Home in­spec­tion

500 prac­tices launch Medi­care project

Modern Healthcare - - THE WEEK IN HEALTHCARE - An­dis Robeznieks

The clin­i­cal ben­e­fits and fi­nan­cial vi­a­bil­ity of pa­tient-cen­tered med­i­cal homes will be put to the ul­ti­mate test over the next four years by 500 pri­mary-care physi­cian prac­tices that agreed to par­tic­i­pate in a new Medi­care demon­stra­tion project. The CMS an­nounced the par­tic­i­pants in its Com­pre­hen­sive Pri­mary Care Ini­tia­tive last week to much fan­fare and hope in its suc­cess.

“The CPCI is very well con­ceived, well de­signed and, so far, a well-ex­e­cuted pro­gram,” said Patrick Gor­don, pro­gram di­rec­tor for the Colorado Bea­con Con­sor­tium and di­rec­tor of gov­ern­ment pro­grams for con­sor­tium mem­ber Rocky Moun­tain Health Plans of Grand Junc­tion, Colo.

And well stocked. The 500 prac­tices are in seven ar­eas: New York’s Cap­i­tal Dis­trict-Hudson Val­ley re­gion; the Ohio-Ken­tucky Cincin­nati-Day­ton re­gion; Tulsa, Okla.; and statewide in Arkansas, Colorado, New Jersey and Ore­gon. Com­bined, the prac­tices in­clude 2,144 physi­cians, physi­cian as­sis­tants, nurse prac­ti­tion­ers and other providers who care for 313,000 Medi­care ben­e­fi­cia­ries, ac­cord­ing to the CMS. The CMS did not pro­vide an es­ti­mate for how many peo­ple would be cov­ered by Med­i­caid or com­mer­cial pay­ers.

Ac­cord­ing to the CMS, most ef­forts will launch around Nov. 1, with Tulsa prac­tices aim­ing for Oct. 1.

Un­der the pro­gram, Medi­care will pay the prac­tices a $20 per mem­ber, per month care-man­age­ment fee for two years. That’s in ad­di­tion to their tra­di­tional fee-for-ser­vice re­im­burse­ment. The care-man­age­ment fee will be re­duced to an av­er­age of $15 in years three and four, but providers also will be el­i­gi­ble to share in sav­ings they gen­er­ated for Medi­care af­ter the sec­ond year.

In ad­di­tion, 43 other pay­ers—in­clud­ing com­mer­cial plans and state Med­i­caid pro­grams—are par­tic­i­pat­ing, though how much they are pay­ing has yet to be re­leased. With Medi­care, Med­i­caid and pri­vate pay­ers com­bined, the pro­gram’s goal is to have at least 60% of the par­tic­i­pat­ing prac­tices’ pa­tient base cov­ered by per mem­ber, per month man­age­ment fees. The in­tent is to have the prac­tices use that money to in­vest in the staff and in­for­ma­tion tech­nol­ogy nec­es­sary for care-co­or­di­na­tion ser­vices that should help lower hos­pi­tal­iza­tions, elim­i­nate du­pli­cate test­ing and avoid other in­ef­fi­cien­cies that drive up health­care costs.

Al­though the CMS con­vened the par­tic­i­pants, Gor­don noted that most of the money will come from pri­vate com­pa­nies that he said he be­lieves will be pleased with the re­sults and could “fun­da­men­tally change the eco­nom­ics of pri­mary care.”

“There will be a real-world re­turn on in­vest­ment to pri­vate pay­ers in very com­pet­i­tive mar­kets,” Gor­don said. “And that will bring more sup­port for the model—not just from the gov­ern­ment—but from pri­vate pay­ers as well.”

In Colorado, for ex­am­ple, where 73 prac­tices with 335 providers agreed to par­tic­i­pate, 10 pay­ers in­clud­ing Med­i­caid and Medi­care have joined the pro­gram. In Ore­gon, Med­i­caid and Medi­care, plus five pay­ers, will be kick­ing in money to 70 prac­tices with 517 providers.

Three of the Ore­gon prac­tices are run by the Ore­gon Health & Sci­ence Univer­sity in Port­land. Dr. John Saultz, OHSU pro­fes­sor and chair­man of its fam­ily medicine depart­ment, noted the sig­nif­i­cance of the new in­vest­ment Medi­care and pri­vate pay­ers were mak­ing: “Be­fore, if you put ex­tra money into pri­mary care, it had to come from some place else in the health­care sys­tem and—the other parts of the health­care sys­tem—none of them were too keen on do­nat­ing.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.