Physician practices skip round two of primary-care payment model

A CMS primary-care payment model has yet to generate enthusiasm and significant participation from physician practices.

Only 165 new practices have joined the second round of the Comprehensive Primary Care Plus, according to the CMS. CPC+, which started last year, is meant to improve health outcomes and lower costs for Medicare beneficiaries, consumers on commercial plans and individuals using Medicare Advantage and other coverage.

Health policy insiders predicted last year that interest in the second round of the CPC+ would be low because of the model's structure.

The CMS will randomly place CPC+ practices into two groups. One group will receive care-management fees and incentive payments, while the other group won't. The goal is to evaluate if the care management and incentive payments lead to better care.

The federal agency hoped that up to a 1,000 practices would join the program, and it didn't say why so few signed up this year.

Paul Ginsburg, a professor of health policy and management at the University of Southern California, predicted that the change would make federal attempts to evaluate CPC+ stronger, but would lead to less participation.

Providers were also likely not interested in the second round of CPC+ because it doesn't count as an alternative pay model under the Medicare Access and CHIP Reauthorization Act, according to Matthew Katz, a board member of the Physicians Advocacy Institute, which has been following interest in the model.

Also, providers are overwhelmed with how many value-based initiatives are available. "There's a feeling from some practices where they don't know which one they want to go with, or which will even last," Katz said. "There is model fatigue."

Medical practices aren't the only ones that have declined to participate in the second round of CPC+.

Since the model aims to improve health outcomes and lower costs not just for Medicare beneficiaries but for those with any type of insurance coverage, it can only be expanded to areas where there is strong payer interest.

Last year, most insurance companies gave the model a pass, leading to the CMS doing a much more limited expansion of CPC+ to just four markets—in Louisiana, Nebraska, North Dakota and the Greater Buffalo region in New York—for round two of the model versus the originally envisioned 10 markets.

Insurance companies in the past complained about working with the CMS on pay models. A 2012 pilot version of CPC upset some private payers who felt it didn't generate savings and that the CMS wasn't a good partner.