Families USA Submits Response to Request for Information on New Legislation to Improve Primary Care

Families USA joined 19 other organizations (including consumer, provider, and employer advocacy groups) in submitting recommendations on the bipartisan Pay PCPs Act. Primary care is a cornerstone of our health care system and is often the first point of entry into the health care system for many individuals and families. Despite this, broken fee-for-service (FFS) economics have resulted in historical underinvestment in primary care and reduced access to comprehensive primary care for families across the U.S.

These recommendations are aimed at ensuring access to an affordable, equitable, effective and comprehensive primary care system:

• Ensure the Pay PCPs Act gives the Secretary of Health and Human Services (HHS) substantial authority to make regular changes and updates to the design of the hybrid primary care payment model on several areas including:
  • Patient attribution methods to ensure the model utilizes the gold standard of patient attribution.
  • Payment model methodology to account for disparities in access to care and historically low and undervalued reimbursement rates for primary care-related services.
• Prioritize social drivers of health (SDOH) by incorporating social needs and social services data into health care data systems to more accurately account for the health needs and costs of socially vulnerable and marginalized populations.
• Ensure physician fee schedule (PFS) rates, the prices and reimbursements for clinical services, are determined by a variety of non-partisan health care payment experts to combat biased estimates and distorted fees.

The U.S. spends significantly less on primary care than other developed nations, contributing to a national shortage of primary care providers, and providers are currently incentivized and rewarded for higher volumes of services (tests, bloodwork, exams, etc.) without any accountability, oversight, or proof that these services are improving patient health outcomes. In fact, many of the most valuable services provided in primary care, such as home visits or telephone calls, have long gone uncompensated.

Families USA applauds Senators Bill Cassidy, M.D. (R-LA) and Sheldon Whitehouse (D-RI) for the introduction of the Pay PCPs Act which, if passed, would be a significant step toward a sustainable payment mode for primary care providers — with a reimbursement system that directly pays them for what they do best, effectively managing the health of patients.