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Friday Oct 26, 2012

New Partnership Aims to Strengthen Academy's Efforts With RUC, CMS

Earlier this year, the AAFP Board of Directors made the difficult decision to stay involved with the AMA/Specialty Society Relative Value Scale Update Committee (RUC), despite the fact that the committee has historically undervalued primary care services in its recommendations to CMS. I explained at the time that though we would continue to participate in the RUC process, the Academy also would advocate directly to CMS.  

As part of our commitment to improving payment for primary care services through this two-pronged approach, the AAFP recently reached an agreement with the health care advisory firm Avalere Health LLC. Academy staff met with representatives from Avalere this week in Washington to discuss four specific areas in which the firm might assist the AAFP in our efforts:

  • Collect and aggregate data that demonstrate primary care evaluation and management services are different and should be valued differently than services done by other specialties. This aligns with a recommendation of the AAFP's Primary Care Valuation Task Force.
  • Identify overvalued and undervalued services in the resource-based relative value scale (RBRVS), which CMS uses to help set Medicare physician payments.
  • Help the Academy's participants in the RUC and CPT processes work more effectively in those arenas.
  • Define the content and value of care management fees.

Avalere is expected to provide preliminary data for the first three items by March. The proposed timeline will give the Academy time to influence the proposed rule for the 2014 Medicare physician fee schedule.

The fourth item likely will take longer. The AAFP  promotes a blended payment model that includes a fee-for-service component, quality incentives and a per-member per-month care management fee (PMPM) to support the patient-centered medical home. However, no one has consistently defined what a PMPM care management payment should cover or its true value. Medicare is paying an average of $20 -- with a range from $8 to $40 -- in CMS' Comprehensive Primary Care initiative. But private payers' PMPM fees vary widely, and some are as low as $2.

Avalere will help us demonstrate the value of our ability to coordinate and manage care and the return on investment for payers.

We're optimistic this partnership will strengthen our position in our dealings with the RUC as well as in advocating directly to CMS. Primary care physicians must be paid differently than subspecialists and more fairly than we have been. The outcomes from this project should make that clear once and for all.

Glen Stream, M.D., M.B.I., is Board Chair of the AAFP.

Posted at 01:27PM Oct 26, 2012 by Glen Stream, M.D., M.B.I.

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