Federal Policy Updates

PCC joined more than 800 health care associations, accountable care organizations (ACOs), medical practices, and health systems to urge Congressional leaders to extend incentive payments meant to encourage participation in risk-bearing alternative payment models (APMs), in a letter released on September 28, 2022. Those incentives expire at the end of the year unless Congress acts.

Congress in 2015 created a 5 percent incentive payment to support  new payment models. While there are nearly 300,000 clinicians expected to receive the incentive this year, that number is far below Congressional expectations when the incentives were established. Therefore, the letter calls on lawmakers to extend the incentives to allow more time for a greater number of practices to move into APMs, which have shown an ability to improve quality and lower overall cost of care. 

Failure to renew the incentives could deter participation in a range of primary care payment reform initiatives, including the Primary Care First, state primary care payment reform initiatives like the Maryland Primary Care Program, the Medicare Shared Savings Program, and private sector primary care initiatives. “Ending these important incentive payments would discourage future participation in models that have seen growing uptake in recent years,” the letter states. “The incentive payments...provide additional resources that can be used to expand services beyond traditional fee-for-service.” 

Read the full letter here.

PCC and the Better Health – NOW Campaign support key provisions of the Telemental Health Access Act discussion draft
 
Telehealth technologies have the potential to contribute to safe, high-quality primary care particularly if utilized in coordination with an individual’s medical home. PCC and the Better Health – NOW Campaign support key provisions of the Telemental Health Access Act discussion draft including those described below:

• PCC supports removing the requirement for in-person visit for tele-mental health visits and leaving the decision of the appropriate modality of tele-mental health care to the professionalism and training of the care team and the patient.
• PCC supports provisions enabling primary care practices to rely on audio-only telemental health services beyond the pandemic.
• PCC urges the Committee to work with CMS to limit the burden on practices associated with any modifier.
• PCC supports requiring the Secretary of HHS to issue guidance on provision of Medicare telehealth services for individuals with limited English proficiency.

Medicare Advantage (MA) Is growing part of Medicare and influencing new primary care models. In a August 31st response to a recent CMS Request for Information , PCC’s Better Health-NOW Campaign called for policy changes that reform both how much we invest in primary care as well as how we pay for it – to assure everyone has access to primary care they can trust. PCC’s letter:

• Measure primary care spending and its impact on Medicare Advantage beneficiary outcomes.
• Improve CMS capacity to collect, standardize, report, and where practicable and effective, stratify data to facilitate comparisons across all parts of Medicare (traditional fee-for-service, ACOs/MSSP, and Medicare Advantage).
• Use plan design and payment reform to encourage proactive care and to remove cost and other barriers to beneficiaries accessing preventive care, integrated behavioral health care and chronic care.
• Encourage MA plans to use primary care payment reform and investment to drive practice level innovation, support comprehensive primary care, and reduce administrative burden, as recommended in the 2021 National Academies of Science, Engineering, and Medicine (NASEM) report, Implementing High-Quality Primary Care.
• CMS should use a small, robust, valid set of quality measures and incentives that reflect the contribution of primary care. Quality measurement should facilitate comparison across all parts of the Medicare program. Performance incentives should reward both high achievement and improvement in beneficiary outcomes and experience of care in all communities with respect to behavioral and physical health.

Read the full letter here.

On August 1st, the Primary Care Collaborative's Better Health - NOW Campaign submitted consensus recommendations to shape a forthcoming federal Action Plan to Strengthen Primary Health Care - now under development by the Office of Assistant Secretary of Health, Admiral Rachel L. Levine, MD.

Review the Campaign’s comments on the new HHS Primary Care Initiative attached below.

Read the full letter here.