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SGR fix moves toward accountable care
The American College of Physicians (ACP) presented its annual state of healthcare assessment today. It’s main thrust was the organization’s support of the current legislation to fix Medicare’s Sustainable Growth Rate formula, which is now in Congress.
Any payment reform must include accountability for physicians in controlling runaway healthcare costs, and Bob Doherty, ACP senior vice president of government affairs and public policy, says the SGR fix does hold physicians accountable for effective use of resources and efficiencies such as electronic health records. Likewise, there are alternative payment models in use that change the fee-for-service paradigm, he says.
“It’s a move toward systems of accountable payment,” Doherty says.
Many provisions of the Affordable Care Act attempt to address cost control, but most observers believe they will have marginal effect at best.
“Clearly physicians play a key role here,” says Molly Cooke, MD, FACP, ACP president. “It’s been said the most expensive tool in the medical armamentarium is the physician’s pen. Absolutely we have a role, and the College has been actively engaged in help physicians understand that.”
However, ACP also went on to address what it considers to be barriers to care, such as narrow networks, restrictive formularies and states opting out of Medicaid expansion.
Doherty says ACP wants to see a fair process to allow patients to review health plan networks and change plans if they aren’t able to access their preferred providers. For providers, the group would like to see more advanced notice of network changes and direct hotlines to insurers so physicians can have their concerns addressed immediately. But he understands that networks have their place in the healthcare system.
“ACP does not advocate for unfettered access,” he says. Likewise, the group “does not advocate for every medication to be on formulary.”
Dr. Cooke also reported on letters sent by ACP to HHS Secretary Kathleen Sebelius, the National Association of Insurance Commissioners, America’s Health Insurance Plans, and the Blue Cross and Blue Shield Association of America, featuring specific and detailed recommendations from ACP to address concerns about the impact of narrow networks and restrictive drug formularies. ACP calls for a balanced, constructive and transparent approach, including due process for clinicians and patients and regulatory oversight of Qualified Health Plans.
Another way to reduce barriers to care for patients is for all 50 states to drive Medicaid expansion under ACA.
“It is simply wrong to leave the poorest of the poor without coverage,” Doherty says. “That makes no sense; it’s not fair; it is wrong. [The Centers for Medicare and Medicaid Services] should work with states and grant waivers.”
Twenty-seven states, including the District of Columbia, have expanded Medicaid, with three states-Arkansas, Iowa and Michigan-expanding with waivers. Additionally, Pennsylvania has a proposal in progress to expand with a waiver from CMS.