Internal Medicine Specialists Challenge Congress to Work withPhysicians to Repeal SGR and Develop Better Payment Models

Response to House Ways and Means Committee letter urges Congress to build upon Patient-Centered Medical Homes, Other Promising Models to Improve Care Delivery

May 23, 2012

(Washington) The American College of Physicians (ACP) today urged the House Ways and Means Committee to report legislation to repeal the Sustainable Growth Rate (SGR) and transition to better payment models, building on the extensive work being done in the public and private sectors by physicians, government, consumers and other stakeholders to develop new models aligned with high-value patient care.

The 16-page letter from David L. Bronson, MD, FACP, president of ACP, responded to an April 27 request from the Ways and Means Committee for information on "physician-led efforts to enhance the value of care provided to patients" that could contribute to a permanent transformation of the Medicare payment system. ACP was asked specifically to provide ideas on "Rewarding Quality and Efficiency," promoting "Patient Involvement and Regulatory Relief" and developing "Alternative Payment Models."

ACP's letter:

  • Offered a framework to repeal the Medicare Sustainable Growth Rate (SGR) formula, provide a period of positive and stable updates with additional incentives for primary and coordinated care, and a transition to new patient-centered payment models, based on the bipartisan Medicare Physician Payment Innovation Act, H.R. 5707.
  • Highlighted the extensive and growing positive experience in the private and public sectors with Patient-Centered Medical Homes (PCMHs), one of the most promising physician-led models to support primary care practices that demonstrate the capability to provide high value care to patients. ACP expressed confidence that the PCMH model, and the related PCMH-Neighborhood, will have enough supporting data and experience to be incorporated into the options available to physicians after a transition period similar to that established by H.R. 5707.
  • Identified other models under development that have the potential to improve quality and reduce costs, including Accountable Care Organizations and bundled payments, which could be ready for adoption after a transition period.
  • Recommended shorter-term approaches to support high value, coordinated care, including payment for new CPT codes for chronic, complex care and transitions after a hospital discharge.
  • Summarized ACP's extensive leadership in developing and/or supporting evidence-based guidelines of care, performance measures, patient registries, clinical research, and adoption of electronic health records, including a new program to provide physicians and consumers with expert guidance on high value, cost-conscious care.
  • Proposed ways that Congress and CMS could reduce administrative and regulatory barriers to high value care.

Dr. Bronson closed his letter with seven specific recommendations to Congress on how it could partner with ACP and other physician organizations to eliminate the SGR, learn from the work being done in the public and private sectors in partnership with physicians, and reduce barriers to high value, cost-conscious, and patient-centered care.

"ACP agrees with the Ways and Means Committee that the SGR is creating uncertainty in the Medicare program for both physicians and beneficiaries" noted Dr. Bronson. " A permanent solution to this problem is needed-and it should include a transformation of the Medicare physician payment system from one that incentivizes volume to one that preserves and promotes the patient-physician relationship and rewards high-quality and efficient care."

The American College of Physicians ( is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 132,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter and Facebook.

David Kinsman, (202) 261-4554,
Jacquelyn Blaser, (202) 261-4572,