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Payment reform and solutions to challenges facing primary care addressed in policy papers

WASHINGTON New policy papers addressing comprehensive payment reform and solutions to challenges facing primary care physicians were released today by the American College of Physicians (ACP). The new policy papers are:

  • Reforming Physician Payments to Achieve Greater Value in Health Care Spending
  • Solutions to the Challenges Facing Primary Care Medicine: Comprehensive Strategies from the American College of Physicians

"These papers are complementary," noted ACP President Jeffrey P. Harris, MD, FACP. "By approving them earlier this week, ACP's Board of Regents showed that reform of physician payment policies must go hand-in-hand with policies to reverse the growing shortage of primary care physicians in the United States."

The papers were featured today in a panel discussion, ACP's Comprehensive Strategies for Payment Reform and Solutions to the Challenges Facing Primary Care Medicine, at Internal Medicine 2009, ACP's annual meeting. The session was moderated by Dr. Harris. Panelists were Joseph W. Stubbs, MD, FACP, president-elect of ACP, J. Fred Ralston, Jr., MD, FACP, an ACP regent, and Robert B. Doherty, senior vice president of ACP's division of governmental affairs and public policy.

"Taken together, these papers propose comprehensive changes in medical education, workforce, financing, delivery, and payment policies to ensure there will be enough primary care physicians to meet the growing demand in the United States," said Dr. Stubbs. "Primary care is essential to an effective and high-performing health care system. In fact, primary care has been proven to save money and improve health, yet primary care is nearing collapse."

The "Payments" paper features 30 policy recommendations and suggests elements relating to 11 broad themes that should be included in payment reform models. It recommends a two-component process to realize the comprehensive payment reform that will result in better value for health care spending in the U.S. The recommendations address not only the need for new payment models to support primary care, but the need to design, test and then implement a variety of new models to align incentives for high quality, effective and efficient care for all physicians.

The first component is to develop, test and evaluate innovative payment models that align incentives with quality, effective and efficient care instead of paying on the basis of the volume of services. The second, concurrent and complementary component is to improve the current fee-for-service payment system, which is largely based on the resource-based relative value scale (RBRVS, a schema used to determine how much money medical providers should be paid).

The recommendations involve changes to reverse the declining interest in the practice of primary care that is on the verge of making particular specialties extinct and to provide a better environment for physicians to respond to patient needs. Refinement of the fee-for-service system is needed because it is likely to remain in effect until new, more effective payment models are identified and implemented and it may serve, at least in part, as the basis for determining payments under the new models.

In the "Solutions" paper, ACP's recommendations offer a comprehensive strategy to address the challenges facing primary care by providing:

  • Reforms in medical education
  • Relief from educational debt
  • Reduced regulatory and administrative burdens
  • A redesign of how primary care is financed and delivered
  • Payment reform (which is addressed more fully in the payment reform paper)

These efforts are designed to halt and reverse the decline in the number of physicians entering primary care.

"Efforts to expand coverage will fail to achieve improvements in access, quality and efficiency of care without enough primary care physicians," Dr. Harris concluded.

Together, the ACP policy papers point out that the long pipeline of medical education and training and the retirement and career changes of older physicians necessitate that the nation have a constant influx of new students embarking on medical careers. Because it takes a minimum of seven years to train a physician in a primary care specialty, it is imperative that policymakers take immediate, comprehensive and sustained action to avert the impending collapse of primary care.


Contact: David Kinsman
American College of Physicians

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