Regional Professional Foundations: A Blueprint for Physician-Led Quality Oversight

Strategic Insights -

The Clinton health reform plan has proposed Regional Professional Foundations (RPFs) as a means of giving physicians oversight over healthcare quality. According to the plan, RPFs would develop patient-education and ongoing-medical-education programs, conduct research, foster collaboration, and disseminate quality-related information. However, the proposal has received little support from the medical community, with many physicians expressing concerns about the structure and funding of RPFs.

Key Takeaways:

  • RPFs would be established and overseen by a new National Quality Consortium reporting directly to the National Health Board, with a minimum of one academic health center, public health schools, insurance-buying alliances, plans, and providers as members.
  • The foundations' primary activities would include developing patient-education and ongoing-medical-education programs, conducting research, fostering collaboration among health plans and providers, and disseminating information about successful quality improvement programs, practice guidelines, and research.
  • The RPFs would have a voluntary structure, with regions opting in to establish the foundations, which would be funded through $250,000 federal planning grants and 5% of total regional health outlays paid by alliances and Medicare.
  • Providers would make up a large part of the RPFs' boards, with other constituencies, such as consumers and academics, also represented to ensure public accountability.
  • RPFs would have no regulatory role, but would be purely educational, with the goal of improving the scientific basis of clinical medicine and coordinating studies of clinical practice across broad populations.
  • The proposal authors, Drs. Wennberg and Keller, argue that RPFs would be a "new vehicle for professionalism" and an opportunity for the medical profession to control what rightfully belongs to it.
  • Critics, including the American Medical Peer Review Association, argue that the RPFs' provider dominance creates an inherent conflict of interest and would not provide the necessary objectivity and accountability to improve quality healthcare.

Statistics:

  • $250,000 federal planning grants would be offered to interested nonprofits, such as state medical societies, medical schools, or state agencies, to propose the boundaries, work plans, and links between academic centers and clinicians.
  • RPFs would be allowed to use up to 5% of total health care outlays in their region, though their impact on utilization would have to be budget-neutral.
  • Funds would come equally from purchasing alliances and Medicare.

Sources:

  • Clinton health reform plan, including the proposal for Regional Professional Foundations.
  • Statement by Alan R. Nelson, MD, chief executive of the American Society of Internal Medicine and chairman of the Health Care Quality Alliance.
  • Testimony by Robert E. McAfee, MD, AMA President-elect.
  • Interview with John E. Wennberg, MD, director of Dartmouth Medical School's Center for the Evaluative Clinical Sciences.
  • Testimony by Andrew Webber, executive vice president of the American Medical Peer Review Association.
  • American Association of Retired Persons (AARP) congressional testimony.