Improve Outcomes & Reduce Costs

Improve Outcomes and Reduce Costs Through Primary Care and Support for Family Physicians

The goal of any healthcare system is to improve the overall health of the patients it serves, and to achieve this goal, the importance of primary care must be recognized and its greater use must promoted. Many studies show dramatic benefits in geographic areas that have higher primary care provider (PCP) use and higher ratios of PCPs per capita.[i]

 A retrospective literature review by Dr. Barbara Starfield found that overall health is better in areas in the U.S. with more PCPs. Areas with higher ratios of PCPs per capita had better health outcomes, including lower rates of all-cause mortality, mortality from heart disease, cancer, and stroke, as well as infant mortality. In addition, areas with higher ratios of PCPs per capita had lower healthcare costs than other areas, possibly due to better preventative care and lower hospitalization rates. This contrasts with areas where there are higher numbers of specialists—characterized by more spending and worse health outcomes.[ii]

 CMS provides reimbursement for several services, including transitional care management,[iii][iv]^, chronic care management,[v][vi] and the Medicare Diabetes Prevention Program[vii][viii], to support the delivery of primary care, improve patient outcomes, and reduce costs. In addition, these programs provide physician payments for care coordination activities, which normally are not covered. Family physicians devote considerable time to ensuring patient care is efficiently and effectively coordinated among specialists and nonphysicians. However, family physicians still face administrative challenges obtaining records and results when there are multiple physicians involved a patient’s care. The timely sharing of this information must be promoted or incentivized. These activities drive down costs for payers and hospital systems, while improving health outcomes for patients. With nearly half of primary care clinicians employed in health systems, attention should be paid to primary care payment methods in such settings.[ix]

ACOFP supports CMS care models that emphasizes the provision of primary care such as the Making Care Primary (MCP) model.  However, the participation of solo, small, and rural physician practices may be limited because of the resources necessary to implement these types of models.  The agency therefore must provide these physician practices with the resources necessary to participate in these models.

 More needs to be done to support family physicians who have upgraded their EHR systems in compliance with federal programs, including QPP, at great expense. Implementing EHR software is both incredibly time-consuming and costly. A 2014 study found that small and rural hospitals were noticeably delayed compared to larger hospitals in terms of EHR implementation rates; further, only 5.8 percent of hospitals were able to meet all of the EHR stage two meaningful-use criteria.[x] Many small, rural, and solo practices are unable to change their EHR system as rules shift annually, so policymakers should consider whether any new EHR requirements will require additional information technology (IT) systems investments. It is essential that federal policymakers do not implement policies that require physicians to invest additional funds in EHR updates, management, and repairs without adequate financial and technical support.

The Commonwealth Fund’s Task Force on Payment and Delivery System Reform recently emphasized that the U.S. will only achieve its goals to create a healthier population with more consistent access to primary care and a more equitable distribution of health care through changes in how and how much primary care is paid. Thus, focusing on primary care physician payment is a critical issue for the future of health care that must be addressed.[xi][xii]

ACOFP also supports measures to increase payments for vaccine reimbursement, as well as resources and regulatory flexibilities for providers administering vaccines—especially due to the costs associated with maintaining COVID-19 vaccines.

 In addition, OMT, a clinically appropriate pain management treatment that can help reduce the need for addictive medications, is a valuable tool that can be used to provide holistic care and treatment to all patients. This underutilized service improves health outcomes and must be protected and made more available to patients.

Advocacy Positions:

• Support primary care models that empower and reward PCPs who focus on preventing chronic illness, managing patients, and appropriately using specialists.
• Educate specialists on the role of PCPs in coordinating care to ensure the patient is receiving high-quality care.
• Support reimbursement policies that reward care provided by family physicians who provide high-quality and improved patient outcomes.
• Ensure physicians are incentivized to perform care coordination activities, which are essential for improved outcomes and reduced healthcare costs.
• Ensure the timely sharing of patient information from specialists to family physicians.
• Appropriately reimburse family physicians through Medicare Part B for the administration of medically necessary vaccines (beyond influenza, pneumococcal, and the hepatitis B virus [HBV]) to reduce COVID-19 and maintain appropriate care coordination.
• Recognize the clinical value and cost savings from physician-led care coordination and establish appropriate reimbursement policies for such activities.
• Equalize reimbursement across settings of care, including rural practices, across state lines, and between primary care and specialty care, to encourage high-quality care.
• Ensure that primary care practices have the resources to obtain and provide the newest technology that assists with improving quality and reducing costs.
• Carefully consider how new federal health program policies will affect EHR systems and provide support to physicians for any new policy that requires changes to existing EHRs.
• Support measures to increase payments for vaccine reimbursement, as well as resources and regulatory flexibilities for providers administering vaccines.
• Protect reimbursement for OMT and encourage OMT to be utilized as a tool to improve patient care.

[i] Shi L. The impact of primary care: a focused review. Scientifica (Cairo). 2012;2012:432892. doi:10.6064/2012/432892

[ii] Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502. doi:10.1111/j.1468-0009.2005.00409.x 

[iii] Centers for Medicare & Medicaid Services. Care Management. Updated January 5, 2023. Accessed January 12, 2023. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Care-Management

[iv] Centers for Medicare & Medicaid Services. Medicare Learning Network. Transitional Care Management Services. 2022. Accessed January 11, 2023. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf

[v] Centers for Medicare & Medicaid Services. Care Management. Updated January 5, 2023. Accessed January 12, 2023. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Care-Management

[vi] Centers for Medicare & Medicaid Services. Medicare Learning Network. Chronic Care Management Services. 2022. Accessed January 11, 2023. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

[vii] Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program (MDPP) Expanded Model. Updated January 5, 2023. Accessed January 11, 2023. https://innovation.cms.gov/innovation-models/medicare-diabetes-prevention-program

[viii] Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program (MDPP) Expanded Model Fact Sheet. Accessed January 11, 2023. https://innovation.cms.gov/files/x/mdpp_overview_fact_sheet.pdf

[ix] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Implementing High-Quality Primary Care. Robinson SK, Meisnere M, Phillips RL Jr, McCauley L, eds. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. National Academies Press; 2021. doi:10.17226/25983

[x] Adler-Milstein J, DesRoches CM, Furukawa MF, et al., More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most, Health Aff (Millwood), 33(9):1664–71 (September 2014). https://www.healthaffairs.org/doi/10.1377/hlthaff.2014.0453

[xi] Commonwealth Fund Task Force on Payment and Delivery System Reform. Health care delivery system reform: Six policy imperatives. 2020. Accessed January 11, 2023. https://www.commonwealthfund.org/publications/fund-reports/2020/nov/commonwealth-fund-task-force-payment-and-delivery-system-reform 

[xii] Hill L, Artiga S. COVID-19 cases and deaths by race/ethnicity: Current data and changes over time. Kaiser Family Foundation, August 22, 2022. Accessed January 20, 2023. https://www.kff.org/racial-equity-and-health-policy/issue-brief/covid-19-cases-and-