CMS states it wants to increase pay to primary care physicians. And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself. In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems are moving to outcome and value measures, the revenue for most primary care practices continues to be fee-for-serviced based, and alternate payment models (APM) are built on top of fee-for-service.
Some of the new services defined by CPT HCPCS codes haven’t pleased primary care physicians, either because of the definition of the services or the payment for them. Working with and listening to primary care physicians, I think that some of these services can be embraced, and some should be ignored, for the time being. I’m an advocate of implementing Medicare wellness visits and transitional care management services into primary care and setting aside chronic care management for most practices. Advance care planning will be relevant in selected practices, but not all. And many other prevention services just don’t pay enough.
There can be significant variation in work RVUs per encounter (or revenue per encounter) within a group. When I look at this variance, some of it comes from differences in level of service reporting, but more is from the use of wellness visits and transitional care management.
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