Medicare would pay participating primary care providers monthly through 2031

Patients would owe no share of monthly payments made under the primary care model. This option would cover people with Medicare Part B outside Medicare Advantage. Patients could choose a provider participating in the model. If patients do not choose, federal health officials could match them with their existing participating provider based on past claims. The model would run from 2027 through 2031.

Medicare would set annual updates and separate spending adjustments for doctors’ base payment rates. The standard update would equal the health secretary’s estimated increase in the MEI payment index, minus one percentage point, bounded by 25% and 75% of that increase. Clinicians qualifying through alternative payment programs would receive an extra half percentage point. The 2.5% limit would exclude annual updates. Medicare would still have to balance spending. Both provisions would apply starting in 2027.

Medicare would give efficient care 15% of clinicians’ performance scores. These rules would cover clinicians in Medicare’s performance-based payment system. Efficient care measures could include avoiding preventable hospital stays. Quality measures would receive the lowest score unless reported through certified electronic health records or clinical data registries, which collect care data. The weight would apply from 2032. The reporting rule would cover performance periods beginning on or after January 1, 2032.

Medicare would pay affected clinicians half their otherwise calculated regular performance bonuses. The tests cover ownership, outside control, clinician voting rights, board membership, and who can remove clinician directors or officers. The exception covers practices consisting of 15 or fewer designated clinicians, such as nurse practitioners and physician assistants; doctors are not automatically included. The bonus rule would have to leave overall spending unchanged. These bonus limits would start in 2032.

Medicare would exempt certain scan orders from its requirement to check medical guidance. Small practices would mean 15 or fewer ordering clinicians. Rural practices must be in a federally designated area with a shortage of health professionals. The named test exceptions would cover mammograms, CT lung cancer screening, and CT colon exams. Orders for clinical trials or actual or suspected emergencies would also qualify. Federal health officials could exempt other preventive or screening scans. The imaging amendments would apply to items and services furnished on or after January 1, 2027.