CMS to test new ACA payment system for primary care

CMS has announced it will be testing a new model for primary care delivery and payment through the Affordable Care Act, a program it says represents its largest push to transform how physicians are paid across the nation.

The program, Comprehensive Care Plus, referred to as “CPC+” by CMS, would create a two-track system for payments. Track 1 would see CMS pay primary care practices receive a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule. Under Track 2, practices would receive the monthly care management fee, and a hybrid of reduced Medicare fee-for-service payments and upfront comprehensive primary care payments.

According to CMS, CPC+ is designed to help practices “move away from one-size-fits-all, fee-for-service” care. The move would allow physicians the freedom to deliver the care that best meets the needs of their patients, said officials.

“Strengthening primary care is critical to an effective health care system,” Patrick Conway, MD, CMS deputy administrator and chief medical officer, said in a press release. “By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside 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 new CPC+ model builds on the previous Comprehensive Primary Care program, which launched in late 2012 and was made available to approximately 500 practices in seven markets around the United States. In contrast, CPC+ will be rolled out to 5,000 practices in 20 regions, including 20,000 physicians and clinicians serving 25 million patients.

Under both tracks of the new model, primary care practices would be required to:

support patients with serious or chronic diseases achieve their health goals;
grant 24-hour access to care and health information for patients;
provide preventive care;
engage patients and their families in their own care; and
collaborate with hospitals and specialists to better coordinate care.

Practices in Track 2, in addition to the above, would also be required to deliver more comprehensive services for patients with complex medical and behavioral health needs, including an assessment of their psychosocial needs and an inventory or resources to support those needs.

In addition, as an incentive for providing high-quality care, practices in both tracks would receive up-front payments that they would either keep or be forced to repay based on performance on preset metrics.

Responding to the announcement, the American College of Physicians (ACP) praised the new program, stating it has long called for CMS to expand its previous Comprehensive Primary Care program.

“ACP believes that CPC+ offers the potential of greatly strengthening the ability of internists and other primary care clinicians, in thousands of practices nationwide, to deliver high value, high performing, effective, and accessible primary care to millions of their patients,” Wayne J. Riley, MD, MPH, ACP president, said in a statement. “… The success of the Comprehensive Primary Care Plus program will depend on Medicare and other payers providing physicians and their practices with the sustained financial support needed for them to meet the goals of providing comprehensive, high value, accessible, and patient-centered care, with realistic and achievable ways to assess each practices’ impact on patient care.”

CMS will select which regions will see CPC+ implemented based on sufficient interest from payers. According to CMS, it will enter into a memorandum of understanding with selected payer partners to document a shared interest to align on payment, data sharing and CPC+ quality metrics.

CMS will be accepting proposals from payers from April 15 through June 1. Practices in the selected regions will be able to apply to partner with CPC+ from July 15 through Sept. 1. – by Jason Laday

Additional reading:

https://www.acponline.org/acp-newsroom/statement-from-internists-on-comprehensive-primary-care-plus-initiative