Legislators can reduce health care costs and improve the nation’s health by taking specific steps to invest more in primary care, a past AAFP president testified in a May 20 congressional hearing.
Steven Furr, MD, FAAFP, told the House Committee on Energy and Commerce’s Subcommittee on Health how patients at his Jackson, Alabama, clinic—and doctors and patients throughout the country—are harmed by an outdated Medicare physician payment system that needs urgent reform.
“Payment for physicians is on an increasingly unsustainable path,” Furr said in a written statement submitted in advance of his testimony. “If we think health care costs are out of control now, it will only get worse unless Congress acts to ensure that the work we do is adequately compensated and keeps pace with the actual costs required to deliver care.”
Medicare payment lags behind physicians’ rising costs
As it stands now, the Medicare physician fee schedule overvalues procedural care from more narrow medical specialties. Current budget neutrality requirements passively devalue primary care as new, narrow procedural codes are added.
“This devaluation has led to lower compensation for primary care physicians who specialize in treating the whole person compared to our specialist peers,” Furr wrote, “despite the vital role we play in managing chronic conditions and coordinating patient care across a large team—and despite the fact evidence has shown that primary care office/outpatient evaluation and management visits are more complex and comprehensive than those delivered by other specialties.”
“Health systems that invest more heavily in primary care consistently achieve better population health outcomes, lower rates of hospitalization and emergency department use, and lower overall health care spending.”
Primary care investment improves health and lowers spending
“Evidence has shown that health systems that invest more heavily in primary care consistently achieve better population health outcomes, lower rates of hospitalization and emergency department use, and lower overall health care spending,” Furr told legislators.
Despite this, Medicare devotes only a small fraction of total health care dollars to primary care.
Reduce administrative burden with primary care APMs
Existing payment policies also create administrative burdens that steal time from actual patient care and don’t reflect the true value of primary care.
The traditional fee-for-service model forces physicians to document numerous discrete services, ignoring how the comprehensive nature of primary care spans everything from preventive care to chronic care management, integrated behavioral health and acute illnesses.
Alternative payment models (APMs) could help, but continuous cuts to Medicare fee-for-service payments mean it’s impossible for most practices to make the necessary investments that would let them move to APMs.
First steps to reinvest in primary care
Furr outlined for legislators four initial steps toward better primary care that the AAFP has been advocating for:
Implement annual physician payment updates based on inflation.
Reform Medicare’s budget neutrality requirements.
Make quality measures more meaningful to physicians and patients.
Waive patient cost-sharing barriers to chronic care management services.
Focus on prevention, not procedures
Overall, health care payment reform must reward prevention, care coordination and long-term patient relationships rather than the volume of services delivered.
“We need to pay family physicians for preventing disease, not incentivizing the delivery of more services to treat it,” he told lawmakers.
Speak Out for primary care investment
It’s essential that Congress understands how reforming Medicare payment will help family physicians improve the health of their patients and communities with better outcomes at lower overall costs.
You can add your voice to advocacy for greater investment in primary care by calling or writing your legislators through the Academy’s Speak Out tool.