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Tuesday Aug 16, 2016

CPC+ Holds Plenty of Potential for FPs

ā€œEven after expenses, this will mean a six-figure boost in income for each of us and the delivery of care will be significantly better.ā€  

This is a portion of an email we received from a family physician in Michigan who wanted to share the impact that the Comprehensive Primary Care Plus (CPC+) program would have on the writer's six-physician practice. This physician estimates that not only will the program allow everyone in the practice to better serve their patients, especially those with complex health conditions, but it will generate significant revenue for each of them, as well as for the practice.

The AAFP shares this excitement about CPC+, but we recognize that to realize the full potential of the program we need to ensure that a high number of family physicians apply and participate in it.

On Aug. 1, CMS announced the 14 states and regions that will participate in CPC+ and opened the application process.  Interested and eligible physicians who practice in one of the selected states/regions may apply by Sept. 15.

CPC+ is a five-year primary care medical home program that will begin in 2017 and conclude in 2021. It is a multi-payer model, which means that Medicare, Medicaid and commercial insurance programs will all be participating in the selected states/regions. The multi-payer approach is essential to creating alignment across a practice. Fifty-seven payers have signed up to participate in the program.

CMS plans to select 5,000 practices for participation in the CPC+ program from the selected states and regions. The participating states are Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Ohio (including northern Kentucky), Oklahoma, Oregon, Rhode Island and Tennessee. In addition to the 11 states, three regions were selected: Kansas City metro (Kansas and Missouri), Philadelphia metro and New York Hudson Valley. Many of the selected states/regions also participated in the Comprehensive Primary Care Initiative (CPCI), which concludes at the end of this year.

The CPC+ program aims to build on the experiences gained from CPCI or, as it is now known, the CPC Classic program.  

CPC+ will have two tracks. Track 1 aims to support practices in building key comprehensive primary care capabilities. Track 2 targets practices that have more experience delivering advanced primary care and aims to support delivery of enhanced care through IT, targeting patients with complex needs and helping to meet patients' psychosocial needs. Participating practices in both tracks must develop, implement and execute against five key primary care functions. Those five functions are:

  • access and continuity;
  • care management;
  • comprehensiveness and coordination;
  • patient and caregiver engagement; and
  • planned care and population health.

In addition, participating practices must prove that they have support from multiple payers, use a certified electronic health record technology and report electronic clinical quality measures at the practice level. Practices participating in Track 2 must also demonstrate a commitment to using enhanced health IT functions in their practice and a commitment to caring for complex patients. Track 2 practices are required to have a letter of support from their IT vendor(s) when applying. All IT vendors for Track 2 practices will be required to enter into a memorandum of understanding with CMS.

Payment Models
Participating practices will receive prospective payments in three forms: comprehensive primary care payments, care management fees and performance-based incentive payments. Unlike other pay-for-performance programs, payments under the CPC+ Performance-based Incentive Payment (PBIP) system will be made to practices at the beginning -- not the conclusion -- of the performance year. Practices will be retroactively evaluated on their performance on patient experience, clinical quality and utilization. Practices that fail to meet quality and utilization thresholds must repay some of PBIP.

Track 1 practices will continue to receive Medicare fee-for-service (FFS) payments along with a prospective per-beneficiary-per-month care management fee. The practices also will receive prospective PBIP payments of $2.50 per beneficiary per month.

Track 2 practices will receive a blended payment made up of Medicare FFS and a prospective percentage of expected Medicare reimbursement for evaluation and management claims, along with a prospective per-beneficiary-per-month care management fee. The practices also will receive prospective PBIP payments of $4 per beneficiary per month.

Care Management Fee
Participating practices in both tracks will receive prospective monthly care management fees (CMF) on a per-beneficiary basis.  The amount of the monthly payment will be based on the health care condition (HCC) of the beneficiary. CMS estimates that the average CMF will be $15 per beneficiary for Track 1 practices and $28 per beneficiary for Track 2 practices. Additionally, Track 2 practices will receive a CMF of $100 per beneficiary for their most complex patients.  The CMF structure is as follows:

Risk Tier  Attribution Criteria  Track 1 Track 2
 Tier 1  First quartile HCC  $6  $9
 Tier 2  Second quartile HCC  $8  $11
 Tier 3  Third quartile HCC  $16 $19 
 Tier 4  Fourth quartile HCC for Track 1
75% to 89% for Track 2
 $30  $33
 Tier 5  Top 10% HCC  Not available  $100

Application Process

Family physicians who meet the eligibility criteria and practice in one of the selected 14 states/regions may apply to participate in the CPC+ program by Sept. 15. Practices applying to Track 2 will need to submit a letter of support from their health IT vendor(s) that outlines the vendors' commitment to supporting the practice with advanced health IT capabilities.

The AAFP has numerous resources that can assist you in evaluating your eligibility and completing the application process. We also have partnered with Caravan Health to provide assistance in the practice evaluation and application process. If you are interested in partnering with the AAFP and using the resources available from Caravan Health, please email cpcplus@aafp.org.

Additional Resources


Despite what your opening quote implies, according to the CMS FAQ regarding care management payments "Practices will use this enhanced, non-visit-based compensation to augment staffing and training in support of population health management and care coordination" and "practices will be required to both forecast their spending of the care management fee and CPCP and, a t the end of the performance year, provide an account of actual CMF and CPCP revenue received and actual expenditures". Also the "practice" minimum requirement of 150 Medicare Part B clients (Advantage clients don't count) is potentially disenfranchising to solo docs.

Posted by brett on August 16, 2016 at 12:33 PM CDT #

Despite being a level 3 NCQA patient centered medical home and jumping through every friggin hoop every bloody state or regional 'quality' purveyor holds up to my practice, I still cannot quality for CPC+. I do not have the requisite 150 medicare patients, at least half are siphoned off through Medicare Advantage plans ( no advantage to me or to total cost of care) . Hope you guys at AAFP are working to change that. I would be reasonably compensated at $28 PMPM

Posted by Lynn on August 16, 2016 at 02:53 PM CDT #

Is anyone one doing the math at AAFP? Do you know what it costs to run a medical practice? Pay for NCQA for certification. Pay for ongoing EHR maintenance fees. Paying for overhead, rent, med supply and Staff. There is nothing left for a salary...

Paying for a "Care Coordinator" costs $50,000-70,000 a year for a well trained Case Management RN. 200 seniors at $33PMPM = $6600 per mo and $79200 per year. Doctor hours for management of the team 3 hours per day x 5 days = 15 hours per week @ $100/hour (cheap rate Mechanics and plummers make this in California) = $1500 per week, $6000 per month equals $72000.00 of unpaid physician man hours.

Please show real world calculations that Physicians can understand stop with the MBA/MHA formulas that cheat physicians out of fees earned from hard work.

The Insurance, Hospitals and Big Pharma industries gobbled up all of the healthcare dollars, then Doctors who actually provide the care get a pay cut? I don't get it...

Posted by Elias Sanchez on August 17, 2016 at 05:25 PM CDT #

I am a solo practitioner of 30 yrs. I participated in Pennsylvania Chronic Care
Initiative from 2008-2012. This essentially was about transforming our practice into
a medical home.
There are many problems with this concept:

1. The "quality care" goals that are set are of questionable quality.
2. The system rewards "cookie cutter" "factory line" medicine.
3. The system rewards a physician for using precious time as a clerk and punishes
him for spending his expertise as a healer and thinker.
4. The system rewards minimal medicine for populations rather than for the
the individual personal care of the patient.
5. The system punishes physicians for being creative and for spending time
creating the necessary therapeutic alliance with a patient.
6. These are but a few problems with this system.

Our physician organizations would be better off spending their time and our money fighting for the ideals and real things that make physicians, physicians. Instead they have succumbed to being lead by non physicians and the corporate world of business and government who just don't get it and who know little about what a good physician, good medicine and good patient care consist of.

Posted by Daniel Orr on August 22, 2016 at 08:32 AM CDT #

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About the Author

Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.