To calculate a practitioner's primary care percentage, CMS states that it uses Medicare claims data from the calendar year that is two years prior to the incentive payment year. Emergency, hospital inpatient, drug and laboratory charges are excluded in the practitioner's total allowed charges under the physician fee schedule.
"This is improving fee-for service for primary care, which is great," Cain says, with a laugh, of the MPCIP. "We're pleased with that." Cain says healthcare reforms and models are necessarily being studied with the hope of aligning physician payments under value, and not fee for service.
"AAFP believes the fee-for-service system is broken," he adds. "It doesn't reflect value the services of primary care. We need to transition to a different way of paying, not just incenting (physicians) for widgets on a fee for service, volume based system, but for incent for value," Cain says.
And, he says hopefully, increased payments to primary care physicians may follow.