Improving Primary Care Valuation Decisions for the Physician Fee Schedule by the Center for Medicare

Consensus

Download PDF

Paperback - $19.80
Ebook - $16.19

Request an exam or desk copy

In 2024, the National Academies of Sciences, Engineering, and Medicine were tasked with convening a committee to examine the current process and data inputs used by the Centers for Medicare and Medicaid Services (CMS) to valuate primary care in the Physician Fee Schedule. Additionally, the committee was tasked with outlining alternative methodologies for data collection and potential sources of input to more accurately capture the time, intensity, and complexity of the work required to deliver high-quality primary care.

The resulting report, Improving Primary Care Valuation Decisions for the Physician Fee Schedule by the Center for Medicare, makes specific recommendations for CMS to address the systemic flaws currently affecting primary care professionals and limiting the potential of high-quality primary care services for all.

Publication information

64 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-73535-1
ISBN Ebook: 0-309-73536-X
DOI: https://doi.org/10.17226/29069

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2025. Improving Primary Care Valuation Processes to Inform the Physician Fee Schedule. Washington, DC: The National Academies Press.

Import this citation to:

Asaf Bitton

ASAF BITTON, MD, MPH, is the executive director of Ariadne Labs, a health systems innovation center at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. He is an Associate Professor of Medicine and Health Care Policy at both Harvard Medical School and the Harvard T.H. Chan School of Public Health. He leads Ariadne Labs’ efforts to design, test, and spread scalable systems-level solutions that improve health care processes, enhance communication between patients and clinicians, and impact population health at scale. He has served as a senior advisor for primary care policy at the Center for Medicare and Medicaid Innovation since 2012, helping to design and test four major primary care initiatives, representing the largest tests of combined primary care payment and clinical practice transformation work in the United States. He was a core founder and vice chair of the steering committee for the Primary Health Care Performance Initiative, an 8-year partnership that included more than 25 countries and the World Bank, the World Health Organization, UNICEF, The Global Fund, the Bill & Melinda Gates Foundation, and others, dedicated to improving the global provision of primary health care.

Dr. Bitton practices primary care at Brigham and Women’s South Huntington clinic, a team-based community primary care practice in Boston that he helped found in 2011. He currently serves on the Center for Strategic and International Studies Bipartisan Commission on Strengthening America’s Health Security, the National Advisory Committee for Advancing a Healthier Wisconsin, and is an elected member of the International Academy of Quality and Safety. He formerly served on the National Advisory Council for Healthcare Research at the Agency for Healthcare Research and Quality. He was a member of the National Academies committee that produced Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care

Ishani Ganguli

ISHANI GANGULI, MD, MPH, is an Associate Professor of Medicine, health services researcher, and practicing primary care physician at Harvard Medical School and Brigham and Women’s Hospital. Her research focuses on primary care delivery and payment policy – including the evolution of primary care visits, Medicare’s Annual Wellness Visit, telemedicine, direct scheduling, and fee-for-service and value-based payment models. She also studies the use and consequences (cascades) of low-value care and gender equity. She has received regional and national research awards including the New England Regional SGIM Award for Excellence in Clinician Investigation (2020), the Academy Health Annual Research Meeting Publication of the Year Award (2021), and the Seema S. Sonnad Emerging Leader in Managed Care Research Award (2022). Dr. Ganguli serves as an Associate Editor at JAMA Internal Medicine. She is also a former journalist who has written about science and health care for publications including The Boston Globe and The Washington Post. She received her AB, MD, and MPH from Harvard University and completed internal medicine/primary care residency and health policy and management fellowship at Massachusetts General Hospital. Dr. Ganguli also serves as a consultant for F Prime Capital, a company that invests in health services, technology, and insurance companies.

Andrea Anderson

ANDREA ANDERSON, MD, M.Ed., FAAFP is a family physician and an associate professor at the George Washington School of Medicine and Health Sciences. She is the chair of the American Board of Family Medicine (ABFM), a board member of the Federation of State Medical Boards (FSMB), chair of the United States Medical Licensing Examination (USMLE) Management Committee, a senior medical education consultant for the Association of American Medical Colleges (AAMC), and a former member of the National Advisory Council of the National Health Service Corps and National Health Service Corps Scholar. At GW, she serves in several roles including as the Associate Chief of the Division of Family Medicine, the chair of the clinical curriculum sub-committee, Director of the Scholarly Concentration in Health Policy, and course director of the required Transitions to Residency internship readiness capstone course. Throughout her career, Dr. Anderson has been active in DC health policy and medical regulation as well as teaching primary care, ethics, professionalism, and physician advocacy to medical students and residents. She is the Chair of the DC Board of Medicine, licensing and determining regulatory policy for the over 15,000 DC physicians and other licensees. She is a subject matter expert for national advisory committees of the National Board of Medical Examiners (NBME), namely the Patient Characteristics Advisory Panel and the Legal/Ethical Task Force. She has served on multiple national advisory committees for the FSMB including chairing the 2024 Workgroup on the Regulation of Physicians in Training and the National Ethics and Professionalism Committee which creates model practice national guidelines for state medical licensing boards including the current medical misinformation guidelines for state medical boards. Dr. Anderson is the recipient of the 2022 GW Distinguished Service Award, the 2021 National Exemplary Teaching Award from the American Academy of Family Physicians, the 2019 Society of Teachers of Family Medicine (STFM) Advocate Award, the 2016 Brown School of Medicine Young Alumnae Achievement award, and the 1997 National Health Service Corps Scholarship. She is a current fellow of the Hedwig Van Ameringen Executive Leadership in Academic Medicine (ELAM) program, 2023 graduate of the International Leadership Excellence in Educating for Professionalism (LEEP) Faculty Scholars Program from the Academy for Professionalism in Health Care, a 2018 graduate of the Society of Teachers of Family Medicine Emerging Leaders Program, and a 2017 graduate of the GW Master Teacher Leadership Development Fellowship. Dr. Anderson is an alumna of the Program in Liberal Medical Education (PLME) at Brown University and Brown University School of Medicine. She completed a Master's degree of Education at the GW School of Education and Human Development. She completed her Family Medicine residency and Academic Medicine fellowship at Harbor-UCLA Medical Center where she served as the Chief Resident. Following this, she spent 15 years in clinical practice at the Upper Cardozo Health Center, a multi-lingual Federally Qualified Health Center in Washington, DC

Ramon Cancino

RAMON CANCINO, MD, MBA, MS, FAAFP, is the executive director of the UT Health San Antonio Primary Care Center and senior medical director of Medical Management. Dr. Cancino also helps guide cancer prevention and screening strategies as the co-chair of the joint UT Health San Antonio-MD Anderson Mays Cancer Center Cancer Prevention and Screening Committee. Prior to this role, he was chief medical officer of Mattapan Community Health Center, a federally qualified health center in Boston, Massachusetts. A family medicine physician with more than 10 years healthcare executive experience in academic and FQHC settings, Dr. Cancino has led all aspects of primary care, including value-based care, cancer prevention and screening, and workforce development. His research interests include utilization and quality measurement, use of novel cancer screening strategies, and digital health. He sits on the Texas Primary Care Consortium Advisory Committee, a Medicare shared savings accountable care organization, where he guides the direction of state-wide primary care initiatives, and he sits on the board of directors of the UT Health San Antonio Regional Physician Network ACO. He holds multiple national committee positions. He sits on the Society of Teachers of Family Medicine Practice and Quality Improvement Steering Committee, which guides the direction of relevant education for learners and clinician educators. He also sits on the Agency for Healthcare Quality Healthcare Safety and Quality Research study section.

Prior to these roles, Dr. Cancino completed his residency training at Mayo Clinic, completed an academic medicine fellowship at Boston University School of Medicine, attained a master of science in health services research at Boston University School of Public Health, and completed his MBA at University of Texas at San Antonio.

Deborah J. Cohen

DEBORAH J. COHEN, PhD, is a professor and research vice chair at the Oregon Health & Science University Department of Family Medicine. Dr. Cohen uses her qualitative expertise on mixed methods teams to look at how improvements are implemented in primary care practices, to identify what changes are made, and to compare the effectiveness of observed practice change on process and outcome measures. She has led mixed methods teams to understand and tackle the complicated problems related to implementing and disseminating new innovations and important quality improvements in primary care practice related to prevention and health behavior change, behavioral, mental health and chronic care. She has a PhD in communication, where she studied interpersonal and organizational communication. She was trained in a range of qualitative data collection methods, and was trained to analyze qualitative and quantitative data, but her emphasis was on using a range of approaches to analyze qualitative data, with an emphasis in ethnomethodology and conversation analysis. She was the Principal Investigator of the national evaluation of EvidenceNOW, funded by AHRQ. Dr. Cohen participates in a number of other studies and state-evaluation efforts, including the evaluation of the Medicaid Transformation Project in Washington state. Dr. Cohen is an elected member of the National Academy of Medicine and served on the National Academies committee that produced Achieving Whole Health: A New Approach for Veterans and the Nation.

Kevin Grumbach

KEVIN GRUMBACH, MD, is Professor of Family and Community Medicine at the University of California, San Francisco. He served as Chair of the UCSF Department of Family and Community Medicine from 2003-2022. He is a Founding Director of the UCSF Center for Excellence in Primary Care and Director of the Community Engagement Program for the UCSF Clinical and Translational Science Institute. His research and scholarship on the primary care workforce, innovations in primary care, racial and ethnic diversity in the health professions, and community health improvement and health equity have widely influenced policy and practice. Dr. Grumbach is a member of the American Academy of Family Physicians and California Academy of Family Physicians, and co-chairs the California Academy of Family Physicians Task Force on Primary Care for All to develop policy positions on primary care coverage, investment, and payment. He is also a member of Physicians for a National Health Program. He is a gubernatorial appointee to the California Health Workforce Education and Training Council and a technical expert for the California Office of Health Care Affordability Payment and Investment Workgroup, both of which are uncompensated positions. With Tom Bodenheimer, he co-authored the best-selling textbook on health policy, Understanding Health Policy - A Clinical Approach, now in its 8th edition, published by McGraw Hill. He received a Generalist Physician Faculty Scholar award from the Robert Wood Johnson Foundation, the Health Resources and Services Administration Award for Health Workforce Research on Diversity, the Richard E. Cone Award for Excellence and Leadership in Cultivating Community Partnerships in Higher Education, and the UCSF Chancellor’s Public Service Award.

Dr. Grumbach has been an advisor to Congressional Committees and government agencies on primary care and health reform and a member of the National Advisory Council for the Agency for Healthcare Research and Quality, and currently serves on the California Health Workforce Education and Training Council. He cares for patients at the family medicine practices at San Francisco General Hospital and UCSF Health. He is a member of the National Academy of Medicine.

Michael J. Hasselberg

MICHAEL J. HASSELBURG, NP, MS, PhD is an Associate Professor of Psychiatry, Clinical Nursing, and Data Science at the University of Rochester (UR). Dr. Hasselberg is the first Chief Digital Health Officer at UR Medicine, leading the health system’s digital transformation strategy including the development of a digital front door (patient portal, online scheduling, eCheck-in, on-demand telemedicine, and retail health) for the system’s primary care network. Dr. Hasselberg also leads UR Medicine’s digital innovation incubator, which is currently leveraging generative AI and large language models to reduce clinician burnout. As a Robert Wood Johnson Foundation Clinical Scholar Fellow, he contributed to the development of a digitally integrated care delivery model for behavioral health into primary, acute, and post-acute care settings within rural communities. Dr. Hasselberg was named to the “Top 50 in Digital Health” list by Rock Health to recognize his work to improve health equity through technology innovation during the COVID-19 pandemic and was selected as the 2023 Commencement Speaker for the UR School of Nursing. Board certified as a Psychiatric Nurse Practitioner, Dr. Hasselberg completed his PhD degree in Health Practice Research at the UR and a postdoctoral certificate in Healthcare Leadership at Cornell University.

Lauren S. Hughes

LAUREN S. HUGHES, MD, MPH, MSc, MHCDS, FAAFP (Co-chair), is a family physician working as the State Policy Director of the Farley Health Policy Center and an Associate Professor of Family Medicine at the University of Colorado. In these roles, she leads efforts to generate and translate evidence to inform the design and implementation of evidence-based health policy at the state, national, and federal levels. She participates in the Primary Care Centers Roundtable, a volunteer collective of all of the primary care research and policy centers in the United States. Her research interests include improving rural health care delivery; strengthening primary care infrastructure; and advancing behavioral health integration. She cares for patients at a rural federally qualified health center (FQHC) north of Denver. Dr. Hughes previously served as Deputy Secretary for Health Innovation in the Pennsylvania Department of Health. In this role, she collaborated with the CMS Innovation Center (CMMI) to co-design and launch the Pennsylvania Rural Health Model, a new payment and delivery model that transitions rural hospitals from fee-for-service to multi-payer global budgets and transforms how they deliver care to better meet community health needs. She also oversaw the creation of the Prescription Drug Monitoring Program for the Commonwealth and led the Department to full accreditation through the Public Health Accreditation Board.

In 2018, Dr. Hughes was selected by Presidents Bill Clinton and George W. Bush as a Presidential Leadership Scholar. From 2022 – 23, she served as chair of the American Board of Family Medicine Board of Directors. She also serves on the boards of directors of the Rural Health Redesign Center Organization and the American Medical Student Association Foundation. She is a member of the Primary Care Payment Reform Collaborative through the Colorado Division of Insurance and the Stakeholder Advisory Group for the Agency for Healthcare Research and Quality National Center for Excellence in Primary Care Research. Dr. Hughes is a former Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan, where she earned an MSc in health services research. She also holds a medical degree from the University of Iowa, an MPH in health policy from The George Washington University, and a master’s in health care delivery science from Dartmouth College and completed residency at the University of Washington. Since 2021, Dr. Hughes has been a member of the National Academies Board on Health Care Services.

Alex H. Krist

ALEX KRIST, MD, MPH, is a professor of family medicine and population health at Virginia Commonwealth University and an active clinician and teacher at the Fairfax Family Practice Residency. He is the director of the Virginia Ambulatory Care Outcomes Research Network, director of community-engaged research at the Center for Clinical and Translational Research and is past chairperson for the U.S. Preventive Services Task Force. Dr. Krist’s areas of interest include implementation of preventive recommendations, patient-centered care, shared decision making, cancer screening, and health information technology. He is the primary author of numerous peer-reviewed publications and has presented to a wide range of audiences at national and international conferences. Dr. Krist completed his doctor of medicine at the University of Virginia School of Medicine. Dr. Krist was elected to NAM in 2018, was a member of the committee that produced Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, and was co-chair of the committee that produced Achieving Whole Health: A New Approach for Veterans and the Nation.

Kameron L. Matthews

KAMERON L. MATTHEWS, MD, JD, FAAFP, is the Chief Health Officer of Cityblock Health, a transformative, value-based healthcare provider integrating medical, behavioral, and social services for Medicaid and dually eligible and low-income Medicare beneficiaries. A board-certified Family Physician, Dr. Matthews has focused her career on marginalized communities, having held multiple leadership roles in correctional medicine, federally qualified health centers, and managed care. Most recently at the Veterans Health Administration, she led transformational efforts focused on integrated, Veteran-centered models of care including the implementation of the MISSION Act of 2018 and the EHR modernization effort. She is a member of the sixth class of the Aspen Institute's Health Innovators Fellowship. As a passion outside of work, she founded and co-directs the Tour for Diversity in Medicine, an initiative seeking to bring premedical enrichment activities to underrepresented minority high school and undergraduate students across the country. Dr. Matthews completed her Doctor of Medicine from Johns Hopkins University School of Medicine and her juris doctorate from University of Chicago Law School. Dr. Matthews is an elected member of the National Academy of Medicine.

Eboni Winford

EBONI WINFORD, PhD, MPH, is the Vice President of Research and a licensed psychologist at Cherokee Health Systems in Knoxville, Tennessee. She provides direct clinical care to patients, contributes to workforce development in community health centers, and oversees research initiatives including those funded by the HRSA, the TN Department of Health, and NIH. She is the Clinical Director for CHS’s National Consultation and Training Program, which provides individualized on-site training to other health organizations as they seek to integrate their practices. She is on the board of directors for the Collaborative Family Healthcare Association, is the Chair-Elect of APA’s Ad Hoc Health Equity Committee, is secretary of APHA’s Community Health Planning and Policy Development section and serves as the 2nd Vice Chair of NACHC Committee on Service Integration for Behavioral Health and HIV.

Dr. Winford holds adjunct faculty positions in the Department of Family and Community Medicine at Meharry Medical College and in the Department of Psychology at the University of Tennessee Knoxville. She is a Robert Wood Johnson Foundation Interdisciplinary Fellow and a Health Equity Scholar in Cambridge Health Alliance’s Center for Health Equity Education and Advocacy. Dr. Winford earned her doctorate in Clinical Health Psychology from the University of North Carolina at Charlotte and a Master of Public Health from the University of North Carolina at Chapel Hill. She is a proud life member of Zeta Phi Beta Sorority, Incorporated.

Marc Meisnere

MARC MEISNERE, MHS, is a senior program officer on the National Academies of Sciences, Engineering, and Medicine’s Board on Health Care Services. Since 2010, Mr. Meisnere has worked on a variety of NASEM consensus studies and other activities that have focused on mental health services for service members and veterans, suicide prevention, primary care, and clinician well-being. Most recently, he was the study director for the 2021 NASEM report Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care and the 2023 report, Achieving Whole Health: A New Approach for Veterans and the Nation. Before joining NASEM, Mr. Meisnere worked on a family planning media project in northern Nigeria with the Johns Hopkins Center for Communication Programs and on a variety of international health policy issues at the Population Reference Bureau. He is a graduate of Colorado College and the Johns Hopkins University Bloomberg School of Public Health.

Log In

Sign in to access your saved publications, downloads, and email preferences.

Former MyNAP users: You'll need to reset your password on your first login to MyAcademies. Click "Forgot password" below to receive a reset link via email. Having trouble? Visit our FAQ page to contact support.

Members of the National Academy of Sciences, National Academy of Engineering, or National Academy of Medicine should log in through their respective Academy portals.

Email (required)
Password (required)

Don't have an account?

Register

Email (required)
New password (required)
Retype password (required) Password must be at least 8 characters
I accept the terms of use
terms of use

Thank You

Thank you for creating a MyAcademies account!

Enjoy free access to thousands of National Academies' publications, a 10% discount off every purchase, and build your personal library.

Forgot Password

Enter the email address for your MyAcademies (formerly MyNAP) account to receive password reset instructions.

Reset Requested

We sent password reset instructions to your email . Follow the link in that email to create a new password. Didn't receive it? Check your spam folder or contact us for assistance.

Reset Password

New password (required)
Retype password (required) Password must be at least 8 characters

Reset Password

Your password has been reset.

Log In

Verify email

Verify Your Email Address

We sent a verification link to your email. Please check your inbox (and spam folder) and follow the link to verify your email address. If you did not receive the email, you can request a new verification link below

Subscribe

First Name
Last Name
Email (required)
I agree to receive emails from the National Academies (required)

We respect your privacy and will never share your information.

Improving Primary Care Valuation Decisions for the Physician Fee Schedule by the Center for Medicare

Featured publication

Description

Collaborators

Committee

Sponsors

Staff

Parent projects

Standing Committee on Primary Care

Major units and sub-units

Contact

Contact us

Provide feedback

Request materials

More like this

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

National Cooperative Highway Research Program

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

Review of Methods in the Report on Carcinogens Handbook

Exploring Relevant Policy Domains — Housing Policy and Population Health: A Workshop

Publication information

Suggested citation

My Academies

Improving Primary Care Valuation Decisions for the Physician Fee Schedule by the Center for Medicare

Dropdown items

Featured publication

Improving Primary Care Valuation Processes to Inform the Physician Fee Schedule

Description

Collaborators

Committee

Sponsors

Staff

Parent projects

Standing Committee on Primary Care

Major units and sub-units

Contact

Contact us

Provide feedback

Request materials

More like this

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

National Cooperative Highway Research Program

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

Review of Methods in the Report on Carcinogens Handbook

Exploring Relevant Policy Domains — Housing Policy and Population Health: A Workshop