Incentives for Physicians to Pursue Primary Care in the ACA Era
When President Obama took the oath of office in January 2009, there was mounting evidence that primary care not only improved patient and population outcomes, but also contained costs. It was clear that improved access to quality primary care would be a focus of his administration. Responding to the 2008 economic crisis and recognizing tremendous gaps in the health care delivery system—particularly in the primary care workforce—Congress passed the American Recovery and Reinvestment Act (ARRA) in 2009. The act addressed a number of health delivery system issues; it implemented the Health Information Technology for Economic and Clinical Health (HITECH) Act, which introduced the concept of meaningful use of electronic health records; created the Office of the National Coordinator for Health Information Technology; reinvigorated the National Health Service Corps (NHSC) with a $300 million investment; and expanded the Health Resources and Services Administration (HRSA) workforce programs, including the NHSC, by close to 50 percent.
Societal undervaluation of primary care services continued, however, reflected by the lackluster investment in primary care infrastructure that has not reimbursed for foundational components of primary practice such as care coordination and chronic care management. Instead, the fee-for-service model of payment has incentivized increased services, procedures, and tests. The widening income gap between generalists and specialists and the failure of the Resource-Based Relative Value Scale (used by HMOs to determine clinician payments) to reduce the inequality between office visit fees and payments for procedures have contributed to the trend.
The Council on Graduate Medical Education (COGME) is authorized by law to advise the Secretary of Health and Human Services and Congress on the supply and distribution of physicians in the United States. In light of both primary care’s contribution to improved outcomes and longevity and the attrition of primary care physicians, the COGME recommended that at least 40 percent of the physician workforce should practice primary care and that their salaries should average no less than 70 percent of specialists’ salaries.
