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Past Event

The Medicare Physician Fee Schedule and Alternative Payment Models

An event from the USC-Brookings Schaeffer Initiative for Health Policy and the Urban Institute

Past Event

Introduction to the Day

Session 1- Physician Fee Schedule: Origins and Evolution
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Session 1- Physician Fee Schedule: Origins and Evolution

Session 2- Relationship between PFS and Alternative Payment Models (APMs)
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Session 2- Relationship between PFS and Alternative Payment Models (APMs)

Session 3- Establishing Relative Values: Challenge and Options
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Session 3- Establishing Relative Values: Challenge and Options

Session 4- What's Next for the Physician Fee Schedule
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Session 4- What's Next for the Physician Fee Schedule

The current focus on improving Medicare physician payment through a variety of Alternative Payment Models (APMs) is widely perceived as a major shift away from fee-for-service, therefore reducing the importance of improving Medicare’s Physician Fee Schedule (PFS). But even if APMs eventually replace the PFS as the dominant payment methods, key aspects of the fee schedule (or an equivalent tool) will remain important and deserve attention. Not only does the PFS continue to govern nearly $90 billion in Medicare payments annually, it also serves as the basis for, among other things, setting payment rates, making real-time payments to providers, and calculating shared savings.

On Tuesday, September 26, the Urban Institute, the USC-Brookings Schaeffer Initiative for Health Policy, and the Actuarial Research Corporation hosted a one-day conference on the evolution and state of the PFS and to consider the movement to new payment models. The conference included four sessions and a brief lunchtime address, and feature experts involved in designing and implementing the PFS 25 years ago, those currently working on improvements to the PFS, and those working to design and implement new APMs and other innovations.

Agenda

Introduction to the Day

Eric Schneider

Senior Vice President for Policy and Research - Commonwealth Fund

Robert Berenson

Institute Fellow - Urban Institute

(formerly led Medicare payment policy at the Health Care Financing Administration)

Session 1: Physician Fee Schedule: Origins and Evolution

Moderator

Lauren LeRoy

Strategic Advisor - LeRoy Strategies

(former Executive Director of the Physician Payment Review Commission)

Chip Kahn

President and CEO - Federation of American Hospitals

(former staff director, Subcommittee on Health, House Ways and Means Committee)

Mark Miller

Executive Director - Medicare Payment Advisory Committee

Barbara Levy

Vice President for Health Policy and Advocacy - The American Congress of Obstetricians and Gynecologists

(former chair of the American Medical Association's Relative Value Update Committee)

Session Materials

Session 2: Relationship between PFS and Alternative Payment Models (APMs)

Moderator

Robert Berenson

Institute Fellow - Urban Institute

(formerly led Medicare payment policy at the Health Care Financing Administration)

Mai Pham

Vice President Provider Alignment Solutions - Anthem

(former Chief Innovation Officer at CMMI)

Frank Opelka

Medical Director for Quality and Health Policy, Division of Advocacy and Health Policy - American College of Surgeons

Grace Terrell

CEO - Envision Genomics

Former President and CEO - Cornerstone Health Care

current member - Physician Payment Model Technical Advisory Committee (PTAC)

Alan Lazaroff

Medical Director for Quality and Coding - Physician Health Partners

current member - Relative Value Update Committee (RUC)

Session Materials

Luncheon Panel

Moderator

Stephen Zuckerman

Codirector and Senior Fellow, Health Policy Center - Urban Institute

Victor Rodwin

Professor of Health Policy and Management - NYU Wagner

Antoine Groulx

Deputy Director General of Health Services and Academic Medicine - Quebec Ministry of Health and Social Services

Session 3: Establishing Relative Values: Challenge and Options

Moderator

Katie Merrell

Senior Research Analyst - Actuarial Research Corp (ARC)

(former senior analyst for the Physician Payment Review Commission)

Joseph Newhouse

John D. MacArthur Professor of Health Policy and Management - Harvard University

(former Commissioner, Physician Payment Review Commission)

Stephen Zuckerman

Codirector and Senior Fellow, Health Policy Center - Urban Institute

Antoine Groulx

Deputy Director General of Health Services and Academic Medicine - Quebec Ministry of Health and Social Services

Session Materials

Session 4: What's Next for the Physician Fee Schedule?

Robert Berenson

Institute Fellow - Urban Institute

(formerly led Medicare payment policy at the Health Care Financing Administration)

Gail Wilensky

Senior Fellow - Project HOPE

(former Administrator of the Health Care Financing Administration (now, CMS))

Jonathan Blum

Executive Vice President, Medical Affairs - CareFirst BlueCross BlueShield

(former Principal Deputy Administrator, CMS)

Karen Fisher

Chief Public Policy Officer - Association of American Medical Colleges

(former Senior Health Counsel Senate Finance Committee)

Eric Schneider

Senior Vice President for Policy and Research - Commonwealth Fund

Session Materials

Closing Remarks

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