Despite a looming deadline, the CMS has yet to provide physicians enough information to decide whether to participate in an ambitious initiative meant to improve primary care by placing physician practices in risk-based payment agreements. Lobbying groups say the CMS is not being transparent on just how much doctors may lose if they aren't successful meeting goals and that could affect participation in the program.
The CMS said it would release information on how it would calculate payments under the Comprehensive Primary Care Plus (CPC+) demonstration. But there's been nothing so far, despite the deadline for application ending on Sept. 15.
“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…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,” Donald Fisher, president and CEO of the American Medical Group Association said in an August 24 letter to the CMS.
A CMS spokesman said the agency does not share AMGA's concerns about depressed involvement despite getting close to the deadline and added the agency had received robust interest from physicians and physician organizations. The CMS also has released plenty of other information for practices to educate themselves on about the demonstration, the spokesman said.
The agency is banking on the initiative, which includes a higher risk track, to save about $2 billion over the course of the five-year program.
Under CPC+, the CMS and other insurers would pay physicians a monthly fee for patient primary-care visits. The CMS had estimated that up to 5,000 primary-care practices serving an estimated 3.5 million beneficiaries could participate in the model.
The new model aims to improve health outcomes and lower cost not only for Medicare beneficiaries, but also consumers enrolled in commercial plans and other coverage options, such as insurer-managed Medicaid plans.
CPC+ has two tracks. Under track one, providers receive a monthly fee for specific services in addition to the fee-for-service Medicare payments.
In track two, practices will receive an upfront monthly care-management fee and reduced fee-for-service payments. This hybrid model is designed to let practices provide care outside of the traditional face-to-face encounter, the agency said.
A CMS spokesman said the agency plans to release two papers: one describing the track two hybrid payment methodology, the other describing the performance-based incentive payment methodology. He said they would be released as soon as possible but could not say when.
David Introcaso, senior director for regulatory and public policy for AMGA said he was told they wouldn't be released until later this fall, after the deadline for applications.
Skeptics have already said the CPC+ program faces potential regulatory hurdles and bad experiences with an earlier pilot program. Experts say the model also could steer providers away from alternate payment models like accountable care organizations.
The CMS wants to launch the initiative in 14 regions. Entire states in the project include Arkansas, Colorado, Hawaii, Michigan, Montana, New Jersey, Oklahoma, Oregon, Rhode Island and Tennessee. The markets for CPC+ were chosen based on density and interest shown by practices and payers.