The CMS on Thursday postponed the start of a new alternative payment model, but encouraged Medicare providers to apply and move toward value-based care.
Both Primary Care First model options and the Kidney Care Choices model are voluntary payment models that aim to reform healthcare delivery by paying Medicare providers for the value of the care they provide and giving them incentives to manage chronic illness better. The Center for Medicare and Medicaid Innovation hopes that these programs will reward providers for boosting quality, improving patient satisfaction and cutting healthcare spending.
The innovation center thinks both models will accelerate the healthcare system's move away from fee-for-service payments, which have contributed to overutilization and runaway healthcare costs.
But Primary Care First won't start until 2021 after the innovation center decided to delay implementation by a year.
The models seem to have the support of providers, especially Primary Care First.
"We're very excited to see the start of this new model and commend CMMI for their work in helping advance the value movement," said Don Crane, president and CEO of America's Physician Groups.
Small primary-care practices have two options under that model, which pays them a flat monthly fee per patient for managing care for Medicare beneficiaries with chronic or serious illness.
Primary Care First is similar to the existing Comprehensive Primary Care Plus, which was designed to help primary-care practices become accountable for patient outcomes. The new model puts more financial risk on the physicians in exchange for less federal oversight and performance-based payments.
Participating providers will also score higher pay rates as a group than Medicare fee-for-service if they take care of complex, chronically ill patients.
The innovation center will test the model with two groups of participants for five years each. The first cohort will start in 2021, while the second will begin in 2022. Other clinicians can participate if they help manage chronic illness for high-need populations.
Comprehensive Primary Care Plus practices need to wait until 2022 to join Primary Care First.
Some industry groups were happy that the innovation center is providing a glide path for providers participating in existing payment models.
"NAACOs strongly supports CMS allowing Shared Savings Program practices the option to participate in Primary Care First," said Clif Gaus, president and CEO of the National Association of ACOs. "This allows ACOs to further engage primary-care providers, which is a bedrock of successful population health management."
The Kidney Care Choices model builds on existing kidney-care models and adds financial incentives for providers to manage those patients' care. The CMS hopes that model will help chronic kidney disease patients stay off dialysis or get kidney transplants instead.
Under the Kidney Care First option, the CMS will adjust payments to nephrologists and nephrology practices for managing care for Medicare patients with stage 4 and 5 chronic kidney disease and end-stage renal disease. Their reimbursements will tick up or down based on the quality of their performance and how much they improve over time.
Starting in 2021, the Kidney Care First option will be an advanced alternative payment model and a Merit-based Incentive Payment System Alternative Payment Model.
The Comprehensive Kidney Care Contracting options are direct contract options for nephrologists and nephrology practices. They will need to team up with transplant providers to participate. Nephrologists will receive adjusted capitated payments from the CMS for taking care of patients with stage 4 or 5 chronic kidney disease and end-stage renal disease. Participants will need to join a total cost of care accountability framework. One framework won't have any downside risk in the first year, while the other two ramp up rewards for cost savings from the start.
Kidney Care Choices kicks off in 2021 or 2022, depending on which option providers join.
Jan. 22, 2020, is the deadline to apply for both the kidney-care and primary-care programs.
The CMS will open applications for primary-care directing contracting models in the next few weeks.