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ACA Primary Care Provider Program Ends; Medicare Payments To Fall

Many primary care physicians will receive lower Medicare payments next year as a bonus program established under the Affordable Care Act expires, Kaiser Health News reports.


The Primary Care Incentive Payment Program, which launched in 2011, aims to close a gap between Medicare payment rates for primary care providers and specialists. According to KHN, Medicare reimbursement rates are typically higher for services provided by specialists than they are for those provided by PCPs.

The program provides a 10% bonus payment for PCPs who treat Medicare beneficiaries. The higher the number of Medicare beneficiaries a practice treats, the higher the bonus.

Providers eligible for the bonus payment include:

  • Nurse practitioners;
  • Physician assistants; and
  • Physicians who specialize in family medicine, internal medicine or geriatrics.

According to a 2014 report from the Medicare Payment Advisory Commission, the program awarded an average of $3,938 to 170,000 PCPs in 2012, totaling $664 million.

According to KHN, physician trade groups have lobbied for the program's extension. In addition, MedPAC earlier this year proposed a per-beneficiary reimbursement bump for PCPs, offset by a reduction in reimbursements for specialists, to replace the program, but the proposal has not yet moved forward.


According to American College of Physicians President Wayne Riley, the program's expiration follows the end of a similar program last year that provided bonus payments for Medicaid providers. Riley said the payment reductions could prompt some providers to stop accepting new Medicare patients.

However, David Lipschutz, an attorney with the Center for Medicare Advocacy, disagreed. He said, "We don't have any evidence to show that primary care docs will stop seeing Medicare beneficiaries without the payment bump" (Andrews, Kaiser Health News, 11/24).

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