The Definitive Blog

CPC Plus Encourages Improved Care Quality and Access for Medicare Patients

CMS has implemented the second iteration of their Comprehensive Primary Care plan, dubbed Comprehensive Primary Care Plus (CPC+), in January.

Like the original CPC plan, which ran from 2012 to 2016, CPC+ offers providers upfront financial incentives distinct from fee-for-service (FFS) payments. In straying from traditional FFS models,   practices are encouraged to improve care access and continuity, care management, service coordination, population health management, and patient engagement with their care provider.

Round one of CPC+, which launched this January, has been adopted by nearly 2,900 practices across 14 regions of the U.S. Round two, which will begin in January 2018, will be adopted by an estimated 1,000 additional practices in four new regions: Louisiana, Nebraska, North Dakota, and the Greater Buffalo region of New York. In its first six months CPC+ has already had a significant impact on its participants, particularly smaller practices.

In order to qualify for this trial program, hospitals must serve at least 150 patients insured by Medicare. Unlike its predecessor, CPC+ offers two tracks for its participants. Track 1 is similar to the original CPC plan, with two forms of financial incentives. Track 2, which entails greater reporting requirements and milestones to be met, offers larger payment incentives including one not available to Track 1 participants.

In order to qualify for Track 2, practices must offer alternatives to traditional office visits, develop comprehensive care plans for high-risk chronically ill patients, integrate behavioral health into their services, perform a two-step risk stratification, adopt a certified EHR technology (CEHRT) that meets CMS requirements, and more. Definitive Healthcare tracks the use of nearly 50 EHR systems, including Meditech, Epic, and Allscripts, many of which meet CMS requirements.

The three categories of financial incentives are as follows:

  1. Care management fees
    Participating practices receive upfront payments per patient every month, regardless of practice visits. The amount practices are paid is dependent on the patient’s risk score and payor. Fees for Medicare beneficiaries average $15/month for Track 1 participants and $28/month for Track 2. Private payors negotiate incentive amounts with participating practices.
    This money must be used for staffing or training purposes.
  2. Performance-based incentive payments
    This type of payment is given to practices based on quality measures. While these are upfront payments, practices could be required to return portions of the payment if they do not meet performance goals.
  3. Comprehensive primary care payments (CPCPs)
    This kind of payment is for Track 2 participants only. Fee-for-service (FFS) payments will be reduced in favor of quarterly CPCPs, with the expectation that there will be an increase in the delivery of comprehensive care from Track 2 participants. CPCPs will likely be larger than the FFS payments, and the intention is to replace FFS payments with CPCPs entirely.

Because these payment systems do not rely on CPT codes for reimbursement, physicians and care providers are being rewarded for more than the formal treatments they provide. In offering financial incentives for quality and efficiency measures over FFS models, daily tasks like reaching out to patients via calls and emails have value, and are not being sidelined to make room for face-to-face services that would traditionally bring in more revenue. This encourages physicians to focus less on diagnoses and more on overall patient wellness and relationships.

Comprehensive Primary Care plus

The road to implementing CPC+ has not been entirely smooth for some smaller practices. Difficulties with the CPC+ EHR system has been reported, including delays in information delivery and inconsistencies between the CPC+ risk stratification scoring system and those of individual practices. There have also been reports of CMS setting requirements that were not initially disclosed to participating providers.

Definitive Healthcare currently tracks almost 8,000 hospitals that use EHR systems, including which systems are most popular by number of participating hospitals and by net revenue. Over 400 of these have suffered a security breach in the last reporting period.

Though there have been some technical difficulties in the implementation process, CMS has created a social media platform for providers to share their experiences and learn from one another. The platform, called CPC Connect, offers a place for care providers to exchange best practices, discuss issues they face, and watch weekly webinars produced by CMS.

CPC+ is the most recent alternative payment model (APM) introduced by CMS. APMs like CPC+ aim to reward providers for delivering high-quality care that is also cost effective. Advanced APMs in particular reward participating practices for taking risks to increase positive patient outcomes. Other active advanced APMs include: Comprehensive End Stage Renal Disease (ESRD) Care, Next Generation ACO, the Oncology Care Model, Medicare Shared Savings Programs tracks 2 and 3, and the Comprehensive Joint Replacement (CJR) Program.



Definitive Healthcare tracks which hospitals participate in a variety of CMS APMs, including: nearly 800 hospitals in the CJR program, nearly 3,000 hospitals participating in the value-based purchasing program, over 3,000 ACO hospitals, and more.

For more information on the CMS Comprehensive Primary Care initiatives, visit our blog.

Definitive Healthcare has the most up-to-date, comprehensive and integrated data on hospitals, physicians and other healthcare providers. Our database tracks quality care metrics on nearly 9,000 hospitals across the U.S., including CMS financial and quality care reports. 

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