Trump administration delays start of new primary care payment model to 2021

Male patient sitting in chair having consultation with doctor or psychiatrist
The Trump administration has delayed the start date for a new primary care payment model to 2021 instead of 2020. (noipornpan/GettyImages)

The Trump administration will delay the start of the Primary Care First payment model until 2021 after originally proposing a start date of 2020.

The Center for Medicare & Medicaid Innovation (CMMI) released Thursday the request for applications for the five-year model, which would use an innovative payment structure to reward physicians in smaller practices for value-based care. But the model, which will be offered across 26 regions, will now have a start date of 2021 for new participants as opposed to the 2020 start date when the model was originally proposed back in April.

CMS said that the reason for the delay was to give stakeholders more time to consider participation. The delay also helps practices prepare by giving them additional time to move away from fee-for-service, the agency added.

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The 2021 start date also would not apply to physician practices that are in the current CMMI value-based model called Comprehensive Primary Care Plus (CPC+). Participants in CPC+ are eligible to participate in Primary Care First starting in 2022.

The application period for practices not part of CPC is from Oct. 24 to Jan. 22, 2020. There will be a separate application period for those physicians in CPC in 2021, CMMI said.

Under the Primary Care First model, CMS will use a series of quality and patient experience measures to assess quality at a physician practice.

“Measures include a patient experience of care survey, controlling high blood pressure, diabetes hemogloblin A1c poor control, colorectal cancer screening and advance care planning,” CMS said on its website.

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Physicians participating in the model will get a flat fee for each patient which will be adjusted based on whether the practice can meet the quality outcomes. A physician’s payment could increase as much as 50% each quarter or decrease by up to 10%, according to the request for applications.

The model would also boost payments to physicians that care for a high portion of complex, chronically ill or seriously ill patients.

“What this means is that primary care practitioners will get paid for keeping patients healthy rather than just paying for procedures,” said Health and Human Services Secretary Alex Azar during a speech Thursday before the Health Care Payment Learning & Action Network 2019 summit in Washington.

CMMI has not released a request for applications for the direct contracting model, which is aimed at larger providers already experienced with taking on financial risk. 

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