Payment Reform

The Patient Protection and Affordable Care Act (H.R. 3590) contains several provisions that strengthen primary care through payment and otherwise incentivize payment reform. These include a 10 percent Medicare payment bonus to primary care practitioners beginning in 2011, a requirement that Medicaid payment rates to primary care physicians for furnishing primary care services be no less than 100 percent of Medicare payment rates in 2013 and 2014 and the provisions related to Accountable Care Organizations (ACOs).

The Joint Principles
The Joint Principles of the Patient Centered Medical Home [Link to the following content:  Principles.PDF] requires recognition, in the form of payment, for the added value and services offered in the PCMH. CAFP strongly supports this position.
Click here for The Joint Principles provisions related to payment.
Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home. The payment structure should be based on the following framework:

• It should reflect the value of physician and non-physician staff patient-centered care management work that falls outside of the face-to-face visit.
• It should pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources.
• It should support adoption and use of health information technology for quality improvement.
• It should support provision of enhanced communication access such as secure e-mail and telephone consultation.
• It should recognize the value of physician work associated with remote monitoring of clinical data using technology.
• It should allow for separate fee-for-service payments for face-to-face visits. (Payments for care management services that fall outside of the face-to-face visit, as described above, should not result in a reduction in the payments for face-to-face visits).
• It should recognize case mix differences in the patient population being treated within the practice.
• It should allow physicians to share in savings from reduced hospitalizations associated with physician-guided care management in the office setting.
• It should allow for additional payments for achieving measurable and continuous quality improvements.]

 
ACOs
An explanation of the provisions related to ACOs and a timeline for the rollout (PDF).

The AAFP has developed a set of principles on Accountable Care Organizations (PDF) that is available here.

The California Association of Physician Groups has made available a policy brief on implementing ACOs (PDF).

Deloitte has produced an analysis of ACOs (PDF) and their ability to drive payment reform.