Assessing the Impact of Rural Provider Service Mix on the Primary Care Incentive Payment Program

Date
12/2013
Description

The Patient Protection and Affordable Care Act created the Primary Care Incentive Payment Program (PCIP). For the years 2011 through 2015, if certain evaluation and management services represent 60% or more of Medicare allowable charges, then the provider qualifies for a 10% bonus calculated on the primary care portion of allowable charges. Based on analysis of 2009 Medicare claims data, more than 70% of rural primary care physicians and non-physician practitioners (NPPs) qualify for payments. The average incentive payment for qualifying rural primary care physicians would result in an additional $8,000 in Medicare patient revenue per year. For qualifying NPPs, the result is an additional $3,000 in Medicare patient revenue per year.

Center
RUPRI Center for Rural Health Policy Analysis
Authors
Dan Shane, A. Clinton MacKinney, Fred Ullrich, Keith Mueller, Paula Weigel