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CMS Announces Comprehensive Primary Care Plus Payment Model, Elimination of “Two Midnight” 2% Payment Reduction

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CMS Announces Comprehensive Primary Care Plus Payment Model, Elimination of “Two Midnight” 2% Payment Reduction

On April 11, 2016 the Centers for Medicare & Medicaid Services (CMS) announced a new advanced primary care medical home model – the Comprehensive Primary Care Plus (CPC+) – which builds upon the foundation of the previously implemented Comprehensive Primary Care (CPC) initiative.

Backed with a goal of improving quality of care for patients, the CPC+ is CMS’s latest alternative payment and delivery model. The CPC+ has been designed to offer primary care practices the ability to have greater cash flow and flexibility while still offering quality, patient-centered care and eliminating unnecessary services.

CMS aims to implement the CPC+ in up to 20 geographic areas throughout the United States and will include up to 5,000 practices, 20,000 physicians, and the 25 million people that they serve. CMS will select the regions where there is sufficient interest from multiple payers in order to support both tracks of the CPC+.

Two Tracks

The CPC+ will include two primary care practice tracks with different care delivery requirements and payment options. In summary, under Track 1, CMS will pay practices a monthly care management fee, as well as the fee-for-service payments under the Medicare Physician Fee Schedule. Under Track 2, practices will also receive the monthly care management fee; however, rather than full Medicare fee-for-service payments for Evaluation and Management services, practices will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments. Track 2 aims to allow physicians greater flexibility in how care is delivered outside of traditional office visits.

Under both tracks, practices will receive up-front incentive payments that they will either keep or repay based on their performance on quality and utilization metrics.

These payments will be used to encourage physicians to focus more on health outcomes rather than the volume of visits or tests.


Applying to the CPC+

CMS will begin by soliciting payer proposals to partner with Medicare in the CPC+. This process is expected to run through June 1, 2016. Next, CMS will publicize the CPC+ regions within geographic reach of selected payers, and solicit applications from practices within these regions. The application process for practices is expected to run from July 15 – September 1, 2016.

The CPC+ is expected to launch on January 1, 2017 and will run for five years.

Murer Consultants has extensive experience with CMS innovation projects, including state and federal payment reform initiatives. For more information on the CPC+, contact Murer Consultants, Inc. at 708-478-7030. Please visit our website at www.murer.com for all of the latest healthcare updates.


CMS Proposed Rule: Eliminate “Two Midnight” 2% Payment Reduction

In its recently submitted annual notice of proposed inpatient prospective payment system (IPPS) rates, the Centers for Medicare & Medicaid Services (CMS) has proposed permanently eliminating the 2% payment reduction associated with the “two midnight” rule for fiscal year (FY) 2017.

The health care delivery model remains in flux with a focus on patient access and affordability. These two initiatives reflect the retooling by CMS in a continuously evolving and dynamic sector.

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