Finding Things to Celebrate in Medicare's New Fee Schedule Rule

We are celebrating after #Medicare announced new changes to strengthen primary care and build care teams in the final 2024 physician fee schedule rule. In collaboration with PCC members, our advocacy made a difference!

As we review the final rule we see many of the shared priorities of the Better Health Now campaign are advanced in the final policies from Centers for Medicare & Medicaid Services. Yet current Medicare law forced the agency to couple this forward progress with negative across-the-board payment reductions.

PCC’s Better Health – NOW Campaign applauds CMS for their efforts to support primary care teams in addressing behavioral health and complex care needs. However, we encourage CMS to respond swiftly to the primary care crisis by increasing investment and offering pathways for practices to transition from fee for service to population-based, prospective payment models.

We continue to urge CMS to use all of its authorities to quickly shift primary care to hybrid population-based and fee-for-service payments in the Medicare Shared Savings Program (MSSP). To build robust primary care teams that can deliver whole-person care, we must move away from fee-for-service payment. 

In our comment letter on proposed rule, we urged Centers for Medicare & Medicaid Services to

• Invest in whole-person primary care by implementing payment for inherently complex care (the G2211 code) as well as improved reimbursement for behavioral health services and vaccine administration.
• Bolster primary care in ACOs by quickly implementing a PCC/NAACOS hybrid proposal which would offer upfront, population-based payment options to Medicare Shared Savings Program (MSSP) primary care practices.
• Help primary care teams support whole-person health, by finalizing reimbursement for lifestyle change and community health integration as well as improvements to behavioral health integration services.

We are pleased to see so many of the priorities we fought for---from support for family caregivers, to the inclusion of community health workers in primary care teams, to more support for a broad range of behavioral health services and clinicians, to more opportunities for primary care practices to demonstrate their impact in Medicare ACOs included in the final 2024 rule.

We thank the many collaborators who contributed to our comments and advocacy.