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AAMC Submits Comments to Energy and Commerce Committee on Revised SGR Legislation

July 12, 2013—AAMC President and CEO Darrell G. Kirch, M.D., submitted a July 9 comment letter  in response to the House Energy and Commerce Committee’s request for feedback on its revised June 28 “advanced legislative framework.”  The revised legislation, the latest effort in a series of congressional activities to address Medicare physician payment reform, would repeal the sustainable growth rate (SGR), create a transition period of stable payment updates, establish the Update Incentive Program (UIP), and create alternative payment models (APMs) for those opting out of the UIP. 

The revised legislative framework would incorporate physician-developed quality measures into annual payment updates.  In the AAMC’s letter, Dr. Kirch expresses appreciation for the committee’s recognition of the potential challenges for large multispecialty practice groups in quality reporting and the decision to allow providers the option of applying quality measures, scores, and performance at the group-practice level. 

The letter states, “Academic faculty practices are comprised of hundreds, and in some cases, thousands of individual physicians.  Tracking separate measures for each individual physician is administratively burdensome.”  However, Dr. Kirch also points out that questions remain about how large academic clinic practices would fit into the new UIP model. 

The letter also addresses AAMC concerns about “the effect of non-compliant patients on outcome measures,” and urges the committee to incorporate adequate risk adjustment into any quality program.  Dr. Kirch states, “At a minimum, outcome measures used for payment must be adjusted for socio-economic status (SES).... Despite the best efforts of clinicians, patients with low SES often fail to achieve quality health outcomes.”

Finally, Dr. Kirch points out that the nation’s medical schools and teaching hospitals are working to remedy the physician shortage and have “increased their capacity to train new doctors and continue to fund approximately 10,000 positions over their residency caps.”  Dr. Kirch encourages the committee to “capitalize on this opportunity to address the physician shortage by increasing the number of Medicare-supported Graduate Medical Education (GME) positions.” 


Len Marquez
Director, Government Relations
Telephone: 202-862-6281

Courtney Summers
Senior Legislative Analyst
Telephone: 202-862-6042

Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Telephone: 202-828-0499

Mary Patton Wheatley, M.S.
Director, Health Care Affairs
Telephone: 202-862-6297

Evan Collins, MHA
Specialist, Clinical Operations and Policy
Telephone: 202-828-0552


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