CPC+ operates in 18 different regions of the United States.
In early 2016, the Centers for Medicare and Medicaid Services (CMS) announced a new five-year initiative, partnering CMS, state Medicare agencies, and commercial insurance plans, known as the Comprehensive Primary Care Plus (CPC+) program. This initiative was created to make progress toward the goal of strengthening primary care, promoting health, and reducing overall healthcare costs. While the time to apply for CPC+ has passed, CMS has a history of taking what works from their regulatory programs and using those pieces as a roadmap for future, more far-reaching initiatives. For this reason, it’s important that everyone in the medical field has, at minimum, a basic understanding of CPC+, whether they are in a participating practice or not.
What is CPC+?
CPC+ is a multi-payer initiative designed to improve primary care in America, made up of two five-year rounds, each limited to specific geographic regions. The first round, Round 1, began January 1, 2017 and will run through 2021.
Round 2 will begin January 1, 2018 and will run through 2022. Practices whose applications to participate have been selected will be notified of their acceptance in the coming weeks.
Practices were able to choose from two participation tracks when applying for CPC+. Both tracks focus on the following Comprehensive Primary Care functions:
- Access and Continuity
- Care Management
- Comprehensiveness and Coordination
- Patient and Caregiver Engagement
- Planned Care and Population Health
Track 2, which takes the same principles as Track 1 and delves a little deeper, asks practices to heighten their focus on patients with complex behavioral, psychosocial, and medical needs and the extra demands such needs place on their care. This means that practices participating in Track 2 will need to increase the depth of their services and ensure that they have resources available to meet patients’ psychosocial needs when necessary.
Advanced Alternative Payment Models
CPC+, which is on the list of Advanced Alternative Payment Models (Advanced APMs), is made up of three payment elements:
- Care Management Fee (CMF) – This flat fee is paid per quarter for each Medicare-covered patient, separately from any reimbursement paid for billed patient charges.
- Performance-based Incentive Payment (PBIP) – This is a prospective payment received by CPC+ practices at the beginning of each program year to be used to build capacity and meet patient needs.
- Payment under the Medicare Physician Fee Schedule (PFS) – Practices participating in CPC+ will continue to bill and receive fee-for-service (FFS) payments to differing degrees, depending upon which track of CPC+ they are participating in.
Who is participating in the CPC+ Program?
CPC+ was open to primary care practices of any size, specifically those specializing in family or internal medicine, or geriatrics. Practices were required to meet a number of eligibility requirements. First, the practice must be located in the geographic region specified for either Round 1 or 2. For practices meeting the location requirement, the following criteria were also required:
- A minimum of 125 attributed Medicare Part B fee-for-service beneficiaries
- Approximately 45% or more of current practice revenue is generated from CPC+ payer partners and/or Medicare FFS
- CEHRT software in use
- No retainer or practice membership fee charged
- Existing care delivery activities, such as 24/7 patient access, support for quality improvement activities, and patients assigned to a provider panel
In addition to these criteria, practices seeking to be included in Track 2 of CPC+ had to meet two additional requirements regarding additional care delivery activities and a letter of support from their EHR software vendor. Practices meeting these criteria then had to submit an application and be selected for participation by CMS.
While it is true that a relatively limited number of practices are directly affected by CPC+ at this time, with the history of evolution among CMS regulatory programs the odds are good that at least some components of CPC+ will affect you in the future. And if you are participating, it’s good to take every opportunity to review the program for deeper understanding.
Finally, if you’re a CPC+ participant and you feel you need a new EHR software vendor to see you through the program, 2015 Edition certified MicroMD is an excellent choice.