The End of Fee For Service? 

If there was any doubt that the fee for service model of health care payments is on its last legs, CMS’ launch of the Comprehensive Primary Care Plus on April 11th should end them.  The goal of the plan is to avoid the old fee-for service problem in which interventions, as opposed to the health of the patient, were incentivized by the payment model.  The new plan, according to Politico, tries to incentivize physician practices to keep the patients healthy without tying their revenue to specific medical tests or procedures:

“They will be required to give patients 24-hour access to care and information, and to meet various metrics for managing and coordinating care. Otherwise, though, they can treat their patients just about however they want, and their reimbursements will no longer depend as heavily (and in some cases not at all) on the protocols they follow or tests they administer. They will receive more money up front, and if they help keep their patients healthier, they can receive extra money on the back end.”

And according to CMS there will be two tracks:

 “In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter.”

Clearly the idea is to get practices to think creatively about how to keep patients healthy outside of the traditional visit.  This is similar to what New York Hospitals are wrestling with under the state’s DSRIP program. What is interesting to us at Doctors Council is what this means for the work of the physician.  What is the physician’s role in the future of primary medicine as care moves away from the face to face encounter?

We believe the doctor has a vital leading role in the new approach that will have to be created to operate under new systems of care envisioned by CMS and the NYS Department of Health.  The question of how that transition will take place and the role of the doctor is a critical question in medicine today.

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