Merger memories and abiding realities

July 1, 2018, marks the 20th anniversary of the merger of the American College of Physicians (ACP) and the American Society of Internal Medicine (ASIM). For many current ACP members and staff, the merger is an ancient footnote, something they are generally aware of yet don't perceive as having much bearing on their daily lives now.

For me, it's quite different. July 1, 1998, was the day I transitioned over from my role as Vice President of Governmental Affairs for ASIM, where I had worked since January 1979, to head up the new governmental affairs division for the merged organization. I was asked to help bring together the D.C.-based governmental affairs staff of both ASIM and ACP into a united team of former rivals, one that would live up to the merger's promise of a unified and more effective advocacy voice for internists and their patients.

It was the most challenging and rewarding assignment I've had in my nearly 40 years of professional advocacy for internists. While it wasn't always easy, I'm so proud of what we—my colleagues on staff and the enlightened physician leadership of both ACP and ASIM—accomplished together, then and now.

Together, we created an organization whose advocacy today is the pride of American medicine, with a well-deserved reputation for effectively advancing policies to improve the daily lives of internists and the health of their patients.

Looking at it from the perspective of the merger, we created an organization that carries on ASIM's tradition of advocacy to improve the daily lives of internists through policies to improve payments and reduce unnecessary regulations, as well as ACP's tradition of advancing evidence-based policies to improve patients' health by expanding coverage, reducing health care disparities, and addressing other issues that adversely affect their health.

Just consider how several of the issues we are championing in 2018 live up to this vision.

At ACP, we know problems like administrative burdens are making it harder for internists to practice medicine, earn a living, and help patients. That's why we press legislators and regulators for changes that can successfully improve internists' daily work experience and free them up to focus on the care they were trained to provide.

We are making headway: CMS recently announced two new initiatives, Patients over Paperwork and Meaningful Measures, that are aimed at reducing unnecessary administrative burdens on physicians. Not coincidentally, the first initiative echoes many of the themes in the College's own Patients Before Paperwork initiative, which has been in place since 2015. We'll be watching and providing feedback as CMS rolls out these initiatives in order to ensure that the programs are implemented in a way that will truly help physicians.

Also, ACP's President-elect, Robert M. McLean, MD, FACP, recently addressed Congress at a roundtable that the House Committee on Ways and Means convened as part of its effort toward red tape relief for physicians. Dr. McLean said that excessive administrative tasks divert physicians' time and focus away from patient care. The Medicare Red Tape Relief Project echoes much of what ACP has been striving for in terms of reducing unnecessary administrative tasks.

During ACP's 2018 Leadership Day on Capitol Hill this past May, ACP members called on Congress to enact legislation to streamline preauthorization requirements, eliminate the three-midnight rule that causes patients to be denied coverage for skilled nursing care when admitted to a hospital for observation, revamp documentation requirements for evaluation and management services, and enact other measures to reduce red tape and paperwork.

ACP's Patients Before Paperwork initiative is in many ways an updated version of a campaign launched by ASIM many decades ago to reduce the “hassle factor” for internists.

Regarding improving the lives of patients, ACP championed policies to reduce gun violence even before the 1998 merger with ASIM, and this continues to be an abiding priority for the College.

Deaths and injuries from firearms are not just a result of mass shootings; they are a daily occurrence. As an organization representing physicians who have firsthand experience with the devastating impact on patients of firearms-related injuries and deaths, we believe we have a responsibility to be part of the solution.

We have called on Congress to block concealed-carry reciprocity legislation, which would require states to recognize concealed-carry permits from jurisdictions with lower standards and create a race to the bottom in regulation of concealed carry; to fund research on the causes of gun violence; to ban assault weapons and high-capacity magazines; and to increase penalties for “straw purchases.”

Our advocacy for patients' health can also be seen in a statement ACP issued in May, strongly objecting to the Department of Homeland Security's “zero tolerance” policy requiring that all people unlawfully crossing the U.S. border be referred to the Department of Justice for prosecution of the misdemeanor of illegal entry, including parents seeking asylum from persecution who enter the U.S. with their children. As a result of this policy, parents are detained and their children are taken into custody by the Department of Health and Human Services. In a 2017 position statement on U.S. immigration policy, ACP expressed concern about immigration policies that would split up families. While ACP recognizes the right of the U.S. to control who enters its borders, a policy of universally separating children from their parents will do great harm to children, their parents, and their families.

Our “patients first” advocacy can also be seen in our new policy papers on social determinants of health and women's health policy, in our continued advocacy to expand access and coverage, and in efforts addressing many other issues.

While the ACP and ASIM merger is in many ways a distant memory, it's present today in ways that perhaps only those of us who were personally involved can truly understand. It brought together the best of internal medicine, creating the ACP that we know today, a unified voice for internal medicine that has done so much to improve the daily lives of its members and the health of patients. This continues to be our abiding commitment, and I am so proud to continue to play a part in it.