The Medicare Payment Advisory Commission (MedPAC), which regularly calls for greater payment equity for primary care versus subspecialty services, recently issued its latest call for payment reform.
MedPAC's March report to Congress contains several proposals that would boost primary care payments.
The report(medpac.gov) provides a comprehensive summary of Medicare policies and recommendations on topics such as payments to physicians, comparisons between fee-for-service and other models, and wait times for appointments.
Its major recommendations related to primary care focus on increasing Medicare payments and achieving parity with subspecialist care payment, including support for continuing a primary care incentive payment.
The Primary Care Incentive Payment program currently provides a 10 percent bonus payment for specified primary care services delivered by eligible primary care professionals. The program is scheduled to expire at the end of 2015, and the commission called on Congress to replace it with a per-beneficiary payment if lawmakers choose not to extend it.
- The Medicare Payment Advisory Commission recently voiced its support for continuing a primary care incentive payment.
- The commission has long been critical of the system currently used to determine the value of physician services.
- Eighty-five percent of primary care physicians reported that they are accepting new Medicare patients.
The proposed bonus would be funded by reducing fees for other non-primary care services in the Medicare fee schedule by 1.4 percent. MedPAC says the fee-for-service payment model allows subspecialists to increase service volume and generate revenue more easily there than in primary care, which relies on evaluation-and-management services.
"The Commission remains concerned that the fee schedule and the nature of (fee-for-service) payment lead to an undervaluing of primary care and overvaluing of specialty care," the report states.
The commission has long been critical of the system used to determine the value of physician services. In the latest report, it recommended that Congress allow the HHS secretary to collect data that measure the volume of a service and the time required to perform it to more accurately reflect a physician's time and practice expenses.
The data would be collected from practices that are considered to be efficient rather than from a random sample. The initial round would be completed within three years.
"Payment rates for evaluation-and-management office visits are much higher in hospital outpatient departments than in physicians’ offices, and (hospitals) have recently increased their volume of those services, while physicians’ offices have seen a decrease," the report states.
The commission cautioned that changes in the volume of services could be a result of other factors, such as population changes, disease patterns or patient preferences.
During their meetings, commission members have regularly discussed ways to reduce wasteful spending and deliver more balance in the payment system. Yet at times, Medicare policies stand in the way, they say.
"Certain aspects of the Medicare program pose challenges to reducing wasteful spending, and the Commission has made recommendations to address some of those challenges," the report reads.
MedPAC also repeated its call to replace the Medicare sustainable growth rate system with fee schedule updates. The new method would include a payment rate update that is higher for primary care services.
Other health policy questions addressed in the report include patient access and acceptance of Medicare patients.
Medicare enrollees were slightly less likely than privately insured individuals to have difficulty finding either a new primary care doctor or a new specialist. Only 1.2 percent of all Medicare beneficiaries reported having a problem finding a new primary care doctor, and 1.2 percent said they had a problem finding a new subspecialist. In primary care, 8 percent reported they were looking for a new physician, and among those who are looking, 15 percent reported a problem finding one.
Physician acceptance of new Medicare patients remains high, with 85 percent of primary care physicians and 90 percent of subspecialist physicians reporting that they accept new Medicare patients.
Lack of insurance coverage is not the only reason that people put off medical care. In a telephone survey MedPAC conducted, 10 percent of Medicare beneficiaries and 11 percent of individuals with private insurance said they had a health problem but delayed seeing a physician. Higher costs could be one factor because the number of individuals with private insurance who were enrolled in a high-deductible plan rose from 4 percent in 2006 to 20 percent in 2013.