Internists Encouraged by Continued Progress Made in Congress to Repeal SGR Formula and Reform Medicare Physician Payments

American College of Physicians reacts to Congressional committee agreement that advances its top priorities for physician payment reform.

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

December 4, 2013

(Washington) - The American College of Physicians is greatly encouraged by the continued progress being made in Congress to develop a bipartisan, bicameral plan to repeal Medicare's Sustainable Growth Rate (SGR) formula and to reform Medicare physician payments. Today, we learned that the Senate Finance and House Ways and Means committees have reached agreement on a legislative framework, based on the one released for comment on Oct. 31, that would advance the College's top priorities for physician payment reform:

  1. It repeals the SGR formula.
  2. It creates opportunities for physicians to earn positive baseline updates for participating in a new value-based payment (VBP) program or in an Alternative Payment Model (APM). We are pleased that in response to ACP's comments on the earlier draft, the committees revised the draft to allowing participation in specialty boards' maintenance of certification programs to count toward clinical practice improvement activities.
  3. It creates incentives for physicians who practice in Patient-Centered Medical Homes and Patient-Centered Specialty practices: such practices will qualify for the highest possible clinical practice improvement scores under the VBP program, or alternatively, may become eligible for 5 percent annual bonus payments as a designated APM.
  4. It makes improvements in the process for developing relative value units, including giving CMS the authority to seek additional data from physicians to validate the accuracy of (relative value units) RVUs, and to compensate physicians for providing such data. As recommended by ACP, the new proposal eliminates penalties on physicians who decline to participate in the RVU survey process, and counts changes in RVUs that have been recommended by the (AMA/Specialty Society Relative Value Scale Update Committee) RUC-- and accepted by CMS --toward the annual targets for reducing misvalued RVUs. The new proposal also sets lower annual percentage targets for reducing misvalued RVUs, thereby making the targets more achievable and also lowering the amount of money that will be taken out of the physician payment system if the targets are not met.

Also as recommended by ACP, the proposal released today:

  • Increases funding for performance measure development and validation;
  • Increase funding for physicians in smaller practices-and expands eligibility to smaller practices that fall outside of health professional shortage areas--to assist them in making the transition to VBP programs and APMs.

The College also is pleased that the legislation will require a GAO study of ways to better harmonize measures used by Medicare and private payers.

The College urges the Ways and Means and Senate Finance Committees to move forward on reporting legislation based on the current framework out of their respective committees before Congress recesses for the holidays, so that it can be voted on, and sent to the President for his signature, as early as possible when Congress returns in Jan. In the meantime, we believe that it is essential that Congress act to prevent the nearly 25 percent cut to physicians that will occur on Jan. 1 because of the current SGR formula.

The College will also continue to urge Congress to ensure that existing programs that recognize the critical role that primary care plays in terms of ensuring access, improving quality and lowering costs are not allowed to sunset, including the Medicaid primary care pay parity program, which sunsets at the end of 2014, and the Medicare primary care bonus program, which sunsets at the end of 2015.

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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.