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AS THE HEALTH CARE REFORM DEBATE HAS BECOME more fractious and politicized, the need for clear, productive, and patient-centered input from physicians has increased. The cumulative actions of individual physicians can have a substantial effect on meaningful and lasting reform. For the medical profession to assume a leadership role, individual physicians will need to (1) acknowledge the inequitable and dysfunctional nature of the current health care system and the role of physicians in perpetuating that system, (2) examine his or her professional responsibilities to the public, and (3) take action with specific concrete behaviors that will facilitate and guide efforts to improve the health care system. Physicians have learned to work within a dysfunctional system—committing extra hours to arguing with insurers to obtain a medication for one patient, a computed tomographic scan for another, and a surgical procedure for a third. The annual cost of challenging third-party payers has been estimated at $68 000 per physician. The system has become so unmanageable that some physicians are willing to use deceit to secure insurance coverage for a medical procedure. These burdensome practices and costs, however, have not been effectively challenged by physicians—even during this time of reform. For many physicians, it may simply be a matter of having limited time or a distaste for politics. Others may be resigned to working within a system that is familiar, despite its dysfunction. Whatever the reason, in remaining silent, physicians have perpetuated a system in which patient access to medical care is too often reliant on the physician’s willingness to participate in, and at times game, a highly inequitable system. The American College of Physicians’ charter addresses the professional obligations of a physician, encouraging physicians to work at the societal level to improve access to care, reduce discrimination, manage conflict of interest, control medical expenditures, and facilitate a just distribution of scarce resources. In accordance with these principles, there are immediate and concrete steps physicians can take both at the bedside and in the community to help reshape the health care system and fulfill their moral and professional duties to the public. Work Daily to Provide High-Quality Care Physicians must commit to improving quality in their daily practice. Nearly half of patients do not receive evidencebased medical care, chronic illness is often poorly controlled, and many patients do not receive clinically needed preventive services. Physicians must respond by adopting new approaches to measuring and improving the quality of care they are providing. Physicians and group practices can receive incentive payments for participation in Medicare’s physician quality reporting initiative. Additionally, professional societies and insurers often have mechanisms for collecting and reporting quality data. These data can be used by physicians to improve performance and patient care.
48Exploring the Generalist-Subspecialist Interface in Internal Medicine
Exploring the Generalist-Subspecialist Interface in Internal Medicine
Family Physicians Sue to Shine Light on RUC Deliberations, Claim Specialists Skew Reimbursement Against Primary Care
Family Physicians Sue to Shine Light on RUC Deliberations, Claim Specialists Skew Reimbursement Against Primary Care
11Health Is More Than Health Care.
This article is part of the Annals supplement “Better Is Possible: The American College of Physicians' Vision for the U.S. Health Care System.” The American College of Physicians was the sole funde...
Read more155Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries
This position paper concerns improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it with health care in other countries. The concluding section proposes lessons that the United States can learn from these countries and recommendations for achieving a high-performance health care system in the United States. The articles are based on a position paper developed by the American College of Physicians' Health and Public Policy Committee. This policy paper (not included in this article) also provides a detailed analysis of health care systems in 12 other industrialized countries. Although we can learn much from other health systems, the College recognizes that our political and social culture, demographics, and form of government will shape any solution for the United States. This caution notwithstanding, we have identified several approaches that have worked well for countries like ours and could probably be adapted to the unique circumstances in the United States.
Read more12The Good and the Bad About the 2017 American College of Physicians Osteoporosis Guidelines
The Good and the Bad About the 2017 American College of Physicians Osteoporosis Guidelines
53Navigating Social Media in #Ophthalmology
Navigating Social Media in #Ophthalmology
2Putting prevention into practice: the physician's role.
Currents15 October 1998Putting Prevention into Practice: The Physician's RoleTom ReynoldsTom ReynoldsSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-8-199810150-00043 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical preventive services, such as screening tests, immunizations, and behavioral change counseling, should be a key component of the shift away from a reactive, disease-oriented medical culture toward a proactive, health-based one. But many of these services, studies show, are being honored more in the breach than in the observance.A 1997 report by the National Committee for Quality Assurance showed that nationwide delivery of preventive services by managed care plans varies widely. For example, in 1996, 81% of New England children younger than 2 years of age who were in managed care plans received appropriate immunizations, compared with only ... Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 October 1998Volume 129, Issue 8Page: 679-680KeywordsBehaviorChild healthComputersHealth careInternetMammographyMotivationPatientsPreventive medicineSmoking habits Issue Published: 15 October 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Read moreThe Journal Club
The Journal Club
39Physician Policies on the Use of Preventive Hormone Therapy
Physician Policies on the Use of Preventive Hormone Therapy
Quality Indicators for Diabetes in Adults: A Review of Performance Measures by the American College of Physicians.
Type 1 and type 2 diabetes are prevalent chronic illnesses, are leading causes of mortality and morbidity, and result in substantial public health burden. Timely identification and appropriate management of diabetes can help reduce adverse consequences of diabetes. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care but believes that a performance measure must be methodologically sound and evidence-based in order to be considered for inclusion in payment, accountability, or reporting programs. These principles are critical given the potential impact on physician administrative work, reputation, and reimbursement and to prevent unintended consequences for patient care. To help improve performance measurement and reduce burden, the ACP Performance Measurement Committee (PMC) reviews performance measures using a rigorous process to recognize high-quality measures and address gaps and areas for improvement. In this article, the PMC presents its review of 14 current performance measures for diabetes that are relevant to internal medicine. The PMC supports kidney health evaluation at the individual and group practice levels, hemoglobin A1c control at the health plan level, eye examination at the health plan level, and angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker therapy at the individual physician level.
Read more7Here Comes the Sun: Medical Professionalism and the Implications of the Sunshine Act for Gastroenterology Practice
Here Comes the Sun: Medical Professionalism and the Implications of the Sunshine Act for Gastroenterology Practice
63A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"
Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.
Read more8A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"
A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"
45Clinical Preventive Medicine in Primary Care: Background and Practice: 1. Rationale and Current Preventive Practices
Clinical Preventive Medicine in Primary Care: Background and Practice: 1. Rationale and Current Preventive Practices
273Prevention and Control of Seasonal Influenza With Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 Influenza Season
Prevention and Control of Seasonal Influenza With Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 Influenza Season
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