What are the CPC+ updates you need to know for 2018

The Comprehensive Primary Care Plus (CPC+) program is an initiative launched by the Centers for Medicare & Medicaid Services (CMS). As CMS describes it, CPC+ is “a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation.” In 2018, independent physicians will see some changes in the requirements for the CPC+ program.

One of the updates affects the electronic clinical quality measures (eCQMs). CMS has included 19 eCQMs in the 2018 CPC+ measure set and independent practices must successfully report 9 of those for the 2018 Measurement Period that begins on January 1, 2018, and ends on December 31, 2018. The window for submitting 2018 eCQM reports to CPC+ is expected to be January 1, 2019 to February 28, 2019.

There are outcome measures that must be reported, including whether independent physicians have been successful in controlling chronic conditions such as high blood pressure and diabetes. In addition, there are 17 measures out of which independent physicians have the option of choosing 7 for their report. Measures are reportable through electronic health records (EHRs).

As to payments for these reported eCQMs, Lori Rousche, MD, writing in Medical Economics, explains that in the first year of reporting to CPC+, independent physicians “received 100 percent of the available money, but up to 10 percent had to be paid back in part or in full to the government at the end of the year” if the metrics listed were not met. Dr. Rousche points out that the updated rule for 2018, is that “the split is 75 percent guaranteed payments, but up to 25 percent of the money goes back to the insurer if we don’t meet the metrics.”

CMS advises independent physicians that questions about quality reporting may be submitted to CPCPlus@telligen.com or at 1-888-372-3280.

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