MedCity Influencers, Policy, Payers

Will CMS attempt at primary care payment reform work?

The idea is that the care management and incentive payments will motivate doctors to better support and engage patients, deliver preventive care and coordinate with other providers.

primary care doctorThis summer, payers and providers will have the opportunity to apply for a new primary care initiative launched by the Centers for Medicare and Medicaid Services. Called the Comprehensive Primary Care Plus model, the effort is intended to improve primary care in the U.S. by increasing services and bundling payments.

CMS says the program will move physicians from the “one-size-fits-all, fee-for-service” healthcare system into one that is more comprehensive and patient-centered. The two-track effort generally centers around payment reform, and physicians in both tracks will receive monthly care management fees and upfront incentive payments. In track one, providers will also be paid the regular fee-for-service payments, and in track two, physicians will get a hybrid of fee-for-service and upfront comprehensive payments. The incentive payments will either be paid back or kept based on performance.

The idea is that the care management and incentive payments will motivate doctors to better support and engage patients, deliver preventive care and coordinate with other providers. These are important goals, but it is not clear whether the new program will be successful in achieving them. Here are three key questions for the program, the answers to which will determine the transformative ability of the CMS effort.

1. How many doctors will participate?

Physicians have to apply by September 1 to participate in the Comprehensive Primary Care Plus program, and CMS expects it will be implemented in up to 5,000 practices across 20 regions. It isn’t clear, however, whether the program provides enough of an incentive for physicians to voluntarily sign up.

The practices would receive new incentive payments, but in return, are expected to provide many enhanced services. These include extended in-person hours, 24-hour telephone access and a number of other advanced care services. Will the new payments be enough for doctors to take on so much additional responsibility?

2. Is the technology there?

The program also requires optimal use of health information technology. CMS says it will provide practices with data on cost and utilization that will support them in changing care delivery, and the agency plans to support practices’ IT enhancement.

CMS is correct that technology is vital to this effort, but it also represents a serious investment. Though electronic medical records continue to be implemented, interoperability among and even within healthcare systems is still lacking. Does the Comprehensive Primary Care Plus model provide physicians with enough cash or hardware to upgrade their technological capabilities?

3. Is this new payment system better than the old payment system?

When it comes to payment reform, there are two arguments. The idea behind the fee-for-system model was that reimbursing per unit of service incentivized physicians to provide more, not better, care. The misaligned incentives either created or exacerbated unsustainable costs, and paying doctors to keep patients healthy is the solution.

The alternative take, though, is that bundled payments and comprehensive payments are just as complicated and unproven as fee-for-service when it comes to keeping people healthy. Though seemingly altruistic, bundled payments will almost certainly have unintended consequences just like fee-for-service payments, and will also have to be reformed down the line.

Despite being paved with good intentions, the road to primary care reform is likely to be bumpy as we all learn a lot about paying for primary care along the way.

Photo: Flickr user Eva Blue

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.