CMS Primary Care Program Nets Savings in Some Regions

Added on Nov 17, 2016

CMS Primary Care Program Nets Savings in Some Regions
Industry Edge November 2016

Physicians in four out of seven regions in CMS’s Comprehensive Primary Care (CPC) program generated savings in 2015, the program’s second performance year. The states of Arkansas, Colorado and Oregon, and the Greater Tulsa region in Oklahoma, saved $57.7 million in Part A and Part B expenditures, roughly the same amount that CMS paid them in care management fees. The regions that failed to generate savings include the state of New Jersey, the Capital District–Hudson Valley region of New York and the Cincinnati–Dayton region of Ohio and Kentucky.

CPC is a partnership between Medicare and other programs and organizations that is intended to help selected primary care providers and their practices provide additional resources to improve the quality of care. In 2015, the program included 481 physician practices caring for more than 2.7 million patients and 376,000 Medicare beneficiaries. Participants receive monthly non-visit care management fees of between $15 and $20 per patient from Medicare and other payers. Additionally, each practice can share in the savings it generates. One stipulation of the program is that clinicians must be accessible to patients around the clock.

Physicians in the program are measured on how they identify at-risk patients, care coordination and engagement of patients and caregivers. In a report on 2015 performance, Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer, reported that, in addition to Medicare savings, “CPC practices showed positive quality, with lower than expected hospital admission and readmission rates, and favorable performance on patient experience measures.”

In addition, performance on electronic Clinical Quality Measures (eCQMs) also exceeded national benchmarks, particularly on preventive health measures. Following are some of the CPC practices’ specific eCQM performance highlights shared by Dr. Conway.

  • 97% reported nine eCQMs. The majority of CPC practices who reported surpassed the median national performance for most of the eCQMs in the CPC measure set.
  • 99% reported higher levels of colorectal cancer screening and influenza immunization compared to national benchmarks.
  • 100% 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 as high the care they receive from their CPC practitioners, particularly on how well practitioners supported them in taking care of their own health and the attention they paid to care from other providers.