On April 22, 2019, The Centers for Medicare & Medicaid Services (CMS) announced the new proposal of Primary Care First (PCF) reimbursement models. The program aimed to shift primary care doctors from fee-for-service billing to monthly payments, in order to be compensated for the work they do beyond seeing patients.
Some of the changes since the initial rollout, such as the increase in the monthly per patient payment rate from $24 to $28, were “important improvements,” according to The American Medical Association (AMA). However, the AMA also noted that it may not be sustainable for every practice. Each will need to determine whether the payment rates can support the necessary care delivery requirements of their practice.
Gary LeRoy, MD, president of the American Academy of Family Physicians (AAFP), was interviewed for the article and said that figuring out whether to apply for the PCF program is complicated.
The models "are attractive to our members in the fact they're acknowledging the value of primary care ... even though when we look at overall spending on primary care in our country, it's somewhere in the area of 6% of the total expenditures on healthcare," said LeRoy, a family physician in Dayton, Ohio.
"It really needs to be 12% or more in order to improve healthcare outcomes ... There's obvious interest in it, but some elements of the model do not really increase spending much beyond the current fee-for-service model we have in place, so I think that's why they're proceeding with caution."
Putting Primary Care First
It’s not news to anyone that greater investment in primary care is essential to improve population health. Care models that deliver the right kind of utilization, member experiences, and population health cost management will be on the frontlines of the healthcare revolution.
The advanced primary care methodology is tested and proven to deliver population health outcomes. It minimizes obstacles to health by emphasizing time-rich appointments, empathetic listening, and behavior change. The results are better outcomes, fewer claims, improved population health and satisfaction.