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Wednesday Jul 11, 2012

Application Deadline Approaching for Pilot Program to Increase Primary Care Payment

Some primary care physicians have understandably taken a "show-me-the-money" approach to the patient-centered medical home (PCMH). They want to know that the investment is going to be worth the considerable time, effort and -- of course -- money before implementing the PCMH model.

Meanwhile, trailblazers who believe in this model and already are transforming their practices stand prepared to reap the benefits in seven select markets when CMS puts the patient-centered model to the test in its Comprehensive Primary Care InitiativeBut time is short. The deadline to apply is July 20.

Although the CPC Initiative will affect our members in only seven specific areas initially, it could have far-reaching effects on the future of our specialty. Once CMS is able to show that the initiative meets the triple aim of providing better health and better care at a lower cost, HHS has the discretion to expand the program more broadly.

In short, if this succeeds for practices and payers in the test markets, we all stand to benefit.

      So will the CPC Initiative actually show us the money?

      CMS is offering a well-outlined program for these markets and has provided clear guidance on what participating practices will receive for Medicare patients.

  • CMS will offer a blended payment model that combines fee-for-service with a per-patient, per-month care coordination fee ranging from $8 to $40 with an average of $20. Participating private payers also will offer their own per-patient, per-month fees. Medicaid also is participating in some markets.
  • Participating private payers also may offer their own per-patient, per-month care management fees and /or other care coordination support services.
  • Participating practices also have an opportunity to participate in shared savings with both public and private payers.

The initiative seeks to foster collaboration between public and private payers to strengthen primary care with 45 commercial, federal and state insurers participating in selected markets. I urge practices in the following selected markets to complete a brief screening tool

  • Arkansas (statewide),
  • Colorado (statewide),
  • New Jersey (statewide),
  • New York (Capital District-Hudson Valley region),
  • Ohio (Cincinnati-Dayton region),
  • Oklahoma (Greater Tulsa region), and
  • Oregon (statewide).

Practices that meet eligibility criteria will receive an e-mail from CMS with the full application.

Up to 75 practices in each market will be selected to participate. As of July 9, more than 75 practices had started the application process in Arkansas, Colorado, New Jersey and Ohio, but only a fraction of those practices had completed the application. In both Oklahoma and Oregon, roughly 50 practices had started the application process, but only two had completed the application in Oregon and none had completed it in Oklahoma.

This program has too much potential for us to let it pass by. We must seize this opportunity. For more information, including webinars and other resources, check out our CPC Initiative webpage.

Glen Stream, M.D., M.B.I., is president of the AAFP.

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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.