Article - Importance of healthcare payment reforms in Primary care

Primary care should always be a public priority for any country. It serves people throughout their lives, for everything from school-mandated health checkups to managing multiple chronic conditions, but it remains inaccessible to many people.

Moreover, Due to the covid-19 pandemic primary care visits have declined significantly and struggled with sufficient cash flow to keep their practices afloat.

According to the National Academies of Sciences, Engineering, and Medicine; high-quality primary care implementation needs urgent significant healthcare payment reform, telehealth capabilities, and team-based care. The report focuses on various aspects such as declining workforce and compensation for primary care.

For example- According to a report, 85 deaths per day are associated with the declining workforce in primary care and when compared with another specialty; Compensation in primary care is typically lower.

Let’s try to understand primary care spending and reforms in the following brief:

The decline in primary care spending

According to the Primary Care Collaborative (PCC), primary care spending across commercial payers decreased to just 4.67 percent in 2019 from 4.88 percent of national healthcare spending in 2017.

Moreover, the COVID-19 pandemic affected primary care practices to face declining revenues, which has led to widespread reductions in workforce and even practice closures.

Unfortunately, the US is moving away from primary care, despite the evidence that it is associated with better value, including enhanced population health, greater equity, and more efficient use of healthcare resources.

However, to improve primary care investment, PCC advised states to consider value-based payment models to enhance their efforts to address health disparities in the spotlight because of COVID-19.

Now let’s understand some healthcare payment reforms in Primary care:

The transition from a fee-for-service payment model to hybrid models 

The Healthcare of the US is progressing rapidly with advancements in technology. Community-oriented, coordinated, team-based care is now possible with the help of new and improved data sharing, consumer-facing healthcare apps, telemedicine, and other capabilities. But fee-for-service does not align with this version of care delivery.

FFS VS The value based care

Fee-for-service (FFS) is a very common payment model wherein physicians and other healthcare providers are paid separately for each unbundled service. Hence providers emphasize the quantity of care (office visits, procedures, tests, treatments, etc.) rather than the quality of care.

While the value based care payment model bills on patient satisfaction and positive outcomes rather than individual services rendered, which also makes the option for bundling payments available. Incentives offered through this model motivate healthcare providers to work together to give longer-lasting, more meaningful care and build closer relationships with their patients.

However, it is needed for an hour that both public and private payers should adopt hybrid models instead of fee-for-service payment models to promote better health outcomes and shift into value-based care as the default payment model.

CMS should revise and increase payment rates for primary care physicians with the help of identifying overpriced procedures and services to cut costs would make this feasible.

As mentioned above NASEM offers insights for primary care in its report which states that high-quality primary care is a common good to improve population health and reduce health disparities. 

Some recommendations from the National Academy of Sciences, Engineering, and Medicine (NASEM) report for primary care are given below:

  • Payers should evaluate and disseminate payment models based on their ability to promote the delivery of high-quality primary care, not short-term cost savings.
  • Payers using fee-for-service models for primary care should shift toward hybrid reimbursement models, making them the default over time. For risk-bearing contracts, payers should ensure that sufficient resources and incentives flow to primary care.
  • CMS should increase the overall portion of health care spending for primary care by improving the Medicare fee schedule and restoring the Relative Value Scale Update Committee (RUC) to its advisory nature.
  • States should facilitate multi-payer collaboration and increase the portion of health care spending for primary care.

Now you have a better understanding of various metrics of primary healthcare and how to deal with them, especially payment factors. If you are still looking for any help for your primary care practice, we are delighted to help you out! You get in touch with us.

Published By - Medical Billers and Coders
Published Date - Jun-16-2021 Back

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