PCPCC Supports Draft Legislation to Repeal SGR and Reform Medicare Physician Payment

Statement Attributable to:
Marci Nielsen, PhD, MPH
Chief Executive Officer
Patient-Centered Primary Care Collaborative

JULY 22, 2013 – (Washington, DC) – On behalf of the Patient-Centered Primary Care Collaborative (PCPCC), we applaud the legislative proposal that the Energy and Commerce Committee released on July 18, 2013, which would repeal the Sustainable Growth Rate (SGR) and replace it with a fair and stable Medicare physician payment system. We also congratulate the subcommittee for recognizing the important role of the patient-centered medical home (PCMH) in improving access to continuous, coordinated, and patient-centered primary care for all patients, and for its ability to improve care for patients with complex chronic diseases.

We are particularly pleased the draft includes recognition of PCMH as an approved alternative payment model, and for designating PCMHs as eligible for care coordination fees for chronic disease patients. It is well known that extra attention and expertise is required to care for these complicated and costly patient populations, and health professionals should be reimbursed appropriately for care management and coordination.

This section of the bill also specifies that care coordination codes would be paid to an “applicable physician,” who has achieved formal recognition as a PCMH, or patient-centered specialty practice by the National Committee for Quality Assurance (NCQA). While we agree that medical homes should be validated by an external expert , the long-held position of the PCPCC is that we create a diverse marketplace of accreditation programs (e.g. AAAHC, URAC, the Joint Commission, and commercial health plans). This will help enable PCMH innovation and improvement, especially as evidence continues to clarify which features and strategies are most effective in improving population health and quality of care, while reducing costs.

As the subcommittee has recognized, mounting evidence continues to demonstrate that the medical home has a direct and tangible impact on quality of care, patient outcomes, and health care costs (see PCPCC’s Summary of Medical Home Cost & Quality Results, 2010-2013 for available data). In fact, findings from dozens of providers, health systems, health plans, employers and state Medicaid programs have demonstrated up to 70% reductions in emergency room visits, 40% lower hospital readmissions, and hundreds of millions in health care dollars saved.

Representing more than 1,000 medical home stakeholders and supporters throughout the U.S., including providers, hospitals, health plans, employers, health IT, consulting, and pharmaceutical firms, the PCPCC is dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the PCMH. The PCPCC achieves its mission through the work of our five Stakeholder Centers, led by experts and thought leaders who are dedicated to transforming the U.S. health care system through delivery reform, payment reform, patient engagement, and employee benefit redesign.

The PCPCC sincerely appreciates the bipartisan leadership and openness to stakeholder input that the House Energy and Commerce Committee has shown throughout this entire process, leading up to a promising legislative proposal that will repeal the SGR, and support our collective journey toward health system transformation. We believe the subcommitee’s draft takes an important step toward recognizing the value of continuous and comprehensive primary care, provided through a medical home, and we urge Congress to acknowledge the value of the medical home for all patients.