Thinking Differently About Payment for Primary Care

Topic Overview

Payment for primary care in the U.S. has been, and continues to be, dominated by a fee-for-service model built on the resource-based relative value scale that underpins the Medicare physician fee schedule. As such, most payment for primary care rewards volume rather the value that primary care brings to the system. However, Medicare and other payers are beginning to experiment with different ways of paying for primary care, especially in the context of the patient-centered medical home. In this forum, an expert panel will review what is known about the challenges associated with paying appropriately for primary care; discuss how ambulatory primary care differs from other ambulatory care; and share what is being learned from paying differently for such care.

Panelists

David Katerndahl, MD, MA

David A. Katerndah is a family physician with a Masters Degree in Education and professor with tenure in the Department of Family and Community Medicine at the University of Texas Health Science Center at San Antonio.

Panel Presentation: Complexity of Ambulatory Care Across Disciplines(12 page PDF)

Jesse 'Jay' Crossen, PhD

Jesse Crosson is a Senior Health Researcher at Mathematica Policy Research in Princeton, New Jersey, where he is currently working on several evaluations of federally-sponsored efforts to transform primary care and reform primary care payment models. Crosson’s research employs a variety of research methods to focus on the implementation and use of health information technologies in primary care settings.

Panel Presentation: Paying for Primary Care: Two CMS/CMMI Payment Experiments(15 page PDF)

Robert Berenson, MD

Robert Berenson is an Institute Fellow at the Urban Institute. He is an expert in health care policy, particularly Medicare, with experience practicing medicine, serving in senior positions in two Administrations. From 1998-2000, he was in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.

Panel Presentation: Why the Medicare Fee Schedule Needs Attention(6 page PDF)