Senate Finance Chair Issues Call for Greater Primary Care, Prevention Efforts

The chair of the Senate Finance Committee has unveiled a call to action for health care reform that relies heavily on primary care and preventive services to improve quality, enhance access and reduce the overall cost of health care in the United States.

Sen. Max Baucus, D-Mont., unveiled the plan (98-page PDF; About PDFs) during a Capitol Hill press briefing on Nov. 12. He told the gathering of reporters that primary care and prevention are ways of focusing on America's overall health.

"My plan would put more primary care doctors in practice," said Baucus. "Watching over a patient's full medical history and keeping them healthier all of their lives … that is a quality measure and a cost-control measure."

Baucus has not formally introduced his plan as a bill, choosing instead to issue a 98-page blueprint that lays out a proposal for universal coverage as a way to move the debate about health care reform forward in the next Congress.

AAFP President Ted Epperly, M.D., of Boise, Idaho, said the Baucus proposal recognizes that a strong and robust primary care system must be an essential part of any successful health care reform effort. "Family physicians and the patient-centered medical home are the basic building blocks of this health care foundation," Epperly said.

The blueprint urges increases in Medicare payments for services furnished by primary care health professionals. It also calls for an expansion of Medicare's role in testing the medical home model as a way of promoting quality and efficiency.

"Payments must be well-targeted, starting with careful identification of the list of services that qualify as primary care services -- primary evaluation and management services," the blueprint says.

Baucus said increased payments for primary care physicians may require a shift in resources, resulting in reduced payments to subspecialists. "There might have to be a bit of a readjustment," he said. "Some of these (sub)specialists might have to take a bit of a nick, but the (sub)specialists know the system is not working well. They know primary care doctors need more help individually. They also know, more fundamentally, that by giving more emphasis to primary care doctors, it is going to help the whole system."

"Family physicians greatly appreciate Sen. Baucus' support and his long-standing recognition that primary care physicians and the patient-centered medical home are central to an effective and efficient health care system," said Epperly.

However, he added, Congress needs to look beyond Medicare Part B (i.e., Medicare payments made to physicians) to find savings to support primary care and the patient-centered medical home. These savings should come from every part of Medicare, said Epperly.

Baucus lamented the fact that many medical school graduates are not choosing careers in primary care because "the money is not there."

"There must be a greater role for primary care in America than there is today, and there are various incentives to help us accomplish that," he said.

The Baucus plan is noteworthy for its emphasis on prevention and primary care. The blueprint describes primary care as a "common element of high-performing health systems," and says "strengthening the role of primary care will require a multi-pronged approach." It calls for ensuring accurate prices for primary care services in Medicare, providing an add-on bonus payment for primary care services, and encouraging further testing and implementation of the medical home model.

"Payments for primary care physician visits are undervalued, particularly compared to procedures and services furnished by (sub)specialists," the document says. "In fact, the overvaluation of procedures in the Medicare physician fee schedule has both created financial incentives to provide unnecessary services and served as a disincentive for physicians to become primary care physicians."

The blueprint, meanwhile, also calls for the replacement of the sustainable growth rate, or SGR, formula, which is used to calculate physician payment rates under Medicare. The SGR has triggered steep reductions in payment rates during the past several years, which have only been averted by last-minute congressional action. The blueprint describes the SGR as "fatally flawed."