MedPAC June report proposes per-beneficiary payment for primary care

The Medicare Payment Advisory Commission (MedPAC) has a new idea for what should replace the primary care bonus that is set to expire in 2015: Pay primary care physicians a set fee for every Medicare patient that is part of their panel.

In its June report to Congress, MedPAC offers up the idea of creating a per beneficiary fee that could help boost the income of primary care providers, which MedPAC considers too low compared to specialists. The advantage of a per beneficiary fee, in MedPAC’s view, is that it would encourage primary care providers to increase the numbers in their patient panels by making their care more efficient. Currently, there is little reimbursement for non-face-to-face encounters, but a set per beneficiary fee might change that by rewarding providers who are able to increase their patient panel size through the use of telemedicine, phone and other electronic communication to take care of things that don’t necessarily need to be handled in an office appointment. They would also have an incentive to keep patients healthy so that they would only need to see them once or twice a year for checkups while continuing to collect the per beneficiary fee all year long.

MedPAC suggests that providers might need to meet certain access to care requirements in order to ensure they don’t simply cram their panels with more patients than they can handle, but otherwise it thought providers should be left largely unregulated in how they may decide to capitalize on the potential new income from a per beneficiary payment.

It also suggested that Medicare may want to assign patients to a primary care provider based on where they went for most of their primary care needs. Patients themselves often don’t indicate a primary care provider or may indicate one provider but end up seeing another for most of their needs.

“Expiration of the primary care bonus at the end of 2015 provides an opportunity to revisit the structure of payment for primary care and to consider the alternative of a per beneficiary payment. The Commission plans to continue work on these issues, including design considerations for a per beneficiary payment: the payment amount, requirements that practices must meet to receive the payment, mechanisms for attributing beneficiaries to practitioners or practices, and methods for funding a per beneficiary payment,” the report authors wrote.

A key question of course is how will this idea be received in Congress. MedPAC proposes getting the money to fund the per beneficiary payments by reducing payments to the proverbial “overvalued services.” But legislators know that every time a proposal to reduce payment for any specific Medicare procedure or service is introduced, they will be bombarded with data by the Medicare providers who bill for that procedure or service showing that Medicare is wrong about it being overvalued.

Lena Kauffman,

Contributor

Lena Kauffman is a contributing writer based in Ann Arbor, Michigan.

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