CMS has announced it is delaying the start of several new voluntary value-based payment models, but it continued to encourage Medicare providers to apply to participate in the payment models.

The postponement of four payment models, including two that are part of the CMS Primary Cares initiative and two part of an executive order to overhaul the U.S. kidney care and donation allocation process, are expected to last until at least.

The Primary Care First (PCF) path is specifically designed for primary care practices and includes two voluntary, five-year payment models:

  • PCF–General, which CMS said is designed for primary care practices prepared to assume large financial risk in exchange for reduced administrative burden and performance-based payments; and

  • PCF–High Need Populations (HNP), which CMS said is designed to encourage advanced primary care practices, including practices enrolled in Medicare and providing hospice or palliative care services, to assume financial responsibility for high need, seriously ill beneficiaries who lack a primary care practitioner or effective care coordination.

Both models allow participating practices to receive a simplified, total monthly payment, which CMS said will allow clinicians to focus on patient care rather than unpredictable revenue, along with payment adjustments based on performance of certain clinical quality measures, like controlling high blood pressure, managing diabetes, and screening for colorectal cancer. Specialty practices for patients with complex, chronic, or severe conditions will receive higher monthly payments.

The Kidney Care First (KCF) model, open only to nephrology practices, ties payments to beneficiaries' health outcomes, the health services used, and quality measures.

The Comprehensive Kidney Care Contracting (CKCC) model consists of three tracks:

  • CKCC Graduated, which begins as a one-sided risk model and slowly phases in additional risks and rewards;

  • CKCC Professional, which gives participating clinicians the option to earn 50% of shared savings and be on the hook for 50% of shared losses based on the total cost of care for Medicare Part A and B services; and

  • Global Models, which requires participating clinicians to take on 100% of the financial risk based on the total cost of care for Part A and B services.

CMS began accepting applications to participate in the PCF payment models in spring 2019. When the agency announced the models, it said it planned to launch the payment models in 26 regions throughout the United States beginning in 2020. CMS said it would accept a second round of applications for the payment models in January 2020. The deadline to apply to the kidney care models is Jan. 22, 2020.

CKCC will begin in 2021 or 2022, depending on which track providers pursue.

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