MedPAC hearing panelists call for residency programs to move away from hospital-centered care, toward treatment of chronic illnesses

Residency programs should place greater emphasis on the treatment of chronic diseases and on incorporating health information technology because current graduate medical education focuses too heavily on hospital-centered care, panelists told the Medicare Payment Advisory Commission on Thursday, CQ HealthBeat reports.

Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education, said residency programs are "focusing on the immediate needs of the public they serve, not on future needs."

Panelists Michael Whitcomb, vice president for medical education at the Association of American Medical Colleges, and Benjamin Chu, president of Kaiser Foundation Health Plan's Southern California Region, said that hospital-centered education leaves physicians less prepared to practice medicine in clinics and outpatient facilities. Whitcomb said, "The major challenge facing American medicine today is providing care to those with chronic illnesses." He noted that the hospital-based approach contradicts current thinking that treatment for chronic illnesses should take place outside the hospital. Chu emphasized the need for increased training on health IT innovations in residency programs. Panelists also stressed the need for an innovative approach to recruit more primary care physicians.

MedPAC Chair Glenn Hackbarth said that Medicare could use its payments as a "lever" to promote new residency programs to implement new technologies and new methods of care (Nylen, CQ HealthBeat, 10/2).

Payment Disclosures

In related news, MedPAC on Thursday discussed four draft recommendations for addressing physician payment disclosures. The first draft recommendation suggests that Congress require all drug and medical device manufacturers to report to the HHS secretary all financial relationships valued above $100 with physicians, hospitals, medical schools, continuing education programs, patient organizations and professional organizations. The second draft recommendation calls for a public, searchable Web site that contains all the disclosure information manufacturers submit to HHS. The third recommendation advises that Congress require all hospitals and ambulatory surgery centers to annually report all physicians who directly or indirectly own an interest in the facilities. The fourth recommendation suggests HHS submit a report on the pervasiveness of financial relationships between hospitals and physicians.

According to CQ HealthBeat, the commissioners also discussed what strategies to take regarding physicians' reporting of no-cost prescription drug samples. CQ HealthBeat reports that Hackbarth "appeared to reflect a consensus of the panel" when he advocated for a separate recommendation that would address drug samples. He suggested the recommendation call for either full public disclosure of the samples or a system in which physicians would report to HHS and the data become available to the research community to study the influence of no-cost samples on physician prescribing behavior.

The final recommendations are expected to be issued at MedPAC's Nov. 6-7 meeting (Reichard, CQ HealthBeat, 10/2).