Proposed Physician Fee Schedule Emphasizes Primary Care

HealthLeaders Media News, July 11, 2016

The proposal puts the "nation's money where its mouth is," according to CMS Acting Administrator Andy Slavitt.

Primary care took center stage in the Centers for Medicare & Medicaid Services' proposed Physician Fee Schedule for 2017, announced July 7.

In particular, the new rules would improve payment for care coordination and planning, mental healthcare, and care for cognitive impairment.

Andy Slavitt
Andy Slavitt

"We conservatively estimate that these changes would result in approximately $900 million in additional funding in 2017 to physicians and practitioners providing these services," wrote CMS Acting Administrator Andy Slavitt on the CMS Blog.

"Over time, if the practitioners qualified to provide these services were to fully provide these services to all eligible beneficiaries, the increase could be as much as $5 billion in additional funding for care coordination and patient-centered care."

CMS has also proposed expanding its Diabetes Prevention Program as of January 1, 2018, marking the first time a preventive service model from the CMS Innovation Center would be expanded into the Medicare program.

A 2016 analysis of the program, which began in 2013, found that when compared with similar beneficiaries not it the program, Medicare estimated savings of $2,650 for each enrollee in the Diabetes Prevention Program over a 15-month period, more than enough to cover the cost of the program.

This success in cost savings, combined with participants' health improvements, made the ACA-created program eligible for expansion.

Other proposed payment changes affecting primary care include:

  • Increasing payments for routine office visits for treating patients with mobility-related disabilities from $73 to $119.
  • Increasing payments to geriatricians or family practice physicians treating eligible Medicare beneficiaries by at least 2% for providing all of the care outlined in the proposed rule. In his blog post, Slavitt indicated that these increases could amount to more than 30% over time.
  • Payment for behavioral healthcare using the Collaborative Care Model, which supports mental and behavioral health through a team-based, coordinated approach involving a psychiatric consultant, a behavioral health care manager, and the primary care clinician and which extends beyond the scope of an office visit.

"If this rule is finalized, it will put our nation's money where its mouth is by continuing to recognize the importance of prevention, wellness, and mental health and chronic disease management," said Slavitt a media statement.

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