CMS Heeds Concerns, Allows ACOs to Join CPC+

New strides toward better care and spending can stir up plenty of blowback along the way, but CMS has shown a willingness to listen and adjust, this time by allowing ACOs to jump aboard the Comprehensive Primary Care Plus (CPC+) train – an initiative with the potential to impact up to 5,000 practices, 20,000 providers and 25 million patients.

“Moving the needle on payment reform and population health is devilishly difficult and fraught with unintended consequences,” says Cindy Ehnes, JD, executive vice president of COPE Health Solutions and an attorney who previously served as director of the California Department of Managed Health Care.

When the CPC+ initiative was first announced in April, primary care physicians (PCPs) were told they needed to choose between participating in shared savings programs like ACOs or the CPC+ model.

This either/or option created concern among primary care doctors already participating in a Medicare ACO because of the lack of up-front payments or care management fees for managing their patient populations, explains Carrie Nixon, JD, CEO of Healthcare Solutions Connection and managing member of Nixon Law Group.

PCPs felt they were losing out financially and many contemplated leaving the Medicare Shared Savings Program (MSSP) models altogether.

“But PCPs are the quarterbacks for patient/population health management, and if the PCPs abandoned MSSPs to join CPC+ it would put the entire MSSP model at risk of collapse,” she adds.

Adjustments Made

CMS listened to the comments calling for ACO inclusion and recognized that allowing physicians to participate in both CPC+ and ACOs could potentially boost both initiatives. This ultimately led to the May announcement that up to 1,500 (of the 5,000) CPC+ practices would also be allowed participation in MSSP ACOs.

“First and foremost, I think primary care service providers stand to gain as this is yet another opportunity for them to be financially rewarded for delivering high-quality care,” says Jeb Dunkelberger, MSc, McKesson Business Performance Services executive director of accountable care services and corporate partnerships.