Patients in the United States rely on medical specialists – like cardiologist or gastroenterologists – over primary care physicians for many of their healthcare needs. But globally, this setup is much less common than we might think. In fact, it’s often the other way around: Primary care physician first, specialist second.
The aptly named Primary Care First Act, a piece of legislation passed by Congress in 2018, was created to jump start the move toward such a system. While there are many factors that have contributed to our current structure, a large piece of the puzzle is in the financials. Specialists tend to earn more – significantly more – than physicians in family medicine and related primary care practices.
Because of this, a large part of the Primary Care First Act deals with reimbursement rates. Specifically, it details a new payment structure for practices participating in the program – one that is much more akin to the value-based care models seen in other areas of medicine.
Like anything dealing with the finances of healthcare, the Act’s changing reimbursement structure has a lot of moving parts, and it can be hard to get a grasp on the proposed changes. In our new insight brief, IMO takes a closer look at what you need to know about reimbursement under Primary Care First.