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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: The proposed schedule decreases conversation factors for qualifying and nonqualifying alternative payment models. It also would move primary care closer toward hybrid payment system. CMS recently issued its proposed 2027 Medicare Physician Fee Schedule. The proposed schedule includes a 0.75% increase to the qualifying alternative payment model (APM) conversion factor and a 0.25% increase to the nonqualifying APM conversion factor.
But because the Working Families Tax Cut Act provided a 1-year conversion factor increase of 2.5% for the 2026 PFS \u2014 which does not apply to the 2027 PFS \u2014 current law requires a 2.5% decrease in Medicare payments compared with 2026. Therefore, CMS said the proposed qualifying APM conversation factor of $33.17 for 2027 is a projected reduction of $0.40 (\u20131.19%) from the current $33.57 conversion factor. The proposed non-APM conversation factor of $32.84 is also a projected decrease of $0.56 (\u20131.68%) from the current $33.40 non-APM conversion factor. CMS also proposed: reducing payment \u201cwhen a separately identifiable office\/outpatient evaluation and management visit is furnished by the same physician (or a physician in the same practice) on the same day as a 0-, 10- or 90-day global procedure\u201d; moving away from relying on AMA surveys to determine practice expenses; and requirements for supplying, reporting and reimbursing remote therapy monitoring and remote physiologic monitoring. Healio spoke with Ann Greiner, MCP, president and chief executive officer of the Primary Care Collaborative, about the positives, concerns and implications of the proposed rule. Healio: What is encouraging, or concerning, to you about the proposed 2027 PFS? Greiner: I think it builds on things that the administration did last year that helped to make a more sustainable path for primary care and help beneficiaries get the care that they need. There\u2019s a lot that\u2019s positive, and there\u2019s a number of requests for information (RFIs) that we think signal their future direction and we\u2019re very excited about. This notion of a hybrid payment \u2014 which is a mix of prospective and fee-for-service \u2014 included in an RFI is something we see as very positive, and CMS has signaled that they would likely start with Accountable Care Organizations (ACOs) and perhaps expand from there. PCC helped to get the Primary Care Flex Model into the Shared Savings Program as a model test, and now they\u2019re moving forward with that approach, and we think that it could give more payment stability and flexibility to primary care clinicians. They also are proposing increasing payment for primary care for those in ACOs, and we see that as important because primary care-centric ACOs do such a good job with quality of care for beneficiaries and managing costs. Another part that is good for patients is making it clear to ACOs that they can waive patient cost-sharing, because you don\u2019t want there to be a financial barrier for people getting primary care and that\u2019s what waiving of cost-sharing does. We also see things that help to better support whole-person primary care in this proposal, like payment support for health coaches, more support for behavioral health \u2014 including substance use disorders \u2014 and support for shared medical appointments. Shared medical appointments be game changers for patients learning and getting support from both a trusted clinician and fellow patients, while building community. The perennial challenge is that CMS doesn\u2019t have control over the reduction in the conversion factor. There\u2019s a 1.2% reduction in the conversion factor, and that results in a payment reduction across all of medicine. What has happened in the past is that Congress has had to step in to address that cut, which CMS needs to put in place by law. Frankly, I think they\u2019re getting tired of doing that. That just creates a lot of instability. The legislation usually isn\u2019t passed before the cut goes in, and you have a sort of seesaw for physician and other clinician pay. There is a bill that was introduced called the Patients First Act that would address this, and we\u2019d like the broader Medicare reform to incorporate that as we move forward so we don\u2019t have this payment seesaw. Healio: Can you expand on the implications of the RFIs? Greiner: There is a very substantive RFI focused on a number of dimensions related to primary care. It asks how CMS might implement hybrid payment in the fee schedule. We\u2019re a big fan of hybrid payment. We see Advanced Primary Care Management as a step on that path. Internally, we call that a mini hybrid because it is a bundled payment that\u2019s paid monthly. It\u2019s also more predictable, because you know that if your patient panel doesn\u2019t undergo a lot of changes, you know what that payment will be. It does, though, need to be not just moving the deck chairs in terms of changing the payment model with the same amount of dollars. We want more investment in that hybrid payment. Another aspect of the RFI is about how technology can enable primary care. We\u2019re working with our members and thought leaders around the country to understand this rapid adoption of AI into primary care. We see a lot of use cases on the administrative front, and we\u2019re hopeful that it reduces the administrative burden for primary care. We also see use cases on the clinical front, though with not as many being adopted, and those are important as well. But the thing we see as important as we move forward with AI is to preserve the aspects of primary care that we know deliver better results. How can AI support care coordination<\/p>\n","protected":false},"author":1,"featured_media":3502,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3501","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3501","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3501"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3501\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3502"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3501"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3501"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3501"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}