CMS Delays Primary Care First Implementation to 2021

Though the U.S. Centers for Medicare & Medicaid Services is now accepting applications to participate in the agency’s new Primary Care First payment models, the agency has delayed the program’s launch to 2021, as opposed to the original Jan. 1, 2020 date.

CMS moved the start date to allow stakeholders more time to consider participation, a decision that requires practices to assume risk in exchange for outcomes-based rewards, a CMS spokesperson said in an e-mail to Hospice News. The delay also helps practices prepare for participation by allowing them additional time to move away from a fee-for-services (FFS) structure, according to CMS.

The agency first announced the program in April and will implement the models in phases beginning in January 2020, initially in 26 regions throughout the United States. Hospices and palliative care organizations are eligible to participate in the payment models provided they meet the program’s criteria. The program is designed to control costs, reduce avoidable hospitalizations and improve care coordination.

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Hospices and palliative care practitioners will be able to receive payments through Primary Care First’s general payment option if they meet the programs eligibility requirements. They can also participate exclusively in the Seriously Ill Population payment option, either directly as an organization or by partnering with a primary care practice.

The agency has yet to release some key details about how the program will work. In light of this, industry advocates felt the delay was appropriate.

“We applaud CMS on the implementation delay, given that it’s almost November. It would be a mistake to launch this in 2020, and it is certainly responsible to delay the demo by a year. I wouldn’t be surprised if it were delayed further given some of the implementation concerns,” Edo Banach, president of the National Hospice and Palliative Care Organization (NHPCO), told Hospice News. “This is crucial and really important that we are able to provide better more coordinated serious illness care, and we have to make sure we do it right.”

Eligible providers can choose to participate in one or both of two payment options under the program: A general payment option and a Seriously Ill Population payment option designed to serve patients with complex, chronic needs, through which providers focused on caring for that population would receive increased payments.

Among the NHPCO’s concerns about how the program might be implemented are issues related to locating, contacting and ultimately providing care to a population with complex needs.

“Nobody is contacted by CMS, so it is probably going to be a contractor. Who is that contractor and what is their track record in finding and helping folks who are difficult to find and help? That’s going to be crucial,” Banach said. “Remember the whole cadre here is folks who have been disconnected or who are getting uncoordinated care. We have behavioral health concerns. We have substance abuse concerns. We have high rates of homelessness. These are folks who are disconnected often for a reason. It’s not easy to find them.”

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