CMS will allow primary care practices in the Medicare Shared Savings Program (MSSP) to participate in the Comprehensive Primary Care Plus (CPC+) initiative. The announcement came in response to stakeholder concerns that a new Medicare primary care payment model could steer physicians away from accountable care organizations.
Up to 1,500 eligible primary care practices currently participating or applying to participate in Tracks 1, 2 or 3 of the MSSP as of January 1, 2017 will be able to participate in the CPC+ model. If more than 1,500 eligible practices apply, CMS said it would use a lottery system to determine which ones participate in CPC+.
Practices in the ACO Investment Model, Next Generation ACO Model, or other shared savings programs are not eligible for CPC+, according to FAQs from CMS. (“CMS Says ACOs May Participate in Primary Care Plus Initiative,” AHLA Weekly, June 3, 2016)
In April, CMS announced CPC+, a voluntary multi-payer primary care payment model, for up to 5,000 practices and more than 20,000 clinicians. CPC+ will use either monthly payments or advanced prepayments to incentivize certain primary care approaches, such as supporting patients with serious or chronic diseases to achieve their health goals; providing 24-hour access to care and health information; delivering preventive care; and coordinating care with hospitals and other clinicians, including specialists. (“CMS Reverses Course, Allows ACO Physicians in CPC+,” HFMA Weekly News, June 3, 2016)
Analysts had expressed concerns that CPC+ would create disincentives for physicians to join or stay in ACOs. Even sorting out the specific opportunities within CPC+ would slowdown the decision-making process for primary care providers and deter enrollment and growth of physician-led ACOs in 2017, said a senior fellow at the Schaefer Center for Health Policy and Economics at USC.
The National Association of ACOs also wrote that “given the option of pursuing uncertain shared savings through MSSP or receiving comparable guaranteed payments through COC+ as well as additional payments under this program, we are deeply concerned many will choose the latter.” (“CMS Reverses Course, Allows ACO Physicians in CPC+,” HFMA Weekly News, June 3, 2016)
Benefits of Participating in Both Programs
In addition to eliminating an incentive for ACO physicians to depart the MSSP, allowing physicians to participate in both programs may provide benefits for each.
- A combination of care management fees and capitated primary care with shared savings (instead of performance-based payments) will be more successful at reducing spending while improving quality.
- Fee restructuring included in CPC+ would be very helpful for physician-led ACOs, according to experts. The enhanced per member, per month (PMPM) and patient support fees provided in CPC+ would give the practices the advance resources they need to implement reforms in their practices to achieve population-level health improvements and Medicare spending reductions.
- The combination could incentivize CPC+ practices to achieve the savings some doubt will occur among practices participating only in CPC+, which offers no specific incentive to lower the total cost of care.
(“CMS Reverses Course, Allows ACO Physicians in CPC+,” HFMA Weekly News, June 3, 2016)
To read CMS’ updated FAQs on CPC+, click here.
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