ACP proposes solutions for America's health care system

A policy paper providing proposals for resolving some of the major problems with the health care system in America was released today by The American College of Physicians (ACP) at its annual report on "The State of the Nation's Health Care."

"The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care," proposes a fundamental change in the way that principal - or primary care - is delivered and financed. "ACP proposals would provide patients with access to care that is coordinated by their own personal physician," explained C. Anderson Hedberg, ACP president. "The physicians will be working in a practice environment organized around patients' needs."

The paper recommends voluntary certification and recognition of primary care and specialty medical practices that use health information technology, quality measurement and reporting, patient-friendly scheduling systems and other "best practices" to deliver better value and improve care coordination for patients, especially those with multiple chronic illnesses.

While the specific criteria for being listed as a qualified advanced medical home will be developed later, ACP envisions that qualified practices will have the following kinds of services in place.

Primary care physicians would be responsible for partnering with their patients to assure that all of their health care is managed and coordinated effectively. This will be a major improvement from the fragmented health care system that we see today. They would partner with, and educate patients with chronic diseases, like diabetes, to help them manage their own conditions and prevent avoidable complications that would inevitably occur without long-range attention. These complications of diabetes include amputation, blindness, heart attacks and kidney failure.

The practice would use innovative scheduling systems to minimize delays in getting appointments.

Electronic health records and other health information technologies would be used to store all clinical data and test results, which would be immediately available. Physicians in the advanced medical home would use computerized, evidence- based clinical decision guidelines at the point of care to assure that patients get appropriate and recommended care.

Patients would have access to non-urgent medical advice through email and telephone consultations. The practice would have arrangements with a team of consultants and other health care professionals to provide the full spectrum of patient-centered services.

Advanced medical home practices will also be accountable for the care they provide, by using health information technology to prepare regular reports on quality, efficiency, and patient satisfaction.

The paper calls for fundamental changes in third party financing, reimbursement, coding and coverage policies to support practices that qualify as advanced medical homes. It also recommends that changes be made in workforce and training policies to assure an adequate supply of physicians who are trained to deliver care consistent with the advanced medical home model, including internists and family physicians. Finally, it calls on Medicare and other payers to pilot testing the "Advanced Medical Home" model with a revised reimbursement system that recognizes the value of physician-guided care coordination.

The paper was released by ACP in conjunction with its annual report on the state of the nation's health care. The state of the nation's health care report provides compelling evidence that the nation will soon be facing a collapse of primary care medicine, due to increased demand for primary care resulting from changes in patient demographics, coupled with fewer physicians going into primary care while many of those in practice will be retiring or changing careers. The advanced medical home is one key part of a comprehensive set of ACP policy proposals for reversing the looming shortage in primary care.