Despite a looming deadline, the CMS has failed to provide physicians with enough information to decide whether to participate in an ambitious initiative meant to improve primary care by placing practices in risk-based payment agreements. The CMS has not yet released information on how it would calculate payments under the Comprehensive Primary Care Plus (CPC+) demonstration despite the deadline for applying ending on Sept. 15.
In a letter to the CMS, Donald Fisher, president and CEO of the AMGA, formerly known as the American Medical Group Association, said that lack of information will prohibit participation.
A CMS spokesman said the agency plans to release information but couldn't say when, only saying it would be as soon as possible.
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 and that it could save about $2 billion over the course of the five-year program. The new model aims to improve health outcomes and lower costs not only for Medicare beneficiaries, but also consumers enrolled in commercial plans and other coverage options, such as insurer-managed Medicaid plans.
Skeptics have already pointed out that the CPC+ program faces potential regulatory hurdles and that participants in an earlier pilot program reported bad experiences. 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.