Physicians who successfully apply to the CPC+ APM by Sept. 15 will remain in the program for five years.
Primary care providers who'd like to participate in a MACRA-approved alternative payment model (APM) can join the Comprehensive Primary Care Plus (CPC+) APM. CMS is accepting applications for the CPC+ through Sept. 15, 2016. CPC+ consists of two tracks, each capped at 2,500 practices, which will begin CPC+ on Jan. 1, 2017, and remain in the program for five years. Here’s what’s required for each:
- Track 1: Use certified EHR technology. Assign patients to a provider panel. Provide 24/7 access for patients. Support quality improvement activities.
- Track 2: Use certified EHR technology and complete all Track 1 care delivery activities listed above. In addition, develop and record care plans; follow up with patients after emergency room or hospital discharge; create a process that links patients to community resources; and provide a letter of support from a health IT vendor outlining their support of your practice.
- View the application or apply online.
Both tracks will receive a combination of care management fees on a per-member-per-month basis and a performance-based incentive payment.
- Track 1 will layer these payments on top of a fee-for-service payment structure.
- Track 2’s underlying payment structure is a hybrid of reduced fee-for-service and an additional comprehensive primary care payment (CPCP). Practices will receive a certain percentage of their expected Medicare E&M payment as an upfront lump sum CPCP on a quarterly basis. CMS will allow Track 2 practices to move toward the desired percentages at their own pace over the five-year program.
Track 1 Payment
- Average Medicare Care Management Fee of $15 per beneficiary per month
- Practices are eligible for a performance based incentive payment of $2.50 per beneficiary per month
- Practices will receive regular fee-for-service payments
Track 2 Payment
- Average Medicare Care Management Fee of $28 per beneficiary per month, which includes a $100 Care Management Fee for patients with more complex needs
- Practices are eligible for a performance based incentive payment of $4 per beneficiary per month
- Practices will receive Comprehensive Primary Care Payments (CPCP) in addition to reduced fee-for-service payments