November 26, 2019 08:44 am News Staff – Decades of the Academy's payment-reform advocacy have borne fruit in the Center for Medicare and Medicaid Innovation's new Primary Care First payment model. For some physicians, the initiative -- announced this past spring, with the first call for applicants issued last month and a start date of Jan. 1, 2021 -- stands to finally re-focus payment on comprehensive and continuous patient-centered family medicine rather than on episodes of care.
AAFP analysis suggests that the PCF program, which uses prospective, risk-adjusted, population-based payments for primary care services, is structurally sound and directionally appropriate. The Academy's modeling indicates that it should consistently work better than the Medicare Quality Payment Program's Merit-based Incentive Payment System, even for those getting the maximum MIPS bonus.
Still, it's a first step, meaning there's not enough fruit to go around yet, and not everyone will find the flavor appealing.
The selective program, for which applications are due Jan. 22, will be available to physicians in just 26 states and regions. (Expanding the number of participating states moving forward is an AAFP goal.)
And it seems likely to favor practices that are already good at scale, savvy about value-based payment programs and knowledgeable about their patient populations. Academy analysis shows a sweet spot for those who
With these caveats in mind, the Academy has readied tools to help members decide whether to apply.
The AAFP Primary Care First Dashboards for CPC+ Practices and Non-CPC+ Practices, and the AAFP Practice Assessment Checklist are designed to help assess a practice's readiness to participate in PCF, addressing criteria including care delivery capabilities, data infrastructure and potential financial impact.
Geography first: In 2021, PCF will be offered in Alaska, Arkansas, California, Colorado, Delaware, Florida, the Greater Buffalo region of New York, the Greater Kansas City region of Kansas and Missouri, the Greater Philadelphia region, Hawaii, Louisiana, Maine, Massachusetts, Michigan, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, the North Hudson-Capital region of N.Y., Ohio and the Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma, Oregon, Rhode Island, Tennessee and Virginia.
Beyond that, applicants must
They also must
Practices accepted into the model will receive payments for primary care services through three mechanisms:
Related AAFP News Coverage
AAFP Advises CMS on Making Value-based Model Work for FPs