ACP IM 2015

BOSTON – When the Medicare Access and CHIP Reauthorization Act goes into effect in 2019, will you be ready?

In a video interview at the annual meeting of the American College of Physicians, Robert B. Doherty, senior vice president of governmental affairs and public policy for the ACP, outlined what physicians need to know about Medicare’s post–Sustainable Growth Rate payment structures, including the difference between MIPS and ACMs.

He also explained how these new Medicare payment structures give physicians more control over their reimbursements while also requiring physicians to endure greater risk.

[email protected]

On Twitter @whitneymcknight

BOSTON – When the Medicare Access and CHIP Reauthorization Act goes into effect in 2019, will you be ready?

In a video interview at the annual meeting of the American College of Physicians, Robert B. Doherty, senior vice president of governmental affairs and public policy for the ACP, outlined what physicians need to know about Medicare’s post–Sustainable Growth Rate payment structures, including the difference between MIPS and ACMs.

He also explained how these new Medicare payment structures give physicians more control over their reimbursements while also requiring physicians to endure greater risk.

[email protected]

On Twitter @whitneymcknight

BOSTON – When the Medicare Access and CHIP Reauthorization Act goes into effect in 2019, will you be ready?

In a video interview at the annual meeting of the American College of Physicians, Robert B. Doherty, senior vice president of governmental affairs and public policy for the ACP, outlined what physicians need to know about Medicare’s post–Sustainable Growth Rate payment structures, including the difference between MIPS and ACMs.

He also explained how these new Medicare payment structures give physicians more control over their reimbursements while also requiring physicians to endure greater risk.

[email protected]

On Twitter @whitneymcknight

BOSTON – Four-thirty in the afternoon isn’t the time slot most conference presenters covet.

By that point, many attendees are done for the day – loaded up with new knowledge and weighed down with schwag-stuffed tote bags. By 4:30 p.m., the hotel bar is enjoying stronger attendance and better survey-sheet ratings than a closing-time clinical diagnosis session.

But, by 4:30 Thursday at the annual meeting of the American College of Physicians, cavernous room 107 in Boston’s convention center was filling up.

Was it hosting “Atrial Fibrillation 2015”? “Prescribing Chronic Opioids”? “Update in Endocrinology”?

In fact, the session’s topic wasn’t clinical, but its nature was definitely acute. Room 107’s attendees had arrived for a session with the potential for as much action as the weekend’s upcoming Mayweather-Pacquiao megafight: “ABIM: Understanding MOC Requirements.”

There behind the podium stood the subdued president and CEO of the American Board of Internal Medicine, Dr. Richard J. Baron, looking like a Yankees fan about to lecture the Fenway Park faithful on the many merits of Bucky “Bleepin’ ” Dent.

In fact, before him seethed bleachers of angry doctors eager to share their opinions about what they viewed as ABIM’s own Bucky Dent: the Maintenance of Certification program.

With the ABIM board’s chair-elect, Dr. Clarence Braddock III, sitting nearby on the dais, Dr. Baron dutifully outlined the MOC backtracking that came with February’s public apology by ABIM: updates to its internal medicine exam; suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years; and MOC enrollment fees set at or below the 2014 levels through at least 2017. And if those three requirements did return, ABIM would give physicians a year’s notice before they would have to start meeting them.

By the end of the year, ABIM also will unveil more flexible ways to earn MOC points, Dr. Baron noted. He also offered his listeners assurances that the fall 2015 MOC exam would better reflect doctors’ clinical experiences.

“The most important thing we learned from Feb. 3 is that ABIM needed to change to an organization much more rooted in the community,” Dr. Baron explained.

Then he opened the meeting to questions from the audience – triggering an Airing of Grievances worthy of a “Seinfeld” Festivus.

Terry Rudd/Frontline Medical Communications

Beginning with a New Jersey physician who vigorously aired her own grievances at a volume that made a microphone redundant – “Don’t scare us away – we WANT to keep up!” – room 107’s open mics amplified a steady stream of physicians eager to vent their MOC-fueled fury and despair.

What about changing the MOC exam to open-book? “ ‘Consult the gastroenterologist’ is the real-world approach to solving problems!” Why can’t multiple sources of CME credit count toward MOC? Why not dump the recertification exam and simply use the modules to keep physicians fresh?

One physician who spent most of his practice in urgent-care settings and occupational medicine – in which relationships with patients are, by nature, short-lived – worried that a return of the patient voice requirement would make failure certain for him.

“I may be 72, but I will retire before I do one of those Practice Improvement Modules again!” warned another physician.

Attendees also zeroed in on financial allegations made in two recent Newsweek articles about ABIM (“The Ugly Civil War in American Medicine” and “A Certified Medical Controversy”). “Is an independent group going to review reports about ABIM’s finances?” one attendee asked. Another stated that ABIM’s board shouldn’t be paid, a suggestion for which the doctor received a generous round of applause.

Dr. Baron categorically dismissed claims that ABIM was financially troubled and that it manipulated exams to drive down pass rates – and thus boost its revenues with retests. “We had the sixth-largest auditor review our finances, and they found no issue with our finances,” Dr. Baron countered. “Our audited finances are available on our website.”

Although the audience appeared unified in its deep displeasure with ABIM’s approach to the now-postponed MOC changes, the still-active issue of recertification exams revealed fissures between older and younger doctors.

One younger physician questioned the fairness of the dual system: “Why do older doctors not have to recertify? Abolish grandfathering!”

That drove “grandfathered” physicians to the room mics to defend their exclusion from recertification tests. Some stated that no data backed the belief that recertified physicians delivered better care. One grandfathered physician insisted she shouldn’t be “bullied into recertifying.”

Dr. Baron backed recertification by declaring that “we know that knowledge decays over time.” A study of grandfathered physicians vs. recertified physicians showed higher costs associated with grandfathers, he added.

After nearly an hour of open mics and talk therapy, the session came to a less-animated end. Attendees drifted off to evening events and, no doubt, nearby hotel bars for postgame MOC analysis. Dr. Baron left with the look of a New York fan relieved simply to escape Fenway Park physically unscathed after a Yankees win.

Will the communal catharsis from the Beantown Airing of Grievances – and similar sessions elsewhere – earn ABIM more time to morph MOC into something more acceptable and relevant to its test-takers and fee-payers before more physicians flee to upstart competing boards? Probably for many physicians, for whom ABIM’s MOC program remains at best a valued, necessary credential, and at worst a necessary evil.

But others say they’ve had enough.

As one physician emphatically declared to her colleagues in room 107 and beyond: “I would like the opportunity to put ‘Boycotting the MOC’ as my status on the ABIM website!”

[email protected]

BOSTON – Four-thirty in the afternoon isn’t the time slot most conference presenters covet.

By that point, many attendees are done for the day – loaded up with new knowledge and weighed down with schwag-stuffed tote bags. By 4:30 p.m., the hotel bar is enjoying stronger attendance and better survey-sheet ratings than a closing-time clinical diagnosis session.

But, by 4:30 Thursday at the annual meeting of the American College of Physicians, cavernous room 107 in Boston’s convention center was filling up.

Was it hosting “Atrial Fibrillation 2015”? “Prescribing Chronic Opioids”? “Update in Endocrinology”?

In fact, the session’s topic wasn’t clinical, but its nature was definitely acute. Room 107’s attendees had arrived for a session with the potential for as much action as the weekend’s upcoming Mayweather-Pacquiao megafight: “ABIM: Understanding MOC Requirements.”

There behind the podium stood the subdued president and CEO of the American Board of Internal Medicine, Dr. Richard J. Baron, looking like a Yankees fan about to lecture the Fenway Park faithful on the many merits of Bucky “Bleepin’ ” Dent.

In fact, before him seethed bleachers of angry doctors eager to share their opinions about what they viewed as ABIM’s own Bucky Dent: the Maintenance of Certification program.

With the ABIM board’s chair-elect, Dr. Clarence Braddock III, sitting nearby on the dais, Dr. Baron dutifully outlined the MOC backtracking that came with February’s public apology by ABIM: updates to its internal medicine exam; suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years; and MOC enrollment fees set at or below the 2014 levels through at least 2017. And if those three requirements did return, ABIM would give physicians a year’s notice before they would have to start meeting them.

By the end of the year, ABIM also will unveil more flexible ways to earn MOC points, Dr. Baron noted. He also offered his listeners assurances that the fall 2015 MOC exam would better reflect doctors’ clinical experiences.

“The most important thing we learned from Feb. 3 is that ABIM needed to change to an organization much more rooted in the community,” Dr. Baron explained.

Then he opened the meeting to questions from the audience – triggering an Airing of Grievances worthy of a “Seinfeld” Festivus.

Terry Rudd/Frontline Medical Communications

Beginning with a New Jersey physician who vigorously aired her own grievances at a volume that made a microphone redundant – “Don’t scare us away – we WANT to keep up!” – room 107’s open mics amplified a steady stream of physicians eager to vent their MOC-fueled fury and despair.

What about changing the MOC exam to open-book? “ ‘Consult the gastroenterologist’ is the real-world approach to solving problems!” Why can’t multiple sources of CME credit count toward MOC? Why not dump the recertification exam and simply use the modules to keep physicians fresh?

One physician who spent most of his practice in urgent-care settings and occupational medicine – in which relationships with patients are, by nature, short-lived – worried that a return of the patient voice requirement would make failure certain for him.

“I may be 72, but I will retire before I do one of those Practice Improvement Modules again!” warned another physician.

Attendees also zeroed in on financial allegations made in two recent Newsweek articles about ABIM (“The Ugly Civil War in American Medicine” and “A Certified Medical Controversy”). “Is an independent group going to review reports about ABIM’s finances?” one attendee asked. Another stated that ABIM’s board shouldn’t be paid, a suggestion for which the doctor received a generous round of applause.

Dr. Baron categorically dismissed claims that ABIM was financially troubled and that it manipulated exams to drive down pass rates – and thus boost its revenues with retests. “We had the sixth-largest auditor review our finances, and they found no issue with our finances,” Dr. Baron countered. “Our audited finances are available on our website.”

Although the audience appeared unified in its deep displeasure with ABIM’s approach to the now-postponed MOC changes, the still-active issue of recertification exams revealed fissures between older and younger doctors.

One younger physician questioned the fairness of the dual system: “Why do older doctors not have to recertify? Abolish grandfathering!”

That drove “grandfathered” physicians to the room mics to defend their exclusion from recertification tests. Some stated that no data backed the belief that recertified physicians delivered better care. One grandfathered physician insisted she shouldn’t be “bullied into recertifying.”

Dr. Baron backed recertification by declaring that “we know that knowledge decays over time.” A study of grandfathered physicians vs. recertified physicians showed higher costs associated with grandfathers, he added.

After nearly an hour of open mics and talk therapy, the session came to a less-animated end. Attendees drifted off to evening events and, no doubt, nearby hotel bars for postgame MOC analysis. Dr. Baron left with the look of a New York fan relieved simply to escape Fenway Park physically unscathed after a Yankees win.

Will the communal catharsis from the Beantown Airing of Grievances – and similar sessions elsewhere – earn ABIM more time to morph MOC into something more acceptable and relevant to its test-takers and fee-payers before more physicians flee to upstart competing boards? Probably for many physicians, for whom ABIM’s MOC program remains at best a valued, necessary credential, and at worst a necessary evil.

But others say they’ve had enough.

As one physician emphatically declared to her colleagues in room 107 and beyond: “I would like the opportunity to put ‘Boycotting the MOC’ as my status on the ABIM website!”

[email protected]

BOSTON – Four-thirty in the afternoon isn’t the time slot most conference presenters covet.

By that point, many attendees are done for the day – loaded up with new knowledge and weighed down with schwag-stuffed tote bags. By 4:30 p.m., the hotel bar is enjoying stronger attendance and better survey-sheet ratings than a closing-time clinical diagnosis session.

But, by 4:30 Thursday at the annual meeting of the American College of Physicians, cavernous room 107 in Boston’s convention center was filling up.

Was it hosting “Atrial Fibrillation 2015”? “Prescribing Chronic Opioids”? “Update in Endocrinology”?

In fact, the session’s topic wasn’t clinical, but its nature was definitely acute. Room 107’s attendees had arrived for a session with the potential for as much action as the weekend’s upcoming Mayweather-Pacquiao megafight: “ABIM: Understanding MOC Requirements.”

There behind the podium stood the subdued president and CEO of the American Board of Internal Medicine, Dr. Richard J. Baron, looking like a Yankees fan about to lecture the Fenway Park faithful on the many merits of Bucky “Bleepin’ ” Dent.

In fact, before him seethed bleachers of angry doctors eager to share their opinions about what they viewed as ABIM’s own Bucky Dent: the Maintenance of Certification program.

With the ABIM board’s chair-elect, Dr. Clarence Braddock III, sitting nearby on the dais, Dr. Baron dutifully outlined the MOC backtracking that came with February’s public apology by ABIM: updates to its internal medicine exam; suspension of the practice assessment, patient voice, and patient safety requirements for at least 2 years; and MOC enrollment fees set at or below the 2014 levels through at least 2017. And if those three requirements did return, ABIM would give physicians a year’s notice before they would have to start meeting them.

By the end of the year, ABIM also will unveil more flexible ways to earn MOC points, Dr. Baron noted. He also offered his listeners assurances that the fall 2015 MOC exam would better reflect doctors’ clinical experiences.

“The most important thing we learned from Feb. 3 is that ABIM needed to change to an organization much more rooted in the community,” Dr. Baron explained.

Then he opened the meeting to questions from the audience – triggering an Airing of Grievances worthy of a “Seinfeld” Festivus.

Terry Rudd/Frontline Medical Communications

Beginning with a New Jersey physician who vigorously aired her own grievances at a volume that made a microphone redundant – “Don’t scare us away – we WANT to keep up!” – room 107’s open mics amplified a steady stream of physicians eager to vent their MOC-fueled fury and despair.

What about changing the MOC exam to open-book? “ ‘Consult the gastroenterologist’ is the real-world approach to solving problems!” Why can’t multiple sources of CME credit count toward MOC? Why not dump the recertification exam and simply use the modules to keep physicians fresh?

One physician who spent most of his practice in urgent-care settings and occupational medicine – in which relationships with patients are, by nature, short-lived – worried that a return of the patient voice requirement would make failure certain for him.

“I may be 72, but I will retire before I do one of those Practice Improvement Modules again!” warned another physician.

Attendees also zeroed in on financial allegations made in two recent Newsweek articles about ABIM (“The Ugly Civil War in American Medicine” and “A Certified Medical Controversy”). “Is an independent group going to review reports about ABIM’s finances?” one attendee asked. Another stated that ABIM’s board shouldn’t be paid, a suggestion for which the doctor received a generous round of applause.

Dr. Baron categorically dismissed claims that ABIM was financially troubled and that it manipulated exams to drive down pass rates – and thus boost its revenues with retests. “We had the sixth-largest auditor review our finances, and they found no issue with our finances,” Dr. Baron countered. “Our audited finances are available on our website.”

Although the audience appeared unified in its deep displeasure with ABIM’s approach to the now-postponed MOC changes, the still-active issue of recertification exams revealed fissures between older and younger doctors.

One younger physician questioned the fairness of the dual system: “Why do older doctors not have to recertify? Abolish grandfathering!”

That drove “grandfathered” physicians to the room mics to defend their exclusion from recertification tests. Some stated that no data backed the belief that recertified physicians delivered better care. One grandfathered physician insisted she shouldn’t be “bullied into recertifying.”

Dr. Baron backed recertification by declaring that “we know that knowledge decays over time.” A study of grandfathered physicians vs. recertified physicians showed higher costs associated with grandfathers, he added.

After nearly an hour of open mics and talk therapy, the session came to a less-animated end. Attendees drifted off to evening events and, no doubt, nearby hotel bars for postgame MOC analysis. Dr. Baron left with the look of a New York fan relieved simply to escape Fenway Park physically unscathed after a Yankees win.

Will the communal catharsis from the Beantown Airing of Grievances – and similar sessions elsewhere – earn ABIM more time to morph MOC into something more acceptable and relevant to its test-takers and fee-payers before more physicians flee to upstart competing boards? Probably for many physicians, for whom ABIM’s MOC program remains at best a valued, necessary credential, and at worst a necessary evil.

But others say they’ve had enough.

As one physician emphatically declared to her colleagues in room 107 and beyond: “I would like the opportunity to put ‘Boycotting the MOC’ as my status on the ABIM website!”

[email protected]

BOSTON – New guidelines for cervical cancer screening in average-risk women issued today by the American College of Physicians are intended to standardize care and balance the harms and benefits of testing.

“Historically, physicians have initiated cervical cancer screening too early, and it is performed too frequently,” Dr. Tanveer P. Mir, chair-elect of the ACP’s Board of Regents, said during a media briefing. She noted that physicians also continue to screen patients at low or average risk, such as those who are older or who have had a hysterectomy. “There is much room for improvement.”

Terry Rudd/Frontline Medical News

The ACP defines “average risk” as asymptomatic women with no prior history of precancerous lesions or cervical cancer, women who do not have HIV, and women who were not exposed in utero to certain synthetic estrogens.The potential harms of over testing range from false positives that require painful biopsies to unnecessary hysterectomies.

The American Congress of Obstetricians and Gynecologists and the American Society for Clinical Pathology have both endorsed the ACP’s new guidelines, which adhere closely to those released by the U.S. Preventive Services Task Force in 2012.

The ACP’s new guidelines advise that women at average risk for cervical cancer who are age 21 or older should undergo cytology testing every 3 years. For women age 30 and older who prefer less frequent screening, physicians should combine HPV (human papillomavirus) testing with the cytology tests every 5 years (Ann. Intern. Med. 2015 April 30 [doi:10.7326/M14-2426]).

Physicians should not screen women aged 65 years and older who have had three consecutive negative cytology results or two consecutive, combined negative cytology and HPV test results within 10 years, with the most recent test having been within 5 years, according to the new guidelines.

The guidelines also recommend that physicians should not screen average-risk women under 21 years of age for cervical cancer. For average-risk women who are 21 or older, cytology testing should not be done more than once every 3 years.

The ACP does not recommend screening in women at average risk who have had a hysterectomy with the removal of their cervix at any age.

“These are guidelines. It really is a clinical decision by the individual physician as to whether they’re going to follow guidelines, and which particular guidelines they’re going to follow,” ACP President David A. Fleming said.

Nearly one-third of all women aged 21-24 years will test positive for HPV, while 12% of women aged 30-34 years and 5% of women aged 60-64 years will also test positive, according to the ACP.

About 13% of all women aged 21-24 years, 7% of those aged 30-34 years, and 3% of women aged 60-64 years will have abnormal cytology. While cytologic abnormalities are common in female patients under 21 years of age, clinically important cervical lesions are not.

The paper’s release is part of the ACP’s effort to prepare its members for the transition from fee-for-service payment models to value-based ones that the U.S. Department of Health & Human Services has said will be the basis for at least 80% of all care by 2018.

“This is high-value care,” Dr. Robert M. Centor, chair of the ACP’s Board of Regents, said of the new guidelines. “Value is not merely cost. Some expensive tests and treatments have high value because they provide high benefit and low harm. Conversely, some inexpensive tests and treatments have low value because they do not have enough benefits to justify even their remote costs, and might even be harmful.”

More guidelines will follow as part of the ACP’s campaign to change what Dr. Centor called the “paradigm” of over treatment.

In anticipation of pushback from patients who would prefer to have the screening even if they are at low to average risk, Dr. Fleming said in an interview that the ACP will make educational materials available online for physicians to distribute to patients.

“I try to put it in human terms and explain the unintended consequences of [too much testing], and sometimes I do have a strong recommendation that we either do or do not do whatever the guideline is,” he said. “That’s where the trust relationship comes in.”

[email protected]

On Twitter @whitneymcknight

BOSTON – New guidelines for cervical cancer screening in average-risk women issued today by the American College of Physicians are intended to standardize care and balance the harms and benefits of testing.

“Historically, physicians have initiated cervical cancer screening too early, and it is performed too frequently,” Dr. Tanveer P. Mir, chair-elect of the ACP’s Board of Regents, said during a media briefing. She noted that physicians also continue to screen patients at low or average risk, such as those who are older or who have had a hysterectomy. “There is much room for improvement.”

Terry Rudd/Frontline Medical News

The ACP defines “average risk” as asymptomatic women with no prior history of precancerous lesions or cervical cancer, women who do not have HIV, and women who were not exposed in utero to certain synthetic estrogens.The potential harms of over testing range from false positives that require painful biopsies to unnecessary hysterectomies.

The American Congress of Obstetricians and Gynecologists and the American Society for Clinical Pathology have both endorsed the ACP’s new guidelines, which adhere closely to those released by the U.S. Preventive Services Task Force in 2012.

The ACP’s new guidelines advise that women at average risk for cervical cancer who are age 21 or older should undergo cytology testing every 3 years. For women age 30 and older who prefer less frequent screening, physicians should combine HPV (human papillomavirus) testing with the cytology tests every 5 years (Ann. Intern. Med. 2015 April 30 [doi:10.7326/M14-2426]).

Physicians should not screen women aged 65 years and older who have had three consecutive negative cytology results or two consecutive, combined negative cytology and HPV test results within 10 years, with the most recent test having been within 5 years, according to the new guidelines.

The guidelines also recommend that physicians should not screen average-risk women under 21 years of age for cervical cancer. For average-risk women who are 21 or older, cytology testing should not be done more than once every 3 years.

The ACP does not recommend screening in women at average risk who have had a hysterectomy with the removal of their cervix at any age.

“These are guidelines. It really is a clinical decision by the individual physician as to whether they’re going to follow guidelines, and which particular guidelines they’re going to follow,” ACP President David A. Fleming said.

Nearly one-third of all women aged 21-24 years will test positive for HPV, while 12% of women aged 30-34 years and 5% of women aged 60-64 years will also test positive, according to the ACP.

About 13% of all women aged 21-24 years, 7% of those aged 30-34 years, and 3% of women aged 60-64 years will have abnormal cytology. While cytologic abnormalities are common in female patients under 21 years of age, clinically important cervical lesions are not.

The paper’s release is part of the ACP’s effort to prepare its members for the transition from fee-for-service payment models to value-based ones that the U.S. Department of Health & Human Services has said will be the basis for at least 80% of all care by 2018.

“This is high-value care,” Dr. Robert M. Centor, chair of the ACP’s Board of Regents, said of the new guidelines. “Value is not merely cost. Some expensive tests and treatments have high value because they provide high benefit and low harm. Conversely, some inexpensive tests and treatments have low value because they do not have enough benefits to justify even their remote costs, and might even be harmful.”

More guidelines will follow as part of the ACP’s campaign to change what Dr. Centor called the “paradigm” of over treatment.

In anticipation of pushback from patients who would prefer to have the screening even if they are at low to average risk, Dr. Fleming said in an interview that the ACP will make educational materials available online for physicians to distribute to patients.

“I try to put it in human terms and explain the unintended consequences of [too much testing], and sometimes I do have a strong recommendation that we either do or do not do whatever the guideline is,” he said. “That’s where the trust relationship comes in.”

[email protected]

On Twitter @whitneymcknight

BOSTON – New guidelines for cervical cancer screening in average-risk women issued today by the American College of Physicians are intended to standardize care and balance the harms and benefits of testing.

“Historically, physicians have initiated cervical cancer screening too early, and it is performed too frequently,” Dr. Tanveer P. Mir, chair-elect of the ACP’s Board of Regents, said during a media briefing. She noted that physicians also continue to screen patients at low or average risk, such as those who are older or who have had a hysterectomy. “There is much room for improvement.”

Terry Rudd/Frontline Medical News

The ACP defines “average risk” as asymptomatic women with no prior history of precancerous lesions or cervical cancer, women who do not have HIV, and women who were not exposed in utero to certain synthetic estrogens.The potential harms of over testing range from false positives that require painful biopsies to unnecessary hysterectomies.

The American Congress of Obstetricians and Gynecologists and the American Society for Clinical Pathology have both endorsed the ACP’s new guidelines, which adhere closely to those released by the U.S. Preventive Services Task Force in 2012.

The ACP’s new guidelines advise that women at average risk for cervical cancer who are age 21 or older should undergo cytology testing every 3 years. For women age 30 and older who prefer less frequent screening, physicians should combine HPV (human papillomavirus) testing with the cytology tests every 5 years (Ann. Intern. Med. 2015 April 30 [doi:10.7326/M14-2426]).

Physicians should not screen women aged 65 years and older who have had three consecutive negative cytology results or two consecutive, combined negative cytology and HPV test results within 10 years, with the most recent test having been within 5 years, according to the new guidelines.

The guidelines also recommend that physicians should not screen average-risk women under 21 years of age for cervical cancer. For average-risk women who are 21 or older, cytology testing should not be done more than once every 3 years.

The ACP does not recommend screening in women at average risk who have had a hysterectomy with the removal of their cervix at any age.

“These are guidelines. It really is a clinical decision by the individual physician as to whether they’re going to follow guidelines, and which particular guidelines they’re going to follow,” ACP President David A. Fleming said.

Nearly one-third of all women aged 21-24 years will test positive for HPV, while 12% of women aged 30-34 years and 5% of women aged 60-64 years will also test positive, according to the ACP.

About 13% of all women aged 21-24 years, 7% of those aged 30-34 years, and 3% of women aged 60-64 years will have abnormal cytology. While cytologic abnormalities are common in female patients under 21 years of age, clinically important cervical lesions are not.

The paper’s release is part of the ACP’s effort to prepare its members for the transition from fee-for-service payment models to value-based ones that the U.S. Department of Health & Human Services has said will be the basis for at least 80% of all care by 2018.

“This is high-value care,” Dr. Robert M. Centor, chair of the ACP’s Board of Regents, said of the new guidelines. “Value is not merely cost. Some expensive tests and treatments have high value because they provide high benefit and low harm. Conversely, some inexpensive tests and treatments have low value because they do not have enough benefits to justify even their remote costs, and might even be harmful.”

More guidelines will follow as part of the ACP’s campaign to change what Dr. Centor called the “paradigm” of over treatment.

In anticipation of pushback from patients who would prefer to have the screening even if they are at low to average risk, Dr. Fleming said in an interview that the ACP will make educational materials available online for physicians to distribute to patients.

“I try to put it in human terms and explain the unintended consequences of [too much testing], and sometimes I do have a strong recommendation that we either do or do not do whatever the guideline is,” he said. “That’s where the trust relationship comes in.”

[email protected]

On Twitter @whitneymcknight