An analysis explores the two reform methods the Centers for Medicare & Medicaid Services is using to address underpayment for primary care in Medicare: new primary care billing codes and demonstrations.
Lower incomes for primary care practitioners relative to specialty practitioners contribute to shortages of primary care physicians in many areas of the country. The Centers for Medicare & Medicaid Services (CMS) is addressing this and working to improve care through a two-pronged reform strategy that aims to modernize Medicare payment for primary care.
CMS is using two distinct strategies to address underpayment for primary care:
New billing codes incentivize specific activities that CMS already knows it wants clinicians to engage in.
Demonstrations test whether CMS can achieve favorable outcomes by paying for promising new care delivery approaches.
Medicare is the nation’s largest and most influential insurer, and how CMS decides payments has a large impact on practitioners. CMS is using new billing codes and demonstrations to achieve higher value in care, and this two-pronged approach allows CMS to incentivize specific activities known to work while testing promising new services.
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