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The Centers for Medicare and Medicaid Services (CMS) have officially launched their ambitious multi-payer 5 year master plan to enhance the quality of Primary Health Care in the United States.
CPC+ has been designed to empower Primary Care Physicians in specific regions of the country to deliver care which should result in healthy patient populations, while keeping per patient costs under control. The current version of this program is actually an improved version of the Comprehensive Primary Care (CPC), which has been under testing by the Centers for Medicare and Medicaid Innovation (CMMI) since October 2012 and will run through December 2016.
There are mainly two driving forces behind CMMI’s (Centers for Medicare & Medicaid Innovation) continues struggle to improve & implement this program:
1. Enable Primary Care Practices to organize themselves better and be able to provide Comprehensive Primary Care Services in a cost effective manner
2. CMS, private insurances, state Medicaid programs to work together in order to standardize & align the various difference payment models, patient outcomes & quality data sharing capacities.
Here some of the Major responsibilities of Practices that will provide Comprehensive Primary Care Services:
1. Accessibility to Services and Information:
Patients would be able to access their health records & information round the clock. In addition, enhancements are made to the extent of hours at which a patient might have access to care, over the phone or electronically.
2. Individualized Care:
It would be the Physicians responsibility to develop & implement relationship based patient-specific plans of cares to achieve the best health outcomes for patients suffering from serious or chronic conditions
3. Comprehensive Care:
The practice would be responsible in addressing the major aspects of the patients overall physical & mental Health. A higher level of patient care coordination between Hospitals, Clinicians, Specialists & other health care professionals will be attained to ensure that Comprehensive Primary Care Services are being provided and all individuals involved in Patient care are on the same page, especially after a Hospital discharge.<br />
4. Patient & Caregiver Engagement:
The Practice would develop a Patient-centered approach, in which the Patients, their Families & Friends would participate as the “core members” of the patient care team.
5. Quality & Outcomes:
The Practice would continuously measure its Utilization of services provided to the patients versus the Quality of care in comparison to the overall health improvement outcomes of the patients.
The CMS Deputy Administrator and CMO Dr. Patrick Conway quoted that it is the most crucial decision to toughen Primary Care. This will lead to a positive change in the entire system of health care. As per him – the support to the clinicians and primary health care doctors by encouraging them to spend more time with patients will help in giving more attention to their patients. Also, to serve the patients outside the office, by coordinating with the specialists can effectively build a perfect system of health care.
Tracks for Physician Practices
This track is for practices that are currently not delivering “Comprehensive Primary Care” to their patients but are ready to implement pathways designed by CMS.
This track is for practices that are currently operating under a model similar to the CMS CPC+, however can improve their comprehensiveness by adding or improving their Health Care IT, and adding resources to their practices to meet the needs of their patient’s mental health.
The Program will be launched within the next 12 months.
Up to 20 regions around the country will be selected in which eligible practices would be able to apply for either one of the CPC+ Tracks.
As per the statistics, approximately 5000 Practices (2500 practices in each Track) & Twenty thousand clinicians will be offering their services in the selected regions.
The total number of people who will be benefited under these doctors and clinicians will approximately be 25 million.
In the midst of all of the excitement that the CPC+ brings, there are a few apparent drawbacks for participating practices.
For what CMS is expecting from Physician practices, most physicians feel that the incentives are simply not enough. Physicians are dreading scenarios where they won’t be able to control costs especially when services aren’t provided by their practices. In instances when patients must be transferred to Hospitals & Rehab facilities, Primary Care Practitioners only have limited control over expenses uncured at those facilities.
No ACO Participation
Initially, when the CPC+ program was launched, it was declared that Practices participating in CPC+ would not be able to participate in any ACO Plan. On May 27th 2016, in an update of the Frequently asked questions update CMMI eased some of the restrictions on participating practices. According to the recent update, up to 1500 out of the 5000 practices participating in CPC+ will be allowed to also be part of the Medicare Shared Savings Program (MSSP) ACO’s. CMS will continue to monitor the number of practices wishing to participate in CPC+ as well as MSSP ACO’s and if the number of joint enrollees goes over 1500, a lottery will be held.
Observing this trend, it is apparent that CMMI isn’t prioritizing ACO’s at this time and wants smaller practices to be able to manage & maintain a healthy patient population on its own. CMMI is convinced that CPC+ is just as well thought of a model for practices as the ACOs. They are creating alternative payment reform models for practices that either do not want to participate in traditional ACO’s or want to move towards more of an individualized model that enable them to partake in excellent patient care utilizing Health Care IT.