CMS Pays Primary Care Bonuses Amidst Bureaucracy

Payments from the Medicare Primary Care Incentive Program are "a good start," to help bolster physician pay, but primary care physicians consistently fall "below 50% of the average specialty incomes," says the head of the American Academy of Family Physicians.

While primary care physicians, lagging behind other specialists in salaries, are eager to tap into the Medicare Primary Care Incentive Program's multimillion dollar bonus largess, some doctors are upset about bureaucratic "hoops and hassles" in seeking funds, says the head of the American Academy of Family Physicians.

The Center for Medicare & Medicaid Services paid $664 million to doctors, nurses, and other providers under the MPCIP in 2012, according to a recently released CMS report. Payment began in 2011 and will continue in 2015 to boost Medicare payment [PDF] for primary care services.

Referring to the millions of dollars in incentive payments, Jeffrey J. Cain, MD, the AAFP president, said in an interview that "these are good start," to help bolster primary care, especially because of projected shortages in years ahead. Still, primary care physicians consistently fall "below 50% of the average specialty incomes," Cain said.

Undoubtedly, the MPCIP is "one of the ways to incent primary care," he Cain added.

And the healthcare system is in need of primary care, he says. "We are going to have an upcoming [primary care] shortage and increasing numbers of people who will be insured; an increased aging population, and chronically ill."

Internal medicine physicians were paid 49.4% of MPCIP funds, followed by 37.9% of family physicians. Others included nurse practitioners; 7.5%; physicians' assistants 2.9%; geriatrics, 1.9%; and clinical nurse practitioners, .2%, according to CMS. The agency reported that MPCIP funds were allotted to 80% of physicians in urban areas, and 20% in rural. Incentive payments equal 10% of the Medicare paid for primary care services.

Cain did not disclose how many members of the 100,000-member AAFP have applied for the funds, but said his organization "is helping our members understand they have to be proactive" in receiving payment. "We are helping members through the process," he says.

"The number of folks who qualify (annually) is pretty stable, but we want to make sure they are part of this program. One of the things family doctors complain about is the number of hoops and hassles in Medicare and Medicaid," Cain says. The number of physicians enrolled was unavailable.

"We have to be careful as we improve payment (structures); we are not increasing the hassle factor." The AAFP is "encouraging (the government) to simplify procedures," he says.

The Medicare payment plan is authorized under the Affordable Care Act. Eligible practitioners are eligible for the payments if primary care services accounted for at least 60% of the practitioner's total allowed charges under the physician fee schedule in the qualifying calendar year. The payments are made quarterly.

To calculate a practitioner's primary care percentage, CMS states that it uses Medicare claims data from the calendar year that is two years prior to the incentive payment year. Emergency, hospital inpatient, drug and laboratory charges are excluded in the practitioner's total allowed charges under the physician fee schedule.

"This is improving fee-for service for primary care, which is great," Cain says, with a laugh, of the MPCIP. "We're pleased with that." Cain says healthcare reforms and models are necessarily being studied with the hope of aligning physician payments under value, and not fee for service.

"AAFP believes the fee-for-service system is broken," he adds. "It doesn't reflect value the services of primary care. We need to transition to a different way of paying, not just incenting (physicians) for widgets on a fee for service, volume based system, but for incent for value," Cain says.

And, he says hopefully, increased payments to primary care physicians may follow.