CMS to Implement New Primary Care Payment Model

The Centers for Medicare and Medicaid Services (CMS) is planning to implement a new primary care payment model in up to 20 regions that will affect up to 5,000 practices, encompassing more than 20,000 doctors and clinicians. Under the Comprehensive Primary Care Plus initiative, providers will be able to participate in one of two ways. In Track 1, CMS will pay a monthly fee to practices for specific services in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for care. In Track 2, practices will receive a monthly care management fee, as well as reduced Medicare fee-for-service payments and upfront comprehensive primary care payments. The goal of Track 2 is to allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter such as telemedicine visits or longer office visits for patients with complex needs. Currently, providers submit a claim to Medicare for payment after performing a service.

To be eligible for either track, providers must demonstrate that: 1) services are accessible and responsive to a person’s preferences, and offer enhanced in-person hours and 24/7 telephone or electronic access; 2) patients at highest risk receive proactive, relationship-based care-management services to improve outcomes; 3) care is comprehensive, and practices can meet the majority of each individual’s physical and mental healthcare needs, including prevention; care is also coordinated across the healthcare system, including specialty care and community services; and patients receive timely followup after emergency room or hospital visits; 4) the practice is patient-centered, recognizing that patients and family members are core members of the care team, and the practice actively engages patients to design care that best meets their needs; and 5) quality and utilization of services are measured, and data is analyzed to identify opportunities for improvements in care and to develop new capabilities.

CMS plans to identify regions to be affected after it assesses interest by providers. Once determined, practice applications will be accepted from July 15 through September 1.