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ACP Gets to Know New Innovation Center Director at CMS

ACP invited to sit-down during CPC+ national payment model meeting

May 25, 2018 (ACP) -- ACP member Louis Friedman, DO, FACP, among the first internists to participate in the Comprehensive Primary Care (CPC) program, and Shari Erickson, VP of Governmental Affairs and Medical Practice at ACP, shared hopes and goals recently with the new Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation, Adam Boehler.

Dr. Friedman, a Woodbridge, NJ-based physician, whose practice is now taking part in the updated CPC+ program, is something of an expert on how the Alternative Payment Model (APM) performs in real-world setting.

During their meeting with Boehler, Dr. Friedman and Erickson discussed CPC+ as well as the College's commitment to this APM and future endeavors. They met during a larger conference on CPC+ where Boehler served as one of the keynote speakers. "The meeting was a way for us to get to know him and start the process of being included in the development of current and future APM models for internists," Erickson said.

The Medicare Access and CHIP Reauthorization Act (MACRA) shifted physician payment so that it rewards value and quality over volume via the creation of the Quality Payment Program (QPP). The QPP offers two pathways for reimbursement: the Merit-based Incentive Payment System (MIPS) and APMs. The initial CPC initiative and CPC+ emphasize care coordination and are the only patient-centered medical home models specifically identified as an APM in the QPP for those in practices with 50 or fewer doctors.

Both the original CPC initiative and CPC+, which have included select practices in limited markets across the country, could be expanded throughout the Medicare program if they are deemed successful in terms of improving quality, and/or reducing cost, Erickson said.

"We wanted [Boehler] to get to know the College and talk about CPC+ and share our overall support for this APM because of its importance to primary care," she explained.

After the meetings on May 9, Boehler tweeted "we had a great conversation about the future of primary care at the CPC+ Annual Meeting. We discussed the importance of transparency (of data and performance), simplicity (reduce burden, focus on measures that matter) and accountability (reimbursement for outcomes not effort)." Appointed in April 2018, Boehler was the founder and CEO of Landmark Health, a home-based medical care company. He has also held other executive level positions at aLabs, Accretive LLC and MedeFinance.

Inside the Sit-Down

A lot of the discussion focused on risk-stratified care management in which practices -- like Dr. Friedman's -- can get monies up front based on the level of risk they assume. "He's definitely on-board with the risk-payment model," said Dr. Friedman who first began sharing his experiences with the APM in November 2017 at a congressional hearing on the development of value-based options such as APMs under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). "He was asking about how a practice could best utilize the funds."

It takes time for practices to learn how to best implement programs using the incentive payments. "We have used it to improve patient self-management with diet classes and an eight-week weight management class that is free for all and offered four times a year."

Dr. Friedman has had a positive overall experience with the APM. "CPC and CPC+ allowed us to remain independent, and we were lucky that we have good staff to help us and a software company that worked with us to make things happen," Dr. Friedman said.

He discussed some of what it takes to participate in this APM with Boehler. "You need buy-in from clinical and administrative staff, a strong electronic health record (EHR), which is hard for smaller practices," he said. "As care plans become more complicated, you need more data and your software needs to be able to handle it," he said. "The interoperability piece is big part of what is needed for these APMs to be successful as are ways to reduce administrative burden for physicians and their staff."

Interoperability refers to the ability of different EHRs to communicate, exchange data, and use the information in a clinically meaningful way, and achieving such interoperability ranks high on CMS Administrator Seema Verma's to-do list.

More information

ACP's article on Dr. Friedman before a congressional committee is here.

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