so is respectful recognition and discussion of our differences as we, together, sort through the often conflicting and large amount of information on health care reform. I, along with everyone at ACP, will do my best to make sure that we provide you with up-to-date and accurate facts so you can assess the various health care proposals and engage in a productive dialog. You can learn more about how to become involved in ACP's advocacy activities through our Legislative Action Center.

We should also consider the consequences if health reform fails, and we leave it to a future Congress to pick up the pieces of a broken health care system -- years or even decades from now. The result will be more uninsured patients, more families going bankrupt because of high health care bills, more cherry-picking, Medicare insolvency, and continuation of a payment system that undervalues the care provided by internists, leading many young physicians to choose other fields. This is not a future I want for my patients or our noble profession.

Within our grasp is achievement of health reform legislation that makes coverage affordable by building upon and improving our current employer-based system, providing incentives for young doctors to go into primary care internal medicine, reforming and improving Medicare physician payments, and reducing the costs associated with our broken medical liability system. Let's not let it slip away.

Yours truly,

Joseph W. Stubbs, MD, FACP

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