Letter from the EVP and CEO

ACP advocates on behalf of internists on a number of timely issues and works to improve the practice environment. Here's a breakdown of our most important efforts and initiatives over the past year, and why they matter:

The repeal of the sustainable growth rate (SGR) formula: In April 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law. The new law did away with the sustainable growth rate (SGR) formula that had been used to calculate Medicare Part B payments to physicians, eliminating the threat of annual cuts in physician payments that physicians had faced for more than a decade.

MACRA, however, does more than repeal the SGR: it replaces Medicare’s three current burdensome and non-aligned reporting programs (PQRS, Meaningful Use, and the Medicare Value Modifier) with a new unified and streamlined Quality Payment Program that offers more options and flexibility for physicians to achieve higher Medicare Fee-for-Service payment updates for improving care to their patients, as well as positive payment incentives for physicians in alternative payment models like Patient-Centered Medical Homes. Yet enactment of MACRA is only the beginning of the story; ACP’s advocacy is now devoted to ensuring that implementation of the law truly achieves the promise of offering more flexible options without further burdening physicians and their practices. ACP’s advocacy has included:

• On April 19, 2016, Robert M. McLean, MD, FACP, a member of ACP’s Board of Regents and a practicing internist, testified before the House Energy and Commerce Subcommittee and spoke about what ACP is doing to help its members succeed under the new law. He highlighted three ACP priorities as MACRA is implemented: to establish better measures and less burdensome reporting; create realistic pathways for patient-centered medical homes; and define eligible alternative payment model (APM) requirements.
• Shortly after, on April 27, 2016, the Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking to implement key provisions of MACRA. The proposed rule would implement these changes through the unified framework called the “Quality Payment Program,” which includes two paths:
• Merit-Based Incentive Payment System (MIPS)
• Advanced Alternative Payment Models (APMs)

ACP’s review of the proposed rule suggests to us that CMS is moving in the right direction: reducing the number of quality measures that need to be reported, replacing Medicare’s flawed EHR Meaningful Use (MU) program with the Advancing Care Information program, and providing opportunities for physicians in Patient-Centered Medical Homes to obtain positive payment adjustments under either the MIPS or APM pathways. In commenting to CMS on the proposed rule the College offered practical recommendations for how CMS could improve upon their proposal. These recommendations include replacing an unnecessarily complex quality scoring system with a much simpler and understandable approach, revamping how use of health information technology is reported to make it less burdensome and more relevant to clinicians, offering safe harbors for smaller practices until a “virtual reporting” system is established, and providing expanded choices and opportunities for physician-led models to qualify for higher payments as “alternative Advanced Payment Models”—including three new pathways for Patient-Centered Medical Home Practices.

More details about ACP’s comments, including the full comment letter submitted to CMS are available on our website.

Meaningful Use of Electronic Health Records (EHRs): Even though MACRA will replace the MU program with the Advancing Clinical Information program (see above), internists in 2015 and 2016 continue to be subject to the existing MU program. During 2015 ACP succeeded in getting several important changes to the Medicare EHR Incentive Program (Meaningful Use), including making the 2015 reporting for Stage 2 easier by allowing physicians to qualify by reporting only for 90 days instead of an entire year, and making it easier for physicians to get hardship exceptions.

Reform of “Facility Fees”: As of January 1, 2017, most services provided by an off-site hospital department that was not billing as a hospital prior to fall 2015 will not be eligible to add an additional facility fee to their claims. ACP strongly supported this change to level the playing field between independent physician practices and those owned by hospitals. This change will reduce the incentive for hospitals to acquire physician practices to generate facility payments to the hospital, as well as the increased Medicare expenditures and higher out-of-pocket costs to Medicare patients resulting from facility fees.

Creating new codes for improved reimbursement for internists’ services: In 2015, several coding changes were made that will mean increased reimbursements to internists, including chronic care management codes, new advance care planning codes, and changes to the transitional care management (TCM) codes. CMS recently made an important improvement in the TCM code by allowing physicians to bill for it on the same day that the visit occurs. ACP has suggested to a bipartisan Senate Finance Committee working group dozens of ways to reduce barriers to chronic care management, including eliminating patient cost-sharing for the new CCM code.

Putting Patients Before Paperwork: ACP’s success in advocating for changes in Meaningful Use to reduce burdens on our members is just one part of the College’s broader initiative of “Patients Before Paperwork,” which is intended to ease or eliminate unnecessary, burdensome insurance paperwork and regulatory, documentation, and billing requirements, as well as make EHRs more useful and functional.

ACP is developing an evidence-based, comprehensive approach to address the top administrative complexities members face. Through policy development and education, feedback to regulatory agencies, and collaborations with other groups, ACP seeks to reduce physician burn-out and help restore the joy of practice. A 2013-14 ACP member survey showed the top 3 frustrations are electronic health record usability, quality reporting, and dealing with insurance companies.

Making the Affordable Care Act work for internists and patients. As recommended by ACP in an amicus (“friend of the court”) brief, in June 2015 the Supreme Court of the United States issued its ruling that the insurance premium subsidies that are part of the Affordable Care Act will continue to be available in states where the federal government manages their health insurance marketplace. Had the court ruled against the subsidies, premiums would have skyrocketed in the affected states. In addition, ACP has successfully influenced CMS and state insurance regulators to improve network adequacy standards. While the ACA has been successful in driving down the uninsured rate to historic lows, the College continues to advocate to close remaining gaps in coverage, to ensure that out-of-pocket costs are reasonable, and to ensure that patients have a wide choice of physicians.

ACP Public Policy: Giving voice to the issues that affect patients and the profession

ACP public policy papers summarize and dissect published research and discussion on current issues involving clinical practice, medical education, bioethics, and health care financing and delivery, and make specific recommendations for internists, patients, and policy makers. ACP’s recent policy efforts include:

• Financing U.S. Graduate Medical Education: A Policy Position Paper of the Alliance for Academic Internal Medicine and the American College of Physicians (Annals of Internal Medicine, May 2016)
• Climate Change and Health: A Global Call to Action (Annals of Internal Medicine, April 2016)


Dr. Nitin Damle, MD, MS, FACP, 2016-2017 president of ACP, testified before Congress about the impact of rising prescription drug prices on internal medicine physicians and their patients.

• Stemming the Escalating Cost of Prescription Drugs (Annals of Internal Medicine, March 2016)
• Medicaid Expansion: Premium Assistance and Other Options (March 2016)
• Assessing the Patient Care Implications of "Concierge" and Other Direct Patient Contracting Practices (Annals of Internal Medicine, December 2015)
• Retail Health Clinics (Annals of Internal Medicine, December 2015)
• Policy Recommendations to Guide the Use of Telemedicine in Primary Care Settings (Annals of Internal Medicine, November 2015)
• The Integration of Care for Mental Health, Substance Abuse, and Other Behavioral Health Conditions into Primary Care (Annals of Internal Medicine, August 2015)

Advocacy around firearm injuries and deaths

ACP has continued to advocate for common sense reforms to reduce firearm-related injuries and death. ACP President Wayne Riley, MD, MACP, represented ACP in Charleston, SC, at a commemoration of the six-month anniversary of the shootings at the Emanuel A.M.E. Church. “Moving from Crisis to Action: A Public Health Approach to Reducing Gun Violence” included representatives from national and local medical, legal, and law enforcement communities who discussed the impact of gun violence on citizens, communities, and the economy.

An op-ed, “Firearms violence in America: Long past the time for action,” co-authored by Dr. Riley and Paulette Brown, President of the American Bar Association, was published in The Post & Courier, a Charleston-based newspaper.

A joint letter to the editor from the presidents of ACP and the American Bar Association, entitled "From Doctors and Lawyers: A Plea for Action on Guns," was also published in the New York Times in December 2015.

A recent Annals article stated that physicians are legally allowed to ask and counsel their patients about firearms. An accompanying editorial, written by Dr. Steven E. Weinberger, was also published.

Leadership Day

ACP's Leadership Day, held in conjunction this year with the Internal Medicine Meeting in Washington, D.C., is an annual two-day event held on Capitol Hill in Washington, D.C. The event provides ACP members a unique opportunity to experience grassroots advocacy training, attend in-depth issue briefings, and meet with their senatorial and congressional representatives. This year, 440 physicians and medical students from almost every state came to Washington to increase the visibility of internal medicine issues and share with lawmakers how policy affects their practices and their patients. They urged Congress to: reduce barriers to chronic care management, support the integration of behavioral health into primary care, promote EHR interoperability, expand access to telemedicine services, among other issues. Watch a video about Leadership Day and see members speaking about their experience.