American College of Physicians urges system reform, new model of care

The health care system needs major reforms and should embrace a patient-centered model of care, according to a new report from the American College of Physicians.

Adopting that model would avert a collapse of primary care medicine by restructuring payment policies to support the value of care provided by primary care doctors, the ACP's annual report concluded about the state of the nation's health care. Under the model, a primary care physician partners with the patient and leads a team that provides enhanced access to care and better health care coordination.

"This builds on what we've been doing the past three or four years in looking at primary care," said ACP President Lynne Kirk, MD, of Dallas.

A system built on a patient-centered medical home would mean improved outcomes, more efficient use of resources and higher patient satisfaction, according to the Jan. 22 report. ACP leaders said implementing recommendations in the report would change the way primary care is organized, delivered and financed.

Many physicians provide some elements of patient-centered care but few provide all of them, Dr. Kirk said. A key reason why the United States does not consistently deliver such care is that payment systems reward doctors for the volume of procedures and number of office visits rather than for ongoing management of patients' health, she said.

To bring about change in payment systems, the ACP also issued a policy paper that calls for the federal government to take the lead in restructuring payment policies to support patient-centered care.

The ACP's leaders want to see Medicare transition from paying doctors solely on the number of procedures or visits to paying physicians for providing patient-centered health care. The sustainable growth rate would be replaced with a methodology that would provide positive and predictable baseline payments and create strong incentives for doctors to design and participate in programs to improve quality, the report said.

"Physicians would be paid for taking responsibility for coordinating the care of the whole patient and for implementing systems-based approaches to improve outcomes and reduce costs," Robert B. Doherty, ACP senior vice president of governmental affairs and public policy, said at a briefing on the report.

The ACP will meet with congressional leaders to present its road map for change, Doherty said.

Last month, the American Medical Association unveiled its 2007 advocacy agenda, which includes reforming the Medicare payment system and expanding health insurance coverage for the uninsured. The AMA and ACP were among 10 physician associations that last month released principles to reform the health care system, including health care coverage for all.

Meanwhile, the American Academy of Family Physicians also is working toward a new care model. The move is a result of the 2004 Future of Family Medicine report that called for a transformation of the specialty with core elements that include patient-centered care, electronic health records and a team approach to care.

Three dozen family practices are taking part in a national demonstration project of TransforMED, an $8 million AAFP practice redesign initiative.