Are you ready for another Value-Based Program?

Last Monday, CMS announced yet another payment reform for Medicare to help accelerate the transition from Fee-for-Service (FFS) to Value-Based Care. The program is called Comprehensive Primary Care Plus. So, how does it work?

The model involves supplementing doctors’ regular fee-for-service with new monthly rewards.

Practices who opt for Track 1 will receive an additional $15 per patient per month (PPPM) in care management fees. This will include additional workflow changes around 5 key areas: (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; and (5) Planned Care and Population Health

If a practice chooses the higher-risk, higher-reward Track 2 option, they will receive a $28 PPPM fee. However, under Track 2 instead of receiving the full Medicare fee-for-service payments for evaluation and management services, physicians will get reduced Medicare fee-for-service payments and up-front comprehensive primary care payments. Track 2 practices will have other requirements in place, such as providing comprehensive services for patients with complex medical and behavioral health needs, systematic assessments of their patients’ psychosocial needs, and an inventory of current resources and support, which will include a signed MOU with CMS that outlines the practice’s commitment to the enhancement of their health IT capability.

Also, regardless of which track you choose, CMS will provide practices with a small performance-based payment up front to help get started. However, if practices do not meet quality standards, they will have to pay this upfront payment back.

The program officially begins on January 1st 2017 and CMS is looking for up to 5,000 practices and 20,000 physicians to sign up over the next 5 years.

CMS will accept practice applications in the determined regions from July 15, 2016 through September 1, 2016.

This is a huge step in the right direction toward movement toward CMS stated goal of reaching 50% of Medicare reimbursements toward alternative payment methods by 2018.


CMS is sincerely aware of the need to dramatically shift away from FFS so they are setting in place many methods to achieve this goal. So far, there is Accountable Care Organizations (who can’t participate in the new CPC+ program), Value-Based Purchasing for Hospitals, and the new physician reimbursement called MACRA that will tie doctor pay to outcomes. While I agree that all the programs are great, in the field, the vast majority of practices still receive something like 80% of their revenue from FFS. So what will happen to practices that don’t get on the Value-Based Care program? Well, as you can guess, many are slowly seeing FFS payments being reduced to pay for these new alternative methods. I foresee a point where many practices will wake up and realize that they can no longer run their medical practice as a going concern.

So if you are behind the Value Based 8-ball, what can you do? First, figure out where you are currently. A baseline of your revenue mix and the patient population will help you gauge what direction you should go. Second, evaluate certification programs that can help prepare your organization for Value-Based Care. For example, NCQA has a great credentialing program for primary and specialist called Patient Center Medical Home. This is a great place to start down the path toward receiving incentive payments based on quality. Finally, look at your technology and how you can better manage your patient population with innovative tools for patient stratification and remote monitor tools designed to drive toward positive patient outcomes. An E H R alone will simply not be enough.

Another value-based program is not something to fear, but a starting point to figure out which direction you need to take your practice to prepare for the future.

For more info about CPC+:

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