Providers want CMS to create new payment methods to boost primary care

A collection of nearly 30 provider groups wants the Biden administration to combine fee-for-service and prospective payments to primary care doctors to bolster the workforce. 

The groups wrote a letter to officials with the (PDF) Centers for Medicare & Medicaid Services (CMS) on the need for such a hybrid payment model. The missive comes as CMS has tried in recent months to get more rural and primary care providers invested in value-based care, including offering upfront investments to new entrants in models. 

“All communities—especially those that are disadvantaged or underserved—face lapses in preventive care, unmanaged chronic conditions, skyrocketing mental health and substance use issues, and emerging health challenges associated with long COVID,” according to the letter led by the National Association of Accountable Care Organizations, AMGA, the American Academy of Family Physicians and the Primary Care Collaborative.

The groups added that “time is of the essence” to implement strategies to bolster the primary care workforce.

A hybrid payment system should be applied to the Medicare Shared Savings Program, a model that seeks to pay providers on a prospective basis. ACOs that are part of the program agree to abide by quality and spending benchmarks and get a share of any savings but must repay Medicare for missing such targets.

Hybrid payments have been explored over the past decade through various models, most notably the Comprehensive Primary Care Plus program launched in 2017. One of the tracks in the model enables a physician to get normal fee-for-service payments alongside performance-based payments. 

However, it has been difficult for primary care providers to transition to such hybrid methods, and physicians in some models had issues finding “the time or resources necessary to fully implement desired changes, even with multi-payer models,” according to a 2021 report from the National Academies of Health. 

“Alternative payment models need to have stronger incentives to counter [fee-for-service], and multi-payer participation with more substantial shifts away from [fee-for-service] towards risk-based contracting can help achieve this,” the report said. 

The groups said that CMS must include certain principles within the hybrid payment, including embedding health equity, which has become a major priority for the Biden administration. 

Such a hybrid payment must also offer cost-sharing relief “from any services covered by the per-beneficiary payment,” the letter said.

CMS should adopt the hybrid payment across the country starting in 2025 with “no limited window for new participants and no geographic restrictions on participation.”

The letter comes as the primary care workforce has been struggling in recent years due to underinvestment and worker shortages. A recent primary care scorecard found that a chronic lack of support has strained primary care and that spending on such care has declined slightly across all types of insurance from 2010 to 2020.