January 20, 2017

MedPAC Targets Specialty Reimbursement

The Medicare Payment Advisory Commission (MedPAC) considered options at its Jan. 13 meeting for raising Medicare payments for primary care physicians while reducing reimbursement for specialty physicians.

A session, entitled Next Steps in Primary Care, picked up on previous MedPAC discussions concerning a discrepancy between primary care physician and specialty physician reimbursement. MedPAC staff proposed three options, with one proposing a 1.3 percent reduction in payments for non-primary care services, including procedures, imaging, tests, and evaluation and management services provided in emergency departments and inpatient hospitals. This reduction would be used to pay primary care providers an additional per-beneficiary payment estimated to total approximately $3,600 per clinician per year. Under this policy, radiologists would be among a large group of specialty physicians subjected to a 1.3 percent payment reduction.

The MedPAC commissioners expressed concern about the possibility of a future shortage of primary care physicians to treat Medicare patients if the current physician payment imbalance is not addressed.

The recent expansion of health care access to millions of Americans through the Affordable Care Act has separately contributed to a widely reported shortage of primary care and family practitioners for non-Medicare patients.

Despite concerns, MedPAC commissioners were largely unsupportive of the proposed options, which they believe would have minimal impact on primary care reimbursement. Instead, most commissioners favored a complete overhaul of the Medicare Physician Fee Schedule.

MedPAC Chairman Francis “Jay” Crosson, MD, emphasized the commission’s goal of supporting policies that would reverse the negative trend for primary care payments. He indicated his preference for the commission to take action in the short term to reduce the discrepancy while recognizing the long-term goal of revisiting the fee schedule.

MedPAC will continue to explore this issue in future meetings, and the ACR staff will remain engaged as the Commission moves forward in developing specific recommendations for Congress.