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Another Voice: New reimbursement model enhances primary care

By Thomas J. Foels

Michael Merrill, M.D., accurately diagnosed the frustration felt by primary care physicians (PCPs), in particular the “15-minute office visit,” in his Oct. 14 letter to the editor (“Raising reimbursement rate would end primary care gap”), saying increased payment for these visits would allow more quality time with patients and help grow primary care.

The 2016 Physician Compensation Report, based on a survey of more than 19,000 doctors, found the average time spent with each patient is 13 to 16 minutes, supporting Merrill’s position.

Shorter office visits, a symptom of the current payment system, and increased demands placed on PCPs are contributing to a critical shortage in New York State, including upstate and rural regions of the state.

When doctors have one eye on the patient and the other on the clock, there is less dialogue, resulting in missed opportunities for getting patients more actively involved in managing their health.

PCPs are integral to patient care. That’s why Independent Health is taking steps to address this situation.

First, we partnered with physicians to develop an enhanced annual visit (EAV) with increased reimbursement that enables PCPs to spend more time with our Medicare Advantage members. The EAV has no co-payment and incorporates many of the services already provided during preventive and wellness visits, with an expanded focus on the management of chronic disease.

These visits, typically booked by the physician in one-hour increments, are nearly twice the rate of a traditional office visit. This higher payment accounts for the extra time the physician needs to have an in-depth patient discussion, to update medical records, ensure all tests and screenings are current, and to address advance care planning.

Secondly, we continue to expand the Primary Connection (TPC), an innovative physician-led initiative with nearly 190 PCPs from more than 30 practices. These high-performing physicians are reimbursed through an advanced value-based model of care that encourages them to spend the appropriate time with each patient.

Thirdly, we collaborate with the University at Buffalo School of Medicine to encourage medical students to choose primary care as their specialty, and offer opportunities for placement of generalist scholars in a TPC practice, where students experience team-based care in a progressive primary care setting, mentored by a physician leader.

New and enhanced reimbursement models, based on value and quality, will improve access and care for patients and strengthen the future of primary care.

Thomas J. Foels, M.D., is executive vice president and chief medical officer of Independent Health. He is also a member of the Primary Connection’s Leadership Council.

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