May 15, 2024

Whitehouse and Cassidy Introduce Legislation, Release RFI on Primary Care Provider Payment Reform

Washington, DC – As part of their ongoing work to address primary care challenges and reform physician payment models, U.S. Senators Sheldon Whitehouse (D-RI) and Bill Cassidy, M.D. (R-LA) released a Request for Information (RFI) to accompany the introduction of the senators’ bipartisan Pay PCPs Act, legislation to better support and improve pay for high-quality primary care providers. 

“Primary care is a critical part of the health care equation.  Overwhelming evidence shows that primary care both improves health outcomes for patients and drives down health costs.  There are many issues to address in primary care, and we look forward to receiving feedback on our legislation through the RFI to make a meaningful difference to health care success,” said Senator Whitehouse and Dr. Cassidy.

The U.S. spends more on health care as a share of its GDP than peer countries, but U.S. life expectancy is below that of its peer nations—and falling.  Three in ten people report not having a usual source of primary care, and reports find the U.S. will face a shortage of between 17,000 and 45,000 primary care doctors over the next decade.  Senator Whitehouse and Dr. Cassidy’s bipartisan legislation aims to head off this expensive primary care shortage while also improving Medicare beneficiaries’ health outcomes and helping primary care providers lower health costs. 

The Pay PCPs Act would task the Centers for Medicare & Medicaid Services (CMS) with establishing hybrid payments to reward primary care providers who provide the best care to their patients — care that reduces patients’ emergency visits, hospitalizations, excess specialist services, and other big cost drivers — and reward patients with better health outcomes.  The bill would provide Medicare beneficiaries with reduced cost-sharing for certain primary care activities and services, and would also create a new technical advisory committee to help CMS more accurately determine Fee Schedule rates.

“We at America’s Physician Groups represent roughly 360 organizations committed to providing patient-centered, coordinated health care that is accountable for costs and quality.  We can’t achieve this goal without a strong basis in advanced primary care, and outside of value-based payment models, the current structure of Medicare fee-for-service physician payment doesn’t adequately support the model, and in fact, undermines it,” said Susan Dentzer, President and CEO of America’s Physician Groups.  “We’re excited to see this new plan for a hybrid form of Medicare payment that will combine prospective, per-member-per-month payments with fee-for-service.  This approach will enable many smaller physician practices not only to survive the current headwinds facing primary care, but also to build the infrastructure that they will need to thrive in value-based models – the direction in which the nation’s health care system must continue to move.  We also applaud the move to reduce copayments from Medicare beneficiaries for vitally important care coordination services.  America’s patients, doctors, and the nation as a whole would be better off with this overall approach, and we look forward to working with policy makers to embed it in law and see it flourish in practice.”

The senators’ accompanying RFI provides stakeholders the opportunity to comment on the bipartisan bill, which serves as a marker for legislation in the primary care space.

Feedback can be submitted to until July 15, 2024.

Click here for the text of the Pay PCPs Act.  Click here for the RFI. 

Press Contact

Meaghan McCabe, (202) 224-2921