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Medicare Announces Major Test for Changing Pay for Primary Care

By Kerry Young, CQ Roll Call

April 11, 2016 -- Medicare officials announced on Monday a major plan to shift primary care for the nation's elderly and disabled toward a more coordinated approach through a large-scale test program. The initiative is part of the Obama administration's bid in its final months for an overhaul of how the federal health program pays for medical services.

The Centers for Medicare and Medicaid Services (CMS) described the new program as its largest initiative affecting primary care. Known as the Comprehensive Primary Care Plus model, the program is meant to involve more than 20,000 doctors and medical providers and more than 25 million consumers. CMS plans to kick off the five-year test in January. The program would be implemented in as many as 20 regions and may enroll as many as 5,000 practices.

"By supporting primary care doctors and clinicians to spend time with patients, serve patients' needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars," said Patrick Conway, the chief medical officer at CMS, in a statement.

CMS is working to move much of Medicare's more than $600 billion in annual payments away from the traditional fee-for-service approach to care, which is seen as a root cause of poor coordination of care. Doctors tend to work in silos, with specialists and primary care physicians sometimes failing to share test results, replicating each other's work or inappropriately prescribing treatments for patients.

CMS wants to tie more physician payments to measures of how well patients' care is coordinated or their health is preserved or regained. The agency has a goal of tying about half of its payments to alternative payment models by 2018. Among the major Medicare tests underway is a model that will tie payment for many hip and knee replacements to judgments about how well patients fare in the 90 days after surgery.

The primary care program announced Monday includes two approaches. In its Track 1, CMS would pay a monthly care management fee in addition to the usual fee-for-service payments for doctors' care. In Track 2, practices also would get a monthly care management fee while shifting to a hybrid of reduced Medicare fee-for-service payments and upfront comprehensive primary care payments for those services. The intent is to allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter, CMS said.

Primary care practices in both tracks will get feedback through data on their costs and use of health services. Those enrolled in Track 2 will sign an agreement with CMS to commit to supporting enhanced health information technology capabilities.

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