CMS Plan to Strengthen Primary Care Praised, But Financial Concerns Remain

October 3, 2011

It may be too early to tell the degree to which participating physicians will reap benefits from the Comprehensive Primary Care Initiative.

A new federal incentive program that will provide bonuses to primary care physicians who better coordinate care and help use healthcare dollars more wisely is winning a lot of praise from medical associations. However, it may be too early to tell the degree to which participating physicians will reap benefits.

As part of the Comprehensive Primary Care Initiative, launched Friday by CMS under the direction of the Affordable Care Act, CMS will pay participating practices a risk-adjusted, monthly care-management fee for their Medicare Fee-for-Service beneficiaries. For the first two years of the initiative, the per-beneficiary, per-month amount will average out to $20; for years 3 and 4, the PBPM will be reduced to an average of $15, according to CMS.

To participate in the Comprehensive Primary Care Initiative, public and private healthcare payers are required to submit a letter of intent by November 15, 2011.

"Thanks to the Affordable Care Act, we are helping primary care doctors better coordinate care with patients so they get better care and we use our healthcare dollars more wisely," said HHS Secretary Kathleen Sebelius, in a statement.

The American Medical Association, among others, has given the initiative a thumb’s up.

“The AMA applauds [CMS] for launching the Comprehensive Primary Care Initiative and taking an important step toward transforming the delivery of healthcare in our nation,” Peter W. Carmel, president of the American Medical Association, said in a statement. “This new initiative is an exciting opportunity that will provide physicians with the resources and data they need to work with CMS, private health insurers, employers, and patients to transform care at the local level.”

The American College of Physicians issued a statement that said the initiative has the potential to promote the kind of personalized and coordinated care that patients seek and that physicians want to deliver.

"It will provide primary care physicians with the support needed to work hand-in-hand with patients toward a shared goal of ensuring high-quality care while making the most efficient use of healthcare resources," said Steven Weinberger, CEO of ACP, in a press statement. "We are particularly pleased that this initiative invites other payers to join with Medicare to support comprehensive, coordinated, and patient-centered primary care. Aligning support from multiple payers will provide a more realistic evaluation of these innovative payment and delivery reforms than earlier, more limited efforts."

Meanwhile, healthcare consultants like Greg Mertz, senior partner with Healthcare Strategy Group, have pointed out that the current initiative seems to indicate that CMS is accepting the fact that its Accountable Care Organization (ACO) program may be a non-starter.

“[CMS is] looking at more acceptable alternatives,” Mertz told Physicians Practice. “Basically this is a medical home program so the model is more common and likely to attract interest.”

Mertz also said it is also interesting that insurance plans will be the applicants rather than physician practices.

“This tells me that Medicare simply doesn’t have the infrastructure to manage a risk program and wants to pass along that responsibility to experienced commercial plans,” said Mertz. “Unfortunately, since these companies will want to recover administrative costs, the amount of money available for the physicians will be diminished.”

We’ll keep you posted as we hear additional feedback. In the meantime, please share what you think of CMS’ latest plan for primary care physicians below.