Proposal to Keep Higher Primary Care Pay Heads to Congress

Members of the Medicare Payment Advisory Commission (MedPAC) voted last week to forestall a 10 percent pay cut for primary care physicians who treat Medicare patients that is slated to take effect next January. Rather than allowing a primary care bonus payment to expire at year's end, the commissioners are recommending a budget-neutral way to continue the payment, albeit in a different form.

During their Jan. 15-16 meeting,(www.medpac.gov) commission members voted unanimously in favor of a per-beneficiary payment that would be offset by applying a 1.4 percent payment reduction to 75 percent of other physician services in the Medicare physician fee schedule. The recommendation will be included in MedPAC's March report to Congress.

For years, MedPAC commissioners have sought to rebalance the Medicare fee schedule, pointing out that primary care services have long been undervalued compared with subspecialty care services. The per-beneficiary payment will be available only to physicians who practice family medicine, general internal medicine, general pediatrics or geriatrics. The increased payments will be made for specific evaluation and management services provided during office visits, patient visits in a long-term care facility and home visits. Hospital visits are excluded from the bonus payment.

Before voting, members discussed the long-term prospects associated with the payment imbalance between primary care and other specialties and the struggle to transform medical care away from episodic treatment paid for by on a fee-for-service basis.