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New CMS Program Offers Enhanced Reimbursement for Adopting PCMH Methods

Tuesday, August 9th, 2016

URAC’s PCMH Certification may benefit applicants of the Comprehensive Primary Care Plus (CPC+) program, a new federal initiative that offers an enhanced method of reimbursement to promote primary medical home care. CPC+ is meant to help physicians make the investments many consider necessary for long-term success.

A public-private partnership administered by the Center for Medicare and Medicaid Services (CMS), the program – which began taking applications this month – is aimed at advancing primary care toward a more coordinated and efficient means of delivering services to patients and encouraging population health.

Applications for CPC+ enrollment ask if practices have medical home recognition from an accreditor, including URAC.

While CMS noted “practices are not required to be [patient centered medical home (PCMH)] certified” to participate in CPC+, it is explained that “the care delivery eligibility requirements to participate in CPC+ may align with criteria for PCMH certification.” For a practice already certified or involved in the PCMH certification process, such a distinction can serve as a declaration the practice is making a commitment to provide the highest quality care and abide by the industry’s best practices.

URAC offers a PCMH certification process that is unique in the industry. Rather than being a methodical checklist of standards, it is:

  • Designed to support growth, shared learning, and peer support that facilitates the transformation of primary care practices into viable PCMHs, and
  • Based on the principles of patient centeredness, a comprehensive interdisciplinary care team lead by a clinician, coordination of care, commitment to quality and safety, and access to health services.

PCMH Certification from URAC is a step-by-step progression in which a practice develops its functions and capabilities in a manner meant to lead to a more sustainable transformation. It also contains a special designation for health information technology achievement.

In addition to the mention in the CPC+ application, CMS also officially recognized URAC’s PCMH Certification in its recent proposed rule for MACRA implementation.

Applied to the goals of the CPC+ program, URAC’s PCMH Certification process can help primary care practices align with the expectations for both tracks of the new program. The first CPC+ track provides an additional monthly contribution to traditional fee-for-service payments so that these providers can make investments to help allow them take on additional risk. The more advanced track offers a larger, up-front reimbursement with a stipulation that these practices already understand and can employ increased coordination of care as well as meet performance goals. All participants must also be committed to integrating health information technology into their practices.

“We are very supportive of CMS recognition of the certification of a PCMH as a way to demonstrate quality. We are pleased to offer quality standards to help physician practices meet new expectations for improved care,” said URAC President and CEO Kylanne Green. “URAC worked hard and engaged a broad array of stakeholders to design a PCMH Certification that allows practices to enter at a level that’s right for them, and works to make their transformation to a more accountable delivery of care strong and sustainable.”

CPC+ enrollment is set at 2,500 practices for each track. CMS estimates this initiative could impact approximately 20,000 physicians and 25 million patients.

Learn more about URAC PMCH Certification at urac.org/PCMH, or by calling (202) 326-3943.


About URAC

Founded in 1990, URAC is the independent leader in promoting health care quality through accreditation, education and measurement. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in health care and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of health care.

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