Michael Brady November 25, 2019
The pilot will allow providers that deliver
primary-care services to take on financial risk for original, fee-for-service
Medicare patients in exchange for less federal oversight and the opportunity to
earn financial rewards. Under the new payment model,
small primary-care practices can volunteer to accept full or partial risk for
managing the care of beneficiaries of traditional Medicare who are seriously
ill or have a chronic illness. The CMS will pay them a fixed monthly fee for
each participating enrollee.
The Center for Medicare and Medicaid Innovation
calls the approach "direct contracting." It's aimed at providers who couldn't
participate in the Medicare Shared Savings Program or the Next Gen Accountable
Care Organization model because they didn't meet the requirements. The agency
hopes that the payment model will better align payer-provider incentives and
create a predictable revenue stream for participating providers.
Direct contracting has support from industry
stakeholders.
"This is yet another step by CMMI in
affirming its commitment to ensuring that patients have access to the
high-quality, accountable and coordinated care physician groups have been
providing for decades," said Don Crane, president and CEO of America's
Physicians Group.
"Premier is encouraged by the release of
the direct contracting model," said Blair Childs, senior vice president of
public affairs for Premier. "We look forward to working with our members
to implement this model, which could offer providers an offramp from the
fee-for-service treadmill."
The Trump administration is leaning heavily on
value-based arrangements to control healthcare spending without sacrificing the
quality of care. But the uptake has been slow because doctors and hospitals seem to
prefer the financial incentives of the traditional fee-for-service model,
which reimburses them based on what they do instead of holding them accountable
for patient outcomes.
The CMS is considering a third option for the
Primary Care First alternative payment model. It would allow larger providers
to accept full financial risk for "the total cost of care of all Medicare
FFS beneficiaries in a defined target region." But the agency hasn't
announced if or when it will move forward with the option.
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