George Aaron, Sachdev Neha, Hoff John, Borg Stanley, Weida Thomas, O'Connor Malachi, Davis Kisha N
Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA.
Health Data Decisions, Boston, MA.
Fam Med. 2019 Feb;51(2):185-192. doi: 10.22454/FamMed.2019.286478.
Fee for service (FFS), the dominant payment model for primary care in the United States, compensates physicians based on volume. There are many initiatives exploring alternative payment models that prioritize value over volume. The Family Medicine for America's Health (FMAHealth) Payment Team has developed a comprehensive primary care payment (CPCP) model to support the move from activity- and volume-based payment to performance-based payment for value.
In 2016-2017, the FMAHealth Payment Team performed a comprehensive study of the current state of primary care payment models in the United States. This study explored the features, motivations, successes, and failures of a wide variety of payment arrangements.
The results of this work have informed a definition of comprehensive primary care payment (CPCP) as well as a CPCP calculator. This quantitative methodology calculates a base rate and includes modifiers that recognize the importance of infrastructure and resources that have been found to be successful in innovative models. The modifiers also incorporate adjustments for chronic disease burden, social determinants of health, quality, and utilization.
The calculator and CPCP methodology offer a potential roadmap for transitioning from volume to value and details how to calculate such an adjustable comprehensive payment. This has impact and interest for all levels of the health care system and is intended for use by practices of all types as well as health systems, employers, and payers.
按服务收费（FFS）是美国初级保健的主要支付模式，根据诊疗量对医生进行补偿。目前有许多举措在探索替代支付模式，这些模式更注重价值而非诊疗量。美国健康家庭医学（FMAHealth）支付团队开发了一种综合初级保健支付（CPCP）模式，以支持从基于活动和诊疗量的支付向基于绩效的价值支付转变。
2016 - 2017年，FMAHealth支付团队对美国初级保健支付模式的现状进行了全面研究。该研究探讨了各种支付安排的特点、动机、成功之处和不足之处。
这项工作的结果为综合初级保健支付（CPCP）的定义以及CPCP计算器提供了依据。这种定量方法计算出一个基础费率，并包括一些调整因素，这些因素认识到在创新模式中已被证明成功的基础设施和资源的重要性。这些调整因素还纳入了对慢性病负担、健康的社会决定因素、质量和利用率的调整。
该计算器和CPCP方法为从诊疗量向价值的转变提供了一个潜在的路线图，并详细说明了如何计算这种可调整的综合支付。这对医疗保健系统的各个层面都有影响和吸引力，适用于所有类型的医疗机构以及医疗系统、雇主和支付方。
