CMS Responds to AAFP Concerns, Makes Changes to PCIP Program

Changes Ensure 80 Percent of FPs Will Be Eligible for Incentives

November 03, 2010 05:40 pm James Arvantes

After feedback from the AAFP and several other primary care organizations, CMS has changed its implementation rules for the Medicare Primary Care Incentive Program, or PCIP. Those changes will allow approximately 20 percent more family physicians to qualify for the bonus program than previously anticipated.

As of January, the Patient Protection and Affordable Care Act requires Medicare to pay all primary care physicians whose primary care billings comprise at least 60 percent of their total Medicare allowed charges a 10-percent bonus. The bonus program will last until December 2015, and bonuses will be paid quarterly.

However, CMS' original proposed implementation of the program would have precluded a significant number of primary care physicians who are providing comprehensive and longitudinal care from receiving the 2011 incentive payment. The AAFP, both on its own and along with several other primary care organizations, repeatedly pointed out the drawbacks of CMS' implementation proposal.

In response, CMS made eligibility rules for the PCIP more inclusive. The agency excluded laboratory charges and other charges from the bonus payment eligibility calculation and subtracted physician hospital visits from the allowed charges, as well. These changes will ease the PCIP's eligibility requirements and allow as many as 80 percent of the nation's family physicians to qualify for the bonus payment, according to initial estimates from CMS.

"The final CMS payment rules expand the number of family physicians who will qualify for the 10 percent payment bonus to an estimated 80 percent of family doctors," said AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas. "We have been telling everyone who would listen how wrong the message would be to family physicians who provide comprehensive family medicine services -- often in the most needy areas -- if they do not qualify. This is incredibly good news and further confirmation that our issues are being heard and responded to."

AAFP Board Chair Lori Heim, M.D., of Vass, N.C., said, "We are very pleased that the administration and HHS listened to our concerns about the unintended consequences of the legislation and used their regulatory rulemaking authority to right an unintended consequence."

She noted that the change to the proposed CMS rule serves as another example of how the AAFP has grown in its advocacy efforts. "It also shows the good working relationship that has developed between the Academy and various departments with HHS," she added.

"In this rule, CMS finalizes adjustments to proposed policies in response to public comment so that more primary care physicians and nonphysician practitioners can qualify for the incentive payments, including adjustments for practitioner practice patterns in rural and professionally underserved areas, as well as providing special consideration for practitioners newly enrolling in Medicare," CMS said in a Nov. 3 press release(