From the internists: an alternative health care reform program

The American College of Physicians, which represents internists and promotes primary care, issued yesterday two related papers: A Report from America's Internists on the State of the Nation's Health Care and a position paper, A System in Need of Change: Restructuring Payment Policies to Support Patient-Centered Care. Both of these are linked here. Like the variety of other proposals that have come forth in the past couple of weeks from states, presidential candidates, insurance groups, and to some extent the White House, the ACP proposal advocates making health insurance affordable to all Americans.

The ACP goes beyond other proposals in several directions, however, principally through its focus on patient-centered care, for which it advocates "advanced medical homes" - not nursing homes, but primary care centers that house primary-care providers. These providers would actually coordinate care, supported by electronic medical records, evidence-based decision-support systems, and payment policies based on defined packages of services related to care coordination. Current reimbursement for care is based solely on office visits and procedures; although capitation currently results in disincentives for office visits after a certain maximum benefit is reached, the ACP proposal does allow for fee-for-service reimbursement for office visits as part of ongoing, coordinated care. In addition, the ACP proposal advocates a performance-based component to payment, based on measures of evidence-based quality, efficiency, and patient satisfaction.