If you are a primary care provider who treats Medicare patients — and looking to increase your revenue — the Primary Care First model might be just what you’re looking for. Earlier this year, CMS announced its Primary Cares Initiative, consisting of two new Alternative Payment Models (APMs).
Both qualify as Advanced APMs for participation in the Quality Payment Program and offer population-based payments and bonuses for exceeding quality thresholds.
But how do you know if the Primary Care First model is a good fit for your practice? Keep reading for four essential facts to help you decide.
CMS Primary Care First Model: Is Your Practice Ready?
1. The application deadline is fast approaching.
To begin participating in the model for performance year 2021 (in January 2021), you must apply by Jan. 22, 2020. The application period recently opened on Oct. 24, 2019. CMS will begin the practice — and payer — selection process in the winter/spring of 2020 and conduct onboarding for selected organizations between July and December 2020.
2. The Primary Care First model consists of two tracks to choose from.
Practices can participate in one or both tracks:
- The Payment Model Option encompasses five population-level risk tiers, each with its own specific per-patient-per-month payment amount (ranging from $24 per patient per month for the lowest-risk patients to $175 per patient per month for the highest risk). Providers will also be paid $50 for each face-to-face patient encounter.
- The High Need Populations Payment Model Option is geared towards a seriously ill patient population (SIP) who do not currently have either a PCP and/or effective care coordination. In addition to a $50 flat fee payment for every face-to-face patient visit, providers in this track will be paid $325 for the first visit with each SIP patient and $275/patient/month for every SIP patient.
Each track also offers the opportunity to receive payment adjustments of up to a 50 percent bonus or a negative 10 percent penalty (for performance either above or below performance benchmarks).
Is Your Practice Eligible for the Primary Care First Model?
3. Not all practices are eligible to participate in the Primary Care First Model.
In addition to being located in one of the 26 regions where the Primary Care First Model is available (view map here), eligible practices must meet the following requirements:
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- Provide primary care services to at least 125 Medicare beneficiaries per location.
- Primary care providers (MD, DO, CMS, NP, and PA) must be certified in Internal medicine, general medicine, geriatric medicine, family medicine, and/or hospice/palliative medicine.
- Primary care services must account for at least 70 percent of the practice’s billing based on revenue. For multispecialty practices, at least 70 percent of the PCPs’ combined revenue must be from primary care services.
- Must have experience with non-fee-for-service based payment models (i.e. value-based or capitation models).
- Must use the 2015 edition CEHRT (Certified EHR Technology), support data exchange via API (application programming interface) and connect to their regional HIE (health information exchange).
- Meet the requirements of the Practice Application and Primary Care First Participation Agreement.
4. You can preview application questions before you apply.
Application for the Primary Care First Models is completed through an online portal. However, you can view a list of the application questions here (beginning on page 54).
Document: https://innovation.cms.gov/initiatives/primary-care-first-model-options/
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