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CMS announces new primary-care payment and health care delivery model



April 14, 2016
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Primary Care 

The Centers for Medicare and Medicaid Services (CMS) this week announced a new payment model aimed at transforming and improving how primary care is delivered and paid for in America. The Comprehensive Primary Care Plus (CPC+) model will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care. It builds on the current Comprehensive Primary Care program. 

"Strengthening primary care is critical to an effective health care system," said Dr. Patrick Conway, CMS deputy administrator and chief medical officer. "By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars. The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards."

The program is a five-year program that will begin in January 2017. It may also qualify as an alternative payment model under MACRA beginning in 2019. 

According to CMS, clinicians will be able to participate in two ways. In Track 1, clinicians will receive a monthly care management fee for specific services. That fee is in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for care.

Track 2, is a hybrid payment design that will allow practices to receive payment for monthly care management and, instead of full Medicare fee-for-service payments for evaluation and management services, they will receive reduced Medicare fee-for-service payments and up-front bundled comprehensive primary-care payments. This plan will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter, the agency said.

Physicians in both tracks can receive upfront incentive payments that they might have to repay if they do not perform well on quality and utilization metrics. Payment reductions for poor performers could be as high as 14 percent.

"At first glance, this new payment model initiative includes several advances over the current primary care model, particularly because it emphasizes improvements in care that are achievable by primary care physicians instead of cost reductions that are beyond their control," said Dr. Steven J. Stack, M.D., president of the American Medical Association.

"We look forward to reviewing the proposal in detail and working constructively with CMS to ensure physicians have flexible and workable payment models that support high-quality patient care and put less administrative burden on physician practices to alleviate physician burnout."

CMS is expected to announce the CPC+ regions in July.

For questions about the payment model and solicitation process, please visit the Comprehensive Primary Care Plus web page or email CPCplus@cms.hhs.gov.

CMS is also hosting two webinars about the initiative open to all interested stakeholders.  To register, click on the links below.

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