Medicare Part B Payment: Impact on Primary Care

Only July 16, 2024, The Primary Care Collaborative hosted a discussion with CMS leaders about how Medicare Part B payment policy could improve health by strengthening primary care.

Leaders from the Centers for Medicare and Medicaid Services (CMS) outlined how recently proposed changes to Medicare Part B payment policy could strengthen primary care.

Speakers included: 

  • Dr. Meena Seshamani – Deputy Administrator, CMS; Director, Center for Medicare
  • Dr. Liz Fowler – Deputy Administrator, CMS; Director, CMS Innovation Center
  • Dr. Doug Jacobs – Chief Transformation Officer, Center for Medicare
  • Dr. Purva Rawal – Chief Strategy Officer, CMS Innovation Officer

CMS invited attendees to submit additional questions and comments about the proposed rule and encouraged folks to respond to an RFI included the proposed regulation. 

Following the presentation, PCC President and CEO Ann Greiner moderated a panel discussion reflecting on CMS’s presentation. The panel included:

  • Amol Navathe, MD, PhD, MedPAC; University of Pennsylvania
  • Sarah Coombs, National Partnership for Women & Families
  • Amy McKenzie, MD, Blue Cross Blue Shield of Michigan

The webinar event kicked off with remarks from CMS leaders. Introducing key elements of CMS’ new Physician Fee Schedule proposals, Dr. Seshamani explained that value-based primary care models have reduced emergency and hospital visits while meeting patient needs, and CMS plans to use these insights to create a new primary care payment bundle. This bundle, the new Advanced Primary Care Management (APCM) service will include adjustments for patient complexity to promote health equity and link services to quality measures for better Medicare outcomes. 

Building on Dr. Seshamani’s comments, Director Fowler stated that the Innovation Center has been embedding various innovations into the Medicare program to support primary care, with a focus on collaboration across CMS. This includes the adoption of the ACO Investment Model as the Advanced Investment Payments Program as well as the upcoming ACO PC Flex Model.  She too then touched upon the proposal for new APCMt codes to enhance care coordination and team-based care. 

Dr. Jacobs explained the proposed changes in the 2025 Physician Fee Schedule related to primary care, focusing on the proposed APCM services. He detailed the three levels of APCM codes based on patient complexity and emphasized improvements in billing simplicity and care quality. He also highlighted requirements such as 24/7 care access, care management, and quality measurement. He encouraged the audience to thoroughly review proposed rules and weigh in with the agency by the close of the comment period, September 9th. 

Dr. Rawal explained that this APCM bundle is the first step in a multi-year effort to enhance the nation's primary care infrastructure and improve patient outcomes. After highlighting the Innovation Center's commitment to primary care transformation through various models and collaboration with the Center for Medicare, Dr. Rawal detailed a Request for Information (RFI) seeking feedback on designing a future hybrid primary care payment system that incentivizes advanced team-based care. The RFI seeks feedback to specific questions on extending value-based care opportunities, alleviating billing requirements, supporting person-centered care, advancing health equity, and improving quality of care. She encouraged comments on the RFI. 

Following this presentation, PCC President and CEO Ann Greiner moderated a panel discussion with health leaders reflecting on CMS’s presentation. 

Dr. Navathe praised CMS for their thoughtful efforts to simplify coding and funding for primary care. However, he noted that the changes only apply to clinicians in advanced models, not all Medicare providers and questioned the extent of change and stressed the need to transform the primary care system nationwide. He highlighted that Medicare must lead this transformation. 

Coombs also lauded CMS for their efforts to strengthen primary care, noting that a fee-for-service system limits progress in advancing health equity. While acknowledging the proposed APCM codes could be a step toward value-based care, she stressed they alone could not ensure equity without addressing underlying disparities and patient cost barriers. Coombs highlighted the need for a value-based system designed to focus on health equity and reduce beneficiary cost-sharing. 

Dr. McKenzie also commended CMS for moving towards bundled payments and simplified coding, which she believes will reduce administrative burden and improve practice sustainability. However, she expressed concerns about cost-sharing barriers and emphasized the need for consistency in reporting and support for practice transformation. She also highlighted the importance of multi-payer adoption and ongoing support for physicians in implementing these changes. 

The panel provided further insight as they answered various questions from meeting attendees. As the event concluded, Greiner stressed the importance of engagement from and mobilization of the primary care community as reforms are debated. CMS also encouraged folks to submit additional questions and comments about the proposed rule and respond to an RFI included the proposed regulation.

A headshot of Amol Navathe.

Amol Navathe, MD, PhD

Professor, Perelman School of Medicine, University of Pennsylvania
Amol Navathe, M.D., Ph.D., is founding director of The Parity Center, codirector of the Healthcare Transformation Institute, and associate director of the Center for Health Incentives and Behavioral Economics in the Department of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine. He is also an professor at Penn and staff physician at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, PA. Dr. Navathe’s research group designs, tests, and evaluates payment models for public and private payers, including national insurers and state Blue Cross Blue Shield plans. His work led to the founding of Embedded Healthcare, a healthcare technology company that accelerates high-value practice using behavioral economics. Dr. Navathe received his M.D. read more
Headshot of Dr. Amy Milewski McKenzie from Blue Cross Blue Shield of Michigan.

Amy Milewski McKenzie, MD

Vice President, Clinical Partnerships; Association Chief Medical Officer, Blue Cross Blue Shield of Michigan
Dr. Amy Milewski McKenzie, MD, is vice president of clinical partnerships and associate chief medical officer at Blue Cross Blue Shield of Michigan. She is a board-certified family medicine physician. She serves on the State of Michigan Certificate of Need Commission. She graduated from Northeast Ohio Medical University and completed her residency at St. John Providence Health System in Southfield, Michigan. In 2017, she completed her MBA with a focus in medical management at the University of Massachusetts Amherst. read more

Douglas Jacobs, MD, PhD

Chief Transformation Officer, Center for Medicare
Douglas Jacobs, MD, is the chief transformation officer in the Center for Medicare at the Centers for Medicare and Medicaid Services (CMS). In this role, he helps to lead centerwide efforts to move the health care system toward value-based care, advance health equity, and promote delivery system transformation. Medicare is the nation's largest payer, responsible for more than one in five health care dollars spent in the US and responsible for covering more than 63 million Americans. Prior to this role, he was the chief medical officer and first chief innovation officer for the Pennsylvania Department of Human Services (DHS), where he helped oversee the state’s Medicaid program. Dr. Jacobs is a board-certified internal medicine physician and has continued seeing patients throughout the pandemic. read more

Elizabeth J. Fowler, PhD, JD

Deputy Administrator and Director, CMS Innovation Center
Elizabeth Fowler is the Deputy Administrator and Director of CMS Innovation Center. Liz previously served as Executive Vice President of programs at The Commonwealth Fund and Vice President for Global Health Policy at Johnson & Johnson. Prior to that was special assistant to President Obama on health care and economic policy at the National Economic Council. And in 2008-2010, she was Chief Health Counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), where she played a critical role developing the Senate version of the Affordable Care Act. read more
Headshot of Dr. Meena Seshamani

Meena Seshamani, MD

Deputy Administrator; Medicare Director, Centers for Medicare and Medicaid Services
Meena Seshamani, MD, PhD is an accomplished, strategic leader with a deep understanding of health economics and a heart-felt commitment to outstanding patient care. Her diverse background as a health care executive, health economist, physician and health policy expert has given her a unique perspective on how health policy impacts the real lives of patients. She most recently served as Vice President of Clinical Care Transformation at MedStar Health, where she conceptualized, designed, and implemented population health and value-based care initiatives and served on the senior leadership of the 10 hospital, 300+ outpatient care site health system. read more
Headshot of Purva Rawal

Purva Rawal, PhD

Chief Strategy Officer, CMS Innovation Center
Purva Rawal, PhD, is the chief strategy officer at the CMS Innovation Center at the Centers for Medicare and Medicaid Services. As part of the senior leadership team, she provides guidance and leadership on the execution of the Innovation Center’s strategy. read more

Sarah Coombs, MPH

Director, Health System Transformation, The National Partnership for Women and Families
Sarah Coombs is director for health system transformation at the National Partnership for Women & Families, where she manages policy and programmatic work on health access and system transformation, including health equity, health coverage and affordability, and payment and delivery system transformation. read more
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