Source: American Academy of Family Physicians Leader Voices Blog, Michael Munger, MD, AAFP President-Elect
Too often in primary care, our practices don’t get paid for all of the work we do.
For example, the average medical practice wastes roughly 16 hours of staff and physician time each week — per physician — on prior authorizations. And we know that for every hour we spend with patients, physicians spend two hours on documentation.
Although the American Academy of Family Physicians is working to reduce these types of administrative burdens, there are still other examples of vital work, returning patient phone calls, telehealth, etc., that aren’t reimbursed adequately, if at all.
This year, my practice is one of nearly 3,000 primary care practices working with more than 50 payers to change that. The Comprehensive Primary Care Plus (CPC+) program, launched in January, is a five-year pilot that aims to move practices away from the volume-driven, fee-for-service payment system. It will do so by providing a new payment structure that encourages flexibility in engaging patients with methods beyond the traditional office visit. Improved payment is expected to allow practices to improve infrastructure, integrate behavioral health, and essentially lay the groundwork for the value-based payment systems of the future.
Shawn Martin, the AAFP’s senior vice president of advocacy, practice advancement, and policy, outlined the specifics of how CPC+ will pay better and differently in a blog post published during the application period last summer.
The short version is that CPC+ offers a payment model with three components that de-emphasize fee-for-service payments and provide prospective payments to support practices as they provide advanced primary care to meet the needs of their patients.
The advance payments in this structure will allow practices to invest in the capabilities they need to be successful in transforming care. These capabilities may include care managers, clinical social workers, licensed counselors or other resources needed to deliver robust population health, chronic disease management, and care coordination. We will be able to better identify our high-risk populations, more closely monitor utilization, and reduce emergency room visits, and recurrent hospitalizations.
Once we identify patients in those high-risk groups, we can ensure they are linked to resources within our health care system as well as to external resources and work with them to improve their overall health. We also will work to close gaps in care, improve transitions in care, and proactively manage chronic diseases.
As a level three patient-centered medical home, we already are doing many of the things we will be judged on in this pilot. Now we will be able to do them even better and get paid accordingly.
This month, the Centers for Medicare and Medicaid Services (CMS) is expected to begin accepting applications from payers for an expansion of this concept. CMS will select up to 10 new regions that have sufficient payer commitment to support practices in adopting the CPC+ model. The agency then plans another application period this spring or summer for practices in those new regions.
The AAFP will notify members about opportunities and provide support and resources for those interested in applying. I urge you to consider how your practice, and your patients, might benefit from the experience.