The ACP Advocate Blog
by Bob Doherty
Friday, May 25, 2012
Government, private payers bank on primary care
One of the tired refrains from some physician critics of the health reform law is that it did “nothing” to help primary care—when in fact, the law spends tens of billions of dollars to increase payments and improve the lot of primary care doctors.
Writing in the current issue of the New England Journal of Medicine, respected health journalist John Iglehart writes:
“Primary care physicians, long in the doldrums over their incomes and challenging work–life balance, may be heartened by recent steps taken by policymakers and payers signaling the increased recognition of the foundational role they could play in a restructured health care delivery system. Hopeful signs include increased Medicare and Medicaid payments for several years under the Affordable Care Act (ACA), plans by major private insurers to increase primary care fees, and initiatives that medical groups are taking on their own . . . although the ACA’s fate rests with the Supreme Court . . . [its] enactment and the preceding debate built momentum for strengthening primary care. Thus, whatever the Court decides, many of these efforts may well survive, thanks to heightened interest in primary care from policymakers and the private sector. The initiatives include “fee increases of 10% over 5 years (2011–2016) for [designated services by] primary care providers” . . [and] “equalization of Medicaid and Medicare fees for primary care services in 2013 and 2014.” [Emphasis added in italics.]
CMS, in announcing a proposed rule to implement the Medicaid pay equalization provision, reports that the government will provide states with $11 billion to bring Medicaid fees for primary care up to the Medicare rates. CMS also reported that “in 2011, over 150,000 primary care providers nationwide received almost $560 million in higher Medicare payments” because of the 10% primary care bonus program.
Because of the Medicaid pay equalization rule, many physicians will get a huge Medicaid raise next year. The California Medical Association says that the rule will result in a “50 to 60 percent increase in Medi-Cal rates for primary care physicians, including family medicine, pediatrics and internists, plus related subspecialties.” The Kaiser Family Foundation has a nice chart comparing Medicaid fees as a percentage of Medicare in every state, and although it is several years out-of-date (2008), it shows how physicians stand to gain. In eleven states, Medicaid payments for primary care were less than 60% of the Medicare rates (NY, RI, NJ, CA, DC, ME, FL, IL MN, MI; in two states (NY, RI), Medicaid paid less than 40% of the Medicare fee.
Mr. Iglehart points out that there are other initiatives in the work to help primary care:
“The Comprehensive Primary Care Initiative aims to foster collaboration between public and private payers to strengthen primary care. It creates a new value proposition for primary care, offering additional payments for currently unreimbursed services considered essential to a higher-performing delivery system: proactive care management for high-risk patients, improved access to after-hours care, communication with patients between office visits, and shared decision making. The Centers for Medicare and Medicaid Services committed, on behalf of Medicare beneficiaries, to pay a $20 monthly care management fee and offer shared savings to 75 high-performing primary care practices in seven markets—the states of Arkansas, Colorado, New Jersey, and Oregon, plus New York's capital district (Albany and the Hudson Valley), Cincinnati–Dayton (Ohio), and Greater Tulsa (Oklahoma)—where multiple insurers have committed to a similar payment model. The CMMI hosted a recent gathering of 41 payers in these markets to discuss their participation.”
He also notes that several large insurers, covering millions of lives and involving hundreds of thousands of physicians, have announced plans to increase primary care fees.
It may be too early to whistle “Happy Days are Here Again” when it comes to primary care. But for the first time in many years, public and private payers are putting their money into primary care, due in large part to “enactment [of the ACA] and the preceding debate” on the “foundational role [primary care] could play in a restructured health care delivery system.”
Today’s question: What do you think of Mr. Iglehart’s premise that primary care may be seeing a light at the end of the tunnel, due in large part to the ACA?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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