In August 2013, the AAFP issued a news release calling for an overhaul of the valuation system for primary care services. Without reform, the primary care physician shortage will continue to threaten patients' ability to obtain high-quality, coordinated primary care that prevents the need for more expensive and invasive procedures in the long run.
In its proposed 2014 Medicare physician fee schedule, the Centers for Medicare & Medicaid Services makes headway toward achieving meaningful Medicare physician payment reform by adjusting undervalued codes for primary care services. However, the benefits resulting from the adjustments do nothing to sustain the primary care workforce and improve access to care unless the flawed SGR is repealed.
Inaccurate payment rates can distort the market for physician services. This report calls for the Secretary of Health and Human Services to establish a standing panel of experts in health economics and physician payment, as well as members with clinical expertise, to help CMS identify overvalued and undervalued services, and to review recommendations from the American Medical Association’s Relative Value Scale Update Committee (RUC).
The current valuation system for physician services does not take into consideration that primary care visits have grown more complex as a result of a rising percentage of patients with multiple chronic conditions, the aging population, an increase in recommended preventive services, a myriad new medications and treatments, and a significant shift away from inpatient to outpatient settings. The AAFP has called for creation of separate primary care evaluation and management codes that would more accurately compensate primary care physicians for the complexity and density of services they provide in office and other outpatient settings.
Introduced by Rep. Jim McDermott (D-Wash.), the Accuracy in Medicare Physician Payment Act of 2013 calls for a separate commission within Medicare to oversee the valuation of physician services and to help correct distortions in the Medicare physician fee schedule. It is consistent with MedPAC’s 2006 recommendations.
In March 2013, the AAFP submitted a letter to CMS which, as part of the 2014 Medicare physician fee schedule, calls for the creation of separate, primary care E/M codes that would more fairly compensate primary care physicians for the time and complexity involved in providing those services.
In July 2013, the AAFP submitted a letter to Rep. Jim McDermott (D-Wash.) in support of the Accuracy in Medicare Physician Payment Act. The legislation calls for a separate commission within Medicare to oversee the valuation of physician services and to help correct distortions in the physician fee schedule.
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Undervalued Primary Care Threatens Access to Health Care in the United States