Internists Supportive of Effort to Repeal Medicare SGR Formula

American College of Physicians Backs Draft Bipartisan, Bicameral Framework Also Provides Recommendations for Changes and Improvements

Statement attributable to:
Molly Cooke, MD, FACP
President of the American College of Physicians

(Washington) - The American College of Physicians (ACP) today responded to the House Ways and Means and Senate Finance committees' draft, bipartisan, bicameral framework to achieve medicine's decade-long goal of repealing the Medicare SGR formula, once and for all. In our response, we noted four points in particular:

  1. Expressed our preference for positive updates and our reservations about the 10-year freeze on baseline updates, but acknowledged that if Congress decides to freeze the updates because of fiscal constraints, the impact on access will need to be monitored, and the door should be open to higher future updates in the future to ensure access. We will also seek an understanding of the need to extend the Medicare Primary Care Incentive Program, which is set to expire at the end of 2015.
  2. Expressed overall support for two pathways for physicians to earn more than the flat zero baseline updates: the new Value-Based Payment Program-which replaces the existing PQRS, Meaningful Use, and Medicare Value Index Modifier--and Alternative Payment Models.
  3. Expressed strong support for the incentives created for Patient-Centered Medical Homes (PCMH) and PCMH specialty (neighborhood) practices:
    1. Certified PCMHs and PCMH specialty practices will automatically qualify for the highest possible practice improvement score under the new Value Based Payment Program. They also will be able to be reimbursed for new complex chronic care coordination services.
    2. Advanced PCMHs, modeled on the Comprehensive Primary Care Initiative, would be eligible to be designated as Alternative Payment Models, qualifying them for annual 5 percent bonus payments, if CMS certifies that they can improve quality without increasing costs, or lower costs without decreasing quality. They will not be required to accept financial risk.
  4. Recommended improvements in the proposals to set a target to reduce misvalued RVUs, to create a new value-based payment program, to add appropriateness criteria requirements for advanced imaging and electrocardiograms, and to develop a pathway for Alternative Payment Models.


The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 137,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.