Code to reproduce results of:
Potential Implications of Changes in Medicare Payment for Office Visits on Primary Care
Sanjay Basu, MD, PhD,1,2,3 Zirui Song, MD, PhD,1,4,5 Russell S. Phillips, MD,1,6 Asaf Bitton, MD, MPH,1,4,7,8 Bruce E. Landon, MD, MBA1,4,6
1 Center for Primary Care, Harvard Medical School 2 Research and Analytics, Collective Health 3 School of Public Health, Imperial College London 4 Department of Health Care Policy, Harvard Medical School 5 Department of Medicine, Massachusetts General Hospital 6 Division of General Medicine, Beth Israel Deaconness Medical Center 7 Division of General Medicine, Brigham and Women’s Hospital 8 Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health
Primary care is conceptualized as accessible, timely, first-contact care that is comprehensive, coordinated, and longitudinal.1 Primary care in the U.S., however, often falls short of these goals. Many have attributed this to a payment system that underpays services provided by primary care physicians (PCPs) and primary care teams, including non-visit based care.2 In addition, relatively few medical students choose primary care which, along with the retirement of older PCPs, may lead to an insufficient workforce for an aging population.3 In response, proposals to pay primary care more are being considered, including several by states aiming to raise the share of total health care spending on primary care to 7-12%.4,5
Recently, the Centers for Medicare and Medicaid Services (CMS) finalized the first major change to primary care payment in the Physician Fee Schedule in decades, which raises fees for evaluation and management visits and lowers documentation requirements beginning in 2021.6 We sought to estimate the potential impact of this policy on primary care spending and the extent to which it might approach targeted levels.4 In addition, we simulated the potential implications of the reduced documentation requirements on time use in primary care practices.
References
- Institute of Medicine (US) Committee on the Future of Primary Care, Donaldson MS, Yordy KD, Lohr KN, Vanselow NA. Defining Primary Care [Internet]. In: Primary Care: America’s Health in a New Era. National Academies Press (US); 1996 [cited 2019 Aug 9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK232631/
- Basu S, Phillips RS, Song Z, Bitton A, Landon BE. High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care. Health Aff [Internet] 2017;36(9):1599–605. Available from: http://dx.doi.org/10.1377/hlthaff.2017.0367
- Petterson SM, Liaw WR, Tran C, Bazemore AW. Estimating the residency expansion required to avoid projected primary care physician shortages by 2035. Ann Fam Med [Internet] 2015;13(2):107–14. Available from: http://dx.doi.org/10.1370/afm.1760
- Koller CF, Khullar D. Primary Care Spending Rate — A Lever for Encouraging Investment in Primary Care [Internet]. New England Journal of Medicine. 2017;377(18):1709–11. Available from: http://dx.doi.org/10.1056/nejmp1709538
- Primary Care Investment: State Policy and Spending Maps | Milbank Memorial Fund [Internet]. Milbank Memorial Fund. [cited 2019 Dec 9];Available from: https://www.milbank.org/programs/primary-care-spend/other-resources/
- CMS-1715-F | CMS [Internet]. [cited 2019 Dec 2];Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1715-F