Internists Testify on Developing 'A Viable Medicare Physician Payment Policy' that Will Repeal SGR

ACP Testimony to Ways and Means Health Subcommittee Recommends Key Elements for Plan That Emphasizes Graduated Approach to Rewarding Quality and Effectiveness

May 7, 2013

(Washington) "The American College of Physicians (ACP) strongly supports a phased approach to repealing the Sustainable Growth Rate (SGR) and progressing to better, value-based payment and delivery models," Charles Cutler, MD, FACP, chair of the ACP Board of Regents, today told the House Ways and Means Health subcommittee. Dr. Cutler is a practicing primary care internist in a multi-specialty group practice in Norristown, Penn.

Dr. Cutler said that a proposal developed by Ways and Means Committee chairman Dave Camp (R-MI), and Energy and Commerce Committee chair Fred Upton (R-MI), is a "bold plan for Medicare payment reform that holds the promise of breaking a decade-long impasse on repeal of the Medicare Sustainable Growth Rate." He noted that the plan had four key elements to create a viable Medicare payment system: it repeals the SGR, stabilizes payments, and provides multiple pathways for physicians to participate in efforts to improve quality and effectiveness of care.

He also praised the Medicare Physician Payment Innovation Act of 2013, H.R. 574, introduced by Representative Allyson Schwartz (D-PA) and Joe Heck (R-NV). "This bill, which we support, has a similar approach as the Camp-Upton proposal" he observed and "merits strong consideration by the subcommittee."

He recommended that the Subcommittee on Health consider adding the following policies to the Camp-Upton proposal:

  • establish positive baseline updates, with an increase for evaluation and management services, for five years;
  • allow physicians to qualify for additional value-based payment (VBP) allowances for participating in an approved or deemed transitional VBP program, beginning in 2014;
  • create a process by which CMS would deem a private sector initiative to qualify physicians for graduated incentive payments;
  • develop standards for deemed programs based on how many core elements they have that are associated with better quality and effectiveness of care; and
  • enable physician practices that have received independent recognition as Patient-Centered Medical Homes to qualify for the graduated incentive program.

ACP, Dr. Cutler noted, strongly believes that the patient-centered medical home (PCMH) and PCMH-Neighbor models are ready to be a part of this new, value-based health care payment and delivery system-for practices that have made or are ready to make the transition to these models. It is also critical, he said, that robust and aligned performance measurement approaches and a stable infrastructure be developed, tested, validated, and integrated into performance measures for all physicians and practices in all of the VBP programs. Additionally, all measures, whether developed by a specialty society or other experts, should go through a multi-stakeholder evaluation process, a role that is performed by the National Quality Forum as a trusted evaluator of measures.

"In conclusion," Dr. Cutler's testimony said, "ACP's approach, like the chairmen's proposal, recognizes that physicians are starting out in different places on incorporating best practices to achieve greater value for their patients, with some physicians already being very far down the road in redesigning their practices to achieve better value, while others are just getting started on the entrance ramp to value-based models. Physicians at all points on this journey need to have models available to them that are appropriate and realistic for their particular stage but with the opportunity for physicians to earn additional incentive payments when they are doing more, and sooner, to improve outcomes and effectiveness of 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 133,000 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.

David Kinsman, (202) 261-4554