Medicare to pay Medical-Home Fee of $20 per patient

[Guest guest]

Docs:

See any implications for us in this?

Lyndon McGill, D.C.

Salem, Oregon

www.SalemSpineClinic.com

www.EvolvingDaily.com

www.medscape.com

CMS to Pay Monthly Medical-Home Fee of $20 per Patient

Lowes

September 29, 2011 — The Centers for Medicare and Medicaid

Services (CMS) put a price tag on the much-discussed

medical-home concept when it unveiled a plan yesterday to

strengthen primary care through new test models for

delivering and paying for services.

Physicians participating in the Comprehensive Primary Care

Initiative (CPCI) will receive a monthly care-management fee

on top of their usual Medicare fee-for-service

reimbursements during a 4-year trial run. CMS will initially

pay clinicians an average of $20 per Medicare beneficiary

per month in the first 2 years. Actual payments will range

from $8 to $40 per month because of risk-adjustments based

on patients' claims histories and medical status. The agency

also will adjust care-management fees up or down to reflect

geographic differences in costs.

Baron, MD, director of the Seamless Care Models

Group at the CMS Innovation Center, said at a briefing today

that the care-management fees are 40% to 50% more than

Medicare invests now in primary care.

The care-management fee drops to $15 in the third and

fourth years of the CPCI based on the CMS assumption that

physicians will become more efficient in this work. In

addition, the agency wants to "shift reliance to accountable

forms of payment" such as shared savings, which kick in

during year 2. Under a shared-savings arrangement,

physicians attempt to come under budget in caring for a

group of Medicare patients while meeting quality standards.

If they succeed, they receive a slice of the savings.

Private Insurers Needed to Make Plan Work

CMS states that the CPCI, an outgrowth of healthcare

reform, builds on and extends the patient-centered

medical-home concept that many primary care physicians view

as the salvation of their specialty. In this delivery model,

primary care physicians are financially rewarded for

care-management chores — such as talking to a patient's

family members or managing specialty referrals — that

typically go unreimbursed in traditional fee-for-service

Medicare. Medical homes emphasize prevention, patient and

caregiver engagement, continuity of care, easy access, and

the use of electronic health record (EHR) software to help

make it all happen.

CMS is inviting private insurers to participate in the CPCI

as well and either pay care-management fees to physicians or

support them with embedded care managers, health educators,

or pharmacists. Getting these insurers to sign up is

critical for the initiative's success, according to the

agency. Medicare alone cannot motivate physicians to switch

to a new care model.

"Having a majority of a practice's payers supporting

enhanced primary care will ensure that a practice can

implement a more consistent and comprehensive approach to

treating patients," the agency stated in a solicitation for

insurers to apply. "Without that majority, practices risk

not having enough sustained support to provide the services

we are seeking."

Private insurers have until January 17, 2012, to submit an

application to participate. CMS will then choose insurers in

5 to 7 markets and recruit 75 primary care practices in each

one to come aboard. The agency expects to begin selecting

the practices by the spring of 2012 and start paying them

under CPCI by the summer.

"We believe that participating practices, depending on the

degree of (private) insurance participation, may see a 30%

to 50% increase in their gross revenue," said Dr. Baron. The

boost in pay, he said, will enable them to invest in the

staffing and information technology needed for this "new

business model of primary care."

CMS Innovation Center Director Gilfillan, MD, added

today that by giving primary care physicians more time and

resources to care for patients, healthcare costs will

eventually stabilize, patients will be healthier and

happier, "and doctors will be more fulfilled."

Medscape Medical News © 2011 WebMD, LLC

Send comments and news tips to news@....