Doctors need to spend more time with patients and less time dealing with insurance paperwork and government-hassles, according to recommendations from the American College of Physicians.
In a report on the "State of the Nation’s Health Care," ACP officials outlined a series of policy recommendations aimed at reducing the regulatory requirements that they said get in the way of the physician-patient relationship.
At the top of their list: Paying physicians more for time-intensive visits with complex patients under the current fee-for-service system. For new models, such as capitation and bundled payments, they urged policy makers to ensure that there are explicit incentives to spend an appropriate amount of time with patients.
The ACP also called on the government and insurers to dramatically reduce clinical "micromanagement" such as preauthorization requirements and detailed documentation of clinical encounters. They recommended that the Centers for Medicare and Medicaid Services (CMS) harmonize and reduce the number of measures used in their various reporting programs, moving away from process measures and toward composite outcomes measures.
Bob Doherty
"Measurement can be a good tool in helping to improve outcomes, but not if the measures themselves don’t make sense, if they are in conflict with each other, or [are] too difficult to report on," Robert Doherty, ACP senior vice president of government affairs and public policy, said during a press conference on Feb. 20.
The CMS should not require physicians to transition to the new ICD-10 coding system, according to the ACP. The conversion process would place "enormous costs and administrative burdens" on physicians, Mr. Doherty said. Instead, the government should adopt a clinical terminology system to be used by physicians and then use automated crosswalks to generate codes for payment and reporting.
Also in the ACP’s sights: The current medical liability system and the strain it puts on the physician-patient relationship. Reforms such as caps on noneconomic damages, limits on attorney contingency fees, early disclosure of medical errors, and the use of specialized health courts should be enacted, according to college officials.
"The current adversarial tort system interferes with the patient-physician relationship and inhibits physicians from responsibly ordering tests and procedures based primarily on clinical and cost effectiveness and their patients’ needs in accordance with good practice guidelines," Mr. Doherty said.
The ACP also warned state and federal officials to stop trying to legislate how physicians talk to patients. Several states have laws or pending legislation that limit what physicians can say about certain risk factors or require them to provide diagnostic tests not supported by evidence.
Dr. David L. Bronson
"The inevitable result of the unrelenting assault on the patient-physician relationship is physician burnout, causing many physicians to leave their beloved profession," Dr. David Bronson, ACP president, said during the press conference.
The ACP report also outlines a series of recommendations aimed at improving the overall U.S. health care system:
• All states should participate in the expansion of Medicaid eligibility and set up health insurance exchanges on their own or in partnership with the federal government.
• Congress and the Obama administration should replace the across-the-board sequestration cuts scheduled to take effect on March 1.
• Congress should eliminate the Sustainable Growth Rate formula used to set Medicare physician payments
• Policy makers should preserve funding for graduate medical education and narrow the gap between primary care and specialist pay
• Congress should enact gun control legislation that includes improved access to mental health services, requires background checks on gun sales, bans high-capacity magazines, and bans certain semiautomatic weapons.
Convincing lawmakers to tackle the ACP’s list of priorities will be a "tall order," Mr. Doherty said, but he said he’s hopeful they will make headway since these are "commonsense" changes.