With the SGR gone, are ACP members all in?

ACP has been part of a major legislative victory in the repeal of the sustainable growth rate. The organization has embraced quality improvement and high-value care as the future of internal medicine, and it seeks the same commitment from its members.


The sustainable growth rate (SGR) is literally history. What a relief! ACP, working with many other physician organizations and patient advocacy groups across the ideological spectrum, secured a great victory in the spring when, in rare bipartisan fashion, the 114th Congress passed and President Barack Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

ACP strongly supported MACRA. We were 1 of well over 700 organizations from coast to coast who agitated for its enactment into law. MACRA came about because our collective voice addressed in a meaningful way physician payment reform that was symbiotic in nature, benefiting internists and all physicians, and providing all taxpayers with real value and robust quality initiatives to ensure the best possible care for patients.

Wayne J Riley MD MPH MBA MACP poses in Washington DC during Leadership Day Photo by Rick Reinhard
Wayne J. Riley, MD, MPH, MBA, MACP, poses in Washington, D.C., during Leadership Day. Photo by Rick Reinhard

After 12 long, frustrating years and 17 congressional “patches,” or short-term fixes, no longer will we have to contemplate painful Medicare physician payment cuts of up to 21% to care for our patients who are Medicare beneficiaries. Over time, I hope this encourages more physicians to accept patients who rely on Medicare. Suffice it to say, a complicated series of factors led to this great result.

MACRA is a much needed improvement for internists and the patients we serve. It provides for annual payment updates of 0.5% starting on July 1, 2015, through 2019, and those rates will remain in place through 2025. It also presents an opportunity to earn additional payment adjustments via a new payment system. The current Physician Quality Reporting System (PQRS), Value-Based Modifier, and Meaningful Use programs will be replaced by a single quality improvement program, the Merit-Based Incentive Payment System (MIPS). Adoption of MIPS will go a long way in clearing up the confusion experienced by many internists in figuring out the requirements of the current quality reporting programs.

This new program will clearly benefit internists in that it will allow them to choose to participate in the MIPS, or stay with their current system if they are already participating in advanced primary care medical homes or other alternative payment models such as accountable care organizations. The alternative payment models will also make it possible to receive a 5% bonus each year from 2019 to 2024. Internists will be able to choose the payment model that makes sense for them and their patients, a long cry from the cookie-cutter, 1-size-fits-all approach to the current way that internists are paid by Medicare. To emphasize the point, internists will have the choice of which payment model is best for their practice.

ACP applauds and salutes members of Congress for getting the job done and addressing 1 of the most urgent issues that has occupied our advocacy agenda and efforts. With this great victory in hand, a new job awaits. The era of new payment models is here. Thus, we must now pivot to understanding, embracing, and implementing these important new models.

With this major change, ACP is all in and embraces the quality improvement and high-value care aspects of our daily work as internists. It is hoped that the change also goes a long way in decreasing the administrative complexity and the hassle factor many of us experience on a daily basis. College officers and leadership are also all in, reviewing our products and services to make sure that the transition to these new payment models is as seamless as possible. New and updated products and services are on the horizon.

ACP takes its responsibility very seriously to make sure that members are as prepared as possible for this new era, and I give my firm commitment that this important undertaking will be 1 of our top priorities over the next few years. I'm all in. Are you?