Dive Brief:
- At its October meeting, MedPAC had a session that focused on Medicare payment rates, particularly differentials between those for primary care and other providers. The commission has shown concern in the past that services like primary care are undervalued in its fee schedule compared to specialty treatment. For instance, if orthopedists were paid only at Medicare rates, they would make about $392,000 annually, more than double the pay for a primary care provider.
- In 2011, MedPAC recommended that the Centers for Medicare and Medicaid Services examine the inaccuracies of relative value reimbursements. CMS is looking at various approaches to figuring out the amount of time a physician works compared to the time estimated in the fee schedule. They took data from four practices: cardiology, family medicine, urology and orthopedics to understand the correlations.
- Preliminary data has shown that primary care services are undervalued and testing and procedures may be overvalued in the current RVU system. The commission discussed the issue to inform Congress and CMS of potential advantages to using a new approach to make the fee schedule more beneficial for primary care physicians.
Dive Insight:
Whether or not primary care physicians are paid well enough is a longstanding issue in the industry. The Affordable Care Act tried to address the problem by requiring states to increase Medicaid payments to primary care providers to the same rate as Medicare reimbursements for two years. But the trend was short-lived: According to The Daily Beast, only six states are planning to use their own funds to continue those levels of reimbursement in 2015. Colorado, New Mexico, Iowa and Maryland will extend the raise and have expanded Medicaid in their states. Alabama and Mississippi extended the pay increase, but did not expand Medicaid eligibility. Alaska and North Dakota already paid their physicians at a higher rate and the remaining states will fall back to 2012 reimbursement levels.
Want to read more? You may enjoy this story on the 6 states that are extending the primary care pay hike in 2015.