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Primary problems and medical homes

I suppose only in Washington could a panel meet to discuss ways to increase payment for primary-care services, but be forbidden to attach a dollar amount to those figures.The American Academy of Family Physicians-convened primary-care valuation task force met in our nation's capital Jan. 24, discussed the findings of its various work groups and prepared to write a report to present to the AAFP board in March. That's what AAFP President Dr. Glen Stream told me just before getting on plane for a Washington-to-Washington flight (from D.C. to his Spokane home).

Stream, who described himself as "an optimistic person by nature," said the meeting was attended by different stakeholders, payment experts and representatives from the American Academy of Pediatricians, the American College of Physicians and the American Osteopath Association.

"This is still in the methodology phase," Stream said, noting that task force was launched from a foundation acknowledging that primary care has been historically undervalued and has become increasingly complex. That's especially true as the field adopts the patient-centered medical home practice model.

The panel's work has focused on developing metrics to assign values to evaluation and management services and other activities that come under the umbrella of "non-face-to-face visits.".

This becomes complicated in that, when physician groups meet to assign dollar values to these tasks, this could be determined to be price-fixing by the Federal Trade Commission. Also, although the idea of paying for telephone and e-mail consults with patients has also been suggested by the AMA/Specialty Society Relative Value Scale Update Committee (better known as the RUC), there is concern that the CMS will determine that paying for physician-patient phone calls will only incentivize providers to spend a lot of time chatting on the phone.

There is also the danger that documenting these episodes may prove more trouble than it is worth. But Stream said the task force sees paying for these tasks as an intermediate step and that practices should have the option to decide for themselves whether the reimbursement is worth the hoop-jumping they'd have to engage in to collect payment.

Stream said AAFP envisions a process of stepping gradually toward a blended payments system that supports practices operating as medical homes. This would include a continued-but-slowly-diminishing-in-importance fee-for-service component, a care-management fee (most likely on a per-member, per-month basis) and a pay-for-performance component that rewards outcomes.

And while any payment boost would surely be welcomed by today's primary-care practitioners, Stream said, the aim is to narrow the primary-care-subspecialty compensation gap that serves as a disincentive for medical students to choose a primary-care career.

"It's a workforce issue," Stream explained. "The amount of payment coming to primary care isn't adequate enough to support student interest."

Follow Andis Robeznieks on Twitter: @MHARobeznieks.
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