CMS is expanding eligibility for participation in Medicare's new primary care payment model to physician practices that are in Medicare's most popular accountable care organization model.
In an update fact sheet released May 27, federal officials announced that
As many as 1,500 primary care practices will have the opportunity for dual participation in the new Comprehensive Primary Care Plus (CPC+) payment model and the Medicare Shared Savings Program (MSSP).
CPC+ was introduced in April and the multi-payer payment model is set to launch Jan. 1, 2017.
The Centers for Medicare & Medicaid Services on Friday, May 27 released an updated fact sheet after receiving "feedback from a variety of stakeholders expressing interest in the dual participation of primary care practices in both an ACO and in CPC+."
CMS officials believe dual participation in CPC+ and an MSSP ACO "may enhance the coordination of care for Medicare beneficiaries and help to achieve our aims of better care, smarter spending, and healthier people," according to a statement accompanying the fact sheet.
One of the top goals of CPC+, which is a two-track payment model, is to encourage commercial payers to align their reimbursements for Medicare beneficiaries' primary care services with Medicare's payment structures, quality measures and data sharing.
MSSP, which has three tracks with varying levels of financial risk for healthcare providers, is CMS's most popular accountable care organization model. As of January, the MSSP roster stood at 434 ACOs, compared to 404 MSSP ACOs enrolled in the program in January 2015.
The fact sheet released May 27 includes details about payment changes to CPC+ to accommodate MSSP ACOs:
- Care management fees for primary care practices in MSSP ACOs will be the same as all other CPC+ primary care practices. Care management fees will be included in the ACO's calculations for shared savings.
- Primary care practices in MSSP ACOs will not receive the prospectively paid/retrospectively reconciled CPC+ performance-based payment incentive.
- For practices in Track 2 of CPC+, there will be a payment impact in the Medicare Physician Fee Schedule. These practices will shift a portion of Medicare fee-for-service (FFS) payments for "evaluation and management" into Comprehensive Primary Care Payments (CPCPs), an accounting move designed to reduce FFS payments while boosting comprehensiveness of care.
According to the revised fact sheet, "The CPCP and reduced FFS payments together will be calculated based on an amount 10% larger than historical billings to support increased comprehensiveness of care."
Other features of dual participation for primary care practices in CPC+ and MSSP ACOs include:
- Financial benchmark calculations for MSSP ACOs will not be changed.
- Primary care practices in MSSP ACOs will have to adopt the CPC+ care delivery model.
- Participation is limited. A total of 5,000 primary care practices will be allowed to participate in CPC+, with 2,500 in Track 1 and 2,500 in Track 2. Only 1,500 of the 5,000 total CPC+ primary care practices can also be participating in MSSP ACOs.
Payers have until June 8 to submit proposals to CMS to participate in CPC+. CMS will then designate as many as 20 geographic regions where primary care practices will be able to participate in the program. Practices are expected to be able to apply for CPC+ participation between July 15 and Sept. 1.