Primary care major focus in CMS’ 2017 Medicare proposal

Care team

The Centers for Medicare & Medicaid Services is putting its money where its mouth is, placing primary care at the forefront when it comes to the proposed changes in the Medicare physician fee schedule released this week, write two top officials from the agency in a blog post yesterday.

"In the United States, we have historically invested far more in treating sickness than we do in maintaining health," wrote CMS Acting Administrator Andy Slavitt and Patrick Conway, M.D., acting principal deputy administrator and chief medical officer.

That is changing as the government puts a value on primary care and care coordination to keep people well and lower healthcare costs, they said. “The road to a better healthcare system means correcting this imbalance. We should reinvest in what we value--primary care--as a practice, as a profession, and as an abundant resource for patients,” the two officials wrote.

The proposed changes will improve how the government pays primary care physicians, mental health specialists, geriatricians, and other clinicians, they said, estimating the changes will result in about $900 million in additional funding in 2017 to physicians and clinicians providing these services. Over time, the increase could be as much as $5 billion in additional funding for care coordination and patient-centered care by fully providing services to all eligible beneficiaries, they said.

They highlighted the following changes under the proposed rule:

  • An increase in primary care provider payments for routine office visits involving patients with mobility-related disabilities, with payment increasing from $73 to $119 per visit.
  • An increase in payments to geriatricians and family physicians, with an anticipated 2 percent increase in payments. "Over time, if all of the practitioners that can provide these services provide them to all eligible patients, we estimate that the payment increase could be as much as 30 percent and 37 percent, respectively, to these specialties,” the two officials said.
  • Payment for mental healthcare using the behavioral health Collaborative Care Model, which supports a team-based approach involving a psychiatric consultant, a behavioral health care manager and a primary care clinician.

Diabetes prevention is also a focus in the proposed fee schedule. The rule proposes policies to expand the Diabetes Prevention Program within Medicare starting January 1, 2018. This is the first time a preventive service model from the CMS Innovation Center would be expanded into the Medicare program, according to a CMS announcement and fact sheet. The proposed rule, which will be published next week in the Federal Register, is open for comment until September 6.

- read the blog post
- check out a CMS announcement
- find a fact sheet
- check out the proposed rule