Internists' Annual Report on Nation's Health Recommends Payment Reform

The American College of Physicians, or ACP, has released its annual overview, which highlights problems in the U.S. health care system and calls for sweeping payment reforms designed to shift the nation's focus back to patient-centered primary care and prevention.

ACP's report, "State of the Nation's Health Care" (PDF file: 18 pages / 80 KB. More about PDFs.) contains a laundry list of red flags, including

And the situation is only getting worse, according to the ACP.

The report says that the health care system in the United States is on the verge of collapse. By undervaluing primary care, new physicians are discouraged from entering the field, and practicing physicians are discouraged from staying. Meanwhile, an aging population is increasing demand for care management and other primary care services. This inevitably will lead to "higher costs, lower quality, diminished access and decreased patient satisfaction," according to the report.

"The solution to such inadequacies is to redirect federal health care policy toward supporting patient-centered health care that builds upon the relationship between patients and their primary and principal care physicians and supports the systems needed to achieve better results," said ACP President Lynne Kirk, M.D., in remarks (PDF file: 4 pages / 27 KB. More about PDFs.) made during a Jan. 22 press conference.

Ideally, the health care system should provide a medical home where patients have consistent access to a personal physician who can take responsibility for treating and managing their care, she said. The report cites recent studies that show patient-centered, primary care leads to improved quality and reduced costs and recommends that the federal government take the lead in improving the nation’s health care system.

"First, we are calling for Medicare to make fundamental changes in the way they pay physicians for delivering care. If our recommendations are accepted, Medicare would no longer pay physicians based solely on how many procedures or visits are billed," said Robert Doherty, ACP's senior vice president for government affairs in remarks (PDF file: 4 pages / 27 KB. More about PDFs.) made during the press conference.

Under the ACP's proposal, physician practices that can demonstrate delivery of patient-centered care through use of information technology would be eligible to be paid by Medicare under an alternative fee structure, to include

For practices that don't qualify for this payment structure, the report recommends that Medicare revamp its fee-for-service policies to add payments for some of the care coordination services primary care physicians commonly offer.

The ACP also advocates that the government do away with the sustainable growth rate formula, which currently is used to set physician payment rates, and replace it with a calculation that will provide physicians with predictable annual increases in baseline rates.

Beyond the Medicare program, the report recommends that the federal government provide additional financial and administrative support to the states, enabling Medicaid and the States Children's Health Insurance Program, or SCHIP, to provide better care to more children and adults.

In January, an alliance of health care stakeholders, including the AAFP, similarly proposed bolstering the state-run programs by streamlining the enrollment of children in Medicaid and SCHIP and providing new tax credits to help families afford private health coverage.