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SAN DIEGO -- Medicare understands the value of primary care, but the process of increasing payments to such providers may be more difficult than the program realizes, a former head of the American Academy of Family Physicians said here.

The Centers for Medicare and Medicaid Services (CMS) has for the last 2 years introduced new payment codes to reward services unique to primary care -- a sign these agencies realize the value of primary care.

But the process has been difficult for providers to implement. Even 8 months after the introduction of transitional care management code, CMS, AAFP and other primary care organizations are still in order to receive the payment.

"I just think they don't recognize how difficult it is to meet all the bullet points," Glen Stream, MD, immediate past AAFP board chair, told 番茄社区app. "It's a big leap for them to create new codes."

The final rule on the 2014 fee schedule is due Nov. 1, and AAFP leadership hopes CMS' proposed complex care management codes are easier to implement than this year's transition management.

But as AAFP and organizations like it try to narrow the gap in payment between primary care providers and their specialist counterparts, Stream said lobbying for billing codes unique to primary care is a relatively new strategy.

"If you look at E&M services by primary care physicians or family physicians as unique and different than the E&M services done by other people, and you value [them] correctly, that will fix the problem," Stream told 番茄社区app at the AAFP Scientific Assembly here. "We really think that's the answer."

AAFP is in the process of compiling data on the problems of estimating work value -- called -- and plans to submit its findings and its strategy for correcting the problems to CMS soon.

But the AAFP has also advocated hard for Medicare and private payers to provide a per-member-per-month care coordination fee to help primary care practices implement such practice changes as hiring care managers to help manage their most costly patients, Stream said.

Even then, rank-and-file physicians need to be better advocates for alternative delivery models such as patient-centered medical homes (PCMH) and voice their benefits to payers, patients, and employers, , chief executive of the , a PCMH advocacy group in Washington, told the assembly here.

She said primary care doctors are positioned to and must be leaders in the formation of accountable care organizations (ACO) and PCMH movements so that they're in the driver's seat when they become more widespread.

"We've got to keep leading and we've got to be leading outside of our comfort area," Nielsen said.

With talk of payment and delivery reform in full swing, primary care is en vogue right now.

"I've been in public policy for almost 25 years. Public health and primary care have never been the 'it' girls," she said. "We are the 'it' girls now, and we want to keep our reign."

Primary care needs to keep gathering evidence that what they offer really is the foundation of the triple aim, which is saving money, improving outcomes, and improving quality. "As long as we can keep that evidence coming, I think the window stays open," Nielsen said.

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