Congressional Action Strengthens Internal Medicine ACP Says
Measure Averts 5% Cut; Includes ACP’s Proposed Medical Home Pilot
December 12, 2006
(Washington) --Saturday’s Congressional action to avert Medicare payment cuts to physicians will work to strengthen the future of internal medicine, the American College of Physicians (ACP) said today in a statement of appreciation to lawmakers.
ACP told members of Congress that it is very pleased that the Medicare physician payment “will avert a 5 percent payment cut in 2007, stabilize Medicare payments, bring down the cost of a long term fix, and mandate a pilot test of the patient centered medical home.” The statement also said that ACP looks forward to working with the Centers for Medicaid and Medicare Services (CMS) on the new transitional pay for reporting program that will begin in July 2007 to assure that appropriate and validated measures are used and to simplify the process of reporting on the measures. The statement ended with the ACP emphasizing, “Our members and their patients thank you.”
Before the end of the 2006 session Congress replaced a scheduled 5 percent cut to physicians’ payments under the 2007 Medicare Physician Fee Schedule with an extension of current rates. The cut would have resulted from the sustainable growth rate (SGR) formula, which ties physician payments to growth in the overall economy.
Earlier this year CMS proposed changes to work relative value units (RVUs) that would result in payment increases for office and hospital visits and consultations--known as evaluation and management (E/M) services. When the continuation of overall Medicare payments is coupled with the changes to work RVUs, internists and their patients will gain, on average, 5 percent in total Medicare payments.
“ACP believes that the changes to work RVUs are an important first step in preventing the imminent collapse of primary care medicine in the U.S.,” noted Lynne M. Kirk, MD, FACP, president of ACP. “These increases address long-standing inequities in how Medicare values physician services. If the SGR cut had not been averted, internists and other primary care physicians would not have seen the long-overdue improvements in payments for their E/M services.”
The ACP also expressed strong support for Congress’s decision to include a Medicare pilot of the patient-centered medical home. ACP outlined the benefits of a patient- centered medical home in a policy paper released in January 2006, and provided specific recommendations to Congress for legislation to implement a Medicare pilot of the model in testimony to the House Ways and Means and Energy and Commerce committees. The ACP has also joined with the American Academy of Family Physicians in proposing joint principles in support of the patient-centered medical home. The pilot project, which will be launched in eight states, will provide physicians who participate in the program with a “care coordination fee” for managing the care of patients with multiple chronic conditions, and will provide them with the ability to share in system wide savings that may result.
“The adoption of the medical home proposal is key to ACP’s overall long-term strategy of overhauling Medicare payments to support primary care,” said Dr. Kirk. “This is the first time that physicians, including those in smaller practices, will be given the opportunity to share in the savings that may result from physician-directed care coordination.”
Finally, ACP also expressed qualified support for the transitional voluntary pay-for-reporting program to begin on July 1, 2007. Under the program, physicians will be given the option of reporting on as few as three measures to qualify for an additional bonus of up to 1.5 percent for measures reported from July 1 to December 31, 2007. This program also creates the framework for a 2008 pay-for-reporting program that would use consensus-based measures developed by the Physicians Consortium for Performance Improvement and endorsed by the National Quality Forum and the AQA.
“ACP looks forward to working with CMS to ensure that the reporting mechanisms are administratively feasible and there is equity and fairness in the burden of reporting for different specialties,” said Dr. Kirk. “Additionally, we will encourage the new Congress to consider providing additional monies to offset the system costs incurred by internists in reporting on measures for chronic diseases and to ensure that payments are sufficient to drive quality improvements.”
Congress will need to act again next year to avert another cut resulting from the SGR formula.
“While we appreciate the steps that Congress has taken to move toward reform of both the payment and care-delivery systems, it is essential that the new 110th Congress agree on a longer term fix that would provide positive and stable updates, create sustained incentives for quality improvement, lead to the elimination of the SGR, and support physician-directed care coordination,” continued Dr. Kirk. “The potentially huge cuts that could be coming in 2008 would be devastating to Medicare patients’ access and quality. Our patients need a long-term solution, not another temporary reprieve.”
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 120,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.