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Consultative
Preventive Medicine
01-02(A) Consultative Preventive Medicine
Joel L. Nitzkin, MD, MPH, DPA, FACPM
Daniel
Barr, MD, DABPM (member, ACPM)
RESOLVED:
That ACPM endorse in principle the
concept of Consultative Preventive Medicine,
as defined herein; and be it further
RESOLVED:
That ACPM form a task force to
explore the following issues, and report
back to the ACPM Board at Preventive
Medicine 2003 relative to the following:
- A
refined definition of Consultative
Preventive Medicine, and how such
practitioners should define their
practice with regard to the preventive
medicine services to be provided by all
primary care physicians (see attached)
- The
roles such practitioners should play in
clinical, institutional, and possibly
other settings
- A
preliminary set of recommendations
relative to the preventive medicine
consultative services that should be
provided to all Americans, including and
going beyond those currently listed as
"Clinical Preventive Services"
- Proposals
for enhancement of current preventive
medicine training programming for
development of clinical preventive
medicine consultation practitioners
- Recommendations
as to the nature and structure of the
research that should be conducted to
document the value, efficacy and
efficiency of consultative preventive
medicine services at individual, group
and institutional levels.
- A
preliminary advocacy plan to secure
funding for such research.
- A
preliminary advocacy plan to secure
funding and formal recognition for the
needed training programs.
- Preliminary
recommendations for marketing
consultative preventive medicine to
individuals and to healthcare payers.
Action
Taken: The
ACPM adopted the proposed resolution with
the following amendments:
- Resolved
1 is deleted.
- Delete
all references to the term
"consultative" in Resolve 2.
- Insert
two additional items under Resolve 2 as
follows:
"I.
Preliminary recommendations as to how
Preventive Medicine services should be
reimbursed in both fee for service and
capitated systems."
"J.
Recommendations of the role of Preventive
Medicine physicians as consultants."
Remarks: Dr.
Nitzkin presented this resolution at the
Open Policy Forum. The Policy Committee
agreed with the gist of the resolution and
recommended that ACPM establish a task force
to define Clinical Preventive Medicine and
all that it encompasses. The committee had
difficulty with the term,
"consultative," which implied a
role contrary to the integral role of
preventive medicine being espoused in the
resolution. Hence, the committee recommended
that references to "consultative"
be removed from all appropriate places in the
proposed task force charge and that a new
charge be added for the task force to
consider the role of preventive medicine
physicians as consultants. The committee
also felt that the task force should
consider how preventive medicine services
should be reimbursed in existing health care
financing systems.
National
Immunization Program
02-02(A) National
Immunization Program
William B. Klein, MD, ACPM Member
RESOLVED
that ACPM support and advocate for the
United States Federal Government, either
through the existing National Immunization
Program at the Centers for Disease Control
and Prevention or through the creation of a
new National Immunization Program Office at
HHS, to:
- Oversee
the production and distribution of
vaccines with the goal of ensuring
adequate supplies
- In cases
where the private sector fails to meet
requirements, take action to ensure the
production and distribution of affected
vaccines
Action
Taken: ACPM
adopted the following amended Resolve in
lieu of the proposed Resolve: "That
ACPM support and advocate for the United
States Federal Government to assure the
adequate, affordable production and
distribution of vaccine supply for the
health of the public and national
security."
Remarks:
The author presented this resolution at the
Open Policy Forum. The Policy Committee was
supportive of the general concept being
proposed. However, the committee felt that
reference to specific national vaccine
programs/offices was not necessary and
recommended a more simplified Resolve that
addresses the key issues of assuring access
to affordable, adequate supplies of vaccine.
The committee agreed that, even though ACPM
has expressed support of significant policy
on this issue by the American Medical
Association and the Institute of Medicine,
ACPM should have its own stated policy and
be able to articulate its policy in the
national debate.
Health
Care for All
03-02(A) Health Care
for All
John T. Ashley MD, MBA, FACPM
Robert H. LeBow, MD, MPH (active member,
ACPM)
Robert T. Pero, MD, MPH (active
member, ACPM)
RESOLVED
that the ACPM endorse the following
framework for universal coverage, including
the principles (a) through (g) and specific
elements (1) through (18), in a proposal
which could be called Health Insurance for
All (HIFA); and be it further
RESOLVED
that ACPM work with other professional and
community organizations as appropriate
within the limited resources of the ACPM to
promote broad base support for a proposal
that would in principle:
- Guarantee
health insurance for all US residents.
- End the
responsibility of US industry to provide
health insurance benefits.
- Create a
tax-based (like Medicare) health
insurance program funded by the federal
government and/or the states.
- Build on
the current strengths of American health
care professionals and institutions to
deliver quality, scientific based care
and prevention.
- Utilize
the strengths of American health
insurers to administrate the system with
no denial of coverage and minimum
underwriting costs and profit.
- Minimize
the economic incentives or disincentives
to either over-utilize marginally
effective services or underutilize
proven beneficial services.
- Allow
flexibility at the state level –
except for mandating universal coverage;
and be it further
RESOLVED
that some of the agreed-upon specific
elements (by the authors of this
resolution) of this proposal would
include;
- Federally
funded health insurance coverage for
all residents of the USA with a single
risk-pool that enrolls every resident
automatically (details of enrollment
to be worked out) in an Essential
Health Insurance Package (EHIP) in the
state where the individual resides.
- The
proposal will cover all non-federally
covered residents initially, and phase
in already covered groups , such as
Medicare, the VA, and military
populations as authorized by Congress.
- The
EHIP would have no premiums to the
covered individuals; and would include
primary care, essential specialist
care, hospitalizations, and
pharmaceuticals; proven preventive
care; mental health with parity; basic
dental care as defined by an appointed
National Board.
- There
would be no insurance deductibles and
minimal co-payments for essential
services, with a mechanism to waive
co-payments as approved by the
National Board. Proven preventive
services will be delivered "free
of any co-payment" in the context
of primary care.
- Discretionary
specialty services would have higher
co-payments proportional to the level
of discretion for the recipient as
defined by the National Board.
- Creation
of a national board for oversight,
regulation, and design of the benefit
package and co-payment limitations and
requirements.
- EHIP
financed through a progressive payroll
tax (or self-employment tax) on all
income, collected similar to social
security and Medicare taxes.
- Supplemental
insurance, for services or co-payments
not covered in the EHIP, may be sold
by the EHIP insurance carrier to
enrolled individuals or groups.
Employers allowed to purchase
supplemental insurance for non-covered
services as a taxable benefit for
employees.
- Current
employer contributions for health
insurance should be converted to
increased wages for employees.
- Provision
for capture of the tax-exemption
(currently amounts to about $125
Billion a year) in the financing of
this plan.
- Enrollment
process to be developed that provides
a role for remaining insurers in
essential administration of the
program. No denial of choice by
insurer is permitted for the EHIP.
Individuals not choosing an EHIP
health insurer will be randomly
assigned to a licensed insurer
offering insurance in the area of
residence of the individual so that
every resident has insurance.
- Rates
and reimbursements negotiated between
the EHIP administrators and health
care professionals/institutions. Could
be fee-for-service or capitation, or
other negotiated payment mechanism.
- Enrollees
have full choice of participating
providers.
- Quality
Assurance and Case/Disease Management
to be conducted by local and/or
regional professional groups utilizing
local data from all available sources
and providing direct feedback to
professionals and institutions and to
patients upon request.
- Long
term care to be integrated into
package when feasible with current
Medicare and Medicaid long term care
programs retained until altered.
- States
responsible to monitor and regulate
insurers in each state and allowed
flexibility to add needed benefits,
e.g., as with current Medicaid
recipients.
- Assume
continued federal/state support for
delivery systems for special
populations (e.g., Migrant/Community
Health Centers, Health Care for the
Homeless, Public Health Clinics).
- Funding
for prevention and public health, as
well as educational programs, to be
included within this financing system
– but not excluding other funding as
well.
- Federal
government to monitor and regulate
state performance in assuring access
and quality of care to residents of
the states; and be it further
RESOLVED
that the ACPM work with other professional
and community organizations as appropriate
within the limited resources of the ACPM to
form a broad base of lobbying support for
this Health Insurance for All plan; and be
it further
RESOLVED
that the ACPM form a committee to modify
and/or develop this proposal in more detail
to present to our membership for approval.
Action
Taken:
The Policy Committee Chair will appoint a
subcommittee to develop an ACPM policy
position on universal health insurance that
updates its existing policy, builds to the
extent possible on the principles and
elements proposed in Resolution 03-02(A),
and addresses the following key components:
(1) benefits coverage, (2) financing
mechanisms, (3) access principles, and (4)
regulatory authority. The subcommittee will
report back to the full committee at
Preventive Medicine 2003.
Remarks:
Drs. Robert LeBow and John Ashley presented
this resolution at the Open Policy Forum.
The Policy Committee felt that the proposed
resolution contained too much detail,
complexity, and potential controversy and
would not be approved by the Board without
the opportunity for extensive vetting and
consensus building. As such, the committee
initially recommened a pared-down resolution
that contained what were thought to be the
most critical aspects of the proposal (i.e.,
guaranteed health insurance of all U.S.
residents through a federally-funded,
tax-based, Medicare-like insurance program
with a single risk pool. However, one of the
authors felt the committee’s actions would
create a meaningless ACPM position that
would not considerably extend or improve the
current ACPM position. As such, the
committee agreed to form a subcommittee, in
which the authors would be invited to
participate, to consider the authors
proposal in the context of an updated ACPM
policy, as described above.
Availability
and Distribution of Potassium Iodide (KI)
for Radiologic Emergencies
04-02(A)
Availability and Distribution of Potassium
Iodide (KI) for Radiologic Emergencies
Joshua Lipsman, MD, MPH, FACPM
RESOLVED,
that ACPM encourages officials at the
appropriate level of government in
communities where there is potential risk of
exposure to iodine 131 to cooperatively
develop a plan for rapid potassium iodide (KI)
availability from government stockpiles in
emergency situations to individuals with
real potential for exposure to radioactive
iodine; and be it further
RESOLVED,
that ACPM supports the distribution of KI
(as suggested below) in advance of emergency
situations as a preventive measure; and be
it further
RESOLVED,
that availability and distribution planning
processes include but not be limited to:
comprehensive education campaigns about the
risks, benefits and appropriate use of KI;
assisting institutions such as schools to
develop their own KI stockpiling plans if
they request it; facilitating the
availability of KI in retail outlets and via
the Internet for those who wish to purchase
it; and providing KI at no cost to
individuals who are unable to purchase it.
Action
Taken:
The Policy Committee agreed to defer action
on this resolution pending additional
research by the committee.
Remarks:
The author presented this resolution at the
Open Policy Forum. The Policy Committee did
not take action at this time, agreeing to do
more research and learn more about the
subject before taking a position. The
committee agreed the main educational avenue
would be the environmental radiation and KI
education session to be held at Preventive
Medicine 2002 on February 24, 2002. That
session profiled the pros and cons of a KI
stockpiling/distribution strategy. Further
discussion and development will take place
over the ACPM policy listserv.
Principles
for Combating Antibiotic Resistance
05-02(A)
Principles for Combating Antibiotic
Resistance
Cindy
L. Parker, MD, MPH (Active Resident
Member)
RESOLVED,
that ACPM endorse the Seven Principles for
Combating Antibiotic Resistance adopted by
APHA*:
- Support
efforts to curb the growing public
health threat of antibiotic resistance
by reducing the overuse and misuse of
antibiotics in both agriculture and
human medicine.
- Support
phasing out the use in healthy farm
animals of antibiotics used in human
medicine or closely related to human
drugs.
- Support
efforts to promote sustainable
agricultural production methods that
provide alternatives to the use of
antibiotics in healthy farm animals.
- Urge
companies involved in the production of
meat, poultry and fish to voluntarily
agree to stop using nontherapeutic
antibiotics (i.e., those used for
purposes other than treating sick
animals), and we urge companies and
individuals that purchase meat, poultry
and fish products to seek products that
have been produced without
nontherapeutic antibiotics.
- Support
efforts to educate patients and doctors
about the prudent use of antibiotics,
including the importance of prescribing
them only for bacterial infections and
of taking the entire course of the drug.
- Support
the creation of a nationwide system to
collect objective, verifiable data on
production of antibiotics for use in
human medicine, animal agriculture, and
other sectors as relevant, and to make
that information available to the public
on an aggregated basis.
- Affirm
the importance of ongoing collection of
data at the state and federal levels on
antibiotic residues and antibiotic
resistance, including antibiotics and
antibiotic-resistant bacteria both on
food and in surface and ground waters.
* Final
approval for APHA adoption of the Principles
is expected at any time, definitely before
February 21, 2002.
Action
Taken:
ACPM unamiously adopted this resolution as
submitted.
Remarks:
The author presented the resolution at the
Open Policy Forum. By adopting this
resolution, the ACPM endorses the Seven
Principles for Combating Antibiotic
Resistance as adopted by the Coalition to
Combat Antibiotic Resistance. Additionally,
these principles are consistent with the
ACPM's Statement on the Use of
Antimicrobials in Food Animals, adopted in
March 2000.
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