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Internists ask President-elect Obama to include aid for primary care in stimulus proposal

Washington At the request of the presidential transition team, ideas on advancing health care reform in the stimulus package were provided today by the American College of Physicians (ACP). ACP represents 126,000 internal medicine physicians and medical student members. It is the nation's largest medical specialty society and it is the second largest physician membership organization.

"ACP believes that it is essential that the stimulus package provide a 'down payment' on expanding health insurance coverage and delivery system reforms to reverse a growing shortage of primary care physicians," ACP President Jeffrey P. Harris, MD, FACP, wrote Tom Daschle, Secretary-designee of the Department of Health and Human Services.

Dr. Harris recommended that the stimulus package include funding for a 10 percent increase in Medicare payments for all services billed by primary care physicians over 18 months, as a first step toward reversing a growing and potentially cataclysmic primary care workforce shortage. The College also recommended inclusion of incentives, directed toward primary care physicians in smaller practices, to acquire specific health information technology applications to support care coordination in a Patient-Centered Medical Home, as part of a broader plan to encourage universal adoption of HIT.

Dr. Harris recalled that President-elect Obama's concern was "right on the mark" when he noted during the campaign that "primary care providers and public health practitioners have and will continue to lead efforts to protect and promote the nation's health. Yet, the numbers of both are dwindling."

Recent studies project a growing shortage of 45,000 or more primary care physicians. This shortage can be attributed to increased demand for primary care associated with an aging population with more chronic illnesses, a sharp downturn in young physicians choosing primary care, and the accelerating number of established primary care physicians that are leaving practice. The Journal of the American Medical Association reports that only two percent of fourth year medical students plan to practice in primary care internal medicine.

Earlier this month, ACP released an annotated review of more than 100 studies that show that primary care is consistently associated with dramatically lower rates of preventable hospital and emergency room visits, overall lower rates of utilization of all kinds, fewer premature deaths, and longer life spans.

"The primary care shortage is occurring despite the overwhelming evidence that primary care is consistently associated with better outcomes at lower cost," Dr. Harris continued. "The loss of even one primary care practice in a community during these tough economic times will put thousands of patients in the impossible situation of trying to find a new primary care physician, when most of the surviving primary care practices already are at full capacity and unable to take on any new patients."

Dr. Harris also urged that the stimulus plan include financial help and access to health insurance for individuals who are at risk of losing their health insurance during the economic downturn. He also called for a temporary increase in federal matching funds to states for Medicaid and SCHIP to be used to maintain current levels of Medicaid and SCHIP enrollment and benefits. "Such measures are necessary first steps toward comprehensive reforms to expand and guarantee affordable health coverage to all," noted Dr. Harris.

He concluded his letter to Senator Daschle by saying: "We believe the stimulus package provides an excellent opportunity to begin this process by helping individuals who may lose their coverage during the economic downturn, stabilizing the primary care workforce by providing targeted payment increases, and providing help to smaller primary care practices in obtaining the health information systems needed to function as patient-centered medical homes."


Contact: David Kinsman
American College of Physicians

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