Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lori E. Rousche, MD, a family physician in Souderton, Pennsylvania. She is also the hospice medical director for Grand View Health in Sellersville, Pennsylvania. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
The past year was one of phenomenal reformation of our practice trying to provide more intensive care for our sickest patients, and trying to help our patients navigate the health care system to their own benefit as encouraged by the Comprehensive Primary Care Plus (CPC+) program. CPC+ is a Centers for Medicare & Medicaid Services initiative that is attempting to improve the quality of healthcare along with the value by transforming how physicians take care of patients. Our first year of involvement saw many improvements in our care, including the hiring of an in-office behavioral health specialist and dietician. We also hired two new care coordinators, clinical staff members that reach out to our most complicated patients on a regular basis to be sure they are taking their medications, doing their blood work, and going to their specialists’ appointments. We met with patients over dinner to discuss what they liked and did not like about our practice with the hopes of making positive changes.
MORE FROM DR. ROUSCHE: This is how CPC+ impacted my physician practice
For 2018, there are changes to the requirements of CPC+. I will focus on the CPC+ electronic clinical quality measures (eCQMs). These are the metrics that we are graded on at year’s end and that will affect our pay. Remember that in the first year of CPC+, we 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 we did not meet the listed metrics. In 2018, 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.
The eCQMs that will be tracked by CPC+ for the year of 2018 include outcome measures that MUST be reported, which include controlling high blood pressure, and diabetes control (per innovation.cms.gov). Practices must report on these measures and perform to a certain standard, or money needs to be returned. For high blood pressure, it is patients aged 18-85 with a diagnosis of hypertension, and to meet the measure, the blood pressure must be less than 140/90. For the diabetes measure, it includes diabetics aged 18-75 who have hbgA1cs greater than 9 percent.