Improving The Medicare Physician Fee Schedule: Make It Part Of Value-Based Payment

Area of Science:

• Health Economics
• Healthcare Policy
• Value-Based Care

Background:

• Fee-for-service payment models present limitations in promoting healthcare value.
• Current Alternative Payment Models (APMs) are often built upon existing fee-for-service structures.
• The Medicare Physician Fee Schedule represents a core component of the current payment architecture.

Purpose of the Study:

• To advocate for the integration of Alternative Payment Models (APMs) with reforms to the Medicare Physician Fee Schedule.
• To propose structural changes within the Centers for Medicare and Medicaid Services (CMS) to better align payment model development and management.
• To enhance the effectiveness of the value-based payment movement by addressing architectural limitations.

Main Methods:

• Analysis of current healthcare payment structures, focusing on fee-for-service and APMs.
• Proposal for organizational restructuring within CMS.
• Recommendation for a revamped Physician-Focused Payment Model Technical Advisory Committee.

Main Results:

• Identifying the limitations of layering APMs onto existing fee-for-service architecture.
• Highlighting the need to strengthen the underlying Medicare Physician Fee Schedule.
• Proposing a unified approach within CMS for managing payment models.

Conclusions:

• Shoring up the Medicare Physician Fee Schedule is essential for successful APM implementation.
• Integrating APM development and fee-for-service management within CMS is recommended.
• A reformed Physician-Focused Payment Model Technical Advisory Committee can provide comprehensive guidance for value-based payment.