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ACPM
Policy Committee Meeting
November
16, 2003
10:00-11:30
a.m.
Renaissance
Parc 55 Hotel –
San
Francisco
,
CA
MINUTES
Participants
Mark Johnson (Chair), Chris Armstrong,
Mike Barry (staff), Steve Fox, Arvind
Goyal, Neal Kohatsu, Tiffany Kuo
(observer), Perrianne Lurie,
Jud
Richland
(staff),
Stephanie
Zaza
Welcome
and Introductions
Mark Johnson called the meeting to order at
10:08
a.m.
He led introductions and recognized
ACPM
staff for their work on committee and
policy activities in general.
The minutes from the February 2003
Policy Committee meeting were approved.
Continuing
Business
“Health Insurance for All” Position
Statement
Dr. Johnson summarized the work of the subcommittee on health insurance
following the February meetings in
San
Diego
and the differing points of view reflected
in the current position statement.
He then led a point-by-point
discussion of the statement.
(See Attachment A for a copy of the
statement marked up to reflect the
recommendations of the Policy Committee.)
Principle #1
-
It
was suggested that “for all
U.S.
residents” be defined in the
broadest terms.
-
The
committee agreed that “basic package
of health services” should be
revised to “package of essential
health services” because of the
ambiguity of the term “basic.”
-
There
was some discussion about the
modifier, “federally defined,” and
whether the principle should
explicitly state that physicians play
a key role in defining the package of
benefits.
However, the committee agreed
that a federal process for developing
the package based on national
guidelines would achieve the desired
outcome.
-
The
committee raised concern about use of
the phrase “government-funded health
insurance” in the Definitions,
Assumptions, and Supporting Comments
section, and its connotation of a
single (government) payer system.
-
The
committee agreed that the sentence in
the Definitions and Assumptions
section calling for the benefits
package to include evidence-based
community and public health programs
needed additional explanation.
Principle #2
Principle #3
-
There
was discussion about the merit of
having this principle, with some
members feeling that it contradicted
the idea of assuring universal access.
However, the consensus of the
committee was that it is wise
politically for
ACPM
to have this principle, acknowledging
the importance of retaining the
current strengths of the American
health care system.
-
The
committee agreed to add the word
“high” before “quality health
care and preventive services.”
-
The
committee agreed to remove the phrase
“and profits” at the end of the
principle.
Principle #4
-
The
committee agreed to replace the first
word, “Utilize,” with “Use”
and delete the second word,
“known.”
-
Concern
was raised about use of the term
“marginally beneficial” in
describing the need to minimize
over-utilization of these services.
The committee discussed the
idea of revising this term to include
services that may be totally
ineffective, or may be too costly on a
population basis.
The committee agreed to leave
the term as stated in the principle
and to clarify the issue in the
Definitions and Assumptions section.
Principle #5
The committee supported this principle as
stated.
General
A few general comments were offered:
-
The
scope of the statement is now broader
than health insurance (e.g., access)
and the title of the statement should
reflect as such.
-
It
was suggested that the statement
should convey the idea that the system
should reward or build incentives for
individual patients who make lifestyle
changes that promote healthy
behaviors.
The committee did not support
the inclusion of such a statement.
-
One
committee member raised concern about
the potential duplication between a
new financing and delivery system and
existing systems (e.g., VA, Medicaid,
etc.).
The committee agreed that
Principle #3 addresses such concerns.
-
One
committee member submitted comments
prior to the meeting raising concern
about the cost of unnecessary
administrative waste and duplication
and urging
ACPM
to consider administrative
simplification in its key principles.
The committee agreed that
Principle #3 addresses this concern.
Action: The
committee passed a motion recommending the
amended position statement to the Board of
Regents for adoption.
The committee felt the overall
message conveyed by the five principles
was strong and would provide a standard
against which
ACPM
could evaluate other health reform
proposals.
The committee suggested
ACPM
use the statement to evaluate the
proposals of the current Presidential
democratic candidates to gauge its
utility.
Action on Past Resolutions
Mike Barry reminded the committee that
ACPM
had adopted several resolutions over the
past three years on which little action
had been taken because of competing
priorities and resources.
These include resolutions on the
abolition of coronary heart disease,
consultative preventive medicine, patient
safety, and cardiovascular disease
prevention.
He asked if any committee members
felt strongly about the need for
ACPM
to act on these resolutions or was willing
to volunteer to take them on.
Action: No
action was taken on this agenda item, but
the committee suggested that Ron Davis’
proposal for
ACPM
to work with the AMA and the Institute for
Healthcare Improvement to promote quality
and safety in health care (specifically
around clinical preventive services)
offered a good opportunity for
ACPM
to advance its patient safety
recommendations.
New
Business
Secretary’s Health Professions
Roundtable
Jud Richland
briefed the committee about a meeting
being convened by
HHS
Secretary Thompson under the Steps to a
HealthierUS initiative on health
professions development.
Mr. Richland will be attending the
meeting for
ACPM
President Bob Harmon on November 18, along
with presidents and executive leaders from
a handful of other medical societies and
professional associations.
He solicited advice from the
committee on the important issues to
convey (e.g., Medicare GME financing for
PM residency programs).
The
committee recommended that, rather than
make Medicare GME the main issue,
ACPM
should convey to the Secretary the
importance of having a well-trained
workforce, particularly health
professionals with medicine and public
health training, to provide leadership on
today’s biggest issues, such as
bioterrorism preparedness and patient
safety.
Emphasize for BT preparedness, for
example, the dire need for more
specialists qualified to make rapid
administrative and medical decisions.
Regarding patient safety, stress
the only way to address the problem is
through surveillance and other
systems-based approaches, competencies
endorsed by ABMS.
Then mention that the only way to
develop such a skilled workforce that can
infuse leadership and systems-based
thinking into the current delivery system
is by rethinking the way the federal
government pays for training.
Then we can make the case that
preventive medicine is
“public health medicine” and
that the infrastructure is eroding, and
here’s how to fix it…
Preventive
Medicine and Hospital Credentialing
The
committee discussed the issue raised by
ACPM
West Regent Gary Goldbaum via email about hospitals
granting privileges to physicians trained
exclusively in Preventive Medicine.
His message noted a colleague in
Alaska
who had encountered a major barrier to
obtaining privileges because of a lack of
clinical training.
The hospital was requesting a
template for privileges accorded someone
trained in Preventive Medicine.
The
committee recognized that the issue is
limited mostly to
GPM
/PH
physicians without clinical training in
another specialty.
Action:
The committee agreed on a
recommendation to the Board that
ACPM
develop guidance on a minimum set of
privileges that should be granted to
preventive medicine-trained physicians.
The idea of a joint task force with
ABPM was suggested.
Chris Armstrong agreed to share the
guidance document used by the military in
granting hospital privileges to physicians
certified in General Preventive Medicine.
Other
Business
Because
of time constraints, no other business was
conducted.
Mike Barry agreed to address
unfinished business with the committee via
the listserv.
Dr.
Johnson adjourned the meeting at
11:33 a.m.
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