MedPAC Chair Urges Greater Support for Primary Care During Congressional Testimony

Primary care is essential for a high-functioning health care system, according to the chair of the Medicare Payment Advisory Commission, or MedPAC, who recently urged Congress to revise Medicare's payment policies to better recognize and reward the provision of primary care services.

Glenn Hackbarth, J.D., testified before the House Ways and Means Subcommittee on Health here on March 17 that the Medicare payment system undervalues primary care despite overwhelming evidence that primary care produces better outcomes and lower costs. He urged Congress to make changes to the Medicare Resource-Based Relative Value Scale, or RBRVS -- the system used to determine fees for individual Medicare services -- to better compensate primary care physicians for providing health care services. He also said Congress should allocate a separate payment increase for primary care physicians and expedite a patient-centered medical home pilot project.

Hackbarth appeared as a sole witness before the subcommittee to present MedPAC's 2009 Medicare Payment Policy Report to Congress (26-page PDF; About PDFs). The report asked Congress to provide a 1.1 percent increase for physician payment rates in 2010 based on an expected 2.4 percent increase in the inflation rate and a 1.3 percent productivity growth offset. In the report, MedPAC commissioners expressed concern that "primary care services are undervalued and are at a significant risk of being under-provided, despite some recent increases in payments for primary care services."

"To underscore the urgency of this issue, the Commission voted to reiterate its previous recommendation that Congress increase payments for primary care services when provided by practitioners who focus on primary care," the report said. "This adjustment would be budget neutral within the fee schedule."

Hackbarth decried the lack of medical students opting for careers in primary care. He said the declining number of medical students going into primary care is a direct result of public and private payment systems. He also criticized the current fee-for-service Medicare payment system as perpetuating uncoordinated and fragmented care, and he urged Congress to move away from the fee-for-service system and adopt a system that rewards care coordination and outcomes.

The medical home is one model that could link beneficiaries to a regular source of care, thereby reducing and perhaps eliminating gaps in coverage and uncoordinated care, said Hackbarth.

In the report, MedPAC also points out that payments to Medicare's managed care program, Medicare Advantage, continue to exceed what Medicare would spend for similar beneficiaries in the traditional fee-for-service program.

"Medicare Advantage payments per enrollee are projected to be 114 percent of comparable fee-for-service spending for 2009," according to the report.

During the question-and-answer part of the hearing, Hackbarth said overly generous Medicare Advantage payments are driving up Medicare costs. Although these plans provide additional benefits, they may not be the most economical way to provide those benefits. In some parts of the country, beneficiaries have been encouraged to switch from low-cost public Medicare plans to high-cost Medicare Advantage plans, Hackbarth said.