Michael Brady October 24, 2019 04:11 PM
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.
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