Consensus Study Report

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This activity was supported by contracts between the National Academy of Sciences and the Academic Pediatric Association, American Academy of Family Physicians, American Board of Family Medicine, American College of Physicians, Arnold Ventures, California HealthCare Foundation, The Commonwealth Fund, Healing Works Foundation, Milbank Memorial Fund, National League for Nursing, New York State Health Foundation, and Samueli Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-73535-3
International Standard Book Number-10: 0-309-73535-1
Digital Object Identifier: https://doi.org/10.17226/29069

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. Improving primary care valuation processes to inform the physician fee schedule. Washington, DC: National Academies Press. https://doi.org/10.17226/29069.

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COMMITTEE ON IMPROVING PRIMARY CARE VALUATION DECISIONS FOR THE PHYSCIAN FEE SCHEDULE BY THE CENTER FOR MEDICARE

ASAF BITTON (Cochair), Ariadne Labs; Harvard Medical School

ISHANI GANGULI (Cochair), Brigham and Women’s Hospital; Harvard Medical School

ANDREA ANDERSON, George Washington University School of Medicine and Health Sciences

RAMON CANCINO, University of Texas Health San Antonio

DEBORAH J. COHEN, Oregon Health and Science University

KEVIN GRUMBACH, University of California, San Francisco

MICHAEL J. HASSELBERG, University of Rochester Medical Center

LAUREN S. HUGHES, University of Colorado Anschutz Medical Campus

ALEX H. KRIST, Virginia Ambulatory Care Outcomes Research Network; Fairfax Family Practice Residency; Virginia Commonwealth University

KAMERON L. MATTHEWS, Cityblock Health

EBONI WINFORD, Cherokee Health Systems

Study Staff

MARC MEISNERE, Study Director

TAYLOR M. KING, Associate Program Officer

ADAEZE OKOROAJUZIE, Senior Program Assistant

SHARYL J. NASS, Senior Director, Board on Health Care Services

National Academy of Medicine Fellows

STEPHANIE GOLD, University of Colorado Anschutz Medical Campus

ALYSSA TILHOU, Boston University Chobanian & Avedisian School of Medicine

Consultant

REBECCA ETZ, The Larry A. Green Center, Virginia Commonwealth University

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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by PATRICK H. DELEON, Uniformed Services University of the Health Sciences, and WALTER R. FRONTERA, University of Puerto Rico School of Medicine. They were responsible for making certain that an independent examination of this

report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Contents

ACRONYMS AND ABBREVIATIONS

IMPROVING PRIMARY CARE VALUATION PROCESSES TO INFORM THE PHYSICIAN FEE SCHEDULE

CURRENT DATA INPUTS AND PROCESS USED BY THE CENTER FOR MEDICARE TO VALUATE PRIMARY CARE IN THE PHYSICIAN FEE SCHEDULE

The History of the RBRVS

Conflicts of Interest, Representation, and Lack of Transparency in the RUC

RECENT PHYSICIAN FEE SCHEDULE CHANGES IN SUPPORT OF PRIMARY CARE

NEW CONSIDERATIONS FOR THE VALUATION OF PRIMARY CARE

Scope of Services and Activities Included

Scope of Team Members Included

New Data Sources and Methodologies

HOW THESE INPUTS COULD TRANSLATE INTO HYBRID PRIMARY CARE PAYMENTS

RECOMMENDATIONS

CONCLUSIONS

REFERENCES

APPENDIXES

A Statement of Task

B Committee, Fellows, and Staff Biographical Sketches

C Public Meeting Agenda

Acronyms and Abbreviations