THE ACC URGES CONGRESS TO ENSURE PRACTICE STABILITY AND PAYMENT REFORM IN THE FOLLOWING WAYS:

  • PERMANENTLY REPEAL THE SUSTAINABLE GROWTH RATE (SGR) FORMULA
  • ENSURE PRACTICE AND PROVIDER STABILITY THROUGH CONTINUED PATIENT ACCESS TO IN-OFFICE ANCILLARY SERVICES, GREATER INTEROPERABILITY OF HEALTH INFORMATION TECHNOLOGY (HIT), FAIR AND ACCURATE REIMBURSEMENT FOR SERVICES, AND REFORM OF MEDICAL LIABILITY PROGRAMS
  • ENCOURAGE THE TRANSITION TO NEW PAYMENT MODELS THAT REWARD BETTER PATIENT OUTCOMES AND PAY CLINICIANS BASED ON THE QUALITY, NOT QUANTITY, OF CARE PROVIDED

Congress must reform the Medicare Physician Payment system and permanently repeal the flawed SGR formula.

  • The current physician payment system rewards quantity of services performed, not the quality of the outcomes. The ACC has long argued in favor of a permanent repeal of the SGR because the current system is driven by volume and episodic care without regard for improving quality, patient outcomes or patient satisfaction. This misalignment of incentives stifles innovation, limits communication between clinicians and patients, and creates hurdles to the practice of quality care.
  • It is not sound fiscal policy for Congress to continue to “patch” the SGR. In the past 10 years, Congress has spent $146 billion on short-term patches – totaling more taxpayer dollars than if the SGR would have been fully repealed in the first place.

Congress must ensure practice and provider stability through continued patient access to in-office ancillary services, greater interoperability of health information technology (IT), fair and accurate reimbursement for services, and reform to medical liability insurance.

  • The In-Office Ancillary Services Exception (IOASE) to the Physician Self-Referral (Stark) Law recognizes that a referral within a group practice promotes continuity of care in a setting that is best for the patient, and as such, Congress should preserve the IOASE.
  • As physicians transition their practices from paper records to electronic health records (EHRs), Congress must continue to promote and incentivize EHR use with an emphasis on interoperability.
  • Congress must work collaboratively with the Department of Health and Human Services (HHS) to ensure that there are continued efforts to eliminate programs, requirements and regulations that reduce patient care efficiencies within practice settings.
  • Congress must enact medical liability reforms that guarantee the protection of patients, improve patient-provider communication and promote affordable and accessible liability protection, while adhering to successful reform efforts already in place at the state level.

Congress should encourage the transition to new payment models that reward better patient outcomes and pay based on the quality, not quantity, of care provided.

  • Future payment updates should be positive for a period of three to five years, so clinicians are able to transition to new payment models and make necessary infrastructure investments to improve quality and efficiency with some assurance of financial stability.
  • New models of paying for and delivering care should be tested in a variety of settings, including small, independent practices, rural and underserved areas, and large single specialty and multispecialty groups.
  • An appropriate period of transition for models that are proven to be most effective should be reflected. Any new system should reflect increases in health care professionals’ practice costs as a result of health IT requirements, hiring and training of support personnel ,and cuts to Medicare payment, to name a few.
  • A portion of savings achieved through gains in efficiency and reductions in unproductive care should be reinvested in system improvements. Clinicians must be rewarded for improvement of quality and outcomes. There should be disincentives for care providers – and patients themselves – who over- or under-use tests and technologies.