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CMS Says “the Future Is Now” with Comprehensive Primary Care Plus Announcement
CMS Says “the Future Is Now” with Comprehensive Primary Care Plus Announcement
By Denise Burke | 04-12-2016

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that it is launching a new initiative that “represents the future of health care.” The Comprehensive Primary Care Plus (CPC+) model is aimed at strengthening primary care by “enabling primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists,” according to the press release issued by CMS.   The five-year CPC+ model goes into effect on Jan. 1, 2017 and could involve up to 5,000 physician practices in up to 20 regions. CMS projects it could ultimately encompass more than 20,000 physicians and 25 million patients. An online CPC+ Announcement Event has been scheduled to provide additional information on Thursday, April 14 at 2 p.m. central time.

UPDATE: The CMS webinar is full and no longer accepting participants. CMS has indicated that a video recording will be posted online in the next few days. We will post a link to the program once it is available.

CPC+ continues the transition away from fee-for-service reimbursement that began when CMS launched the Comprehensive Primary Care initiative in 2012. Last month, CMS estimated it had met the goal of tying 30% of Medicare payments to quality metrics through alternative payment models.

Two tracks will be available for physician participation in CPC+. In Track 1, physicians will receive a monthly care management fee ranging from $6 to $30 per beneficiary in addition to fee-for-service payments for covered services under the Medicare Physician Fee Schedule. In Track 2, physicians will receive a monthly care management fee ranging from $9 to $33 per beneficiary, and “instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services.”

Incentive payments will be provided in advance to practices in both tracks, but whether participating practices are permitted to retain or are required to return those incentives will be based on health outcomes determined by quality and utilization metrics.  Practices cannot participate in CPC+ if they participate in other Medicare shared savings programs and demonstrations.

Private insurers can submit proposals to join the CPC+ program from April 15 to June 1, 2016. CMS will select the regions for CPC+ based on payor interest in participation. Physician practices will be able to submit applications in the determined regions from July 15 to Sept. 1, 2016.

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Denise D. Burke
901.288.1651
denise.burke@wallerlaw.com
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