FutureFocus June 20, 2018 Patient Choice Hitting Other Areas of Healthcare

Lisa Remington

We have been keeping you informed about patient choice and discharge planning options. This started back in October 2017 with MedPAC's recommendation for discharge planning options. It appears from a recent lawsuit, patient choice is also affecting physician referrals. We provide the details.

Lisa Remington, President, Remington Health Strategy Group

By: Ronald M. Schwartz, Writer, The Remington Report

 In 2012, the Centers for Medicare & Medicaid Services (CMS) launched the Comprehensive Primary Care Initiative (CPC). This multi-payer delivery and payment model required primary care practices to implement the five following primary care functions:

Care Functions:

• enhanced access to and continuity of care,

• planned care for chronic conditions and preventive care,

• risk-stratified care management,

• patient and caregiver engagement, and

• coordination of care with other providers.

It also offered care management fees in addition to regular reimbursement. A new study, published in the June issue of Health Affairs, evaluated CPC’s effects on care delivery for 497 practices that participated in CPC between 2012 and 2016.

According to the authors, there were clear improvements in care delivery: 2 percent lower growth rates in emergency department use and hospitalizations relative to a matched comparison group. Medicare expenditures grew more slowly, although these savings were not enough to offset CMS’s care management fees. The study found that 80 percent of participating physicians responding to a 2016 survey reported improvements in the quality of care they provided their patients, but many found the program’s administrative reporting burdensome.

“The full four-year results of this evaluation are particularly relevant now because primary care initiatives may qualify as Advanced Alternative Payment Models under CMS’s Quality Payment Program,” the authors note. “In addition, CMS and other payers are increasingly interested in effective primary care programs as they pursue value-based purchasing. Moreover, these findings can be helpful to the payers, practices, and other participants in Comprehensive Primary Care Plus (CPC+), a model that is now being implemented by 3,000 practices.”

Study title: The Comprehensive Primary Care Initiative: Effects on Spending, Quality, Patients, and Physicians.