Not all practices were as eager as SAMA to jump into CPC+.
Philadelphia internist Ward assists independent practices that fall under the Jefferson Health umbrella. Only four, including his, applied for CPC+. The rest—more than 20—did not.
“I think it was because it was too overwhelming,” he says, “[The practices] knew it was going to be a lot of money, so they knew that there would be a lot of oversight and a lot of reporting.”
Despite the financial incentives, practices weren’t sure what the reporting requirements would be, Ward adds. “A lot of practices were careful not to get involved in a program with the government that did not have every duck in a row and clearly set-out expectations.”
Some of those concerns have been realized. For example, the launch of CPC+ was rocky at Radnor Family Practice, an independent two-physician, two-nurse-practitioner office in suburban Philadelphia, which provides a range of primary care services.
“It was difficult at first because the program was just rolling out, and the government was a little behind in having information out there,” says practice administrator Debbie Brown, RN, BSN.
She says the delays have caused headaches with the practice’s EHR. CPC+’s risk stratification scoring system, which requires patients to be scored and placed into four risk tiers, didn’t match the system in the practice’s EHR, which scored from zero to 100. And when the practice faced a Friday deadline in April to submit a batch of first-quarter reports, the dashboard to submit wasn’t up and working until the Wednesday before.
Ward says his practice has been surprised by metrics and reporting requirements that CMS hadn’t disclosed earlier.
Both Ward and Brown say the government has been hands-on in helping fix problems during the rollout. Representatives have been available to answer questions after business hours, and weekly webinars and other events update the participants.
CMS hosts a robust social media platform. CPC Connect, for participants to share their experiences and knowledge online.
Despite the problems, CPC+ holds great promise, especially for small independent practices, says Tracey Allen-Ehrhart, manager of the American Academy of Family Physicians' Center for Quality, who works with medical practices nationwide on practice improvements.
“This is a payment model truly designed for primary care,” she says.
CPC+ was created for family medicine, internal medicine and geriatrics, which means the program’s technical support as well as payments are designed for them, she adds.
Michael L. Munger, MD, a primary care physician with Saint Luke’s Medical Group in Overland Park, Kansas, lauds these investments but says the benefits of CPC+ go beyond just the cash.
“For me, the CPC+ program is taking that first step to really putting the value on what we deliver,” he says. “Through care coordination fees, it’s really placing value on the non-face-to-face care that we all do on a daily basis to coordinate care.”
Finally, he adds, physicians are getting paid for the work—the emails, the calls, the extras—they do for patients beyond the exam table, the work that doesn’t have a CPT code.