Proposed Rule Would Pay FPs for Care Coordination, Nonface-to-Face Care

The AAFP has long urged CMS to pay for care coordination and other cognitive services that play a pivotal role in enhancing health care access, improving quality and controlling costs. And now CMS has started to heed that call by including a provision in the proposed 2013 Medicare physician payment regulation (12-page PDF; About PDFs) that would compensate family physicians and other primary care physicians for providing nonface-to-face care that helps patients transition back into the community after hospital and nursing home stays.

According to the proposal, CMS would establish a new G code to pay primary care physicians and other primary care health professionals for furnishing a range of care-coordination services after a patient is discharged from a hospital or other health care facility. These services include obtaining and reviewing a patient's discharge summary, reviewing diagnostic tests and treatments, establishing a care plan, and communicating with other physicians and members of the health care team.

The proposal explicitly addresses the value of primary care and the importance of care coordination in improving quality and controlling costs, acknowledgments that AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash, finds encouraging. "I was struck by the wording of the payment rule -- about wanting to recognize the value of primary care and the importance of care coordination," he said in an interview with AAFP News Now.

"CMS has made a significant effort to recognize the undervaluing of primary care and has made a substantial step in the right direction to address that. We will continue to work with CMS going forward to build on that."

In a July 6 press release, CMS singled out the effect of the proposed rule on family physicians, saying the rule would increase payments to family physicians by approximately 7 percent; other practitioners providing primary care services would receive between 3 percent and 5 percent.

The 7 percent figure for family physicians is based on a 2 percent payment increase that is scheduled to take effect as a result of a phased-in Physician Practice Information Survey and a 5 percent increase from the newly proposed postdischarge transitional care management code, according to a preliminary analysis conducted by the AAFP.

The Academy has until Sept. 4 to respond to the proposed rule and is analyzing and preparing a summary of the proposal.

"The AAFP is going to do a lot more evaluation of this," said Stream. "We will give our assessment of what we think the impact will be and how many of our members we think will offer this (care-coordination) service."