CMS shows desire to innovate with Medicare payment for primary care: 7 things to know

An analysis by the Urban Institute shows Medicare is making efforts to incentivize primary care practitioners for managing the care of chronically ill patients.

The analysis, prepared with financial support from the Robert Wood Johnson Foundation, looks at CMS' approach to payments for Medicare primary care. Researchers specifically examined primary billing codes added to the Medicare Physician Fee Schedule as well as primary care demonstration payment models.

Here are seven takeaways from the analysis.

1. There are differences in both Medicare payment approaches. The billing codes "incentivize specific activities that CMS knows it wants clinicians to engage in," and demonstration models "test whether CMS can achieve favorable outcomes by paying for promising new care delivery approaches," according to researchers.

2. In recent years, CMS has increasingly added billing codes related to non-face-to-face services for beneficiaries, which could include communicating with patients regarding their care or communicating with patients' other clinicians about care coordination, according to the analysis. For instance, in 2013, researchers said CMS started paying practices to manage care transitions for recently discharged patients, and those codes pay for one face-to-face visit with a patient within a certain time period, as well as non-face-to-face services.

3. Additionally, the analysis found "a more diversified approach to paying for primary care" within the physician fee schedule. Researchers said the physician fee schedule still has separate fees for many services, but monthly payments for packages of low-cost activities, like emails and phone calls, are also included. 

4. The analysis also looked at various demonstrations, including the Independence at Home Demonstration, which focuses on medical practices delivering primary care at home, as well as Multi-Payer Advanced Primary Care Practice Demonstration, which researchers state "encouraged primary care practices to adopt the patient-centered medical home model of care and to more closely manage chronically ill patients."

5. Overall, researchers said they found "higher and higher monthly payments offered to primary care practitioners for increasingly broad segments of the Medicare population" as well as a shift from end-of-year bonuses to up-front payments. "We also see that practitioners are held accountable for a growing range of outcomes (including patient satisfaction, care quality and appropriate utilization) but, increasingly, are not expected to independently influence the total cost of all care received by Medicare beneficiaries," they added.

6. Most notably, though, researchers said they saw Medicare will pay primary care practitioners increasingly greater amounts for managing chronically ill patients’ care.

7. The analysis added: "CMS has clearly placed a priority on identifying a payment amount generous enough to incentivize primary care practitioners to more closely manage these high-need, high-cost [chronically ill] beneficiaries. As CMS states in the final rule for the 2018 Medicare Physician Fee Schedule, the agency is engaging in an 'ongoing incremental effort to identify gaps in appropriate coding and payment for care management/coordination, cognitive services and primary care within the PFS.'"

Read the full analysis here.

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