New Medicare Payment Model For Primary-Care Physicians

On Monday, the Centers for Medicare and Medicaid (CMM) announced that it will soon test a new payment model for primary-care physicians who treat Medicare patients.

CMM’s should last five years. It will include about 20,000 physicians and 25 million patients.

The new model shifts away from the much-criticized ‘fee-for-service’ system to one that encourages paying for actual patient health outcomes.

Doctors will receive monthly ‘care management fees’ that will give them more freedom to deliver care that is appropriate to their patients, instead of having to rely exclusively on fees for each service they provide an individual patient. This means that doctors will be rewarded for producing better results for their patients.

In other words, the government is essentially saying, “take care of your patients the way you think is most effective, and you’ll be rewarded for good outcomes.”

Doctors will be incentivized to participate in this new program. Physicians participating in the current reimbursement model will receive an average of $15 per beneficiary. Those participating in the new test model will receive an average of $28 per beneficiary. “Doctors will receive lower fees than those in the first track for each service” according to CMM.

Physicians who take part in the new program must “commit to offering patients preventive care, support for chronic illnesses and 24-hour access to health care and health information. We think there will be a high level of interest across states and regions among primary care providers. … The model aligns with how doctors and patients want to practice medicine.”


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