Providers await key piece to CPC+ puzzle, says industry group

As the application deadline nears for the Comprehensive Primary Care Plus (CPC+) program, one industry group is calling for CMS to release additional details about how the incentive payments work.

 

AMGA, a trade group representing medical practices, recently voiced its concerns about the lack of details surrounding the CPC+ program's performance bonuses and specifically how CMS plans to structure the prepayment -- and potential repayment -- of the incentive payments that are tied to a practice's quality and utilization scores.

 

Under a frequently asked question (FAQ) related to payment design found alongside the CPC+ program materials, CMS stated it would release a "methodology paper" that would give providers firm details about the performance bonus system or, in CMS' words, "the final methodology for calculating the prepaid amounts and repayment amounts."

 

Under CPC+, participating practices will be eligible for up to $4 in per-beneficiary monthly payments tied to quality and performance scores. These payments are doled out ahead of time, and practices that fail to meet reporting thresholds would be forced to repay CMS all or a portion of the upfront payments.

 

Yet, to date, further details about the reporting and incentive methodology remain unreleased, according to AMGA.

 

"Obviously, it is difficult, if not impossible, for provider practices to decide responsibly whether or not they can or should participate in the CPC+ demonstration as either a track 1 or track 2 when they do not know to what extent they will be at risk for repaying all or a portion of their prepaid amounts to CMS," states AMGA in a letter sent to CMS on Aug. 24.

 

AMGA calls for CMS to release clarifying details.

 

Providers in 14 regions are eligible to participate in CPC+. The deadline to apply is Sept. 15.