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CMS Begins Accepting Applications for Primary Care and Kidney Care Payment Models

October 30, 2019

McDermott+Consulting

On October 24, 2019, the Center for Medicare and Medicaid Innovation (CMMI) posted request for applications (RFAs) for the Primary Care First (PCF) and Kidney Care Choices (KCC) Models. The models were announced earlier in 2019. The applications are now available and are due by January 22, 2020.

Both are voluntary payment models that incentivize providers in the enhanced management and care of their patient populations and are expected to qualify as Alternative Advanced Payment Models (APMs) and/or Merit-based Incentive Payment System APMs in 2021 under the Quality Payment Program (QPP).

In addition to these two RFA, CMS is expected to release shortly an RFA for the Direct Contracting Model which was announced in April 2019.

Primary Care First (PCF) Model

The PCF Model aims to reduce Medicare spending on unnecessary inpatient hospital visits and improve the quality of and access to primary care by incentivizing care coordination and other advanced primary care functions. The model is designed for primary care practices with the ability to take on two-sided financial risk. Participants will receive a professional population-based payment; a flat primary care visit fee for each face-to-face encounter; and a quarterly performance-based payment adjustment.  Participation in the model can theoretically increase payment by up to 50% or decrease it by up to 10%. The PCF Model will also have an optional component with a distinct payment model for practices that care for a seriously ill population (SIP).

This model is designed as a multi-payer model and CMS is seeking payer partners that can align with the PCF payment methodology, quality measurement strategy and data sharing approach.

The PCF Model will be tested over six years, with two staggered cohorts. The first cohort will participate from 2021-2025 and the second will run from 2022-2026.

A fact sheet, press release, FAQ and additional information and resources are available on the PCF Model website. The application portal for the PCF Model is currently open.

PCF Webinars

CMS will be hosting two webinars to help interested parties navigate the PCF Model application process.

Primary Care First Application Webinar

Wednesday, October 30

3:00 PM (ET) – 4:00 PM (ET)

Register here

CMS Primary Care First Seriously Ill Population (SIP) Webinar

Thursday, October 31

12:00 PM (ET) – 1:00 PM (ET)

Register here

Kidney Care Choices (KCC) Model

The KCC Model is designed to provide financial incentives for providers to provide coordinated care for Medicare beneficiaries with late-stage chronic kidney disease and end-stage renal disease (ESRD) with the goal of delaying the need for dialysis and encouraging kidney transplantation. The KCC Model is expected to run from January 1, 2021 through December 31, 2023, with the option of an extension of one to two years.

KCC Model participation options:

  • Kidney Care First (KCF): Nephrologists and nephrology practices will receive adjusted capitated payments for managing beneficiaries with chronic kidney disease (CKD) stages 4 and 5 and ESRD. Participants will be eligible for upward and downward payment adjustments based on their performance on quality measures and improvements in their performance over time.
  • Comprehensive Kidney Care Contracting (CKCC): Participating nephrologists and nephrology practices will be required to partner with transplant providers, and may partner with dialysis facilities and other providers and suppliers to become Kidney Contracting Entities (KCEs). KCE nephrologists will receive risk adjusted capitated payments for managing beneficiaries with CKD stages 4 and 5 and ESRD which also will be adjusted for quality. KCEs are also eligible for up to three kidney transplant bonus payments. There are three participation options that vary by level of risk: Graduated Option (one-sided risk); Professional Option (50% of savings or losses); and the Global Option (100% of the total cost of care relative to a benchmark).

CMS has also posted a fact sheet and press release for the model and additional information about the model is available on the KCC website.

The McDermottPlus CMMI Tracker is available here.

 

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For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459/smadhani@mcdermottplus.com or Mara McDermott at 202-204-1462/mmcdermott@mcdermottplus.com.

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