The American College of Physicians has come out overall in support of proposed legislation, backed by Republicans and Democrats in both houses of Congress, that would repeal the Medicare Sustainable Growth Rate, while making detailed recommendations to improve the current proposal.

"We are confident that by working from the foundation created by this discussion draft, this Congress, this year, can achieve a historic bipartisan consensus on legislation to repeal the SGR, once and for all, and create a better Medicare payment system for our members and their patients," Dr. Charles Cutler, chair of the ACP Board of Regents, said in a prepared statement.

ACP supports the draft even though the proposal holds Medicare annual payments flat through 2023. However, the proposal cancels payment penalties scheduled to go into effect starting in 2016, due to the Physician Quality Reporting System, the Value-Based Modifier Program and Meaningful Use provisions, that would have subtracted $10 billion from physician payments over that time frame. The proposal also creates multiple opportunities for physicians to earn additional money through performance-based incentive payments or by opting into alternative payment models that provide bonuses and payment incentives of their own.

"While we're disappointed that there isn't a stable positive payment update to all physicians during this transition period, we feel strongly the opportunity to eliminate the SGR is too good to pass up, particularly when considering the opportunities that this proposal offers for internists," Dr. Molly Cooke, ACP's president, said.

Though ACP continues to strongly prefer a solution that would include annual payment increases for physicians, the College acknowledges that budget realities make that impossible at this time. In a letter to the congressional committees commenting on the proposal, ACP noted that if access problems develop for patients, Congress needs to open the door to the possibility of positive updates. It also indicated that support for the proposal was based on Congress continuing the 10 percent Medicare primary care bonus program that is slated to finish at the end of 2015.

The proposal produced by the Senate Finance Committee and the House Ways and Means Committee would permanently repeal the SGR, which will cut doctors' Medicare reimbursements by 24 percent in 2014 unless Congress acts before the end of the year.

The proposal also accomplishes another goal requested by the ACP: It would consolidate by 2017 the various Medicare reporting and incentive programs into a single value-based payment program. The College believes this would be beneficial to physicians now struggling to meet the reporting requirements of the Physician Quality Reporting System, the Meaningful Use program for electronic health records and the Value-Based Modifier program. It also includes additional opportunities for recognition for physicians engaging in clinical practice improvement efforts.

"They're pulling together what had been a bunch of disparate programs requiring physicians to do different things to show they are complying," Cooke said. "They're all coming together in one place."

The new consolidated Value-Based Performance program would be budget-neutral in that physicians with high-quality scores would receive incentive payments, but those with low scores would find their payments cut.

Cooke sees this as an opportunity rather than a detriment, however. "It creates the opportunity for physicians who are working hard toward demonstrating this kind of value in their care," she said. "They can earn considerably more than the kind of updates we've been seeing when we've seen updates."

Physicians who opted into advanced alternative payment models, such as Accountable Care Organizations and some Patient-Centered Medical Homes, also would receive a 5 percent bonus starting in 2016, in addition to any increased revenue that they might earn due to the payment rules of their specific model -- for example, the shared savings that physicians in ACOs split. That bonus would run through 2021.

Physicians also would be able to boost their pay through new payments for chronic care management services, beginning in 2015.

Cooke said there's a very good chance that Congress will move to enact this legislation during the waning days of 2013.

"With the support of the American Medical Association and the big specialty organizations that are already supportive, I believe the proposal will go through the two houses of Congress before the end of the year," she said.