CMS announces new payment model for primary care physicians

The Centers for Medicare and Medicaid Services (CMS) last week announced a new risk-based primary care initiative designed to “transform and improve†how primary care physicians care for their patients by focusing on quality of care and outcomes over how many patients a physician can see in a given day.

Dubbed the Comprehensive Primary Care Plus (CPC+) model, it will launch in January 2017 and will be implemented in up to 20 regions. CPC+ can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve, according to CMS.

The new five-year model builds on the Comprehensive Primary Care initiative launched in late 2012 and scheduled to end later this year. Under that model, CMS says hospital readmissions fell below national benchmarks and patients gave clinicians high scores on communication and access to care.

The new model moves away from traditional one-size-fits-all, fee-for-service health care to a new system that will give doctors “the freedom to deliver the care that best meets the needs of their patients,†and provide more coordinate care, according to CMS. This can mean delivering care via telemedicine, or simply answering patients’ questions via email, when appropriate. Under the old system physicians were not incentivized to speak to patients via telephone or email because they were not paid to do so.

CMS says the new payment model will benefit patients by helping primary care practices do the following:

• Support patients with serious or chronic diseases to achieve their health goals
• Give patients 24-hour access to care and health information
• Deliver preventive care
• Engage patients and their families in their own care
• Work together with hospitals and other clinicians, including specialists, to provide better coordinated care

Primary care practices will participate in one of two tracks.

Under Track 1 practices will be paid a monthly care management fee of $15 per beneficiary, per month in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. They also will be eligible for a performance-based incentive payment of $2.50 per beneficiary per month.

Track 2 practices will receive a monthly care management fee and a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. They will receive an average monthly care management fee of $28 per beneficiary, per month across five risk tiers and it includes a $100 CMF to support care for patients with the most complex needs. CMS says the goal is to allow practices more flexibility in delivering care outside of the traditional face-to-face encounter.

Practices in both tracks also will receive data on cost and utilization. Doctors will be financially rewarded for hitting quality targets. They also will be required to use certified electronic health record technology and will be expected to report electronic clinical quality measures at the practice level.

CMS will accept payer proposals to partner in CPC+ from April 15 through June 1. Once CMS determines which areas will participate, the agency will accept practice applications from July 15 through September 1.

Both the American Academy of Family Physicians and the American Medical Association have voiced approval for the model noting that it emphasizes improvements in care and provides physicians with the ability to better control that care in a way that benefits patients.

The Health Law Offices of Anthony C. Vitale can assist you and your practice with exploring these new reimbursement options. Give us a call at 305 358-4500 or send an email to info@vitalehealthlaw.com