Saturday, March 20, 2010

What have ACP members told us in surveys?

As I wrote on Friday, ACP doesn't make policy based on opinion polls, but on an consensus and evidence-based process that, we believe, broadly reflects the views of membership while producing policy that is strongly informed by the best evidence from published research. We have heard from ACP members, though, who have asked whether we have surveyed how our members feel about health reform. In Friday's post, I provided links to two ACP surveys, but discovered that they brought you to restricted pages on our website. So below is a summary of the methdologies and findings, prepared by our research staff:

I realized that the links to the two ACP surveys I mentioned in my post are in a restricted area of the ACP website. I asked our research staff to summarize the methodology and findings, as follows:

2009 ACP Member Survey
ACP's 2009 Member Survey included two separate self-administered paper and Web surveys (Surveys 1 & 2) of two independent random samples of 2,000 U.S., non-student, current ACP members ages 65 and younger. The survey results may be used to describe this population. Data were collected between February and July 2009. Public policy and advocacy questions were included in survey 2. The ACP Research Center received 973 valid responses to Survey 2 (51% response rate). About 67% of responses to Survey 2 came from the paper versions. The final respondent sample for each survey is comparable to the sampling frame in terms of age, specialty, U.S. region, race, sex, IMG status, professional activity and employer.

Member views on public policy issues
Members were asked to rate the degree of priority that several policies should have in ACP's advocacy agenda for reforming the U.S. health care system. A clear majority (over 70%) indicated that the following should be a somewhat high or very high priority for ACP:

* Policies to reduce paperwork and administrative costs of health insurance (90%)
* Policies to increase the number of general internists and other primary care physicians, such as improved reimbursement and loan forgiveness (84%).
* Policies to provide better coverage and incentives for prevention and management of chronic illnesses (82%)
* Policies to reduce the cost of health care and reduce gaps in health care quality (76%)
* Laws guaranteeing that all Americans have access to affordable coverage, with government subsidies for those who cannot afford coverage (71%).

2009 ACP Health Care Reform Survey
The 2009 Health Care Reform Survey was a web survey of a random sample of 2,000 U.S., non-student, non-retired, current ACP members ages 65 and younger. Data were collected between October and November 2009. The ACP Research Center received 290 responses to the survey (15% response rate and a margin of error of plus or minus 8%). The final respondent sample for the survey is comparable to the sampling frame in terms of specialty and U.S. region, but differs from the sampling frame in terms of age, race, sex, IMG status, professional activity and employer. For the most part, responses to the survey questions are not related to the characteristics that are over- or underrepresented in the sample, and, therefore bias appears to be minimal.

Support for Specific Positions on Reform
Respondents were asked whether or not ACP should support twelve different positions for achieving health reform.

A clear majority (over 85% of respondents) indicated support for the following five positions:
* Health reform must include reforms in the medical liability system in order to be effective in controlling costs (94%).
* Individuals and small businesses should be able to have a choice of affordable plans through a purchasing pool (exchange) that gives them the same ability as larger companies to get the best group rates (94%).
* Insurance companies should not be allowed to turn away patients because they have medical conditions (90%).

* All legal residents should have access to affordable health insurance and financial help, when they can't afford it (86%).
* The federal government should create incentives to encourage medical students and young doctors to go into primary care internal medicine (86%).

Over half supported the following five positions:
* Insurance companies should be required to cover evidence-based practices that have been shown to prevent disease, as well as screening tests that detect diseases at no out-of-pocket cost to the patient (79%).
* Larger employers (defined by such factors as number of employees and payroll) should be required to offer health insurance to employees or pay into a fund to help pay for coverage for their employees (73%).
* All Americans should be required to buy health care coverage, as long as there are federal subsidies to make coverage available for those who can't otherwise afford it (65%).
* A public plan option should be available to compete with private health insurance plans on a level playing field as long as it has competitive payment rates and participation isn't mandated (64%).
* Insurance companies should not be allowed to charge patients more because they have medical conditions (62%).

The proportions of respondents who support the final two positions reflect the fact that the proposals are correlates:
* The federal government should increase Medicare payments to primary care physicians even if this would result in lower pay for other specialties (66%).
* The federal government should increase Medicare payments to primary care physicians only if it does not involve reductions to other specialists (31%).

The proportion of members supporting the 12 positions did not differ by age, primary professional activity and practice size.

General internists and internal medicine subspecialists differed significantly in their support for two specific positions:
* A higher proportion of general internists (91%) than subspecialists (51%) feel ACP should advocate for the federal government to increase Medicare payments to primary care physicians even if this would result in lower pay for other subspecialties.
* A higher proportion of subspecialists (62%) than general internists (22%) feel ACP should advocate for the federal government to increase Medicare payments to primary care physicians only if it does not involve reductions to other subspecialties.

Today's question: How would you have answered the same questions?


Realistic said...


The two polls are completely meaningless and obfuscate the fact that the vast majority of practicing internists in and outside of the ACP are overwhelmingingly oppose to this bill.

Who cares about polices that support this or that theoretical position on issues ranging from tort reform, support for primary care and all the rest you site. The fact is that internists feel that THIS BILL which will become law will: 1. lead to a complete takeover of medicine by the governmen, 2.will eventually lead to a one payer system as the insurance companies will be put out ofbusiness, 3.will lead to MORE red tape , 4.will lead to worsening of OVERALL reimbursement to Internists,5. will likely cause many Internists to drop Medicare orretire, 6.will worsen Dr. patient relations, 7.will do NOTHING for tort reform except probably cause premiums to rise, 8. Will lead to Nurses achieving equal status to MDs , 9.Will do nothing to mae primary care attractive to young MDs , 10.)11 will lead to an army of IRS agents in American's lives as taxes wil sky rocket, 12.Will start a witchhunt for MD fraud and abuse .

As I said before , conduct a poll ON THIS BILL not some abstract set of princples. Separate ou Med students and Insulated out of touch Ivory tower academics who never made a payroll and show what actual ACP practicing MDs are feeling about this bill.

Now I sent a post yesterday that yu didnot publish and I expect thi wont see the light of day. Thats ok, it will go up on asite if it does not appear here where hundreds more ACP memebers hang out and write. So your censoring wont work .

Arvind said...

I agree with most of what Realistic mentions. Watching these Congressmen on C-SPAN makes me really sick. How did we ever elect them? It helps to read a beautiful article by Milton Friedman in the WSJ about physician-patient relationship and why the Soviet-style universal care destroyed it. We are about to take the same course, thanks to this monster Bill.

Jay Larson MD said...

Rather than increase reimbursement to primary care at the expense of subspecialists, there should be increased value for office visits and less value for procedures. This will change the incentive so that physicians will spend more time with patients rather than doing as many procedures as possible.

Rich Neubauer MD said...

I respectfully disagree fundamentally with Realistic and Arvind.

The results of the ACP polls you mention are significant and indicate that most internists are very concerned about fundamental aspects of our current method of delivering health care and have a different view of what the desired future should be.

I would also point out that the leadership of any superb organization does not govern by plebiscite. In prior blog entries, you've outlined very well the careful processes that ACP uses for policy development. ACP has years of policy development that supports the positive position that has been taken on the current legislation.

It appears that the reform bill is on the cusp of approval. We will see what changes evolve and I for one look forward to seeing how those changes permeate through a system that has stopped working for far too many of our citizens.

PCP said...

The self certitude of some of the leadership at the ACP gives me pause for concern. When one say elitist, it refers to this.
Others have a point of view. We feel just as certain about what we say as any of you do. Perhaps those of you feel you wish to take this organisation in a particular direction. Should that be antithetic to my equally strongly held convictions, I reserve the right to oppose vehemently.
The question on which one of us is right, will be answered in due course. I happen to believe that Realistic is not far off in his assessment of where this reform takes us.
ACP has been so spineless in its advocacy on certain issues, that when they perceived we might get into a fight with the ANP lobby, they put out a position paper on the issue which was so politically correct that it might as well be written by the ANPs themselves. What part of the Doctor-Patient relationship did they feel was worth protecting there. If the advanced medical home can be headed by ANPs, where exactly does that leave the General Internist in this era of ever escalating cost containment?

The myopic views of ACP are going to complete the job that the AMA supported RBRVU system has done to damage Generalist careers. We will see the continuation of fewer and fewer, lesser and lesser motivated general internists coming through.
This is a quite pathetic outcome for General IM.

The phrase "sold out" seems to be what can best sum up my feeling on this entire debacle. What started out with so much promise, has concluded with a massive whimper.
Who in their right senses can conclude that this will give us the shift in Physician manpower that we as a country need? Realistically, come on!