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CMS Announces Continued Positive Results in Primary Care Initiative

October 17, 2016
by Rajiv Leventhal
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The Centers for Medicare & Medicaid Services (CMS) has announced the agency’s Comprehensive Primary Care (CPC) initiative’s second round of shared savings results, with nearly all practices (95 percent) meeting quality of care requirements and four out of seven regions sharing in savings with CMS.

These results reflect the work of 481 practices that served over 376,000 Medicare beneficiaries and more than 2.7 million patients overall in 2015, according to CMS. “As the largest test of advanced primary care in U.S. history, CPC demonstrates the potential of primary care clinicians redesigning their practices to deliver better care to their patients, and provides clinicians support to innovate and deliver care in ways that better meet their patients’ needs and preferences,” CMS Principal Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., said in a blog post announcement.

CPC is a multi-payer partnership launched by the Center for Medicare and Medicaid Innovation (Innovation Center) in October 2012 to advance primary care by paying clinicians with the aim to deliver accessible, comprehensive, and coordinated care in seven regions across the country.

During 2015, its second shared savings performance year, CPC generated a total of $57.7 million gross savings in Part A and Part B expenditures. These savings are essentially equivalent to the $58 million paid in care management fees to the practices. Further, more than half of participating CPC practices will receive a share of over $13 million in earned shared savings, CMS said.

In addition to the gross Medicare savings, CPC practices showed positive quality, with lower than expected hospital admission and readmission rates, and favorable performance on patient experience measures. CPC practices’ performance on electronic clinical quality measures (eCQMs) also exceeded national benchmarks, particularly on preventive health measures, CMS revealed.

This is the first year CMS has included eCQM performance in Medicare shared savings determinations for CPC. eCQM reporting covering the entire practice population at the practice site level is critical to using health IT as a tool to support care delivery transformation, federal officials said. eCQM data are recorded in the electronic health record (EHR) in the routine course of clinical care, allowing practices to engage in real-time quality improvement efforts that drive population health. “As we move to a healthcare system that rewards value over volume, CPC practices are at the forefront of using eCQMs for quality improvement, measurement, and reporting,” CMS said in the announcement.

Quality highlights from the 2015 shared savings performance year include:

  • 97 percent of CPC practices successfully reported 9 eCQMs. For ten out of the eleven eCQMs in the CPC measure set, the majority of CPC practices who reported surpassed the median national performance.
  • Nearly all (99 percent) practices reported higher levels of colorectal cancer screening and influenza immunization compared to national benchmarks. Additionally, 100 percent of practices who reported on screening for clinical depression surpassed national benchmarks.
  • Compared to 2014, most regions maintained or improved their scores on hospital readmissions and admissions for chronic obstructive pulmonary disorder and congestive heart failure.
  • Patients rated the care they receive from their CPC practitioners highly, particularly on how well practitioners supported them in taking care of their own health and the attention they paid to care from other providers.

The experience in CPC has contributed to CMS’ efforts to support primary care going forward with its Comprehensive Primary Care Plus (CPC+), which will begin on Jan. 1, 2017 and for which the agency recently announced the 14 selected regions and are currently reviewing practice applications.

 CMS anticipates that CPC+ could meet the criteria to qualify as an advanced alternative payment model (Advanced APM) under the recently finalized Quality Payment Program rule, under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

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