The Centers for Medicare & Medicaid recently rolled out its Comprehensive Primary Care Plus (CPC+) initiative as a means of developing a quality-based payment model. While the improvements generally move incentives in the right direction, there's still significant room for improvement, according to a post on the Health Affairs Blog.
CPC+ builds on the Comprehensive Primary Care initiative, which debuted in 2012 and sought to improve care quality by replacing fee-for-service (FFS) payments with a monthly fee for certain "comprehensive primary care functions." The new program's first track remains broadly similar to the old program, according to the article, but its second track offers greater opportunities to meet higher performance thresholds in the form of expanded capitation fees and reduced FFS payments.
By covering fixed costs through capitated payments, the article says, CMS is looking to reconfigure the structural incentive for practices to pursue higher volumes of services covered by FFS payments. In the old system, FFS payments were pegged to the average cost of procedures across practices, which the blog post reports made the provision of additional services financially attractive.
On the other hand, the upside offered by CPC+ for efficient use of overall healthcare resources remains relatively small, according to the article. This means physicians have little incentive to take steps to reduce the cost of their patients' care outside the primary care setting. Additionally, physicians who participate in CPC+ cannot also be part of an accountable care organization, which the authors of the post find unwise given the potential ACOs have to reduce overall healthcare spending in their own right.
To learn more:
- here's the post