ACP Raises Concerns About MedPAC Proposal And Proposes An Alternative Plan

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Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 27 Sep 2011 - 1:00 PDT


In a response made to last week's MedPAC proposal, Virginia L. Hood, MPPS, MPH, FACP, president of ACP (American College of Physicians) voiced ACP's concern on behalf of 132,00 internal medical physicians and medical student members that the MedPAC proposal offers no adequate protection and does not ensure access to primary care, reducing access to other essential physician services.

The letter, stating, "While ACP appreciates that MedPAC (Medicare Payment Advisory Commission) has put forward a comprehensive proposal to eliminate the SGR (sustainable growth rate) with the intent of protecting access to primary care for Medicare beneficiaries, we have very substantial concerns that preclude us from supporting it," is a constructive effort to develop a framework that would have ACP's full support. Although the ACP and MedPAC share the same goal, MedPAC's proposal works against the objective to change to new delivery and payment models aligned with value.

Dr. Hood pointed out:

"Although elimination of the SGR is an essential step toward new payment and delivery models, it is only a step - and one that should be designed carefully so as not to result in having unintended consequences. The College is concerned that the payment freezes and cuts outlined in the MedPAC recommendations will have a significant adverse effect on beneficiary access to care, and actually impede timely and effective implementation of new physician payment models."

Hood highlighted that according to MedPAC's proposal, primary care physicians would actually experience a net loss, as their payment updates would not be aligned with inflation. In addition, ancillary services and possibly hospital visits by primary care physicians would experience a cut of almost 17 % over the next three years. She commented: "We anticipate that with such reductions, more primary care physicians delivering primary care will leave practice."

On behalf of Dr. Hood, the ACP also voiced their concern that a cut of nearly 17 % for non-primary care physicians would potentially create significant access problems without justifying evidence that such a cut is merited, appropriate, or serves important policy goals. She stated:

"Such physicians would be cut no matter how efficient or inefficient they were, whether their specialty is facing a projected shortage, or whether they practice in a high or low cost area of the country."

She continued saying:

"The MedPAC proposal will also unintentionally undermine the goal of transitioning to new payment models by denying primary care physicians the resources to redesign their practices and making it more difficult for sub specialists to invest in new models like the Patient-Centered Medical Home Neighborhood."

She said in her letter that the ACP recommends that MedPAC should consider ACP's recommendations to the Energy and Commerce Committee regarding the stabilization of the SGR, including repealing the SGR and setting the annual update for primary care services at no less than 2 percent and no less than zero for other services over the next five years. The ACP recommends:

• To provide a higher update for primary care services similar to MedPAC's proposal, however, the level set would be aligned with the rate of inflation instead of freezing payments for the rest of the decade.
  
  
• Setting the update for all other physician services at no less than zero would reduce severe access problems and unintended adverse consequences, such as discouraging participation in new delivery models, which the ACP reckons will occur under the MedPAC proposal.
  
  
• During this time, new payment and delivery models aligned with value would be developed, pilot-tested and evaluated, with the most effective modes being selected for broad implementation.

According to the letter:

"The ACP also urges MedPAC to consider the proposals we submitted to the Joint Select Committee on Deficit Reduction to finance repeal of the SGR and other critical priorities; for instance, a multi-stakeholder effort to encourage high value care and reduce low value care could yield tens of billions in savings each year out of the estimated $700 billion spent annually on marginal, ineffective and wasteful care, which could be used at least in part to fund SGR repeal."

In a final statement Dr. Hood's letter concluded:

"Finally, ACP recognizes that MedPAC believes that physicians should contribute to deficit reduction, while helping to fund repeal of the SGR. We agree that physicians must contribute to lower health care spending and deficit reduction, by addressing the real cost-drivers. The medical profession must make a firm commitment to reduce marginal and ineffective care and to transition to new payment models aligned with value. Such an approach will address the real cost-drivers in medicine and make a significant and effective contribution to lowering overall health care spending."

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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