Reforming the Payment System for Primary Care

eAlert 62898e61-844b-4b4c-b1a7-58d61e2dba63

<p>High-quality, readily available primary care is critical to keeping America healthy and productive. Yet the number of practicing primary care physicians is likely to decline sharply in coming years, as medical school graduates increasingly choose specialty fields.<br><br>Laying much of the blame on "dysfunctional payment systems that discourage proper delivery of primary care," a group of leading health policy experts propose replacing the current encounter-based system with a per-patient payment system--and offering new incentives for physicians to provide effective and efficient primary care.<br><br>The <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=27351&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D469545%26%23doc469545">new payment model</a>, described in the March issue of the <em>Journal of General Internal Medicine,</em> was developed by Alan H. Goroll, M.D., of Massachusetts General Hospital, Robert Berenson, M.D., of the Urban Institute, Stephen C. Schoenbaum, M.D., of The Commonwealth Fund, and Laurence B. Gardner, M.D., of the University of Miami School of Medicine. According to the authors, paying physician practices to deliver coordinated, well-organized primary care is a good way to reduce the need for hospitalizations and other costly services and ensure a healthier and more productive workforce.<br><br>In an <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=27352&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D469503%26%23doc469503">editorial</a> published today in the <em>New England Journal of Medicine,</em> Fund president Karen Davis explores alternatives to the current fee-for-service payment system, which she says is a barrier to effective, coordinated, and efficient care.<br><br>Davis examines new approaches that base payment on the total care a patient receives during an episode of illness or a defined period. Creating a global fee for "care episodes," she says, would properly reward providers who provide effective, lower-cost care. She also discusses how physician payments could be tied to care provided within a patient's "medical home," rewarding coordination and efficiency and slowing the escalating costs of health care.</p>