While public health systems have plenty of room to become more trustworthy, I am increasingly convinced that much mistrust stems also from health systems. In a recent YLE survey, for example, more than 1 in 2 participants had difficulty finding a primary care provider.
[…]
State Medicaid agencies are concerned that many sick and disabled enrollees will lose their coverage because the Trump administration is narrowing the definition of who is “medically frail” enough to get an exemption from new work requirements.
[…]
On Wednesday, May 20, the House Energy & Commerce Subcommittee on Health held a hearing entitled, “Examining the Medicare Physician Fee Schedule, MACRA, and Opportunities for Payment Reforms.” It marked the fourth hearing in the Committee’s health care affordability series—and primary care took center stage at the hearing.
Witnesses included:
Representatives and witnesses emphasized the critical role primary care plays in improving the health of Americans. Yet despite its importance, primary care remains chronically underinvested in and continues to face a growing workforce shortage. Lawmakers repeatedly sought solutions to better incentivize and support medical students and practicing primary care clinicians in entering and remaining in the field.
A recurring theme throughout the hearing was the idea of primary care serving as the “quarterback” of the American health care system. Speakers highlighted primary care as a critical entry point, providing chronic disease prevention, care coordination and lifestyle medicine through trusted, long-term patient-clinician relationships. Witnesses and members alike noted that stronger investment in primary care is associated with improved health outcomes and lower overall health care costs.
Five major themes emerged from the hearing:
Primary Care as the Backbone of a Healthy America
Ranking Member Diana DeGette (D-CO-01) emerged as a champion for primary care during the hearing. In her opening statement, she described primary care as “the backbone of a healthy population.” Drawing from her personal experience as the mother of a primary care physician, Rep. DeGette emphasized the need to strengthen primary care through increased investment and improved reimbursement for primary care services.
Other members, including Representatives Kelly (D-IL-02) and Carter (D-LA-02), also highlighted the integral role primary care plays in supporting seniors living with one or multiple chronic conditions.
Greater Investment in Primary Care & Hybrid Payment Models
Representatives from across the health care field emphasized that Medicare Physician Fee Schedule reimbursement rates have failed to keep up with inflation. When asked how best to support primary care clinicians in serving complex patient populations, Drs. Fox and Furr stressed the importance of both greater investment in primary care and expanded access to hybrid payment models.
They argued that upfront per-member-per-month payments (PMPM), coupled with fee-for-service reimbursement, gives clinicians greater flexibility to manage patient needs, build care teams, invest in technology and deliver more comprehensive whole-person care.
Representatives John Joyce (R-PA-13 ) and Gus Bilirakis (R-FL-12) also emphasized the need to strengthen the primary care workforce by incentivizing medical students to enter the specialty and by modernizing the Medicare reimbursement system to better support independent primary care practices.
Supporting Rural Communities
Supporting America’s rural health communities stood out as a bipartisan priority throughout the hearing. Representative Carter (D-LA-02) emphasized the challenges facing rural populations during his opening remarks, stating:
“Rural patients are sicker and older, have a higher risk of chronic disease, and are more likely to rely on Medicare and Medicaid. This is a patient population that needs more access, not less, yet they are more likely to face barriers to care because there simply are not enough doctors.”
Witnesses took the opportunity to stress the importance of training the next generation of clinicians in rural settings, noting that physicians are more likely to practice in the communities where they train. Several witnesses encouraged Congress to increase reimbursement for Graduate Medical Education (GME) training opportunities and expand hybrid payment models that would allow clinicians to build care teams, reduce administrative burden and better support rural patient populations.
Reducing Administrative Burden for Clinicians
Reducing administrative burden surfaced as a key priority, with several members focusing their questioning on how streamlining reporting requirements could give clinicians more time for direct patient care and help sustain independent practices. Representative Guthrie (R-KY-02) specifically raised concerns about the burden associated with programs such as MIPS and the disproportionate impact reporting requirements have on rural and small independent practices.
Both lawmakers and witnesses called for greater standardization and simplification of reporting requirements to reduce administrative burden and allow clinicians to spend more time caring for patients.
Consolidation of Independent Practices
Lawmakers sought to better understand both the root causes of vertical integration and its downstream effects on patients and clinicians. Committee members raised concerns about the number of independent practices being bought up by larger health systems and the unintended consequences consolidation can have on patient access and choice.
Witnesses and lawmakers testified that financial instability, growing administrative burden, clinician burnout and persistent staffing shortages, has contributed to the decline of independent practices. Witnesses also pointed to existing federal incentives that make it easier for hospitals and health systems to acquire smaller practices.
Dr. Furr explained that operating an independent practice is like running a small business, noting that without stable reimbursement, many practices struggle to remain financially viable while continuing to support the needs of their patient populations.
Comprehensive primary care promises to transform the U.S. health care system by unlocking powerful health improvements and cost savings for patients and taxpayers. By investing in primary care, lawmakers can improve the health and wellbeing of all Americans.
The package of fact sheets below examines the state of primary care in all 50 states and the District of Columbia.
Comprehensive primary care promises to transform the U.S. health care system by unlocking powerful health improvements and cost savings for patients and taxpayers. By investing in primary care, lawmakers can improve the health and wellbeing of all Americans.
The fact sheet below examines the state of primary care in Colorado.
The United States has the highest spending per person on health care in the world but lags behind other high-income countries in terms of health outcomes. Primary care improves health outcomes, lowers costs over time, and reduces disparities. However, this critical foundation of the health care system is crumbling.
The policy playbook presents a step-by-step guide for state policymakers and policy influencers looking to support high-quality primary care by transforming payment. In addition to policies advancing APMs for state-regulated commercial plans, the playbook also covers related areas of primary care payment reform found to be critical to their success: primary care investment and multi-payer alignment.
Read the full report.
Colorado is one of four states partnering with Medicare to try to pay doctors based on whether they can keep their patients healthy, but it s not clear how they re going to do that.
The idea that insurers can keep costs down by encouraging the kind of care that keeps people from needing costlier procedures down the road isn t new, and Medicare has tried a mix of incentives and financial punishments over the last decade.
Most haven t generated significant savings or shown they improve patients health, and the American health care system still primarily relies on billing for individual services.
The Primary Care Collaborative (PCC) announced today the recipient one of its three annual awards for 2021. The awards recognize individuals and a practice in the primary care community that exemplify excellence in providing high-value primary care and shaping the policies that support such care. The award was presented during the PCC s online working summit, being held Nov. 9 and 10.
The PCC is very fortunate to be associated with these primary care champions, said Ann Greiner, PCC s President and CEO. We congratulate this year s honorees and thank them for their contributions to better patient outcomes, reduced health inequities and greater value during these challenging pandemic times.
Advanced Primary Care Practice Award: Westminster Medical Clinic, Westminster, Colorado
The Advanced Primary Care Practice Award recognizes an organization that is an extraordinary primary care practice. This practice serves as a model for transformation through innovation as reflected in the Shared Principles of Primary Care, including patient- and family-centered, team-based care and high value.
Westminster Medical Clinic (WMC), established in 1952, is an independently owned practice serving 6,500 people. WMC uses a team-based approach that includes physicians, PAs, a nurse practitioner, a certified health coach, behavioral health professionals, a clinical pharmacist, and a Patient Advisory Council (PAC), all supported by medical assistants, care coordinators, program coordinators, technology, and administrative management. Multidisciplinary care teams hold monthly gatherings to develop comprehensive, shared-care plans.
At every visit, WMC patients are screened for depression, anxiety, and a new social determinant loneliness. Clinicians incorporate serious illness conversations with families and loved ones. Home visits are scheduled for patients at their most vulnerable moments after hospitalization.
WMC initiated successful community partnerships with Denver Public Schools and the City of Westminster to teach a healthy lifestyles curriculum. The clinic has participated in practice-based research with the Colorado Center for Primary Care Innovation since 2008.
If you want to see the future of primary care, look at Westminster Medical Clinic. It is the embodiment of the Shared Principles of Primary Care, which envision a patient-centered, team-based approach to delivering comprehensive primary care, said Ann Greiner, PCC s President and CEO. The 350-plus organizations that have signed onto the Shared Principles have a model in Westminster Medical Clinic. Seeing the achievement of the Shared Principles vision is incredibly exciting.
Tasks Insurance Commissioner with 1) forming a collaborative (the Colorado Primary Care Payment Reform Collaborative) to advise on increasing primary care spend 2) issue rules to set affordability standards, including PC spend targets
The Patient-Centered Primary Care Collaborative (PCPCC) applauds Colorado Governor Jared Polis and Vermont Governor Phil Scott for signing into law legislation in their respective states that will enhance primary care services and payment.
The separate bills approved by each state s legislature have a similar goal: strengthening primary care access and capability in ways that will benefit all patients. Both bills align with PCPCC s advocacy efforts to increase primary care investment in order to realize the kind of care envisioned by the Shared Principles, care that improves population health and helps to curbs costs.
Colorado and Vermont are part of a growing movement among states Oregon, Delaware, and Rhode Island have already enacted changes and proposals are being considered in several other states to drive more resources into primary care services.
PCPCC is excited to see Colorado and Vermont join the ranks of states that have made primary care investment a top priority, and we look forward to working with other state leaders on similar initiatives, said Ann Greiner, PCPCC President and CEO. The bills that Govs. Polis and Scott have signed into law will transform their healthcare systems in ways that will better provide high-value, relationship-based care that keeps people healthy instead of waiting until they get sick. We are committed to begin and continue work with more states on these vital issues and applaud the leadership shown by Colorado and Vermont.
In Colorado, HB 19-1233, Investments in Primary Care to Reduce Health Costs sets targets for investment in primary care and establishes a state-run primary care payment reform collaborative.
We were pleased to see a diverse set of stakeholders come together in Colorado to support strong primary care in our state, said John Cawley, MD Colorado Academy of Family Physicians President. The legislation that Governor Polis has signed into law demonstrates that ensuring access to affordable, quality primary care services is a bipartisan priority for all Coloradans, one that voters, clinicians, hospitals, health plans, and other interested parties agree on.
In Vermont, S.53 will analyze spending with the intent of increasing the proportion of healthcare spending allocated to primary care.
This is a significant step that builds on Vermont s already extensive primary care infrastructure, said Susan Barrett, Executive Director of the Green Mountain Care Board. The legislation signed into law by Governor Scott aligns with the focus of the Green Mountain Care Board to increase access to primary care and reduce health care costs for all Vermonters.
###
About the Patient-Centered Primary Care Collaborative
Founded in 2006, the Patient-Centered Primary Care Collaborative (PCPCC) is a not-for-profit, multi-stakeholder membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. Representing a broad group of public and private organizations, PCPCC s mission is to unify and engage diverse stakeholders in promoting policies and sharing best practices that support growth of high-performing primary care and achieve the Quadruple Aim: better care, better health, lower costs, and greater joy for clinicians and staff in delivery of care.