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HEADS UP!!Important news

  • 1.  HEADS UP!!Important news

    Posted 04-24-2019 12:30
    CMS has just  has announced new non FFS  payment  models for primary care  for which even tiny practices are eligible- though  not in every state( presumably??becasue some areas got to do CPC+ and others did not...  not sure) beginning in January  Applications out in June
     this may be good stuff
    Please read about it here


    includes link to register

     and sign up for the webinars
    Please speak up and out
     It is not clear yet what the details are
      It is optimistic in that it is finally  not FFS but a monthly or  quarterly fee + tiny fltt FFS and can be offered to even a one doc practice
     What is not clear is whether it  is pay for  performance where you have  to search for codes to make patients look really sick( eg  how will they risk adjust) and how much  the payment is.  They claim the upside is 50% better over what you do now and the risk is at most 10% They say  Medicare  and medicaid patients but hope to get other payers on boad.
     This may be a major breakthrough ,or  It may  not

    I am of course the author  of one of the proposals they  reference.Not that they let me know about this  I had alot of help pre  and post   going to DC from  national folks Gordon Moore John Wasson  Bob Berenson and HArold miller  They are all watching this with me  One thing is - if the details of the proposal are npt  workable for small practices the only chance we have is to band together and say that on behalf of many of us
     we cannot do X and we suggest Y...  This is a chance for IMP to claim its organizational status and speak for lots of us.


    Jean Antonucci

  • 2.  RE: HEADS UP!!Important news

    Posted 04-25-2019 06:53
     Thank you so much for the "heads up"!  Deborah

  • 3.  RE: HEADS UP!!Important news

    Posted 04-27-2019 08:52
    John Wasson is going to a mtg in Washington  very soon
    He requests comments :(anyone who can  cross post to AAFP small practices   please consider that)

    How many months old is the data you receive about HIGH RISK PATIENTS YOU ARE SUPPOSED TO BETTER MANAGE TO REDUCE FUTURE CARE (USUALLY BASED ON AN ALGORITHM ?  _______ months  _____ I don't know  or can't figure it out  ______ I don't receive this data

    How many months old is the data you receive about these patients subsequent utilization of emergency or hospital care?  _______ months  _____ I don't know  or can't figure it out_______ I don't receive this data
    How many months old after you receive about utilization of emergency or hospital care do you receive a change in payment?  _______ months  _____ I don't know  or can't figure it out ______ I don't receive payment for utilization performance

    Please comment on these questions if you don't think they make sense.


    Jean Antonucci

  • 4.  RE: HEADS UP!!Important news

    Posted 04-28-2019 05:36
    We, two doc practice, reviewed the proposal and are not interested. The question of useful data is puzzling, the insurer including CMS do not send information about high risk utilizers. Are other practices getting data from CMS?

    Adam Schwarz

  • 5.  RE: HEADS UP!!Important news

    Posted 04-28-2019 17:06

    Thank you for your efforts in pushing ahead the idea of a non FFS model.  Do you know how we can to submit comments to Dr. Wasson regarding Primary Care First (PCF) if one is not a member of AAFP?

    Some of my suggestions would be:
    1) Eliminate the 125 patient threshold, especially if a doctor's historical data can show that his/her cost of care is not excessive.   I have never understood why efficient small practices are discriminated against, while overutilizing and more costly behemoth groups are preferred.
         I also believe CMS will no longer be requiring a minimum threshold of patients for MIPS eligibility for doctors in small practices, starting in 2021.

    2) Allow docs who practice in states with CPC+ , but are not part of the that program to still be eligible to apply for PCF participation.  I applied for CPC + but was not accepted.   They seemed to mostly accept larger primary care groups with at least 3-5 providers.

    3) More transparency on the potential global payment $ pmpm would be helpful.

    I doubt I would do better in the non FFS model.  I suspect the time currently spent on FFS billing costs will be more then replaced by patient confusion and education of the new system, reviewing "useful data", new requirements for documenting and submitting quality metrics, adding dx codes to obtain a higher $ pmpm for sicker patients, etc etc etc.

    I have learned (in part from taking advantage of the combined knowledge of this group) how to bill Medicare effectively and be reimbursed for the myriad services we all provide including AWV, CCM, E&M, HHC, end of life discussion, etc.

    Having said all this, I would still consider applying for PCF if the reimbursement is appropriate, and since the writing is on the wall for traditional FFS billing.   I am also sympathetic with the idea of appropriate global payment for effective, comprehensive primary care.

    Ironically, I dont qualify based on the proposed requirements, for the very reasons I stated in my suggestions above.
    1) I have slightly less than  the required 125 Medicare patients.
    2) I practice in NYS, and applied for CPC + a few years ago, but was not accepted.

    Again, thanks for all your efforts.  I would be happy to send my comments to Dr. Wasson.

    Michael Safran

    Michael S. MD

  • 6.  RE: HEADS UP!!Important news

    Posted 04-28-2019 18:02
    Hello Michael things are a little confused here

    let me untangle this

    Number one
    Dr. John Wasson, who helped teach the imp s at our very beginning ,has nothing to do with primary care first
    I posted to this list a question from John about receiving data that identified high-risk patients because he’s going to a meeting soon — and he asked me to ask the group—that meeting is about MIPS
    it has nothing to do with primary care first which is a brand new CMS program

    The new CMS program is called primary care first and has several parts
    if you’re part of an ACO you might to take it vantage of the program through the parts of it that an ACO would join up under ;you might partake in one of the parts of this new program called direct contracting
    it’s very strange language because it’s not like it’s DPC
    so primary care first has several programs
    some of them come under this odd direct contracting label And are for bigger groups

    one of the parts of the new program is not called direct contracting and I forget what it is called but it is for the tiny practices-and could be even for solo solo solo providers
    in other words CMS is listening at least to the fact that many of us have been excluded from other projects
    I have no idea why you would’ve been excluded from CPC plus do you know?
    and the only region of New York State eligible for the new primary care first projects are in the Buffalo region
    I have no idea why, Although my guess is if you could be in CPC plus you could take advantage of that and if CPC plus wasn’t available now you can take advantage of this
    Also CPC plus is still ongoing
    One can switch from CPC plus to these new projects in one year
    Your other suggestions have no place to go right now
    there’s a webinar on Tuesday . I mean that’s the first one there are several upcoming.
    I sent the link register for the webinar it if you’re in one of the regions that can do this and we will all find out more details
    So in other words John Wasson has nothing to do with this project and making suggestions when CMS has already determined the project is probably of little value
    as I suggested – And this is based on my contact with a semi insider –that a great many small practices find they are excluded for X reason and we all write to CMe as a group and say we cannot do x. And suggest y
    I hope that untangles things a bit
    I’ll post to this group after I’ve been to the webinar and get actual details about the project on Tuesday

    Sent from my iPhone

  • 7.  RE: HEADS UP!!Important news

    Posted 04-28-2019 18:05
    And PS
    Wasson has nothing to do with primary care first but also has nothing to do with AAFP
    AAFP doesn’t really have much to do at this new project either except they think they had in put and are patting them selves on the back
    The AAFP proposal was convoluted non-transparent and frankly terrible and just more of what we do now
    so I hope I have untangle d. this
    there was a lot of confusion in your post
    I realize people don’t have a lot of time for things so I’m trying to untangle and I will keep you posted

    Sent from my iPhone

  • 8.  RE: HEADS UP!!Important news

    Posted 04-29-2019 06:09

    We are a medicare opt out practice, however am interested in anything that would convince us that it would make sense to opt back in.  Not sure this would be it.