ED Coding & Reimbursement Alert - 2016 Issue 9
Reimbursement: Get Ready: New Alternative Payment Model Promises to Transform Primary Care
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Article Overview
This article covers a new CMS alternative payment model for primary care and explains why it matters for practices considering Medicare payment reform. It discusses the model’s purpose, the two participation tracks, general payment framework, rollout timing, and the potential strategic impact on accountable care organizations and MSSP participation. The piece is useful for primary care leaders, practice managers, ACO stakeholders, and reimbursement professionals tracking Medicare innovation initiatives.
Why This Topic Matters
The article helps readers understand a major Medicare primary care payment initiative and the operational choices it may create for practices, especially those already involved in ACOs or considering MSSP participation.
Article Sections
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CMS Makes a Bold Move with New Model
Introduces the new CMS primary care initiative and places it in the context of earlier Medicare primary care payment efforts. It also notes the model’s scale and duration.
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CPC+ Offers Up-Front Incentives
Summarizes the model’s intended focus on care improvement, patient engagement, coordination, and support for practices across the two tracks. It also describes the general nature of the upfront incentive structure.
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Understand the Payment Structure
Describes the broad payment approach for each track and contrasts the treatment of routine fee-for-service payments with the model’s alternative payment elements. It also notes that performance affects whether certain upfront amounts are retained or repaid.
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You Have a Tough Choice to Make
Explains the participation conflict between the new model and the Medicare Shared Savings Program and discusses the potential implications for ACOs. It highlights the strategic decision faced by practices and organizations.
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Pay Attention to Model’s Timing
Outlines the general application and selection timeline for the initiative and notes when the program is expected to begin. It also addresses how timing uncertainty may influence practice and payer planning.
What You Will Learn
- The purpose and scope of CMS’s new primary care payment model
- How the model is organized into participation tracks
- The general structure of payments and incentives under the model
- Why the model may affect Medicare Shared Savings Program participation
- Key milestones in the model’s rollout and application timeline
Who Should Read This
- Primary care physicians
- Practice administrators
- ACO leaders
- Medicare reimbursement professionals
- Health policy analysts
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