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Obamacare tests new payment system for primary care

By Stephen Feller
The Center for Medicare and Medicaid Services hopes that moving a fee-for-service system to one based on preventive care could be more effective and save billions of dollars per year. Photo by lenetstan/Shutterstock
The Center for Medicare and Medicaid Services hopes that moving a fee-for-service system to one based on preventive care could be more effective and save billions of dollars per year. Photo by lenetstan/Shutterstock

WASHINGTON, April 12 (UPI) -- The Center for Medicare and Medicaid Services on Monday announced Comprehensive Primary Care Plus, an attempt to encourage higher quality "cognitive" care, rather than the quantity of procedures and visits billed.

The CPC+ program is the most recent move CMS has taken to transition from the fee-for-service system to one that rewards doctors and insurance companies for proactively keeping people healthy.

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Where the exchanges created as a result of the Affordable Care Act resulted in making insurance more available to more people, CPC+ is one of the Obama administration's efforts to lower the overall cost of delivering healthcare.

Primary healthcare is seen as an important way to prevent health problems. The hope is by encouraging doctors to spend more time speaking with patients and finding ways to make them healthier, as well as giving patients more access to their care providers and information, healthcare will be less expensive because people will require less of it.

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Additionally, the expectation is for doctors to deliver better care to patients the way they want to, and in the best way for patients, rather than choosing diagnostic and treatment methods based on reimbursement or the lack thereof.

Already this year, CMS has introduced seamless social work to better link clinicians and other providers, a new reimbursement system for knee and hip surgeries designed to give the most appropriate care to individual patients, and changes to Medicare part B aimed at lowering drug costs by encouraging doctors to choose cheaper drugs with the same effects as more expensive ones.

"Strengthening primary care is critical to an effective health care system," Dr. Patrick Conway, deputy administrator and chief medical officer at CMS, said in a press release.

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In 2012, CMS instituted the Comprehensive Primary Care Initiative in seven regions of the United States to test the delivery of enhanced healthcare services using monthly, non-visit-based management fees to offer patients access 24 hours a day, personalized care plans for both preventative care and chronic conditions, and better engagement with a patient's other care providers, among other goals outlined by the agency.

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Having primed the pump with practices that have instituted many of the changes to provide enhanced primary care, medical offices can apply to CMS from July 15 to September 1, after the agency has selected regions in the country where it will run the program.

Up to 5,000 practices will be accepted for one of two payment tracks, according to the agency, either one most closely tied to the current fee-for-service system or another that allows greater freedom for personalized preventive care.

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All practices receive an up-front payment that they keep or pay back to CMS based on quality of care for patients, which is based on five parts of primary care practices: Support for patients with serious or chronic diseases to set and achieve health goals; 24-hour access to care and health information; Preventive care; More engagement with patients, including beyond short in-office visits; and by working together with patient's other care providers to better coordinate.

Practices on track 1 will be expected to be on a path to deliver comprehensive primary care, CMS says, receiving a care management fee for each patient and performance-based incentives while expanding availability to patients and coordination with other providers. These providers also remain mostly on the fee-for-service system.

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On track 2, however, fee-for-service payments are significantly limited as they are based on preventive care and individual health conditions. Practices on track 2 also receive additional or higher payments for management and other care needs based on quality and utilization performance thresholds.

The program will start in January 2017 and run for at least five years, with as many as 20,000 doctors and 25 million patients affected.

"By supporting primary care doctors and clinicians to spend time with patients, serve patients' needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars," Conway said. "The Comprehensive Primary Care Plus model represents the future of health care that we're striving towards."

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