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Primary Care First - What You Need to Know

Posted on September 21, 2020
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The Centers for Medicare and Medicaid Services (CMS) Primary Care First (PCF) program is a new alternative payment model designed to support the delivery of advanced primary care. The program will begin in 2021 and will examine whether financial risk and performance based payments that reward primary care clinicians will lower Medicare costs and improve health care quality. PCF participants must annually report data on specific quality measures, including the quality measure Advance Care Plan which requires a Qualified Registry or QCDR vendor for reporting since it is not an EHR reportable measure. As a CMS Qualified Registry, MDinteractive can support practices participating in the program by reporting this measure on their behalf.

Primary Care First

Primary Care First (PCF) is a voluntary 5-year demonstration program sponsored by CMS that will offer innovative payment model options for advanced primary care practices. The new initiative is based on the existing Comprehensive Primary Care Plus (CPC+) program. The goal of the program is to improve health care quality and patient experience of care while reducing Medicare spending. Clinicians will be rewarded for reducing acute hospitalization utilization and for exceeding national benchmarks for a small number of quality measures.

Who Can Participate?

CMS has already selected PCF participants following the application deadline on January 22, 2020, and is now focusing on onboarding participating practices through the remainder of the year before the program begins in 2021. However, the agency plans to hold a second round of applications for practices that would begin PCF participation in January 2022. These applications would be exclusively for practices currently participating in the Comprehensive Primary Care Plus (CPC+) program.

Practices participating in PCF must meet the following eligibility criteria:

  • Practice in one of the 26 PCF states/regions;
  • Practice in family medicine, internal medicine, general medicine, or hospice and palliative care;
  • Provide health care to a minimum of 125 attributed Medicare fee-for-service beneficiaries;
  • Have primary care services account for at least 70% of the practice's collective billing based on revenue;
  • Use 2015 Edition certified EHR technology, support data exchange with other clinicians and health systems via an application programming interface, and connect to a regional health information exchange if available;
  • Have experience with value-based payment arrangements; and
  • Attest to a limited set of advanced primary care delivery capabilities, including 24/7 access to a practitioner or nurse call line, and empanelment of patients to a primary care practitioner or care team.
Participating States/Regions
Alaska (statewide)Hawaii (statewide)North Dakota (statewide)
Arkansas (statewide)Louisiana (statewide)North Hudson-Capital region (New York)
California (statewide)Maine (statewide)Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky)
Colorado (statewide)Massachusetts (statewide)Oklahoma (statewide)
Delaware (statewide)Michigan (statewide)Oregon (statewide)
Florida (statewide)Montana (statewide)Rhode Island (statewide)
Greater Buffalo region (New York)Nebraska (statewide)Tennessee (statewide)
Greater Kansas City region (Kansas and Missouri)New Hampshire (statewide)Virginia (statewide)
Greater Philadelphia region (Pennsylvania)New Jersey (statewide)

Payment Structure

PCF will move practices away from fee-for-service payments by providing simple flat rate fees for primary care visits and monthly risk-adjusted, population-based payments. A performance-based adjustment will be calculated and applied on a quarterly basis that provides an opportunity for practices to earn bonuses of up to 50% of their total primary care payments (and a downside risk of 10% of their revenue). The program also includes a payment model to reward practices that specialize in care for seriously ill populations (SIP).

Quality Reporting

CMS will require annual quality measure tracking and reporting as part of the program. To qualify for a positive performance-based adjustment, practices must meet or exceed average national performance thresholds on a limited set of quality measures that are clinically meaningful for patients. These measures include:

  • A patient experience-of-care survey;
  • Controlling high blood pressure;
  • Diabetes hemoglobin A1c poor control;
  • Colorectal cancer screening; and
  • Advance care planning.

The quality measure Advance Care Plan requires a Qualified Registry or QCDR vendor for reporting as it is not an EHR reportable measure. CMS Qualified Registries like MDinteractive can support PCF model participants by reporting this quality measure on their behalf. If you are participating in the program, contact us today to discuss how we can help you meet the annual Quality reporting requirements. We offer flexible data collection options to make tracking and reporting this measures a simple process for you and your practice.

More Information

The PCF program will begin in 26 areas around the country in January of 2021 to support the delivery of advanced primary care to Medicare beneficiaries. While the initial application period has closed, CMS plans to hold a second round of applications for practices participating in the CPC+ program that would begin PCF participation in January 2022. Contact  MDinteractive today for assistance with tracking and reporting the Advance Care Plan Quality measure that is required for performance-based bonuses. More information about the program can be found on the CMS website here.

Primary Care First Quality Reporting Medicare Payments

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