Yesterday, Senator Max Baucus, chair of the Senate Finance Committee, released his plan for reforming U.S. health care. The plan offers a road map for expanding health insurance coverage and improving health care delivery--with a strong emphasis on primary care, which he calls the "keystone of a high performing health care system."
He offers several specific ideas to strengthen primary care:
* A process would be created to reduce payments for services found to be overvalued under the Medicare physician fee schedule and redistribute them to increase payments for undervalued primary care services. The paper implies that this review would take place outside the usual RVS Update Committee (RUC) process.
* Medicare payments for evaluation and management services furnished by primary care practitioners would be increased. Congress would mandate a process for identifying which specific services would qualify for the increase and criteria for determining if a practitioner is truly focused on primary care.
* Medicare's testing of the Patient-Centered Medical Home would be expanded to include more practices that are able to demonstrate that "patients truly receive the primary care and care management services that the medical home is designed to deliver."
* The Medicare sustainable growth rate (SGR) formula might be replaced with multiple expenditure targets based on sub-sets of services. The paper suggests that separate targets have the advantage of "reallocating resources from high-growth, potentially overpaid aspects of health care to underutilized, potentially more valuable services such as primary care and prevention."
The changes in physician payment will be budget neutral, meaning "that any increase to primary care providers requires a corresponding cut to specialist services." The paper acknowledges that such redistribution "has the potential to create significant controversy among physicians."
No kidding. Every effort over the past twenty years to increase payments for primary care has created enormous controversy within medicine.
Senator Baucus' paper is a powerful statement that primary care has arrived as a top concern of policymakers. But the question of "who will pay for primary care?" remains a central challenge.
Today's questions: Do you agree with Senator Baucus that primary care is the "keystone" of a high performing health care system and needs to be supported with higher fees, even if that means taking money from other specialists, including some internists? If you don't believe specialists' fees should be cut, then how would you recommend Senator Baucus and his colleagues pay for higher primary care payments--if at all?