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Internists establish new policies on major health care issues.

The American Society of Internal Medicine (ASIM) House of Delegates has vowed to escalate its fight against the burgeoning "hassle factors" of medical practice, which are confusing and frustrating to physicians and patients alike; promised to fight further cuts in Medicare, which will hurt the elderly; and approved amendments to its existing policy on human immunodeficiency virus (HIV)-infected health workers.

In addition, at ASIM's 35th Annual Meeting in Washington, D.C. from October 9-13, the 146-member policymaking body, representing 44 separate State component and subspecialty societies of internal medicine, continued strong support for ASIM's plan to assure access to health care for all Americans. Delegates called for study of factors causing large increases in volume of services being provided and, when possible, for efforts to assess the cost effectiveness of new and existing technologies, procedures, and pharmaceuticals.

ASIM is a federation of State and national subspecialty societies of internal medicine which send delegates--similar in concept to the U.S. House of Representatives--to a yearly meeting to establish policy and elect leaders for the national umbrella organization. The delegates took action on more than 100 agenda items. Doctors of internal medicine are the major providers of continuing, comprehensive care to adults and adolescents in the United States.

Recognizing that interest is growing in an "all-payer" approach, whereby some process of negotiations between physicians and payers will be a component of comprehensive legislation to expand health insurance coverage to all Americans, the House of Delegates agreed that ASIM should begin studying and develop options for negotiations that could improve the predictability and efficiency of the physician payment system. Delegates also called for ASIM to evaluate and make known to policymakers the external forces (e.g., patient demand and expectations) that affect the volume of services physicians deliver.

Delegates also agreed that, when possible, efforts are necessary to assess the cost effectiveness--in addition to ensuring safety and effectiveness--of new and emerging technologies, procedures, and pharmaceuticals before they become a part of common medical practice. They also supported ongoing efforts to assess the safety, effectiveness, and cost effectiveness of existing technologies, procedures, and pharmaceuticals that have already become a part of common medical practice. Delegates also asked ASIM to develop a white paper on the increasing costs of prescription medicines and effects of such costs on prescribing practices and patient compliance, among other things.

After lengthy consideration, delegates approved several amendments to ASIM policy on HIV-infected patients, physicians, and other health care workers. Supported was the use of universal precautions as the primary method to prevent transmission of HIV infection in all health care settings, but not testing without consent of physician or patient unless care results in significant percutaneous or mucocutaneous exposure to body fluids of the patient. In addition, delegates said that physicians who are at significant risk of HIV infection and who perform exposure-prone procedures should know their HIV status and monitor that status at regular intervals, and those who are cognitively impaired by HIV infection, as with other illnesses, should not engage in any activity which could cause hazard to their patients.

Delegates strongly supported proactive efforts, such as those by the American Medical Association, to educate physicians on their ethical responsibilities regarding referring patients to entities in which they have a financial interest and aggressive investigation of reports of abuse. However, they emphasized that State and Federal policymakers should closely evaluate the effects on access to such services of complete bans on "self-referrals" before taking such action.
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Publication:Health Care Financing Review
Date:Jan 1, 1991
Words:579
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