ACP says Congress must take action to reform dysfunctional Medicare payment system

Chair of Board of Regents emphasizes 'essential' move in testimony

(Washington) -- "It is essential that Congress take immediate action to reform the dysfunctional Medicare physician payment system," William E. Golden, MD, FACP, chair of the Board of Regents of the American College of Physicians (ACP), told the House Energy and Commerce Committee subcommittee on Health today.

"Medicare payments are dysfunctional because they reward high volume, episodic, and fragmented care that undervalues the relationships between physicians and their patients and, as a result, often does not produce desired outcomes," Dr. Golden noted. "Instead, we need a payment system that is centered on patients' needs, one that recognizes the value of a patient's relationship with their personal physician, and one that provides incentives for physicians to engage in continuous quality improvement and measurement supported by health information technology."

A general internist and Professor of Medicine at the University of Arkansas for Medical Sciences, Dr. Golden urged Congress to enact a step-by-step plan that stabilizes physician payments in the immediate term, while establishing the building blocks for longer-term reforms. "We believe that a centerpiece should be the recognition of the enormous potential to improve outcomes and lower costs when care is managed by a patient's personal physician, practicing in systems of care centered on patients' needs," Dr. Golden said. "This model, called the patient-centered medical home, should be included any legislation to address Medicare physician payment issues."

He shared ACP's views on each of the elements of the Discussion Draft prepared by Energy and Commerce Committee chairman Joe Barton.

Providing details on each of the elements, Dr. Golden said the ACP believes that:

  • Congress Must Replace the 2007 SGR cuts with a positive update;
  • Congress should provide a multi-year stable, positive and predictable updates;
  • Congress Should Treat Increased Expenditures as a "Change in Law and Regulation;
  • Begin a Voluntary, Non-Punitive Pay-for-Reporting Program in 2008, with Multiple Pathways for Physicians to Participate;
  • Congress Should Institute the Patient-Centered Medical Home Demonstration;
  • Congress should transition from the initial pay-for-reporting program to one that creates a performance improvement pool to include prioritized funding for programs that use measures having the greatest potential impact on improving quality and reducing costs. Physicians should have the opportunity to earn additional payments on a weighted basis reflecting the impact of the measures, their performance, and the costs associated with reporting.

Dr. Golden emphasized that although members of Congress will have different perspectives on how best to avert the SGR cuts and how to fund it, "it is imperative that Congress reach an accord that will, at a minimum, replace the 5.1 percent SGR cut next year with positive updates that reflect increases in practice costs."

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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 119,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.


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