CMS Primary Care Physician Incentive Program Breaks New Ground

Comprehensive Primary Care Plus (CPC+), a CMS program designed to encourage providers to deliver comprehensive care management within a system promoting payment reform, is getting some good reviews from the people who arguably matter most — physicians in the trenches, reports Medical Economics.

Lawrence Ward, MD, an internist in Philadelphia, tells the publication: “We’ve seen a lot of programs come that don’t lead to real change but involve a lot of extra work. I think this one’s different. I think this is really what we’ve been waiting for from Medicare for primary care.”

The program is a follow-up to the Comprehensive Primary Care initiative, which ended last year. CPC+ began in January. CMS is already planning a second round for CPC+ to begin next year in four regions: Louisiana, Nebraska, North Dakota and Buffalo, New York.

Under CPC+, physician practices get a per-patient, per-month payment up front that isn’t connected to the number of patient visits. The amount depends partly on a patient’s risk score, and they average about $15 for patients on Track 1 and $28 for Track 2, which offers more incentive payments but also more benchmarks. Health plans and the practices negotiate the amount.

There are also performance related payments tied to quality and utilization. Practices will have to return some of the money if they don’t reach their goals.

Then there are the comprehensive primary care payments (CPCP) that practices in Track 2 are eligible for. “With this third type of bonus, CMS is experimenting with replacing some of a practice’s expected fee-for-service billings with upfront CPCP,” Medical Economics reports. “These new payments will include an additional 10% of expected fee-for-service payments to help a practice deliver transformed care.” 

Source: Medical Economics