The Centers for Medicare & Medicaid Services (CMS) recently announced an expansion of its Comprehensive Primary Care initiative (CPCi) payment demonstration program, which CMS is calling the “largest-ever initiative to transform and improve how primary care is delivered and paid for in America.”
According to the CMS press release, the new Comprehensive Primary Care Plus (CPC+) model will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 providers and 25 million patients.
CMS launched CPCi in late 2012 as a multi-payer demonstration program involving Medicare, Medicaid, and commercial insurers. The goal was to support primary care practices in adopting a “medical home” primary care model in five regions. This initiative was set to expire in 2016.
Building on CPCi, the CPC+ model will officially launch in January, 2017 and run for five years. Participation will be voluntary for providers; individuals to participate will depend on which regional payers CMS chooses to participate in the initiative. As announced, CMS will accept payer proposals to partner in CPC+ from April 15 through June 1, 2016, followed by practice applications in the selected regions from July 15 through September 1, 2016.
CPC+ will offer providers two participation options: Track 1 and Track 2. In Track 1, CMS will pay practices a monthly care management fee in addition to standard fee-for-service payments. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. Notably, participation in Tracks 1 and 2 requires the use of a certified EHR (2015 edition CEHRT starting January 1, 2018).
As part of the application process for Track 2, practices will be asked to submit a “letter of support” from their health IT vendor(s) outlining the vendor’s commitment to support the practice in optimizing health IT.
Impact for NextGen Healthcare clients
NextGen Healthcare clients have been well represented in the current CPCi program. Although participation in this expanded CPC+ model is voluntary, NextGen Healthcare clients (including those now participating in CPCi and others), may wish to participate. NextGen Healthcare encourages clients to explore their options as CMS selects participating regions. Along with others in the EHR industry, we are engaged in discussion with CMS regarding specific requirements for a “letter of support” and will make details available to clients.