Comprehensive Primary Care Plus (CPC+)
What is CPC+?
The Comprehensive Primary Care Plus (CPC+) model is an opportunity for primary care to receive better, more flexible payment and participate in a robust learning community to better meet patient needs. It is an advanced alternative payment model (AAPM) built on learnings from the original CPC initiative.
CPC+ offers two tracks: Track 1 for practices building capabilities or Track 2 for those already delivering advanced primary care.
CPC+ is a multi-payer practice transformation model lead by the Centers for Medicare and Medicaid Services (CMS). It provides primary care practices with up-front and improved payment along with technical assistance. Implementation of CPC+ began January 1, 2017 with 2,891 primary care practices participating in 14 regions. This first group of practices and regions is referred to as Round 1.
A second group of up to 1,000 practices will make up Round 2 of CPC+. Round 2 will begin on January 1, 2018, in four regions. Practices located in these new regions will be eligible to apply from May 18 to July 13 2017.
Who Should Apply for CPC+?
CPC+ is only open to primary care, specifically family medicine, internal medicine, and geriatrics. The model is open to any practice size. Some basic eligibility requirements can help determine if CPC+ is a fit for your practice.
For Tracks 1 and 2:
- The practice must be located in a Round 2 CPC+ region.
- The practice must have at least 125 attributed Medicare Part B fee for service beneficiaries. This does not include patients with Medicare Advantage.
- The practice should have approximately 45% or more of current revenue generated from CPC+ payer partners and Medicare fee for service.
- The practice uses CEHRT.
- The practice does not charge patients a retainer or practice membership fee.
- The practice has existing care delivery activities which include: patients assigned to provider panel, 24/7 access for patients, and support for quality improvement activities.
Track 2 only:
- The practice has existing care delivery activities which include: following up with patients after emergency department (ED) or hospital discharge and implementing a process to link patients to community based resources.
- The practice provides, with its CPC+ application, a letter of support from a health IT vendor that outlines the vendor’s commitment to support the practice in optimizing health IT.
Additional information about eligibility requirements are available in the CMS Practice FAQ(innovation.cms.gov).
Round 2 Regions and Application Dates Announced
Note: Practices located in the Round 1 regions are not eligible to apply to CPC+ Round 2. Eligible practices applying in Round 2 regions may be assigned to a comparison group to evaluate and build evidence for the CPC+ model. More about the comparison group expectations can be found on pages 3 and 20 of the CMS Practice FAQ(innovation.cms.gov).
Round 2 is being implemented in the four regions below. Practices located in these regions are eligible to apply via an online portal(app1.innovation.cms.gov) starting May 18 through July 13, 2017.
|North Dakota||New York (Greater Buffalo Region)|
Why should my practice apply for CPC+?
The CPC+ payment model is beneficial for primary care. It provides access to increased and up-front payment for primary care. CPC+ has three components that de-emphasize fee-for-service and increase payment to support practice improvement and capacity building. Both CPC+ tracks offer three payment components:
- Care management fee (CMF): Practices will receive a per-beneficiary-per-month (PBPM) CMF for their Medicare Part B patients. The fee will be paid prospectively on a quarterly basis and will be based on the complexity of the patient population. The average PBPM CMF will be $15 for Track 1 and $28 for Track 2. Track 2 practices will receive a $100 PBPM CMF for the most complex cases, such as patients with dementia.
- Performance-based incentive payment (PBIP): All CPC+ practices receive their PBIP as a prospective payment at the beginning of each program year in order to meet patient needs and build capacity. At the end of the program year, practices that do not meet quality and cost benchmarks will repay some or all of this payment. The PBIP will be equivalent to $2.50 PBPM for Track 1 and $4 PBPM for Track 2.
- Payment under Medicare physician fee schedule: All CPC+ practices will continue to bill and receive fee-for-service (FFS) payments. Track 1 practices will continue to receive standard FFS payments. Track 2 practices will receive a hybrid payment with a prospective portion paid quarterly -- the Comprehensive Primary Care Payment (CPCP) -- coupled with reduced fee-for-service payments. The CPCP plus FFS payments together will be larger than the practice's historical FFS payment.
Within the Quality Payment Program (QPP), CPC+ has been designated as an Advanced Alternative Payment model (AAPM) for practices whose TIN has 50 or fewer clinicians. Qualified Participants (QP) in AAPMs will receive a 5% annual bonus based on their historical Medicare Part B payments and be exempt from the Merit-based Incentive Payment System (MIPS).
CPC+ practices receive technical assistance and support through national and regional learning contractors and are able to connect with and learn from other CPC+ practices through an online platform.
How to Get Started
Step 1: Review the request for applications from Round 2(innovation.cms.gov) and ensure your practice meets the requirements.
Step 2: Contact the AAFP (firstname.lastname@example.org) with your questions. Our staff can help assess if CPC+ is right for your practice.
Step 3: Access free, CMS-funded support programs. The Transforming Clinical Practice initiative (TCPi) and QPP-SURS are technical assistance (TA) programs to help practices prepare for successful participation in alternative payment models, like CPC+. Email the AAFP with questions or if you would like to get connected to the right TA program for your practice.
Step 4: Participate in conversations with other family physicians transforming their practices through the TCPi Member Interest Group.
CPC+ Round 2 Timeline
- May 18 - July 13, 2017: CPC+ Round 2 practice application period open
- January 1, 2018: CPC+ Round 2 performance year one begins
- January 1, 2019: CPC+ Round 2 performance year two begins
- January 1, 2020: CPC+ Round 2 performance year three begins
- January 1, 2021: CPC+ Round 2 performance year four begins
- January 1, 2022: CPC+ Round 2 performance year five begins
- December 15, 2016: CPC+ Round 2 announced
- May 17, 2017: CMS announces four CPC+ Round 2 regions
In order to assure the integrity of the evaluation, new practices cannot join those existing regions. CPC+ Round 1 is currently being implemented in the following states and regions:
Kansas City Metro (KS/MO)
New York (Hudson Valley)
Ohio (includes Northern Kentucky counties)
- January 1, 2018: CPC+ Round 1 performance year two begins
- January 1, 2019: CPC+ Round 1 performance year three begins
- January 1, 2020: CPC+ Round 1 performance year four begins
- January 1, 2021: CPC+ Round 1 performance year five begins
- April 11, 2016: CPC + Model announced
- April 14 and 19, 2016: CPC+ Model Announcement Webinar
- April 21, 2016: CPC+ Health IT Vendor Webinar
- April 27 and May 10, 2016: CPC+ Interested Payer Webinar
- June 8, 2016: CMS deadline for accepting payer proposals to partner in CPC+ (closes at 11:59 p.m. EST)
- Late July 2016: CMS publicizes the 20 CPC+ regions
- August 1 – September 15, 2016: CMS accepting practice applications (closes at 11:59 p.m. EST)
- Late November 2016: Selected practices notified
- December 15, 2016: CPC+ Round 2 announced