If like me you’ve been kinda following Federal physician payment reform (and hoping that what is learned there there will lead to payment reform in the private sector or maybe even workers’ compensation), the Centers for Medicare and Medicaid Services (CMS) made a big announcement this week.
Starting 4 months from now, (January 2017) they will be rolling out / testing a really quite revolutionary change in payments to PRIMARY physicians in 14 regions that include 11 whole states: Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee. Other areas are the Greater Kansas City, MO area; the North Hudson Valley in New York state, the Greater Philadelphia area, and a region that includes all of Ohio plus northern Kentucky.
If you’re in any of those areas, it would behoove you to learn more about this –- and follow it as it unfolds. CMS is estimating that 5,000 primary care practices serving an estimated 3.5 million beneficiaries could be touched by this model. They are currently taking applications for providers in eligible practices in these areas, and don’t expect much trouble recruiting because the care-management fees can be a boon for practices. Providers may be able to earn an additional $100,000 to $250,000 per year under the model, depending on the number of patients who participate.
The new model CPC+ (Comprehensive Primary Care Plus) has two tracks. Under track one, providers get a monthly fee for specific services in addition to the usual fee-for-service Medicare payments. But in track two, practices get an upfront monthly care-management fee coupled with reduced fee-for-service payments. The purpose of this hybrid model is to let practices provide care outside of the traditional face-to-face encounter.