WASHINGTON – Primary care physicians should continue to receive a bump up in pay for their efforts, according to the Medicare Payment Advisory Commission.
At their March 6 meeting, MedPAC commissioners weighed potential options for extending a 10% pay increase for primary care physicians that was established by the Affordable Care Act and began in 2011. The increase is due to expire at the end of 2015.
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The Medicare Payment Advisory Commission says primary care physicians should continue receiving a 10% pay increase, especially considering there is a need for more of them.
MedPAC Chairman Glenn Hackbarth said that the panel is looking for ways to continue to attract more physicians to primary care. "We have too little primary care for the population that needs to be served," said Mr. Hackbarth. He said the commission wants to address that mismatch as quickly as possible.
The country should "expand the capacity of our existing primary care practices to care for bigger populations," Mr. Hackbarth said, adding that waiting for more physicians to be trained will take too long.
Currently, to be eligible for the quarterly payments, primary care physicians have to show that at least 60% of their total Medicare allowed charges come from Current Procedural Terminology (CPT) codes 99201-99215 (for office and other outpatient visits).
In 2011, the Centers for Medicare and Medicaid Services (CMS) paid $560 million in bonuses, and in 2012, the agency paid $664 million in bonuses to 194,428 family physicians, internists, pediatricians, geriatricians, nurse practitioners, and physician assistants.
MedPAC wants to revamp the payment scheme in part because it’s based on the fee-for-service system. "It’s about changing what qualifies as productivity for payment," said Mr. Hackbarth.
Instead, the commission is considering a per-beneficiary payment that would acknowledge all of the intangibles that go with primary care, including care coordination, afterhours access, and non–face-to-face interactions, Mr. Hackbarth said.
MedPAC staff suggested several funding options. One would be to reduce payments for almost all services covered by the Physician Fee Schedule by about 1%. That would allow for a monthly per-beneficiary payment of about $2.60 a month.
Another option would be to reduce Medicare payments for services provided by specialists by 1.4%; that would provide the same $2.60 a month payment.
MedPAC staff also floated the idea of identifying and reducing payments for overpriced services. The CMS is currently evaluating many overpriced services, and the American Medical Association’s Relative Value Update Committee (RUC) has subsequently reduced time estimates and values for many of them. But the reductions in time and work values have not been proportionate, which means some services are still likely overvalued, said MedPAC staffer Kevin Hayes.
He estimated that targeting more of the overpriced services could allow a per-beneficiary pay boost to continue for 5 years, rising from $2.60 a month in the first year to $13 in the final year.
MedPAC meets again in April and submits its report to Congress in June. The next report will likely contain its final recommendations on the primary care incentive payment program.
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