New payment model seeks to reduce cardiovascular disease

The Centers for Medicare & Medicaid Services (CMS) is accepting applications from physicians and other health care providers to test a new model for reducing the risk of cardiovascular disease among Medicare beneficiaries.

The Million Hearts Cardiovascular Disease (CVD) Risk Reduction model will pay participating practices to help beneficiaries determine their individual risk for heart attack or stroke over the next 10 years. It will then pay those practices to help high-risk patients identify the best ways to reduce their individual risk factors and encourage them to make those changes, hopefully leading to lower rates of heart attack and stroke in those patients.

CMS plans to operate the Million Hearts CVD Risk Reduction for five years and involve more than 300,000 Medicare beneficiaries and 720 practices. The practices will vary in size and patient case mix and can include physicians in family medicine, general practice, general internal medicine, geriatric medicine, multi-specialty care, or cardiovascular care. Half of the selected practices will actually participate in the model while the other half will serve as control practices.

To be eligible, participating practices must have:

•    At least one provider, which CMS defines as a medical doctor, doctor of osteopathic medicine, physician assistant, or nurse practitioner; 
•    An electronic health record (EHR) system certified by the Office of the National Coordinator for Health Information Technology; and
•    Met the criteria for Stage 1 of Medicare’s meaningful use EHR incentive program.

But how much are you paid? Under the program, each practice chosen to implement the intervention will receive a onetime payment of $10 per Medicare beneficiary in the target population to perform the initial risk stratification. Once the practice has identified the individuals at high risk for CVD, it will receive $10 per beneficiary per month to work with those patients to reduce their risk. CMS may potentially reduce those payments to a practice beyond the first year depending on how well the practice is reducing the beneficiaries' CVD risk. Practices chosen for the control group will receive an annual one-time payment of $20 per Medicare beneficiary in the target population for successfully submitting their data.

If your practice is interested in applying, you must first submit a non-binding letter of intent (LOI) by Sept. 4. CMS will use letters of intent for planning purposes only. Once CMS receives the LOI, practices will have until 11:59 p.m. (EST) Sept. 4 to electronically submit the application. You can access application materials at http://innovation.cms.gov/initiatives/Million-Hearts-CVDRRM/.

For more information on this new payment model, please review the fact sheet and frequently asked questions on the CMS web site.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted on Jun 09, 2015 by David Twiddy