PCPCC Letter to Congress Supporting SGR Repeal and Medicare Provider Payment Modernization Act

February 20, 2014

Dear Speaker Boehner, Majority Leader Reid, Minority Leader McConnell, and Minority Leader Pelosi:

The Patient-Centered Primary Care Collaborative (PCPCC), commends the Senate Finance, House Ways and Means, and Energy and Commerce Committees on their bipartisan agreement to repeal the Sustainable Growth Rate (SGR) and replace it with a reimbursement model that moves the U.S. health care delivery system away from the current volume-based payment system to one that rewards quality, efficiency, and innovation.  

Representing more than 1,000 medical home stakeholders and supporters throughout the U.S., including clinicians, employers, consumer groups, hospitals, health plans, and various health care industries, the PCPCC is dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home (PCMH).  

The PCPCC strongly supports the bipartisan and bicameral “SGR Repeal and Medicare Provider Payment Modernization Act of 2014,” and is particularly pleased with the agreement’s recognition of the PCMH as an alternative payment model to provide high value cost-effective care for Medicare beneficiaries.  The PCPCC commend the agreement for including the following elements:

Repealing the flawed SGR and replacing it with a payment system focused on quality, value, and accountability.

  • Improving the existing fee-for-service system by focusing on rewarding value over volume and ensuring payment accuracy. We especially are pleased that the new Medicare Incentive Program would credit certified PCMHs with the highest possible score for clinical practice improvement activities.
  • Incentivizing physicians to move toward alternative payment models (APMs).
  • Providing a 5 percent bonus to providers who receive a significant portion of their revenue from an APM or PCMH.
  • Establishing a Technical Advisory Committee (TAC) to review and recommend physician-developed APMs based on criteria developed through an open comment process.
  • Consolidating the three existing quality programs (Physician Quality Reporting System, Value-Based Payment Modifier, and meaningful use of electronic health records) into a streamlined and improved quality measurement program that rewards providers who meet performance thresholds. This will improve care for seniors and provide certainty for providers.
  • Incentivizing care coordination efforts for patients with chronic care needs, including authorizing payment in 2015 for chronic care management services provided by certified PCMHs.
  • Introducing physician-developed clinical care guidelines to reduce inappropriate care that can harm patients and results in wasteful spending.
  • Requiring development of quality measures and ensures close collaboration with physicians and other stakeholders regarding the measures used in the performance program.

As outlined in the January 2014 PCPCC report, The Patient-Centered Medical Home’s Impact on Cost & Quality: An Annual Update of the Evidence, 2012-2013,using the PCMH as a supportive framework for alternative value-based payment models makes economic sense.  The review of 20 recent academic and industry studies demonstrates that when primary care practices embrace the team-based and person-centered PCMH model of care, they see impressive improvements across a broad range of categories, including: cost, utilization, population health, prevention, access to care, and patient satisfaction.

We support swift action on “The SGR Repeal and Medicare Provider Payment Modernization Act of 2014” and encourage the Committees to continue working together in a bipartisan and bicameral fashion to pass this landmark legislation into law as soon as possible.  Should you have any questions, please contact Marci Nielsen, Chief Executive Officer at the PCPCC, either by email at [email protected] or by phone at (202) 417-2074.

Sincerely, 

Marci Nielsen 

Chief Executive Officer 

PCPCC

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