On May 20, the Primary Care Collaborative filed the following Statement for the Record with the House Energy and Commerce Subcommittee on Health for its hearing, “Examining the Medicare Physician Fee Schedule, MACRA and Opportunities for Payment Reform.” The statement urges lawmakers to center primary care in Medicare payment reform by enacting policies that expand viable pathways to move beyond fee-for-service medicine and foster whole-person primary care in value-based models.
Policy recommendations include:
- Properly Value Primary Care: Congress must address the persistent undervaluation of primary care that drives inadequate investment in primary care. It is also vital that CMS explore alternative data sources, beyond surveys, to gain a more complete understanding of the value of different services. Pairing stronger investment with proper valuation going forward can help reverse trends that have contributed to workforce shortages exacerbating access issues across the nation.
- Implement Hybrid Payments: Congress should pair stronger investment in primary care with a smarter approach to payment by implementing hybrid payments, as recommended by the National Academies of Science, Engineering and Medicine.11 Hybrid payments provide primary care with fixed, regular upfront payments to help meet usual health needs of their patients—such as preventing chronic disease and chronic disease complications—while also providing additional fees for high-value, underprovided services.
- Reform and Cut Red Tape in MIPS: Policymakers must address burdensome red tape created by the MIPS program by simplifying and refocusing quality metrics on what matters, including continuity of relationships and comprehensiveness of services. Developing a simpler, and where possible outcome-focused, approach to quality measures—and potentially aligning with other payers—could help eliminate hours of unnecessary paperwork.
- Eliminate Cost Sharing for Primary Care: Medicare beneficiaries need your help to remove unnecessary cost-sharing barriers to primary care. These barriers to care create administrative friction, places needless financial burdens on accessing high-value care for American families and prevent far too many people on Medicare from seeking the type of preventive care essential to better health. Eliminating these barriers is particularly important for expanding care management and integrated behavioral health services, which play a critical role in keeping people healthy.
- Ensure Whole Person Care: Primary care should be comprehensive, coordinated and relationship-based. To support patients in successfully achieving their health goals, practices must have the resources and staff to respond, address and coordinate physical, behavioral and social care across multiple settings. Stronger primary care teams should include behavioral health clinicians, pharmacists, social workers and care managers capable of supporting patients with chronic disease and behavioral health – and connect them to social care and community resources.
Read the full statement for more details.