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ACP, Other Physician Groups Call for New Primary Care Financing Paradigm

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Leading physician organizations provide recommendations for changing the way primary care is delivered and financed

Jan. 8, 2021 (ACP) – Now is the time to change the way primary care is financed in the United States, and the American College of Physicians has joined forces with six other leading primary care physician organizations to provide recommendations for achieving this goal.

Together with the American Academy of Family Physicians, the American Academy of Pediatrics, the American Board of Family Medicine, the American Board of Internal Medicine, the American Board of Pediatrics, and the Society of General Internal Medicine, ACP penned an open letter to policymakers, payers, purchasers and the public outlining the steps that are needed to develop a new paradigm that places value over volume and prevention over treatment. The new collaboration was convened by the Larry A. Green Center and facilitated by X4 Health.

“Our current system rewards volume over value and is reactive medicine rather than proactive medicine,” said Dr. Darilyn V. Moyer, ACP executive vice president and CEO. “We have to stop being bootstrapped to this volume-based system and start to spend money to keep our patients healthy rather than wait for them to get sick.”

The ongoing COVID-19 public health emergency has exposed many cracks in the current health care system and is serving as the catalyst for these changes. “COVID-19 had a tremendous impact on primary care practices with many forced to lay off employees, take salary cuts and even shut their doors permanently,” Moyer said. “Primary care is the anchor of our health care system because internists take care of acutely ill patients, manage chronically ill patients, offer preventive care and coordinate care with community centers and home health services.”

Without a sufficient foundation, the system does not work, yet primary care doctors are not rewarded in the current paradigm, Moyer said. Primary care provides nearly 40 percent of all health care visits and more than 400 million of all outpatient visits, but it accounts for less than 6 percent of all total health care investment, the organizations state.

Time for Change

The group, which represents 400,000 physicians, is calling on the federal government to increase investment in safety-net programs, public health agencies and community-based services to work with the medical care sector in addressing structural racism and social drivers of health. The group also appeals to health care organizations to invest in existing community-based social services and ensure that the flow of dollars supports food banks and other safety-net programs that address social drivers of health. “Many patients live in food deserts and can't exercise outside because it is not safe, so children aren't getting fresh air to burn off calories,” Moyer said. “It's an imperfect storm, and if we want to be a healthy nation, we need to address all of these issues.”

Once such investments are made, primary care clinicians can better coordinate care with community organizations and public health departments to address known social drivers of health and help prevent illness.

The onus is also on physicians and medical societies to create a roadmap for dismantling the policies and regulatory structures that support the current paradigm and pave the way for this new one. “Advocate at the local, federal and state levels to make sure payers are functioning in a way that shifts this paradigm to a new primary care finance model and get these large health care systems and centers to work with communities so that dollars are flowing to support health in its entirety,” Moyer said.

“Primary care physicians cannot adequately meet the needs of their communities if they remain shackled to payment schemes which reimburse for volume instead of value,” Dr. John Brady, chair of the American Board of Family Medicine, said in a news release. “Many current regulatory demands unnecessarily distract clinicians from patient care. Coming out of the pandemic, a return to the status quo is not sufficient. The American public deserves better.”

“We must ensure that our primary care infrastructure is strong and well supported if we are to assure the health of Americans across their lifespan,” agreed Dr. Sally Goza, president of the American Academy of Pediatrics.

More Information

To view the open letter and recommendations, visit www.newprimarycareparadigm.org.

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Back to the January 8, 2021 issue of ACP Advocate