ACPE testimony before subcommittee highlights current Medicare payment issues, provides solutions

Officials from the American College of Physician Executives (ACPE) identified the flaws crippling the current Medicare payment system as succinctly as they would irreparable fractures on an X-ray image during their July 24 testimony before the Ways and Means Subcommittee on Health.

Speaking on behalf of about 11,000 high-level physician leaders from all walks of healthcare, primary presenter Larry Riddles, MD, MBA, CPE, FACS, FACPE, characterized the present payment structure as one that is not only broken but impossible to revive. 

"The current fee-for-service systems are based primarily on volumes of patients seen and numbers of procedures completed. This prevents America from achieving higher quality health care," Riddles said.

ACPE was one of six physician organizations asked by Chairman Wally Herger (R-CA) to speak before the subcommittee in regard to the Sustainable Growth Rate payment system and the fiscal challenges that could potentially arise in light of it.  

"ACPE is privileged to be a part of the national conversation on this important issue," said Peter Angood, MD, and ACPE's CEO. "Our participation in the subcommittee's efforts to reform Medicare physician reimbursement aligns well with ACPE's strategic goal to serve as the balanced voice for physician leadership in America."

Riddles suggested that a new payment seed — if it means to flourish — be planted on a landscape pruned more toward providing higher quality care with expedience and fairness rather than on the barren ground of running tallies as it is now. "Any new reimbursement system must include compensation strategies for providing high-quality care," he said. "The desired endpoint should be timely, equitable access to high-quality healthcare that is physician-led and reimbursed fairly."

ACPE also provided parameters by which a proper payment system should function.

Their nine posts for payment are as follows:

  • Value-driven
  • Evidence-based
  • Quality-centered
  • Safe for all
  • Measured
  • Fair
  • Innovative
  • Streamlined
  • Physician-led

It was also advised that an independent committee be formed to examine Medicare funding dilemmas, analyze best practices and then present their findings to lawmakers for deliberation. ACPE called for this super group to be comprised of physicians, healthcare providers, financial and quality experts, business leaders and even patient representatives.

“Repeal of Medicare’s Sustainable Growth Rate is essential, but repeal by itself will not move Medicare to better ways to deliver care,” noted David L. Bronson, MD, FACP, president of the ACP. 

During his testimony, Bronson proposed that Congress establish a transitional value-based payment initiative to provide physicians who decide to commit to physician-led programs designed to improve quality and value with eligibility for higher Medicare updates. Adding another layer to his aforementioned suggestion, Bronson insisted that physicians practicing in Patient-Centered Medical Homes (PCMH) and Patient-Centered Medical Home Neighborhoods (PCMH-N) also qualify for the higher updates.

“Many insurers are now offering Patient-Centered Medical Homes to tens of millions of patients, achieving major quality improvements and cost savings,” Bronson added. “It is time to make them more available to Medicare patients, by providing higher updates to physicians who are in Patient-Centered Medical Homes certified through an independent recognition and review process.”

On the topic of existing quality improvement programs under the Medicare umbrella, Bronson encouraged Congress to enhance and unify meaningful use standards for electronic health records, e-prescribing incentive payments and the Physicians Quality Reporting System. If performance data were provided to physicians in a more timely fashion and more consistent measures and reporting requirements were employed, functionality would increase significantly according to the ACP president.

“Payment policies should support physicians who participate in and engage their patients in efforts to provide clinical advice and education on high-value and cost-conscious care and who deliver high-quality, coordinated care through Patient-Centered Medical Homes and Patient-Centered Medical Home Neighbors. Existing Medicare quality improvement programs must be improved and harmonized,” Bronson concluded. “Through such efforts, Medicare can begin moving away from a fundamentally broken payment system to one that supports high-value, coordinated, and patient-centered care.”

“As we all know, the Sustainable Growth Rate is not working,” the official ACPE statement reads. But where one system rots, another could potentially grow more fruitfully if the tillers heed mind to those most qualified in the field.

“ACPE’s cadre of physician leaders throughout the U.S. is perfectly positioned to engage all disciplines of physicians in contributing ideas to formulate an improved reimbursement plan and our members are also well-suited to influencing fellow physicians to follow the plan’s guidelines and meet its goals. ACPE’s recognized expertise is with physician engagement and integration,” Riddle’s official statement said.

May Medicare growth begin.


Larry Riddles testified on behalf of the ACPE July 24 regarding Medicare’s Sustainable Growth Rate payment system. Image credit: The American College of Physician Executives news team.  

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