Witnesses Say Congress Needs to Provide More Support for Primary Care

Congress needs to increase Medicare payments for primary care physicians to sustain and strengthen the nation's primary care infrastructure and ensure a high-functioning, cost-efficient health care system. That's according to witnesses who testified before the Senate Finance Committee here on April 21.

"We have abundant research that shows strong primary care is essential to a well-functioning, high-performing health care system," said Glenn Hackbarth, J.D., chair of the Medicare Payment Advisory Commission. "As you know all too well, primary care is weak and, unfortunately, getting weaker."

Hackbarth, one of 13 witnesses to appear at the committee's hearing on reforming America's health care delivery system, said Congress should increase payments for primary care physicians under the current fee-for-service system. But it also should pay primary care physicians a lump sum for managing patients under new models of care, such as the patient-centered medical home, he said.

Hackbarth reiterated his past criticisms of the current fee-for-service payment system, saying it does not promote care coordination. One of the major problems with fee-for-service is what it does not pay for, he told the committee, which is holding a series of hearings on health care as it prepares to address health care reform legislation within the next several weeks.

Former CMS Administrator Mark McClellan, M.D., Ph.D., director of the Engelberg Center for Health Care Reform at the Brookings Institution, pointed out that the fee-for-service payment system does not reward physicians for spending more time with patients. He urged Congress to move away from fee-for-service and adopt a payment system that focuses on accountability and results.

Sen. Olympia Snowe, R-Maine, meanwhile, described primary care as "instrumental" for improving quality and lowering costs. Yet, nearly one-third of working-age Americans do not have access to primary care providers, she said.

John Tooker, M.D., M.B.A., EVP and CEO of the American College of Physicians, said that public and private insurers recognize the value of primary care. But that value does not "translate into valuing primary care providers, including physicians, in this country," he said.

Tooker said the demand for primary care services is only going to increase as the population ages. Like Hackbarth, he urged Congress to increase Medicare payments for primary care physicians.

Even if Congress increases payment for primary care physicians, however, shortages still will persist because there is a lack of primary care physicians in the pipeline, witnesses said.

"We are going to face a shortage of primary care clinicians in the future," said Hackbarth. "We are going to have too many older people with complex illnesses and not enough (providers) coming through the pipeline."