The Primary Care Payment System Needs Reform – It’s a Rare Area of Bipartisan Agreement

Primary care is underserved, undervalued, and chronically shortchanged by the U.S. health care payment system. By neglecting the foundation of care most people use to enter the health care system, policymakers jeopardize the entire health care ecosystem. But re-energized bipartisan efforts to make necessary changes, such as the Pay PCPs Act championed by Senators Sheldon Whitehouse (D-RI) and Bill Cassidy (R-LA), are core efforts health care advocates can get behind.

On Tuesday, September 22, Families USA hosted a bipartisan Capitol Hill briefing, Paying for Health, Not Just Health Care: Primary Care Reimbursement and the Future of Payment Reform, highlighting the reintroduction of the bill and uplifting the promise of payment reform.

Families USA's Managing Director of Health Care Policy, Sophia Tripoli was joined by Primary Care Collaborative's Senior Campaign Director, Katie Comando, Committee for a Responsible Budget's Director of Health Policy, Anna Bonelli, and NAACOS Senior Director of Legislative Affairs, Robert Daley, to discuss long-standing issues with poorly designed incentives in our current payment system and lay out the key features of a reformed system to drive lower costs and improved population health.

From left: Robert Daley (NAACOS), Anna Bonelli (Committee for a Responsible Federal Budget), Sophia Tripoli (Families USA), Katie Comando (Primary Care Collaborative) and Sarah Coombs (National Partnership for Women & Families).

"The Pay PCPs Act is so important because it's making the structural change that we need to make in how we're paying for care. It's not the endpoint, but it's a very important next step, particularly for primary care, to fundamentally change and get to a payment reimbursement system that is more accountable for costs and quality and outcomes," Tripoli said at the briefing.

"We are very excited about this proposal that dropped this summer and we will continue to keep the drum beat up on primary care in the next few months ahead and the next Congress," said Senator Whitehouse's Senior Health Policy Advisor Allison Crha, who shared opening remarks.

The hybrid population-based payment models included in the Pay PCPs Act and similar legislation would, if enacted, begin to transform primary care payment and help achieve a more sustainable and accountable health care system for consumers, taxpayers, and the federal government. The legislation would create a population-based hybrid payment system - one that combines both up-front, capitated payments and traditional fee-for-service payments - into the Medicare physician fee schedule, waives 50% of cost sharing and sets up a technical advisory committee tasked with informing updates to physician payment rates. The Pay PCPs Act would strengthen primary care payment by shifting away from broken, volume-based fee-for-service economics toward a system that pays primary care providers for what they do best: effectively managing the health and health conditions of their patients.

Bipartisan energy for reform doesn't end with the Pay PCPs Act. On the House side, Reps Joyce, Murphy and Schrier introduced the Patients First Act, which attempts to tackle entrenched issues in Medicare physician payment, including unstable payment updates, chronic underinvestment in primary care, and excessive rates of administrative burden. Notably, the bill includes the development of a pilot hybrid primary care program- a less permanent and more limited version of the model included in the Pay PCPs Act. While Families USA has concerns with their alternate approach, explained in further detail in our RFI, it's telling that more and more policymakers on both sides of the aisle are working to advance solutions to try to improve primary care payment.

Improving health care affordability, quality, and accessibility are critical goals that simply cannot be achieved without a primary care payment system that incentivizes those outcomes. It's vital that advocates support the Pay PCPs Act and similar strong reform efforts to ensure a better health care system as the new Congress takes shape in January.

Families USA offers additional recommendations and analysis on our website, familiesusa.org/resources.