MedPAC Wants Congress to Extend Bonus Pay to Primary Care
Written by Editor   
Wednesday, June 18, 2014 12:00 AM

The Medicare Payment Advisory Commission (MedPAC) wants Congress to continue bonus payments to primary care physicians, now set to expire in 2015.  

MedPAC recommends changing the current 10% bonus payment for primary care services now paid as an add-on to claims into a per beneficiary payment that could be paid monthly or annually.

"The current fee for service (FFS) approach encourages volume. A per beneficiary approach could help encourage care coordination," the report said.  Because Medicare undervalues primary care services, average compensation for specialists can be more than double what primary care practitioners earn.

"The fee schedule is an ill-suited payment mechanism for primary care," the report authors write. "[It] is oriented toward discrete services and procedures that have a definite beginning and end. In contrast, primary care services ideally are oriented toward ongoing, non-face-to-face care coordination for a panel of patients. Some patients…will require the coordination of only preventive and maintenance services. Others will have multiple complex chronic conditions and will require extensive care coordination. The fee schedule is not well designed to support these behind-the-scenes activities, and it is precisely these activities that will be crucial in the move to a more coordinated and efficient health care delivery system of the future."  

MedPAC said that Medicare's current focus on quality measures too often reflect processes rather than outcomes.  Yet "current quality measures are overly process oriented, too numerous, may not track well to health outcomes, and are a burden on providers," the report notes.  A fundamental problem with Medicare's current quality measurement programs, particularly in FFS Medicare, is that they rely primarily on clinical process measures for assessing the quality of care provided by hospitals, physicians, and other types of providers, measures that may exacerbate the incentives in FFS to overuse services and fragment care. Some of the process measures are often not well correlated to better health outcomes, there are too many measures, and reporting places a heavy burden on providers," the report says.

The primary care bonus payment averaged $3938 per eligible practitioner in 2012, while the average bonus for a practitioner in the top quartile in the same year was $9300.