3. Comprehensive Primary Care Payments (CPCP)
These payments go only to practices in the more demanding Track 2 of the program. (To qualify for Track 2, practices must do two-step risk stratification, offer alternatives to traditional office visits, develop care plans for high-risk chronic disease patients, and integrate behavioral health, among other requirements.) With this third type of bonus, CMS is experimenting with replacing some of a practice’s expected fee-for-service billings with upfront CPCP. These new payments will include an additional 10% of expected fee-for-service payments to help a practice deliver transformed care.
Another benefit of CPC+ is that it qualifies as an advanced alternative payment model (APM). This makes small, independent practices eligible for an additional 5% lump sum Medicare payment under the Medicare Access and CHIP Reauthorization Act
(MACRA) Quality Payment Program.
For example, Ward estimates that a practice enrolled in Track 2 of CPC+ with about 500 Medicare beneficiaries would get roughly $200,000 in additional payments a year from the program’s incentives. This is separate from the 5% MACRA bonus.
“If you had $200,000 each year for five years, that can be a nurse, a medical assistant and a social worker,” Ward says. “The nurse could do your care coordination, the medical assistant can assist you either in the office or can do outreach. And the social worker can do your integrated behavioral health.”
CPC+ is a complex program with numerous rules, regulations and reporting requirements. The quality measures are ambitious, says Ward.
“It’s a colossal effort,” he adds. But the requirements didn’t stop him. “When this came across our desks as an opportunity, we jumped at it. And we jumped with both feet in.”
Resources to grow
South Arkansas Medical Associates (SAMA), a primary care practice about 10 miles from the Louisiana border, hasn’t been shy about embracing innovations in healthcare. For example, in 2002 the practice became one of the first in the state to adopt electronic health records (EHRs).
“CPC was a good experience, and we felt like we did well,” practice administrator Pete Atkinson says. The new “plus” version, he says, offered a chance to “take care to another level.”
In 2012, the original CPC came at a perfect time for the practice. The four physician- owners sensed an inevitable transformation of primary care in America. They wanted to be proactive about being part of it.
“We felt like healthcare was going to change and change dramatically,” says Gary L. Bevill, MD, a primary care physician and one of the four owners. Led by Atkinson, the practice hatched a plan to implement care coordination.
CPC’s financial incentives allowed the plan to become reality. “They were going to give us the financial resources to hire some people to do some of the things we wanted to do. And we wanted to do care coordination,” he says.
Using CPC’s care management fees, the practice hired care coordinators and reorganized the office into care teams. Over the next four years, the practice went from six providers and 30 employees to 14 providers and 70 employees. By following CPC’s core set of functions, Atkinson says, the practice didn’t just change the way it delivered care. The culture of the organization has undergone a transformation.
And the doctors?
“They’re enjoying practicing medicine today more than they have in the last 30 years,” Atkinson says.