Reform Medicare's physician payment system

We, the physician community, are committed to doing our part to lower costs and improve the quality of care provided to our Medicare patients.  We ask that Congress do its part by enacting bipartisan Medicare physician payment reform legislation before the end of this year, based on a bipartisan, bicameral draft proposal released today.

I am the president of the American College of Physicians, the nation’s largest physician medical specialty society.  Our 137,000 internal medicine physician specialists and medical student members are ready and willing to develop and implement innovative approaches to improve the way that medical care is delivered and reimbursed for the benefit of our patients.  We are committed to:

·         Developing and encouraging use of evidence-based clinical guidelines to reduce over-use of ineffective, wasteful and even harmful care and engaging our patients in shared decision-making based on such guidelines.  ACP’s own High Value Care Initiative http://hvc.acponline.org/ offers recommendations relating to dozens of clinical scenarios where a test or procedure may not be medically indicated, such as routine use of CT or MRI for patients with low back pain. 

·         Transitioning from systems that pay physicians based primarily on how many procedures or visits we perform (traditional Fee-For-Service), to models that align payments with the usefulness of the care we provide our patients.    

·         Creating and participating in new delivery models, such as Patient-Centered Medical Homes and Accountable Care Organizations, which organize care around the needs of patients, incorporating best practices to achieve measureable benefit effectively and efficiently.  Patient-Centered Medical Homes—high performing primary care practices—in particular have been shown to improve outcomes and lower costs in many medical homes across the country enjoyed by tens of millions of patients.

·         Measuring our results, through clinical performance measures developed by physicians based on science, and validated by consumers, physicians, and other stakeholders through a transparent process.

·         Creating more transparency and accuracy in the pricing of medical procedures and redistributing payments from over-priced services to undervalued ones.

·         Proposing responsible ways to achieve hundreds of billions of dollars in federal spending on health care, replacing across-the-board “sequestration” cuts that are harming medical research and other critical health programs.

Last week,  I sent a letter to the Senate-House “conference” committee that is required to report on a budget proposal by Dec. 13.  Our letter provides more detail on ACP’s proposals to improve the outcomes, effectiveness, and efficiency of care provided to our patients enrolled in Medicare and on our alternatives to sequestration.

The letter also asks Congress to do its part by enacting comprehensive Medicare physician payment reform legislation to repeal the Sustainable Growth Rate (SGR) formula.  This formula has resulted in scheduled across-the-board Medicare cuts to physicians in every year since 2001.  In most years, Congress has passed a short-term “patch” that prevents the next round of cuts, but does not change the underlying SGR formula that caused the problem in the first place.  Year after year, the scheduled cut has gotten bigger, with physicians and their patients now facing a more than 24 percent cut on Jan. 1, 2014.  The uncertainty and lack of payment stability created by the SGR is the single biggest obstacle to physicians making the transition to better payment and delivery models aligned with value to patients.  The SGR needs to go, and it needs to go now.

Fortunately, this Congress is making unprecedented progress on reaching a bipartisan consensus on SGR repeal.  Today, the Senate Finance Committee and Ways and Means Committee chairs and ranking members released a comprehensive draft proposal to create the foundation for a better physician payment system, building on a bill unanimously reported out of the Energy and Commerce Committee. It permanently repeals the SGR and eliminates the more than 24 percent cut scheduled to take place on January 1, 2014. It stabilizes payments and creates opportunities for physicians to earn additional Medicare incentive payments, above flat baseline updates, for participating in a new Medicare Value Based Incentive Program. It creates strong incentives for Patient-Centered Medical practices.  And, it allows physicians who are in advanced Alternative Payment Models to qualify for incentive payments. 

And there is more good news: the Congressional Budget Office has determined that the cost of repealing the SGR has dropped by more than $100 billion from earlier estimates!

Football fans know that success is all about moving the football down the field. Congress has moved legislation to repeal the SGR and reform Medicare payments to the equivalent of the 10 yard line, first and 10.  We, the physician community, are doing our part to advance the ball by lending our input and getting behind the bipartisan effort to enact comprehensive Medicare physician payment reform legislation.   And, when the SGR repeal bill becomes law, we will continue to do our part to lower costs and improve quality.  Now is not the time for Congress to punt—let’s all get together and help drive Medicare physician payment reform legislation over the goal line, before the legislative clock runs out in December. 

Cooke is president of the American College of Physicians.