The proposed hybrid per-member-per-month and fee-for-service payment structure in the physician fee schedule for primary care could lead to payment cuts and there may be variation in the PMPM depending on provider type, the AHA said in a July 15 letter to Sen. Sheldon Whitehouse and Sen. Bill Cassidy.
The bill also has language implying that there is room for the PMPM to not be risk-adjusted and potentially restrict what could be included in the risk adjustment, according to the association.
The AHA also backed a provision in the bill that would reduce beneficiary cost-sharing for primary care services by 50% under the hybrid payment model and shared principles for Congress to consider when designing alternative payment models to make participation more attractive for participants.
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