Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

MedPAC Proposes Plan to Improve Primary Care Payment Increases

By Ryan Mcaskill

MedPAC commissioners feel the fee situation is urgent and needs to be addressed now before it becomes irreversible.

- Over the last few weeks, we have covered the end of the Medicaid fee reimbursement bump that has been on the books for the last two years. It brought Medicaid reimbursement up to Medicare levels as a way to encourage physicians to take on more Medicaid patients. However, that fee bump ended on January 1 and reimbursement rates could drop as much as 50 percent.

For the fee bump to continue, one of two things need to happen. Either states need to step in to increase reimbursement or the federal government needs to step in and find a way to reinstate the bump or create a better plan for reimbursement. It is also not the only payment increase that is in jeopardy of going away.

The Medicare Payment Advisory Commission (MedPAC) is a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program. It has been meeting to try and come up with a solution. On December 18, MedPAC met to discuss the 10 percent Medicare payment increase for primary care that is set to expire at the end of 2015. Members of the organization are supporting the fee and have released a draft proposal to show it it can happen.

Essentially, the proposal calls for a reduction in payments for non-primary care services by 1.4 percent. This would span 75 percent of services in the fee schedule. With a budget-neutral proposal, the hope is that it will be able to pass through both houses of Congress.

“Future physicians are deciding whether to go into primary care or a specialty,” Commissioner Craig Samitt, M.D., M.B.A., told AAFP. “With an inadequate payment policy, we could face an irreversible problem five years from now.”

He added that while this would help for now, it does not offer enough incentive for the future. The government is not moving fast enough or substantively enough to help support primary care.

Commissioner Kathy Buto, MPA, also spoke about this move as a temporary one. She called is a foundation piece that can be used for something “more ambitious,” which could include a bundled payment format or a new method where primary care is not subject to payment based on the sustainable growth rate formula, but on a different scale relying on other specialties.

MedPAC also released the results of a survey of 4,000 Medicare beneficiaries and 4,000 individuals with private insurance. The purpose of the survey was to examine the satisfaction levels of patients with Medicare. It was found that 88 percent of those surveyed are either very or somewhat satisfied with their overall care. It also found that payments are adequate and indicators of access are stable. However the disparities in physician compensation raise concerns about fee-schedule accuracy.

MedPAC will reconvene on January 15 and 16. It is safe to assume that this issue will again be a topic of discussion as it has yet to be solved.



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