U.S. primary care is on the brink of collapse because of COVID-19 and an outmoded fee-for-service system, the Academy told Congress and HHS in a pair of recent letters.
What's needed, said the AAFP, is immediate financial relief, along with policy capable of pushing health care delivery toward a sustainable model.
The alternative -- a ruined health care system deprived of enough front-line family physicians -- jeopardizes the health of most Americans.
"An overwhelming majority of people rely on their family physicians and other primary care clinicians," the Academy wrote.
Yet financial assistance to the health care system during the pandemic so far has centered on hospitals -- which is not where most care is delivered.
- The AAFP sent letters to HHS and congressional leaders laying out specific actions that should be taken to ensure that primary care practices remain open.
- The letters advocated for a direct payment to account for lost revenue from Medicaid, Medicare Advantage and commercial insurers.
- In addition, the upcoming Primary Care First payment model should be open to all primary care physicians, the AAFP said.
A May 2 letter(3 page PDF) was sent to HHS Secretary Alex Azar. It was followed on May 7 by a similar letter(3 page PDF) to Senate Majority Leader Mitch McConnell, R-Ky.; Senate Minority Leader Chuck Schumer, D-N.Y.; House Speaker Nancy Pelosi, D-Calif.; and House Minority Leader Kevin McCarthy, R-Calif. Both were signed by Board Chair John Cullen, M.D., of Valdez, Alaska.
Lawmakers and regulators, the AAFP said, must "prioritize financial support to primary care physicians … by distributing provider relief funds using the foundation of the previously used model."
Specifically, the correspondence urged a formula for one-time payments "equal to the total Medicare fee-for-service payments distributed to each eligible National Provider Identifier and/or Taxpayer Identification Number for July through December 2019, multiplied by three to accommodate for lost revenue from Medicaid, Medicare Advantage and commercial insurers."
Primary care physicians have worked on the pandemic's front lines from the start. And their practices remain the country's best defense against the chronic conditions that most complicate COVID-19.(www.nytimes.com)
Pointing to not-yet-published data from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, the Academy wrote, "In a given year, roughly 260,000 people are hospitalized for upper respiratory infections. By contrast, 19.5 million patients are seen by primary care physicians for the same condition, suggesting that a majority of COVID-19 patients will ultimately be treated in the primary care setting."
As for hospitals: In 2018, about 7% of Americans received care in a hospital, the letters said, "compared to the more than 190 million people -- roughly 60% of the population -- who received care from a family physician."
Primary care practices must remain open -- a condition that is in doubt for many, given that lost revenue from canceled office visits and telehealth payment disparity has already led nearly half the country's primary care practices to lay off or furlough staff.(www.pcpcc.org)
Following pressure from the Academy, the administration has moved the needle on telehealth payment. But more remains to be done.
The Academy urged the administration to reinstate the Medicare Accelerated and Advance Payment program, which was halted late last month, and extend it through the remainder of this year.
The hard part -- the best part -- should come next, the letters said: building a better primary care system. Now.
"The COVID-19 pandemic has underscored that fee-for-service is an inappropriate structure to meaningfully resource primary care," the Academy wrote. "This public health emergency should accelerate shifts to more sustainable models of care, such as prospective, global payments for primary care."
Among these models, the Academy said, is Primary Care First,(innovation.cms.gov) set for limited implementation in selected regions in January 2021.
That program should be immediately expanded, the AAFP said, to allow any primary care physician to begin participating on Jan. 1, 2021.
"In addition to reopening and expanding Primary Care First participation for 2021, the AAFP also recommends adding a 2022 program start date for physicians who are eager to move into the model but require more time to do so," the letters added.
Propping up the current system, warned the AAFP, won't work.
"Fee-for-service, in its current form, is incapable of supporting the primary care system that our health care system needs and that patients deserve," the letters said. "The whole construct of FFS, and especially the resource-based relative value system, has failed primary care.
"It is time that we fundamentally change how primary care is financed by providing prospective payments to all primary care physicians participating in Medicare, coupled with expanding Primary Care First as an appropriate bridge to a new future."
Related AAFP News Coverage
AAFP Joins Call for Relief to Non-Medicare Physicians
Letter Points Out Harms if Emphasis Remains on Medicare Fee-for-service
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