From left, featured experts Peggy O'Kane, Robert Berenson, and Caroline Blaum listen intently.Like so many stakeholders in health care, we at the John A. Hartford Foundation have many of our hopes pinned on enhanced primary care as a way of improving health outcomes, particularly for older Americans who face multiple chronic conditions.
Primary care providers will need more skills, more teammates, community partners, and, of course, more money, to live up to these hopes. But we believe that better primary care can prevent some of the acute and expensive events such as hospitalizations that they experience, and thereby also lower total costs of health care.
A newly proposed Medicare physician fee schedule announced July 3, 2014 may help. It proposes a Chronic Care Management payment under fee-for-service Medicare that could be the ongoing mechanism for the non-face-to-face, per-person, per-month reimbursement that would provide the money to pay for enhanced primary care ( ~ $41 pm/pm) and the services that older adults need. (see page 170 in this PDF or the online Federal Register.
As the proposed rule details, there has been considerable evolution in thinking about this benefit, primarily regarding who can deliver services and who will be allowed to bill Medicare for providing them. In prior years, the Centers for Medicare and Medicaid Services (CMS) had floated some very restrictive initial proposals that included good, but very limiting ideas, such as the benefit being available only for beneficiaries who had had an annual wellness visit, and only when delivered by practices that employed a nurse practitioner or physician assistant as part of the primary care team, and/or only by those practices that had achieved formal recognition as a Patient-Centered Medical Home.
In this new version, almost all restrictions and criteria for practice adequacy have been dropped, except for the formulation of a written care plan and the availability of an electronic health record to make some of the required care coordination functions possible. The CMS comment period for the physician fee schedule is still open, so we encourage you to make your views known. You can do so by clicking on the blue Comment Now! button on the right side of the proposal’s page on regulations.gov.
Because these issues are so important and to contribute to the discussion, the Hartford Foundation was proud to convene its first-ever Washington DC, “hill briefing” last Friday to bring what we have learned from our polling of older Americans about their experience of primary care and their preferences for improvements to policymakers and other DC stakeholders.
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In addition to offering the feedback from older adults themselves, we also brought some of our most expert grantees and colleagues with us to help clarify the issues, including Peggy O’Kane, the president of NCQA (which co-sponsored the event with us), Robert Berenson, Institute Fellow at the Urban Institute, and Caroline Blaum, from NYU.
Despite it being a truly lovely day in July, more than 50 people showed up for the presentations, which went off without a hitch thanks to the expert support of Foundation staff and our long-time partners at SCP (Strategic Communications and Planning). We were excited to see many of our colleagues in the audience including Caitlin Connolly of the Eldercare Workforce Alliance, Robyn Golden of Rush University, Joyce Dubow of AARP, and representatives of the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) and CMS.
All of our copies of the poll results and issue brief disappeared, and we all felt that we had made a useful contribution to the deliberations on these important issues. If you are interested in learning more, please visit our Poll Briefing page for the PowerPoint presentations and supporting materials, including NCQA’s white paper of patient-centered medical homes.
And again, we encourage you to share your own insights with CMS on this and other aspects of the proposed Physician Fee Schedule.
For more information about primary care and Patient-Centered Medical Homes, read On Each Others Team: What We Can Learn By Listening to Older Adults and Content of Care and Patient Population Are Crucial in Evaluating Patient-Centered Medical Homes. For more on the many CMS demonstrations, read Good Judgment Comes from Experience and Toward a More Effective CMMI.
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