• CMS provides details on Comprehensive Primary Care Plus

    Like an auto company touting the latest model or a certain soda manufacturer unveiling its “new” version of an old “classic,” the Centers for Medicare & Medicaid Services (CMS) has revealed its latest effort to transform and improve how primary care is delivered and paid for in the United States. CMS will implement the Comprehensive Primary Care Plus (CPC+) model in up to 20 regions of the country, accommodating up to 5,000 practices and more than 20,000 physicians and other clinicians. It would also seek to encompass up to 25 million patients.

    Building on the Comprehensive Primary Care initiative launched in late 2012, which is already being dubbed “CPC Classic,” the five-year CPC+ model will offer primary care practices two tracks for participation. Both tracks will require practices to:

    •    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

    Practices in Track 2 will also be expected to provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs and an inventory of resources and supports to meet those needs.

    Physicians participating in CPC+ will receive monthly care management fees for eligible beneficiaries in their practice. Physicians in Track 1 will be paid depending on where each patient falls across four risk tiers, with an average of $15 per beneficiary per month. In Track 2, physicians will be paid according to five risk tiers, with an average of $28 per beneficiary per month, including $100 per month for the most complex patients. Practices can use these fees for increased staffing and training necessary to meet the model’s patient care requirements.

    In addition to the care management fees, Track 1 physicians will continue to receive their normal Medicare fee-for-service payments. Physicians in Track 2 will receive a new hybrid of fee-for-service payments and a “Comprehensive Primary Care Payment,” which will include a percentage of the expected Medicare reimbursement for Evaluation & Management (E/M) claims upfront. Reimbursement for the E/M claims themselves will be reduced.

    In addition to these payments, CMS will award practices incentives based on performance.

    Like CPC Classic, Medicare will partner under the CPC+ model with commercial and state health insurance plans. CMS will accept proposals from payers wanting to partner in CPC+ between April 15 through June 1, selecting regions of the country that reflect sufficient interest from multiple payers. Practices in the selected regions can apply to participate from July 15 through Sept. 1.

    CMS is offering additional information on CPC+ through a press release, a fact sheet, and frequently asked questions.

    – Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

    Posted on Apr 13, 2016 by David Twiddy

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.