CMS’ Comprehensive Primary Care initiative did not cut Medicare spending

A stethoscope and paper money.
A value-based initiative to improve primary care shows how tough it is to achieve Medicare savings, a study finds. (Getty/utah778)

Physician practices that took part in the government’s Comprehensive Primary Care (CPC) initiative showed improvements in primary care delivery, but the program did not save money overall.

“Results from CPC illustrate how hard it is to reduce Medicare spending,” wrote the authors of a Health Affairs study that evaluated the full four years of the healthcare delivery model developed by the Centers for Medicare & Medicaid Services (CMS).

Led by researchers from Mathematica Policy Research in Princeton, New Jersey, the study compared nearly 500 practices that participated in the CPC initiative to 908 practices that did not participate in the program. CPC had mixed results.

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Among its successes, CPC practices reported improvements in delivery, including care management for high-risk patients, improved access and improved coordination of care transitions, the study found. Practices in the CPC initiative slowed growth in emergency department visits by 2% compared with other practices.

However, CPC did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a set of Medicare claims-based quality measures, the study found.

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Doctors who participated in CPC were enthusiastic when surveyed in 2016, the final year of the program. Some 80% of physicians said it improved quality of care or service they provided their patients and 79% said they would still support their practice’s participation if they could do it over again.

While many said that the reporting burden for the CPC program was difficult, the study found there were no differences in physician burnout compared to the control group. Many indicated that the program’s administrative reporting was a burden and the transformation work was difficult, but compared with other physicians there was no greater degree of burnout, the study found.

"As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care," the researchers said.

Among the reasons why the program may not have produced more favorable results, the researchers said primary care practices may need stronger value-based financial incentives, along with incentives for other providers, such as specialists and hospitals, that care for the same patients.

CMS has already initiated the next-generation program, with the Comprehensive Primary Care Plus (CPC+) initiative, a five-year primary care medical home model that began on Jan. 1, 2017.

HHS Secretary Alex Azar has said the healthcare industry's transition to value-based care is a central focus for the department under his leadership, and he said the agency wants to work with payers to accelerate the changes.

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