Primary care physicians increasingly play a key role in Healthcare Reform and other efforts encouraging innovative approaches to care for a rapidly aging population. These initiatives share a common goal of improving patient outcomes, preventing hospitalizations and reducing costs to the system.
Why This Matters to You
The evolving role of primary care practitioners will encourage greater collaboration between physicians and the entire continuum of care settings, including acute care hospitals, long-term acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home care. This collaboration will lead to better patient-centered care coordination.
The Changing Role of Primary Care
Policymakers and healthcare analysts have predicted the demise of primary care for many years – pointing to the imbalance between retiring physicians and incoming primary care practitioners as well as the perceived bias against primary care in favor of specialists. Recently, the Association of American Medical Colleges predicted a shortage of 45,000 primary care doctors by 2020.
In reaction to these dire predictions, the Affordable Care Act (ACA) and related policies issued by the Centers for Medicare and Medicaid Services (CMS) have sought to emphasize the importance of primary care services in managing patient care, improving quality and reducing cost.

The ACA established the CMS Innovation Center in order to test various payment and delivery models with the goal of creating better patient care outcomes and lower costs. Some programs within the innovation center’s dedicated “Primary Care Transformation” category include:
-
Independence at Home – In a three-year
demonstration, CMS selected and is working
with medical practices to test whether delivering
comprehensive primary care services in the patient’s
home will improve care for high-cost Medicare
beneficiaries with multiple chronic conditions.
Those participating practices that lower costs while
improving outcomes and quality achieve financial
rewards. Most recently Congress passed legislation to
extend the demonstration project by two additional
years in order to build upon the preliminary success of
the program.
- Advanced Primary Care Practice
Demonstration – The goal of the demonstration
was to test the efficacy of patient-centered medical
homes. Specific targets were to improve the safety,
effectiveness, efficiency, timeliness and quality of care;
provide care coordination and care management; and
improve patient experiences with care.
- Transforming Clinical Practice Initiative –
Beginning in late 2015, this effort will provide up
to $840 million over four years in order to support
150,000 clinicians in sharing, adapting and further
developing evidence-based quality improvement
strategies which are expected to lead to greater
improvements in patient health and reduction in
healthcare costs.
The ACA also established the Teaching Health Center
Graduate Medical Education (GME) program in order to
increase the number of primary care residents trained in
community-based settings. Initially a $230 million, fiveyear
program, Congress acted in March 2015 to fund the
program for an additional two years. The Teaching Health
Center GME program pays for direct and indirect medical
education expenses for training residents in new or expanding
community-based primary care residency programs. The
initiative serves to combat the coming shortage of primary
care practitioners while also increasing patient access to
necessary health care.
Additionally, in rulemaking over the past several years,
CMS has emphasized primary care services – and especially
care management – as a critical component of primary care
that improves quality and reduces costs. This has included
refinements to the physician Medicare payment system
to reimburse for services that will serve to increase the
care management abilities of primary care physicians and
practices. New payments for transitional care management
and chronic care management services have been recently
implemented to improve payment and encourage investment
in these capabilities. Now CMS is seeking to add new
reimbursements to physicians for advance care planning.
The Future of Primary Care
It is clear from the recent efforts by Congress, the
Administration and CMS that the role of primary care
practitioners is valued and will be critical as our nation’s
healthcare system transitions to reward and reimbursement
based on value rather than volume.
Patient-centered primary care will be a cornerstone in
efforts to improve care management particularly for
patients with multiple chronic illnesses, in keeping patients
at home – or transitioning them home most appropriately –
and ensuring a continuity in care and communications for
patients most in need.
The Kindred Experience with the Primary Care Solution
Recognizing the valuable role that primary care
physicians play in effective care management
across an entire patient episode – including
post-acute care – Kindred established a homebased
primary care program known as Kindred
House Calls. We are committed to delivering
primary care services to patients who cannot
easily access traditional outpatient care settings
and are at high risk for costly hospitalizations.
Kindred House Calls provides comprehensive
care management, performing important direct
care while coordinating the entire spectrum of
care and services available.
We now deliver these services in many of our
integrated care markets with more than 70 physician and physician extenders, making more
than 70,000 house calls per year.
Kindred House Calls delivers patient-centered
quality-driven care while creating cost savings.
A Medicare cost data pilot project found that
the group’s care was associated with significant
cost savings over traditional care models, and
for the seventh year in a row achieved a 30-day
readmission rate below 7%. Through our tailored
medical care, we are delivering improved clinical
outcomes, preventing emergency room visits
and hospital stays and creating positive patient
experiences.
For more information or for a referral,
contact your local Kindred Clinical Liaison.