CMS Proposes Increased Primary Care Payments, Diabetes Prevention Support

Categories: Policy

The Centers for Medicare and Medicaid Services (CMS) is proposing significant changes to the physician fee schedule that are expected to benefit primary care practitioners (PCP). The proposed changes increase Medicare payments for PCPs serving patients with multiple chronic conditions, behavioral health issues, cognitive impairment, or mobility-related impairments. CMS expects the changes to result in an additional $900 million in reimbursement in 2017 and more than $5 billion annually for PCPs if fully implemented for all eligible beneficiaries.

“By better valuing primary care and care coordination, we help beneficiaries access the services they need to stay well, in addition to keeping people healthy, health care costs are lower when people have a primary care provider and team of doctors and clinicians overseeing and coordinating their care.”

-Andy Slavitt CMS Acting Administrator and Patrick Conway, MD

CMS Acting Principal Deputy Administrator and Chief Medical Officer (From blog post By Andy Slavitt)

In addition, CMS is proposing paying for the Diabetes Prevention Program (DPP) for Medicare beneficiaries. A proven intervention, the DPP aims to prevent the onset of diabetes for pre-diabetic individuals through dietary coaching, lifestyle intervention, and moderate physical activity. In 2016, the CMS Office of the Actuary certified that expansion of the DPP to the full Medicare program would reduce net Medicare spending.

PCDC is reviewing the CMS rule to determine its likely effect on primary care reimbursement and delivery. We encourage others to review the proposal as well.

Read the full summary of the proposed rule by the American Academy of Physicians here.