Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Primary Care Initiative Continues to Reduce Medicare Spending

CMS announced that the Comprehensive Primary Care initiative further decreased Medicare spending and improved quality of care in its third performance year.

- The Comprehensive Primary Care Initiative (CPC) continued to improve quality of care and reduce Medicare spending in 2015 even though the initiative has yet to generate net healthcare savings, according to an official CMS blog post.

The Comprehensive Primary Care initiative reduced Medicare spending in 2015, but failed to generate net healthcare savings

In the initiative’s second shared savings performance year, the 481 participating practices reduced Medicare spending on Part A and Part B services by $57.7 million. The savings, however, covered the $58 million in care management fees paid to participating practices in 2015.

The CPC, a four-year multi-payer program, was launched in October 2012 to help practices in seven regions implement comprehensive primary care. Through the program, participants receive financial support to perform practice transformation and quality improvement activities related to advanced primary care, such as enhanced care coordination, increased access to care and continuity of care, and improved patient engagement.

Participants are paid a monthly non-visit-based care management fee for Medicare fee-for-service beneficiaries and can earn shared savings payments if the Medicare program generates net savings.

While overall initiative expenditures offset Medicare spending reductions in 2015, CMS reported that some regions fared better with decreasing healthcare costs. Four of the seven regions, including Arkansas, Colorado, Oregon, and the Greater Tulsa area in Oklahoma, produced net savings. Practices in these areas, which equates to about half of all participating practices, will be paid a portion of over $13 million in earned shared savings.

However, the remaining three regions experienced net losses approximately equivalent to the net savings in the other regions, the blog post added.

Additionally, CMS touted quality improvement across CPC practices with approximately 95 percent of practices meeting quality of care requirements in 2015.

Participants also demonstrated lower than expected hospital admission and readmission rates as well as improvements in patient experience scores. Most regions, CMS reported, maintained or improved hospital readmissions and admissions rates in the past year for chronic obstructive pulmonary disorder and congestive heart failure.

Patients treated under the initiative also rated CPC practices highly, especially on how practitioners engaged them in their own health and the attention they were given from other providers.

In addition, almost all CPC practices (99 percent) reported higher colorectal cancer screening and influenza immunizations rates compared to national benchmarks and all participants reported clinical depression screening rates higher than the national benchmark.

The federal agency also stated that CPC practices exceeded national expectations on electronic clinical quality measures (cCQMs). This was the first year that CMS added eCQM performance as a factor in Medicare shared savings calculations for the initiative.

About 97 percent of CPC practices successfully reported on nine out of 11 eCQMs, CMS reported. CPC practices also exceeded the median national performance on ten eCQMs.

“Primary care transformation takes time, and it is especially encouraging that CPC practices maintained such positive quality of care results while also seeing gross Medicare savings in the 2015 performance year,” the blog post stated.

Throughout the initiative, practices have improved quality of care and decreased Medicare spending, CMS lauded. Gross healthcare savings almost doubled from the first to second performance year and practices in four regions qualified for shared savings payments in 2015 versus only one region in 2014.

In April, CMS also reported that CPC practices decreased Medicare spending by $11 per beneficiary per month, or one percent, in the initiative’s first two years. The initiative saved Medicare $91.6 million in the first two years before accounting for program expenditures.

As in 2015, however, the CPC did not generate healthcare savings net of care management fees in previous performance years.

CMS plans to build on the successes of the CPC by launching the Comprehensive Primary Care Plus (CPC+) program in January 2017. The new initiative will support roughly 5,000 practices in 14 regions with implementing advanced primary care.

Practices in the CPC+ will enroll in one of two payment tracks. In the first track, practices will be paid an average care management fee of $15 per beneficiary per month to support practice transformations, whereas track two participants will receive an average care management fee of $28 per beneficiary per month to support advanced services for medically complex beneficiaries.

Practices in the second track will also be paid a hybrid fee-for-service and value-based reimbursement in lieu of Medicare fee-for-service payments.

CMS stated that the CPC+ will qualify as an Advanced Alternative Payment Model under the Quality Payment Program. Practices can earn a five percent value-based incentive payment in 2019 for their participation in 2017.

“A robust primary care system is essential to achieve better care, smarter spending, and healthier people,” the blog post concluded. “For this reason, CMS is committed to supporting primary care clinicians to deliver the best, most comprehensive primary care possible for their patients.”

Dig Deeper:

What Is Value-Based Care, What It Means for Providers?

Is Primary Care the Solution to Value-Based Care Challenges?

X

Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks