Five Things to Know: CMS’ Plan to Up PCP Payments by Millions

By 2017, an additional $140 million could be channeled to primary care physicians, according to the final version of the Medicare Physician Fee Schedule (PFS) released by CMS.

Over time, according to a blog post from CMS Acting Administrator Andy Slavitt, if the clinicians qualified to provide these services were to fully provide these services to all eligible beneficiaries, the boost could be as much as $4 billion or more in additional support for care coordination and patient-centered care. Clinicians will additionally be able to bill and be paid more appropriately when they spend more time with their patients and better coordinating care.

“This payment change shows that CMS continues to shift payment structures to support coordination of care whether that’s for coordination of primary care, as in this case—or population health [e.g., ACOs]—or high-cost episodes [e.g., bundled payments],” says Sam Ogie, director of healthcare programs at Simon Business School at the University of Rochester. “Payment for healthcare services has been oriented toward procedures for decades—‘if it bleeds, it pays’—so it is likely a good sign that CMS is putting more money behind diagnosis and care coordination.”

Here, experts share 5 things to know about this boost to primary care reimbursement:

1. Although the evidence is mixed, on balance it suggests that care coordination can reduce spending and utilization while maintaining quality, according to Ogie, referring toThe Patient-Centered Medical Home’s Impact on Cost and Quality: Annual Review of Evidence, published for the last five years by the Patient-Centered Primary Care Collaborative.