Healthcare groups ask CMS to create hybrid primary care payment option
More than two dozen healthcare groups have teamed up to ask the Centers for Medicare and Medicaid Services (CMS) to create a new payment option in the Medicare Shared Savings Program (MSSP) to bolster primary care and accountable care organizations (ACOs).
The payment option proposed is a hybrid model that aligns with evidence-based payment recommendations in the 2021 NASEM Report, Implementing High-Quality Primary Care, developed by the National Academy of Sciences, Engineering and Medicine.
The letter comes after the Medicare Advisory Committee (MedPAC) recently recommended tying physician payments to the Medicare Economic Index (MEI)––a move that would adjust payments to inflation. However, the recommendation would only tie payments to 50% of the MEI, which healthcare groups immediately criticized as being too low. The recommendations also follow a 2% payment cut for physicians in 2023, after years of essentially flat payment updates. Healthcare groups have similarly urged CMS to update physician payments to 100% of the MEI.
Twenty-seven healthcare organizations signed the letter to CMS asking the agency to create a hybrid payment model, including the National Association of Accountable Care Organizations (NAACOS), AMGA, the American Academy of Family Physicians and the Primary Care Collaborative.
“As you have each articulated, CMS’ beneficiaries and the larger American public are grappling with pressing health needs,” the letter stated. “All communities––especially those that are disadvantaged or underserved––face lapses in preventive care, unmanaged chronic conditions, skyrocketing mental health and substance use issues, and emerging health challenges associated with long COVID. Time is of the essence to implement multiple strategies to strengthen the primary care platform to get to better health.”
The letter laid out six principles to govern a new hybrid payment option within MSSP, which is the shared savings program for ACOs. The six principles include:
- Equity considerations embedded within the option.
- Added value for Medicare beneficiaries.
- Increased investment in primary care.
- Must be fully voluntary.
- Must be available rapidly and in all geographies.
- Must create additional value for Medicare
According to the healthcare groups, ACOs are critical for primary care with the biggest opportunity for cost savings.
“CMS has acknowledged that ACOs with a high proportion of primary care practice participants have generated greater net savings to Medicare,” the letter stated. “It is in Medicare’s interest to attract more primary care practices to form and participate in ACOs.”
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."