Medicare Will Pay Bonuses for Intensive Primary Care


Medicare will begin rewarding primary care physicians for spending more time with patients and offering services such as late hours and intensive care management beginning next summer, under a new program unveiled Sept. 28.

The Comprehensive Primary Care Initiative aims to pay primary care physicians for services that they currently might not have time to provide or aren’t getting paid for – such as creating a care plan, reviewing test results on the phone, or helping patients closely manage cholesterol or weight, Dr. Richard Baron, director of the seamless care models group at the Centers for Medicare and Medicaid Services (CMS), said during a telephone briefing with reporters.

Some physician groups welcomed the announcement. The initiative "offers enormous potential to promote the kind of personalized and coordinated care that patients seek and that physicians want to deliver," Dr. Steven Weinberger, executive vice president and chief executive officer of the American College of Physicians, said in a statement. The program "will provide primary care physicians with the support needed to work hand-in-hand with patients toward a shared goal of ensuring high-quality care while making the most efficient use of health care resources."

The initiative is being funded by the Affordable Care Act, and is part of the plan to overhaul how health care is delivered and reimbursed, Dr. Baron said.

"Instead of being paid for doing more procedures and squeezing more patients into each day, primary care practices will receive payments for being accessible after hours or using electronic health records to make sure care is well coordinated," Health and Human Services Secretary Kathleen Sebelius said during the briefing. "For patients, it means valuable extra time with their doctors, to understand their conditions and talk about how to lead healthier lives."

The program aims to recognize the ability of primary care to lower costs and improve health outcomes, Dr. Baron said. Some insurers and self-insured companies have started making similar payments for enhanced primary care services.

Dick Wilkerson, chairman and president of Michelin North America, said that his company has seen a huge decrease in health costs by covering 100% of preventive care services and 100% of care for people with chronic conditions, as well as making primary care services available on-site at two of its major facilities. Primary care physicians are required to spend a minimum of 20 minutes with each Michelin patient, he said.

The company has had a big reduction in emergency department visits, hospitalizations, and high-cost claims, he said.

WellPoint has also been testing bonus payments and coordinated care models in nine of its Blue Cross Blue Shield plans, said Dr. Sam Nussbaum, WellPoint chief medical officer. Participating medical practices offer on-site care managers and 24/7 access for members. There has been a 4%-6% reduction in hospitalizations, rehospitalizations, and emergency department visits, he said.

Medicare is hoping to build on examples like this by enticing more companies and payers – including employer-sponsored plans and state health plans – to join the Primary Care Initiative, Dr. Baron said.

Medicare’s efforts may also make it easier for physicians, Dr. Baron said, noting that many were reluctant to change the way they practice for a single insurer that might account for a small percentage of their patients.

ACP’s Dr. Weinberger said that bringing other payers on board was key. "Aligning support from multiple payers will provide a more realistic evaluation of these innovative payment and delivery reforms than earlier, more limited efforts," he said.

The agency is seeking letters of intent from private insurers and other payers by Nov. 15; final applications are due by Jan. 17. After the CMS has identified the markets where there will be a critical mass of Medicare and private pay patients covered by the incentives, the agency will solicit participation from primary care physicians.

The aim is to be in five to seven markets with 75 physician practices participating.

Physicians who meet the program goals will be eligible to receive $20 per Medicare beneficiary per month for the first 2 years of the program. The payment will be reduced to $15 for the second 2 years.

It will be up to the practices to determine how they can best manage patients for that incentive, said Dr. Richard Gilfillan, acting director of the CMS Innovation Center. But, he and Dr. Baron noted that the CMS will be available to help physician practices with data and other support to make the initiative work for them.

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