PCMHs and PCSPs Could be Getting Cash in the New Year

NCQA and more than 60 key stakeholders want Congress to act now on Medicare physician payment reform that provides much-needed support for PCMHs and PCSPs.

The legislation, which has broad, bipartisan support, repeals the so-called “sustainable growth rate” formula that now requires huge cuts to physician payments that Congress has repeatedly had to overrule. It would move Medicare along in its journey to pay for the value of care on several fronts—not just for volume, and:

  • Authorize payments to PCMHs and PCSPs for non-face-to-face chronic care management services that help prevent costly, avoidable complications.
  • Automatically give PCMHs and PCSPs the highest score for clinical practice improvement activities under a new, value-based purchasing program that rewards quality.
  • Provide bonus payments to providers in “alternative payment models” designed to promote value, for which PCMH and PCSP practices could be platforms.

Support for the legislation is urgently needed to help PCMHs and PCSPs sustain their transformation to patient-centered, high-value care. NCQA strongly supports these and other provisions. Please tell your Congressional representatives to support passage of this vital legislation now.

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