American College of Physicians Launch Initiative
to Improve Health Care Enviromnet
Overarching, multi-organizational initiatives:
Revitalization of Internal Medicine Initiative: As the largest internal medicine group in the United States, the American College of Physicians is helping to facilitate a national initiative to address the challenges in today's health care environment that affect patient care and compromise the future of primary care.
The organization is collaborating on the initiative with the Alliance for Academic Internal Medicine, the American Board of Internal Medicine, the Society of General Internal Medicine, the Society of Hospital Medicine, the Council of Subspecialty Societies and other internal medicine organizations. ACP students, associates and young physicians, internists practicing in hospital and community/office settings, general internists and internal medicine subspecialists are a very important part of the initiative.
As a result of an ACP-hosted summit meeting of all participating organizations, four overarching goals were set to achieve the revitalization of internal medicine:
* Repair a dysfunctional payment system, by reforming parts of the current system, developing new models of care and payment, and addressing medical education issues such as mounting student debt and declining funding of medical education.
* Improve efficiency in practice and reduce hassles, though recommendations for practice improvement, innovation and appropriate-quality care.
* Define the value of internal medicine to the public and the health care system.
* Develop education and training for a new world, by revamping current and traditional training programs and designing new residency and ongoing education programs around multidisciplinary teams, coordination of care, disease management and quality improvement.
ACP is committed to revitalizing the practice of internal medicine by restructuring a system to focus on quality patient care linked to scientific innovation and discovery, underpinned by advances in health information technology (HIT), including adoption of electronic health records integrated with practice management and clinical decision support software, such as ACP's highly regarded Physician Information and Education Resource (PIER-see further description below). ACP is directly participating in, or partnering with other organizations, in a number quality improvement initiatives, including the eHealth initiative, Connecting for Health, the Physicians' Electronic Health Record Coalition (PEHRC), a National Quality Partnership with the Centers for Medicare and Medicaid Services (CMS) and the American Academy of Family Physicians, and two statutorily mandated Medicare demonstration programs-the Doctors Office Quality-Information Technology program, which seeks to create incentives for physician adoption of HIT and reporting of performance data, and the Chronic Care Improvement pilot program, where ACP is advocating testing of a "patient-centered, physician-guided" model of care, underpinned by a real-time, point-of-care decision support tool such as PIER.
With improving the quality of patient care and reducing physician hassles at the heart of ACP's revitalization efforts, the ACP Board of Regents has approved new policies that call for standards to significantly improve exchange of electronic health care information, and which also urge adoption of physician performance measures which can be linked to financial incentives for outstanding performers.. In addition to improved patient care quality and patient satisfaction, bringing the benefits of HIT to the physician office promises a significant reduction of administrative burden, increased practice efficiency and productivity, all of which translate to more time spent on patients and higher practice profitability.
These new policies build on earlier efforts. ACP's revitalization effort dates to 2002, when the organization's governing boards declared revitalization a priority for all boards, committees and administration. Since then, the College has issued an ongoing series of revitalization/quality improvement/HIT advocacy position papers: "Medical Professionalism in the Changing Health Care Environment: Revitalizing Internal Medicine By Focusing on the Patient-Physician Relationship" (April 20, 2004); "Recommendations on Reducing Medical Student Debt" (July 2003); "Time, Time Perception and the Patient-Physician Relationship" (March 2003); "Reimbursing Physicians for Computer-Based Care" (March 2003), "Reimbursing Physicians for Telephone Care" (July 2003), "The Paperless Medical Office: Digital Technology's Potential for the Internist" (January 2004), "Enhancing the Quality of Patient Care Through Interoperable Exchange of Electronic Healthcare Information" (April 2004), and "The Use of Performance Measurements to Improve Physician Quality of Care" (April 2004).
2) Medical Professionalism Project: A joint effort of the foundations of the American College of Physicians and the American Board of Internal Medicine, the Project is a collaborative effort designed to raise the concept of professionalism within the consciousness of internal medicine, both in the United States and Europe. The Project developed "Medical Professionalism in the New Millennium: A Physician Charter," which begins: "Professionalism is the basis of medicine's contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health. The principles and responsibilities of medical professionalism must be clearly understood by both the profession and society. Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and the whole profession." The complete Charter is available on Annals Online (5 Feb. 2002, vol.136, issue 3, pgs. 243-246).
