CMS (Centers for Medicare and Medicaid Services) launched an alternative payment model – Primary Care First. This program is expected to be in effect from this year, and it will assess the financial risk and performance-based payments such as QPP MIPS. This program also contributes to the lower Medicare expenses.
Overview of the PCF Model
In this program, eligible clinicians can submit quality measures including for Advance Care Plan at the end of the performance year. However, clinicians would require a MIPS Qualified Registry or a QCDR (Qualified Clinical Data Registry), especially because there are not any EHR (Electronic Healthcare Record) dependent measures. Therefore, clinicians would require a third party for their successful data submission.
Now, let’s understand what PCF exactly is.
Primary Care First Model
CMS sponsored this payment model for advanced primary care practices via a five-year voluntary program. It is based on the existing CPC+ (Comprehensive Primary Care Plus) program. The idea behind this innovative model is to promote controlled or reduced Medicare spending alongside improved patient experience and outcomes. Just like QPP MIPS reporting, this program incentivizes clinicians for their quality services.
How will CMS Measures Performance?
According to the press release, clinicians’ efforts will be judged upon the reduced acute hospitalization utilization. Moreover, the national performance benchmarks for a small number of quality measures will also come into consideration.
Who Can Participate in This Program?
January 22, 2020, was the last date to submit applications for PCP participation. We can also expect another round of applications from potential participants in January 2022. This window would particularly be for practices that are participating in the current CPC+ program.
Eligibility Criteria for PCF Participation
Eligible clinicians must meet the following eligibility requirements to participate in PCF reporting.
- The medical practice must participate in one of the 26 PCF states/regions
- The healthcare organization involves family medicine, general medicine, internal medicine, or hospice and palliative care
- The practice must provide healthcare services to at least 125 attributed Medicare fee-for-service beneficiaries
- The medical practice must account for primary care services for at least 70% of the collected revenue
- The medical practice uses 2015 Edition certified EHR technology for data exchange with other clinicians and health systems in a digital format and also to a regional health information exchange
- Healthcare organization must indulge in value-based payment arrangements
- The practice must attest to a limited set of advanced primary care delivery features with 24/7 access to a practitioner or nurse call line, and empanelment of patients to a primary care practitioner or care team
Payment Structure of PCF Model
This model is an attempt to reduce the fee-for-service payment approach in medical practices. Instead, practices will be given a flat fee rate for primary care visits (population-based payments) including the monthly risk-adjusted.
Medical practices can also earn a bonus of 50% on their total primary care payments and a 10% of downside risk on their revenue for poor performance. Moreover, CMS also rewards healthcare facilities that specialize in care for seriously ill populations (SIP).
Medical practices, which are unable to meet QPP MIPS reporting requirements can participate in the PCF model. So, Medical Practices! It is a great chance to register your quality care outcomes and get incentives for improved revenue cycle management.