Primary care practices would have a shot at collecting some extra cash while trying a new, more comprehensive clinical approach under a new CMS pilot program. The Comprehensive Primary Care Initiative (CPCI) is a four-year program that pay you an extra $20 per patient, per month, on top of regular Medicare fee-for-service charges.
The $20 rate, dubbed a “monthly care management fee,” is good for the first two years; then the rate falls to $15 per patient, per month. Additional cash: If after two years, the total cost incurred by participating practices is less than that of non-participating practices, a portion of the savings is shared with participants.
While this sounds great on paper, you will have to push hard to get a crack at participating. CMS plans to identify 5-7 markets across the country that will each have about 75 participating primary care practices. That’s a total maximum of 525 practices nationwide.
CMS has yet to lay out the precise details, but you will have to do some extra legwork for the extra cash. This includes tracking some quality measures specific to primary care, and working to meet five goals:
-
Provide “intensive care management” for patients with serious or multiple medical conditions
-
Be accessible 24/7 to patients and use patient data tools to give “real-time, personal health care information to patients in need”
-
Proactively assess the need for preventive care and provide it
-
Engage patients and caregivers/families to participate in care
-
Coordinate care with patients’ other healthcare providers, making meaningful use of electronic health records as appropriate
To throw your hat in the ring, you’ll need to wait until CMS identifies the 5-7 markets, which is expected to happen sometime in the first half of 2012. Then the agency will accept applications to participate from primary care practices in those markets.
For now, it’s private insurance plans that must submit letters of intent and proposals to be considered for the markets. You can get the full release on CPCI and view the letters payers must submit at the official CMS Innovation Center website. This initiative is one of the latest projects to come out of the CMS Innovation Center, which was created by the Affordable Care Act and tasked with developing new payment models to reduce costs to Medicare and improve quality outcomes.