The U.S. Centers for Medicare & Medicaid Services (CMS) has opened the online application period for the Primary Care First payment models.
The agency announced the program in April and will implement the models in phases beginning in January 2021, 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.
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.
“The goal of this model is to provide coordination for patients upstream of the hospice benefit–patients with serious and advanced illness,” Mollie Gurian, former chief strategy officer for the National Partnership for Hospice Innovation told Hospice News in April. “Part of good serious illness care is planning and counseling about appropriate transitions including to hospice.”
Gurian is now director of Hospice, Palliative Care and Home Health for Leading Age.
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.
Participating health care providers would also receive a bonus for reducing avoidable hospitalizations, an area in which community-based hospice and palliative care providers have a strong track record. A growing body of research indicates that hospice and palliative care reduces hospitalizations as well as hospital readmissions.
“That’s where I think the opportunity lies,” Brad Stuart, the chief medical officer at the Coalition to Transform Advanced Care (C-TAC), and co-author of a Health Affairs study that helped inform the new payment models, told Hospice News in June. “You can really score a large increase if you achieve certain metrics that CMS has already specified. There is only one metric in year one, and that is you have to reduce avoidable hospitalizations.”
Development of the models was informed by research and proposals by a number of health care stakeholders, including the American Academy of Hospice, C-TAC, and Sacramento, Calif.-based health system Sutter Health, who received a $13 million grant to study clinical and financial systems for serious illness care through a program called the Advanced Illness Management Model (AIM). The three organizations made proposals to CMS’ Center for Medicare & Medicaid Innovation (CMMI) for new payment models.
A key goal of the models is to create a “spectrum of models” to support patients suffering from serious illness from diagnosis through end of life. In addition to these government programs, the agency foresees that health care providers — including hospice and palliative care organizations — will work with payers to develop similar programs in the private sector, CMMI’s Chief Strategy Officer Gary Bacher told the attendees of the C-TAC National Summit on Advanced Illness Care in Minneapolis.
Bacher made the comments in response to a question from coalition co-founder Tom Koutsoumpas.