What are the benefits of participating in Primary Care First as an independent practice?

This post is part of a series of posts that aim to educate independent primary care practices about CMS’ recently announced Primary Cares Initiative.

Click here to read our overview of Primary Care First.

As policy programs continue to center around value-based care, Elation is here to ensure that independent practices and innovative organizations like ACOs and IPAs are at the forefront of this new healthcare landscape. By keeping you informed, we’re committed to supporting small practices’ participating in programs that focus on prioritizing high-quality, patient-centered care.

Independent physicians participating in Medicare for their patients may find some benefits in the newly announced Primary Cares Initiative. Developed and administered by the Centers for Medicare & Medicaid Services (CMS) Innovation Center, the initiative provides primary care practices with five new payment model options.

CMS has stated that “there is an urgent need to preserve and strengthen primary care as well as a need for support of complex, chronic, and serious illness care services for Medicare beneficiaries.” In addition, the goal of the Primary Cares Initiative is to reduce hospitalizations among Medicare patients and to provide primary care physicians with a steady revenue stream, if they are willing to take on some financial risk as well.

The Primary Cares Initiative options for primary care practices are offered under two paths: Primary Care First and Direct Contracting:

Two payment model options under Primary Care First are:

1.       Primary Care First (PCF) – General
2.       Primary Care First (PCF) – High Need Populations

There are three payment model options under Direct Contracting:

1.       Direct Contracting (DC) – Global
2.       Direct Contracting (DC) – Professional
3.       Direct Contracting (DC) – Geographic

All of the Primary Cares Initiative payment options for primary care practices are designed to reduce the administrative burden for the physician, to improve the overall health outcomes for the patient, and to offer opportunities for the physician to share in the financial rewards that result from reduced hospitalizations and healthier patients. There are some financial risks involved with each model as well.

The Primary Care First (PCF) payment models are most beneficial to smaller practices, as they provide a “monthly, flat revenue stream for each patient.” The main goal of these payment models is to reduce hospitalization and improve health outcomes for Medicare patients. Although small practices could be responsible for a downside risk of up to 10%, they could also be eligible for a 50% bonus for patients who remain healthy and who do not require hospitalization.

Small practices participating in PCF could see regular monthly payments for their Medicare patients, rather than having to bill for each visit and each service provided. The administrative paperwork would be reduced and the revenue from Medicare would be more predictable.

Those providing seriously ill patients with hospice or palliative care services will benefit from the High Need Populations option, in which CMS “encourages advanced primary care practices … to take responsibility for high need, seriously ill beneficiaries who currently lack a primary care practitioner and/or effective care coordination.”