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Thursday Jan 19, 2012

Stressing the Importance of Fair Payment for Primary Care

Payment remains the No. 1 concern for AAFP members, and your Academy is working to address this issue in both the public and private sectors.

For example, on Jan. 12, AAFP leaders -- including myself -- met with representatives of Cigna at the insurer's Bloomfield, Conn., headquarters. I was encouraged by the tone of the meeting and the manner in which our message -- which emphasized the need for fair payment for primary care -- was received. Several of Cigna's medical officers have primary care backgrounds, including three who are AAFP members. They actively sought our input and were not merely listening to our grievances.

Still, much work remains to be done in our ongoing dialogue with one of the nation's largest private payers. Cigna's CEO received more than $15 million in total compensation in 2010, according to Forbes. Meanwhile, the company is offering family physicians in at least one state fee-for-service contract rates that are lower than Medicare.

This is simply unacceptable. Just as we told representatives of UnitedHealthcare during a meeting in October, we told Cigna that this outrageous approach to physician payment is killing primary care practices and giving physicians little choice but to move elsewhere. If unchanged, this policy will lead to primary care deserts as docs flee these distressed practice environments.

We emphasized that the fee-for-service payment system must be fixed because primary care is grossly undervalued. New payment models are likely to have fee-for-service as a base, so it is imperative that primary care is properly valued or these new models also will be severely flawed.

Cigna and other private payers have told us the employers they work with are unwilling to pay more for health care. Our contention is that paying more in total dollars is not the issue. The issue is spending more on primary care and thereby reducing money spent on subspecialty care, urgent care and hospital visits. It's critical that employers understand that coordinated primary care is worth the investment because it can reduce such avoidable costs.

On a positive note, Cigna informed us that it has submitted a letter of intent to participate in the Comprehensive Primary Care Initiative. In October, CMS and its Center for Medicare and Medicaid Innovation announced plans to collaborate with commercial and state health insurance plans to support primary care practices that deliver coordinated and seamless care.

The program will blend fee-for-service payments with a risk-adjusted per-patient, per-month care-coordination fee that ranges from $8 to $40. Participating practices also will have the opportunity to share in savings resulting from the program. (Just an aside: The AAFP and TransforMED are hosting a free CPCI webinar for members on Feb. 1 at 1 p.m. CST.)

It was encouraging to hear that Cigna plans to participate, but our conversation also made it clear that the amount of the per-patient, per-month care-coordination fee will be a topic of debate with payers. We will follow up with Cigna to ensure they understand the importance of coordinated care and the value of our members' time.

Meeting with large health plans can be frustrating, but it has the potential to pay long-term dividends. Although private payers may not change their policies solely based on our input, without that input they most certainly won't change. As advocates for family physicians and our patients, the AAFP will continue to engage major health plans on issues critical to family physicians. In fact, Academy leaders are scheduled to meet with representatives of Aetna in March.

What else is the Academy doing about payment?

The AAFP Primary Care Valuation Task Force will meet Jan. 24 in Washington, and leaders from the AAFP and other specialty medical organizations are planning to meet with legislators in late January on Capitol Hill to discuss the sustainable growth rate (SGR) formula.

The Academy also is launching another wave of its grassroots advocacy campaign(www.capwiz.com) (www.capwiz.com)aimed at getting rid of the SGR once and for all.

It's going to be a busy couple of weeks, so come back to the blog for updates. You also can follow me on Twitter (twitter.com)and Facebook(www.facebook.com).


Posted at 03:06PM Jan 19, 2012 by Glen Stream, M.D., M.B.I.

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