From the Eugene S. Farley Jr. Health Policy Center, University of Colorado Anschutz Medical Campus, Denver (SBG, LAG); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, D.C. (JMW).
J Am Board Fam Med. 2021 Mar-Apr;34(2):424-429. doi: 10.3122/jabfm.2021.02.200433.
The COVID-19 pandemic has added further urgency to the need for primary care payment reform. Fee-for-service payments limit the flexibility of practices to respond to crises and leave practices without sufficient revenues when visit volumes decrease. Historic fee-for-service payments have been inadequate, and prior implementations of prospective payments have encountered challenges; there is a need to bring forward the best available evidence on how to design prospective payments for payers and policymakers. Evidence suggests setting primary care investment at 10% to 12% of the total cost of care, translating to an average $85 per member per month, with significant variation based on age and adjustment for medical and social measures of risk. Enhanced investment in primary care should be aligned across payers and support practice transformation to advanced models of care.
新冠疫情大流行使初级保健支付改革变得更加紧迫。按服务收费的支付方式限制了实践应对危机的灵活性，并且在就诊量减少时，使实践没有足够的收入。历史上的按服务收费支付方式是不够的，之前实施的预期支付方式也遇到了挑战；需要为支付方和政策制定者提供关于如何设计预期支付方式的最佳现有证据。有证据表明，将初级保健投资设定为总护理费用的 10%至 12%，相当于每个成员每月 85 美元，但根据年龄和医疗及社会风险措施进行调整，差异很大。应在支付方之间协调对初级保健的强化投资，并支持实践向先进的护理模式转变。
