For many Americans, a primary care physician (PCP) represents their first point of contact within the health care system. They rely on their PCP for preventative services, to help them manage chronic conditions, and when necessary, to coordinate across multiple specialists. Primary care at its best is the backbone of a high-quality, efficient health care system. Better continuity in primary care is associated with reduced mortality, lower health care expenditures, and fewer hospitalizations.
But despite the critical role primary care plays in keeping communities and families healthy, for too long we have undervalued and underinvested in it. The way we pay PCPs places the volume of services over the quality of care and patient outcomes. This fee-for-service (FFS) model, the leading way physicians are paid, incentivizes more, and sometimes unnecessary, care; rewarding physicians for providing more services, regardless of the benefit to patients. It also fails to give PCPs the flexibility they need to deliver personalized, high-quality care and to spend time on important work like coordinating care and managing patients’ needs outside of a doctor’s office.
While FFS is the predominant way we pay physicians, it is not the only way. In fact, population-based payment models or hybrid payment structures that blend FFS and capitated payments, give doctors greater flexibility to deliver care that improves patient outcomes yet still holds them accountable for quality and total cost of care.
As we continue to push for payment models that strengthen primary care and other policies that would bolster its role as the foundation for a high-quality, high-performing health care system, learn more about our recommendations and efforts.
- This past spring, Senate Finance Committee Chair Ron Wyden (D‑Ore.) and Ranking Member Mike Crapo (R‑Idaho) released a bipartisan white paper outlining policy concepts for reforming the way Medicare pays physicians, as well as meeting the needs of those with chronic illness in part through more comprehensive primary care. AV made recommendations to improve the way we pay physicians and to bolster primary care by addressing misvaluation in the FFS system and moving towards hybrid, capitated payment. Read the full recommendations.
- In response to the bipartisan Pay PCPs Act, introduced by Sens. Whitehouse (D- R.I.) and Cassidy (R‑La), AV made recommendations for Congress to make hybrid capitated payments the default payment model for primary care, establish an advisory board within the Centers for Medicare & Medicaid Services (CMS) to ensure accurate, balanced payments for primary care, and require CMS to implement accurate and ongoing data collection to improve how services in the Medicare physician fee schedule are valued. Read the full recommendations.
- Earlier in 2024, the Center for Medicare and Medicaid Innovation announced plans to test a new approach to paying PCPs to better support and sustain high-quality, patient-centered care, the ACO Primary Care Flex Model. The model, which aligns with reforms that AV and a diverse set of stakeholders have previously called for, would pay primary care clinicians in certain ACOs prospective, monthly payments that reflect their patient population, also referred to as population-based payments. This approach gives primary care clinicians more stable and flexible payments to enable them to deliver care that is tailored to the needs of patients. Read our full take.
- The U.S. Senate Budget Committee held a hearing this past spring and called on witnesses to testify to the needed reforms in how we pay for primary care and reimbursing PCPs more accurately and appropriately for better patient health. AV submitted a statement for the record and we also shared our three key takeaways from the hearing.
- A shift away from fee-for-service could improve efficiency and provide personalized, high-quality care, read our takeaways from Health Care Value Week and conference with Accountable for Health where health care leaders explored new ways to improve physician reimbursement and continue the move toward alternative payment models.
How we pay our doctors is impacting the care we receive. FFS incentivizes quantity over quality, which is why AV supports increasing the share of individuals in patient-first, population-based payment models that hold providers accountable for the cost and quality of care. By making this shift in how we pay physicians, we can create a more sustainable future for primary care and support personalized, coordinated care for patients.
