New Medicare payment model focuses on care management, to begin in Arkansas and 15 other states

by Steve Brawner ([email protected]) 69 views 

Arkansas is one of 16 states where physician practices will participate in a Medicare payment model reimbursing physicians for providing comprehensive, coordinated patient care.

The Centers for Medicare and Medicaid Services (CMS) announced Monday (Aug. 1) that beginning January 2017, the five-year Comprehensive Primary Care Plus model reimburses physicians for providing primary care and focuses on access and continuity, comprehensive and coordinated care management, patient and caregiver engagement, and planned care and population health.

Physician practices also will receive upfront performance-based incentive payments that ensure patients get preventive health screenings and have 24-hour access to the office. That money must be returned if practices don’t meet standards. Practices can participate in two tracks, one more rigorous but with greater potential rewards. Payments to physicians can range from $6 per beneficiary per month for less risky patients to up to $100 for complex cases.

CMS is soliciting applications from physician practices until Sept. 15.

Fifty-seven payers, including insurers and Medicaid, will provide non-visit based supports. CMS is inviting those payers to enter into a memorandum of understanding regarding payment alignment, data sharing and quality metrics. The Obama administration has set a goal of paying 50% of all Medicare fee-for-service payments using alternative methods.

Fourteen regions involving 16 states were selected, including Arkansas, Oklahoma, Missouri and Tennessee. The program will be administered statewide in 10 of the states.

The model builds on lessons learned from the Comprehensive Primary Care initiative, which began in 2012 and in which Arkansas was a participant. According to the CMS website, 58 Arkansas practices involving 230 providers serving 92,670 Medicare and Medicaid beneficiaries were involved. Medicaid, Arkansas Blue Cross and Blue Shield, Humana and QualChoice of Arkansas participated in that program.

Four University of Arkansas for Medical Sciences regional programs in Fayetteville, Fort Smith, Texarkana and Jonesboro were among the practicing medical providers. Dr. Mark Jansen, UAMS medical director of regional programs, said the program has provided additional revenue to those programs, allowing them to give more service and coordinate care, provide post-hospital followups, and use ancillary personnel to assist with various problems including social barriers such as transportation.

Brandi Hinkle, Arkansas Department of Human Services deputy chief of communications, said the program will help DHS expand its patient-centered medical home program for beneficiaries of Medicaid, the program that serves the poor, the disabled and the aged. That program assigns patients a primary care physician responsible for payment care. Comprehensive Primary Care Plus, a Medicare program for senior citizens, is similar to the patient-centered medical home program, so practices will be able to manage both using the same resources.

Insurers including Blue Cross Blue Shield and QualChoice provided their own incentives as participants in the original Comprehensive Primary Care program. QualChoice President and CEO Mike Stock said a bigger participating pool of physicians is needed to determine if the program has a measurable impact. Philosophically, however, QualChoice believes in the concept and will participate in the new model.

“We are strong believers that the more you have primary care physicians involved in overall care management of a patient, the better it is in the long run, and so even if it was not a gain or a loss, we would still probably be participating in the program even if it was just a push,” he said.

Similarly, Max Greenwood, Blue Cross spokesperson, said such programs in the long run will improve care and reduce costs.

“These are the types of programs that actually do make a difference in the type of care that’s bringing better health care and more reform to Arkansans,” she said.

David Wroten, Arkansas Medical Society executive vice president, said programs like Comprehensive Primary Care Plus are an improvement over the traditional payment model, where physicians aren’t paid for patient management.

“The payment model we have now, the traditional payment model, only reimburses or provides payment to a practice when they deliver a specific medical service that has a specific procedure code attached to it, and so many of the things that physicians do for their patients, they don’t get paid for,” he said.

A physician with 30 years of practice in Arkadelphia, UAMS’ Jansen said these kind of changes will be “incredibly challenging” for smaller practices.

“How do you take these sophisticated new ways of doing things and get them to be seamlessly and in a nondisruptive way adopted by an aging provider population, many of whom are not even utilizing computers in their practice? They may be using a computer for billing, but they’re still on paper for their documentation,” he said.