Letter to Congress imparts core elements needed for better Medicare system


“The United States health care system is in the midst of profound change, and we now have a unique opportunity to improve and restructure how we deliver and pay for care in this country.”

[See also: AMA gives public first crack at updated 2013 CPT code sets]

So begins the Oct. 15 letter postmarked to Congress — signed by the American Medical Association (AMA) and a collection of more than 100 other state and specialty medical societies — that outlines signee-sanctioned principles and core elements necessary for the transition to a higher performing Medicare system. The correspondence calls for a variety of alterations, one prominent change being the repeal of a flawed Medicare physician payment formula.

“The sustainable growth rate (SGR) formula is an enormous impediment to successful health care delivery and payment reforms that can improve the quality of patient care while lowering growth in costs. Physicians facing the constant specter of severe cuts under the SGR cannot invest their time, energy, and resources in care re-design. The first step in moving to a higher performing Medicare program must be the elimination of the SGR formula. The status quo is bad for patients, physicians, and taxpayers,” the letter said.

AMA President Jeremy A. Lazarus, M.D, tacked on further condemnation for the SGR formula in an organization news release: "The AMA has consistently urged Congress to eliminate the broken Medicare physician payment formula so we can begin to transition to new payment and delivery innovations that improve patient care.Today, we offer principles that should be the foundation of a new system that supports physicians in improving the delivery of care with payment options that benefit patients, physicians and the Medicare program."

[See also: Letter denouncing House spending bill garners physician support]

According to the letter, if Congress does not intervene before the year’s end, physicians will face yet another 27 percent payment cut on January 1, 2013. Due to such payment slashing and constant last-minute congressional interruption to avoid said cuts from occurring, “new Medicare patients have difficulty securing physician appointments” and patient care as a whole is suffering, argued the letter writers.

And “although the SGR must be eliminated, the physician community recognizes that this is only one-half of the equation.” To this end, letter-affiliates provided the below steps deemed integral to achieving a Medicare program of a more prestigious caliber.

1.) Eliminating the SGR formula is essential to developing a high performing Medicare program. In conjunction with SGR repeal, the following driving principles can provide a foundation for a transition plan that organized medicine can support:

  • Successful delivery reform is an essential foundation for transitioning to a high performing Medicare program that provides patient choice and meets the health care needs of a diverse patient population.
  • The Medicare program must invest and support physician infrastructure that provides the platform for delivery and payment reform.
  • Medicare payment updates should reflect costs of providing services as well as efforts and progress on quality improvements and managing costs. 


2.) The transition plan must include core elements that:

  • Reflect the diversity of physician practices and provide opportunities for physicians to choose payment models that work for their patients, practice, specialty and region;
  • Encourage incremental changes with positive incentives and rewards during a defined timetable, instead of using penalties to order abrupt changes in care delivery; and
  • Provide a way to measure progress and show policymakers that physicians are taking accountability for quality and costs.


3.) The plan needs to be structured in a way that will:

  • Reward physicians for savings achieved across the health care spectrum;
  • Enhance prospects for physicians adopting new models to achieve positive updates;
  • Tie incentives to physicians’ own actions, not the actions of others or factors beyond their influence;
  • Enhance prospects to harmonize measures and alter incentives in current law;
  • Encourage systems of care, regional collaborative efforts, primary care and specialist 
cooperation while preserving patient choice;
  • Allow specialty and state society initiatives to be credited as delivery improvements (deeming authority) and recognize the central role of the profession in determining and measuring quality; and
  • Provide exemptions and alternative pathways for physicians in practice situations in which making or recovering the investments that may be needed to reform care delivery would constitute a hardship.

Find the letter in its entirety and the complete list of contributors here. [See also: Physicians ask CMS for relief from concurrent regulations]

Add new comment