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Primary Care Plus

Last month, CMS brought out a new payment model for primary care. It is scheduled for testing starting next January, and will be placed as a voluntary option during the five-year testing period. The model will be tested across 20 regions in the country, and will be open to up to 5,000 practices to take part in.

The model is mean to stand on for traditional reimbursement, which still operate on a fee-for-service basis when it comes to primary care. The program also suggests a way for participating practices to start earning bonuses from specific quality and performance measures.

CMS describes the CPC+ as a “national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation.” The agency says this model will have two ‘tracks’ for the different levels of advanced care delivery requirements, as well as for the payment used.

The model rests on a handful of main primary care functions, which are:

  1. Access and Continuity;
  2. Care Management;
  3. Comprehensiveness and Coordination;
  4. Patient and Caregiver Engagement; and
  5. Planned Care and Population Health.
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Quality And Performance

The first of the mentioned tracks mixes Medicare FFS with monthly payments of $15 for each patient. Track one lets practices get regular FFS payments, as well as $15 monthly to help with care coordination and innovation. Track 2 takes thing further with a monthly payment of $28 and then a $100 fee for the more complex patient cases.

Track 1 is designed to aid practices prep for track 2, which is the stage that brings substantial innovations in care delivery. CMS hopes to bring in Health IT, improved patient care, and optimal use of resources and support systems. The track two monthly payment is called “Comprehensive Primary Care Payments (CPCP)”, and will mix FFS with a share of the reimbursements evaluated as the participating practices expected (E/M), which will be paid as part of their CPCP. Each track lets participating practices get a bonus payment monthly, of $2.50 or $4.00, respectively.

CMS will also try to expand the model into a multi-payer layout where other payers will start using the reimbursement technique for their beneficiaries. CMS is inviting applications from payers who wish to partner with the agency in this model, starting April 15 and extending up to June 1, 2016. These responses will also be checked to see the 20 regions that qualify to participate in the model.

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