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Friday, November 11, 2011

Blended payment model initiative values primary care

Amidst the doom and gloom of the 27.4 percent fee cut called for in the 2012 Medicare Physician Fee Schedule and the all-too-familiar uncertainty about whether Congress will once again intervene at the 11th hour to patch the flawed formula that gives rise to this annual crisis, there is a hopeful sign, and we want to make sure you don’t miss it. A new demonstration project announced by the Center for Medicare and Medicaid Innovation (CMMI) last month will pay participating primary care physicians a care coordination fee in addition to fee-for-service – the blended payment model that has long been at the center of the AAFP’s payment reform advocacy efforts

The fee, which will range from $8 to $40 ($20 on average) per patient per month for Medicare and Medicaid patients and for patients who are enrolled in participating private-sector plans, is designed to compensate physicians for the administrative costs associated with patient-centered medical home services. Practices must meet several criteria to qualify for the project, known as the Comprehensive Primary Care Initiative (CPCI), including use of an electronic health record system and other criteria characteristic of patient-centered medical homes. The blended payment model also includes the potential for physicians to share in savings resulting from the initiative.

The project will be rolled out in five to seven health care markets next summer, each with about 75 primary care practices participating. Physicians will apply to participate next spring, after the markets have been identified. If the project demonstrates improved quality and lower costs, the Centers for Medicare & Medicaid Services has the authority to expand the initiative across the country.

Look for more details about the CPCI in the January/February issue of FPM.

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