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500 primary care practices to get monthly per-patient payments in new initiative

Article

A new initiative led by the federal government will pay 500 participating primary care practices a $20 monthly per-patient care-management fee – and in many cases more.

A new initiative led by the federal government will pay 500 participating primary care practices a $20 monthly per-patient care-management fee – and in many cases more.

The Comprehensive Primary Care Initiative represents a potential solution to a problem plaguing primary care physicians: They don’t get paid for many tasks they do that enhance patient care, such as emailing with patients and reviewing health records.

The 4-year project is designed to support enhanced, coordinated services for Medicare fee-for-service beneficiaries. Practices will receive an extra $20 per Medicare beneficiary per month, according to a statement for the Centers for Medicare and Medicaid Services (CMS).

Several private insurers and health plans also are participating in the project and will provide compensation to participating primary care practices. CMS didn’t specify how much private payers would compensate primary care practices, although it’s likely the amount will vary by payer.

The project is being rolled out in seven geographic regions, including Arkansas, Colorado, New Jersey, and Ohio.

Practices were chosen based on their use of health information technology, service to patients covered by participating payers, and participation in practice transformation and improvement activities, among other factors. CMS estimates that more than 300,000 Medicare beneficiaries will be served by about 2,000 providers through the initiative.

One participating organization is the Health Collaborative - a Cincinnati, Ohio-based group of hospitals, physicians, insurers, and other healthcare stakeholders. A top official with the Health Collaborative said the project could bring an additional $15 million to 75 participating primary care practices in the region, MedCity News reported earlier this year.

“We really view this is a game changer relative to primary care innovation and support,” Executive Director Greg Ebel said at the time.

The key to CMS' selection of the Cincinnati region was the willingness of local insurers to participate in the pilot project. Ebel said five insurers are participating: Humana, Anthem, UnitedHealthcare, Medical Mutual of Ohio, and HealthSpan.

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Jennifer N. Lee, MD, FAAFP
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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health