Internists review progress, challenges and opportunities

February 11, 2014, American College of Physicians

"For the first time in the history of the United States, Americans are experiencing the benefits of health reforms designed to ensure that everyone has access to affordable coverage including a suite of essential benefits," Molly Cooke, MD, FACP, president of the American College of Physicians (ACP), said at today's annual State of the Nation's Health Care briefing. "In addition, Congress is on the verge of passing bipartisan, bicameral legislation to repeal the Sustainable Growth Rate formula. This flawed formula was put in place by Congress in 1997, and resulted in the first scheduled cut in physician payments in 2002. Now, 12 years later, we have the opportunity to permanently eliminate the SGR and accelerate that transition to value-based payment and delivery models."

In a 21-page report, ACP offers its assessment of where things stand with both the Affordable Care Act (ACA) and Medicare Physician Payment Reform and the next steps to be taken to build on the progress made.

While applauding the historic progress being made in expanding access to coverage, ACP noted two challenges that can create barriers to care. The trend to narrow provider networks and to restrictive formularies, which can make it difficult for patients to see the physicians they trust and get the medications they need. While such trends pre-date and are not limited to offered through the ACA, ACP observed that the federal government has a particular responsibility to address such barriers to access in federally qualified plans. State regulatory agencies and the insurance industry itself also have important roles.

Dr. Cooke reported on letters sent today by ACP to HHS Secretary Kathleen Sebelius, the National Association of Insurance Commissioners, America's Health Insurance Plans, and the Blue Cross and Blue Shield Association of America, featuring specific and detailed recommendations from ACP to address concerns about the impact of unduly narrow networks and restrictive drug formularies and related issues on patient choice, access and continuity of care. ACP calls for a balanced, constructive and transparent approach to allow patients/consumers to make informed choices, to reduce unnecessary interruptions in continuity of care, and to ensure fairness and due process for clinicians and patients, including improvements in federal and state regulatory oversight of qualified health plans.

The specific, detailed recommendations presented by ACP today, are offered in the spirit of making sure that even as coverage is expanded, "we also constructively discuss and address potential obstacles to patients obtaining the care they need, from physicians they trust." ACP noted that as a result of the reluctance of some states to accept federal dollars to expand Medicaid, two out of three of the poorest Americans who were supposed to get covered by the ACA are left out. ACP reissued its call for all states to commit to expand Medicaid by the end of this year. Dr. Cooke noted that ACP is working with its chapters to get the word out to their states that expanding Medicaid is the right thing to do, for the health of their residents and for their state budgets.

In conclusion, Dr. Cooke suggested, "Let's build upon the enormous progress that already has been made. That way, 2014 truly is viewed as a watershed year in which we could honestly say that the state of the nation's health care is good and getting better, millions of Americans formerly without insurance are moving into the ranks of the insured, and we are making serious progress on paying for value to patients in the Medicare system."

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