CMS releases Medicaid primary care physician payment rule
Posted on November 6, 2012 | No Comments
Last week, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to implement increased payments to primary care physicians for specified Medicaid services, as forwarded by the Affordable Care Act (ACA). Under the ACA provision, certain physicians who provide eligible primary care services will be paid the Medicare rates (as opposed to the Medicaid rates currently in place) in 2013 and 2014. The payment increase applies to primary care services delivered by family medicine, general internal medicine, or pediatric medicine physicians or related subspecialists. States will receive 100 percent federal financial participation (FFP) for the difference between the Medicaid state plan payment amount as of July 1, 2009, and the applicable Medicare rate.
The rule includes information about the identification of eligible providers and services, how to meet the requirements when making these payments for managed care services, and how this policy applies to the Vaccines for Children (VFC) program.
- Private entities generally measure performance and make incentive payments at the physician-group level rather than at the individual-physician level. Physician organizations favor this approach.
- Private entities use nationally endorsed performance metrics and noted the need for a standardized set of metrics across all payers. Physician organizations concur that a standardized set of metrics would be less administratively complex.
- Most private entities in GAO's study provide financial incentives tied to meeting absolute benchmarks--fixed performance targets--or a combination of absolute benchmarks and performance improvement. Physician organizations prefer incentives tied to absolute benchmarks over those based on how physicians perform relative to their peers. Physician organizations also favored incentives that reward improvement because baseline levels of performance vary.
- While private entities' incentive payments vary in size and in method, private entities typically provide such payments within 7 months of the end of the performance measurement period. Physician organizations stated that financial incentives should be distributed soon after the measurement period to have the greatest effect on performance.