ACP Issues Recommendations for Healthcare Reform

February 03, 2009

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."

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