CMS seeks primary care practices to enroll in alternate payment model

The Primary Care First Model options ties patient health outcomes to practice payments.

The Centers for Medicare & Medicaid Services (CMS) is asking for primary care practices to enroll in the Primary Care First Model (PFC) Cohort 2.

According to a fact sheet, the PCF aims to improve quality, enhance patient experience, and reduce expenditures by increasing patient access to advanced primary care services, including prioritizing the doctor-patient relationship, enhancing care for patients with chronic needs, and focusing financial incentives on improved outcomes.

The alternate payment model is oriented around five comprehensive primary care functions: access and continuity, care management, comprehensiveness and coordination, patient and caregiver engagement, and planned care and population health, the fact sheet says.

The fact sheet says the PCF model options are an attempt to be transparent, simple, and hold practitioners accountable. It does this by providing model payments through a simple payment structure which includes:

  • A flat payment encouraging patient-centered care which compensates practices for in-person treatment
  • A population-based payment providing more flexibility in providing patient care
  • A performance-based adjustment which provides an upside of up to 50 percent of model payments and a downside of 10 percent less than model payments as incentive to reduce costs and improve quality on a quarterly basis

The PCF program also provides participating practices with performance transparency through identifiable information on the performances of their practice and of other participants to enable and motivate improvement, according to the fact sheet.

Eligible practices are those in internal, general, geriatric, family, and or hospice and palliative medicine. CMS can reject any application on the basis of the results of a program integrity screening, the fact sheet says.

PCF options are offered in26 regions: Alaska (statewide), Arkansas (statewide), California (statewide), Colorado (statewide), Delaware (statewide), Florida (statewide), Greater Buffalo region (New York), Greater Kansas City region (Kansas and Missouri), Greater Philadelphia region (Pennsylvania), Hawaii (statewide), Louisiana (statewide), Maine (statewide), Massachusetts (statewide), Michigan (statewide), Montana (statewide), Nebraska (statewide), New Hampshire (statewide), New Jersey (statewide), North Dakota (statewide), North Hudson-Capital region (New York), Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma (statewide), Oregon (statewide), Rhode Island (statewide), Tennessee (statewide), and Virginia (statewide).

The request for applications is now available and the deadline to apply is April 30. More information can be found here.