The press release jointly released by the two senators’ offices began: “As part of their continued work to address primary care challenges and reform physician payment models, U.S. Senators Sheldon Whitehouse (D-RI ) and Bill Cassidy, MD (R-LA) published a Request for Information (RFI) to accompany the introduction of bipartisan Senators PCP Compensation Act, legislation to support and improve compensation for high-quality primary care providers.” And he quoted the two senators as stating that “primary care is a critical part of the health care equation. There is overwhelming evidence that primary care improves patient health outcomes and reduces healthcare costs. “There are many issues to address in primary care and we look forward to receiving feedback on our legislation through the RFI to make a significant difference to the success of healthcare.”
According to that, “The PCP Payment Act would task the Centers for Medicare & Medicaid Services (CMS) to establish hybrid payments to reward primary care providers who provide the best care to their patients: care that reduces patient emergencies, hospitalizations and excess attention to specialists. services and other important cost factors, and reward patients with better health outcomes. The bill would provide Medicare beneficiaries with reduced cost sharing for certain primary care activities and services, and would also create a new technical advisory committee to help CMS more accurately determine fee schedule rates.”
As we have noted, APG leaders expressed their strong support for the legislation. And in that sense, Healthcare innovation The Editor-in-Chief interviewed APG’s Susan Dentzer following the announcement of the legislation’s introduction, to get her perspectives on the legislation and also on the broader issues surrounding empowering physicians to more fully immerse themselves in evidence-based contracting. the value. Below are excerpts from that interview.
What is your perspective on this newly introduced legislation?
At the moment, we only have the basics of the legislation, but we think it is a good proposal. The Medicare medical fee schedule is an eyesore and has hurt primary care providers for a long time, and continues to do so. And if one imagines a world in which more primary care providers are able to provide adequate care in the 21st century, paying them less, as we have been doing, is wrong, and we can see the impacts: the number of Americans who say that having a regular PCP continues to decline and we are entering a crisis. And Medicare’s medical fee schedule also influences private payers’ payment patterns and exacerbates the problem. So not only will we not have enough primary care physicians to provide care in the 21st century; and if we really want to push the system towards value-based models, we are shooting ourselves in the collective foot. The ability to take risks and be accountable for costs and quality simply will not be achieved if we continue to deprive primary care.
So Senators Whitehouse and Cassidy have a good proposal. Does it go as far as the nation needs to go? No. Is modifying the medical fee schedule a good first step? Yes. At the moment, we do not know the cost; he has to get an estimate from the CBO, which could take him out of the ring. But even setting the cost, that’s why they’ve put out a request for information and a request for interested parties to weigh in on key features of the legislation. The most obvious is that if you are going to deliver potential payments to a certain group of providers, you have to decide who will qualify and who will be the Medicare beneficiaries. And then we have the same problem as in the MSSP and other models. The challenge is that the potential payment will be an amount per member per month, but in this case, they will still be working at FFS. Then you have to link a patient to a doctor; and that’s just one of a long list of questions they’ve asked interested parties for comment on.
How do we get more and more doctors to opt for value-based care delivery, based on incentives?
Yes, there is tension and this proposal: they need the same kind of infrastructure support that they would need in VBC. Right now, they need to produce volume to stay afloat financially. And we know that practice cost inflation is now almost 4 percent annually, and yet once again this year, we are cutting pay to doctors in absolute terms and relative to overall inflation, even further. So right now, if you are an FFS doctor, you are on a hamster wheel and seeing as many patients as possible. And what this bill essentially says is that we’ll take over your payment and deliver it to you prospectively, and we’ll take you off the hamster wheel for half of your practice so you can focus on volume and add more. your workforce in the office. Perhaps you can hire an advanced practice nurse to alleviate some of the burden; Perhaps hire a pharmacy consultant to deal with medication issues. That’s all really good and really positive. Does this alone lead you to value-based care? No. Does it give you some of the things you need? Yes. So this opens a path for primary care practices to survive; and that is a prerequisite for engaging in value-based care. But there is still a long way to go between this very valuable proposal and VBC.
Can meaningful legislation like this be passed in this presidential and congressional election year?
I think it’s possible. And besides, Congress can do all kinds of things to mitigate the cost in the short term. There are many issues that need to be resolved fairly quickly, and some of them are serious. They have to decide if they will accept half of the FFS payment and, if they make it a potential payment, they must determine how large that payment will be. And it is not yet known how clinics will use this hybrid payment. So realistically, if they approved something like this this year, they would instruct CMS to create this model and get it up and running within a few years, because it would probably take a couple of years to answer all of these questions and get the model up and running. So do I think it’s possible they’ll enact it this year? Yes. But they would pass many of the details to the CMS and delay implementation by a couple of years, maybe more. On the other hand, cost estimates could eliminate this, although it is not a fact that this would cost more, because they are going to need half of the FFS payment to work; We don’t know yet how it will work.
And there is a component to this legislation that would cost money. Several years ago, Congress determined that if you voluntarily designate a provider to manage and coordinate your care, when that legislation was adopted, Medicare adopted a copay. But Medicare beneficiaries are rejecting that option because of their copay. This bill reconfigures that, so that if a Medicare beneficiary designates a primary care provider to be their primary source of care, their coinsurance can be cut in half. That should encourage Medicare beneficiaries to participate. But doing so will cost money. And we know that piece will cost money. And then depending on how the rest is structured, it could cost more. But it doesn’t have to cost more if they use existing spending as a base.
