Health reform is top ACP priority in annual status report

The physician organization also says President Obama can begin enacting meaningful changes on his own before any action from Congress.

By Chris Silva — Posted March 1, 2010

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The U.S. health care system is in such decline that major reforms are needed to address the high number of uninsured, dwindling number of primary care physicians and rising costs of administering care, the American College of Physicians concluded in a recent report.

The political climate in Washington is too highly partisan and polarized for lawmakers to craft effective piecemeal reforms to address the health challenges facing the nation today, the ACP said in its annual "State of the Nation's Health Care" report. Those challenges include making health insurance coverage more affordable, available and secure; ensuring a sufficient supply of primary care physicians and specialists; and reforming payment and delivery systems to achieve better value.

But such measures can be achieved, the internists' organization said, if lawmakers take the House and Senate bills passed late last year and agree on a legislative pathway to enact a final bill.

"We shouldn't toss them out and start from scratch," said Robert Doherty, the ACP's senior vice president of government affairs and public policy. Instead, he proposed that lawmakers revise provisions that caused concerns -- such as state exemptions from public health expansions and a Medicare payment board that could require spending cuts. The bills' main provisions would expand affordable coverage, address primary care shortages, and implement needed payment and delivery reforms, he said. The ACP also recommended that:

  • Congress give preferred funding to discretionary programs that ensure a sufficient supply of primary care physicians.
  • Congress permanently end the cycle of Medicare physician payment cuts caused by the sustainable growth rate formula.
  • President Obama require that all federal health agencies and contractors develop plans to increase the number of primary care physicians and reduce administrative burdens.
  • The administration accelerate pilot tests of innovative models such as patient-centered medical homes and comparative effectiveness research.

Congress is unlikely to achieve these goals with piecemeal bills, Doherty said. "We understand the appeal of passing a series of smaller bills. The problem ... is that small bills are likely to produce Swiss cheese reforms that do not work in practice."

Other physician organizations, including the American Medical Association, also have called on lawmakers to find common ground between the House and Senate reform bills. AMA President J. James Rohack, MD, sent a letter Jan. 26 to President Obama and Congress renewing a call to enact reform legislation.

The ACP also believes the Obama administration does not need to wait for legislation to begin implementing important changes. For example, a systematic review of the Centers for Medicare & Medicaid Services should be conducted to address unnecessary and ineffective paperwork requirements, the ACP said.

"We are urging President Obama to use his executive authority to increase primary care work force capacity and to reduce the time that physicians and patients spend on administrative interactions that take time away from patient care," said ACP President Joseph Stubbs, MD.

But primary care concerns are not the only ones that should be on the minds of lawmakers and the White House as they try to push reform over the finish line, specialists warn.

Katie Orrico is a founder of the Alliance of Specialty Medicine, a coalition of national medical societies representing specialty physicians. She said Obama and Congress need to consider the reform needs of both primary care and specialty physicians.

"The alliance is certainly in favor of reform and mindful that there are cracks in the current system, and that there is a need to shore up the primary care base," said Orrico, director of the Washington office for the American Assn. of Neurological Surgeons. But "we're concerned there's been too much focus on primary care, including on the coverage of preventive services, and that little or no attention has been paid, frankly, to the fact that you need a strong specialty work force as well."

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The gloomy state of health care

The American College of Physicians paints a bleak insurance landscape for doctors and patients unless the federal government is able to enact meaningful changes to the health system. Compiled findings include:

  • By 2020, the number of uninsured will climb from 46 million to 60 million, or one out of every five people.
  • Health plans covered slightly fewer expenses in 2007 than in 2004, but out-of-pocket spending grew more than one-third because of overall health spending growth.
  • On average, physicians spend 43 minutes per workday -- equivalent to three hours per week and nearly three weeks per year -- on interactions with health plans. Primary care physicians spend more time (3.5 hours weekly) than do medical specialists (2.6 hours) or surgical specialists (2.1 hours).
  • When time is converted to dollars, practices spend an average of $68,274 per physician per year interacting with health plans. Primary care practices spend $64,859 per physician -- nearly one-third of the income plus benefits of the average primary care physician.

Source: "The Declining State of the Nation's Health Care and the Urgency of Moving Forward on Essential Reforms," American College of Physicians, Feb. 17 (link)

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