What is Primary Care First?

As a part of the CMS Primary Cares plan, Primary Care First is the newly proposed value-based reimbursement program for physician practices. The goal for this plan is simple: reimburse physicians for delivering care that keeps patients healthy and out of the hospital. It prioritizes the importance of the doctor-patient relationship and delivers financial rewards for taking the time to manage complex, chronic needs patients.

At this point, most physicians have lived through the pain of other value-based reimbursement strategies. One of the more complicated and burdensome in recent history was Meaningful Use. The criteria were complex and the reporting requirements were difficult.

Primary Care First is was designed around the following functions of primary care:

  • Access & continuity
  • Care management
  • Comprehensiveness & coordination
  • Patient & Care Team engagement
  • Planned care & population health
Primary Care First CMS

How does reimbursement work?

With Primary Care First, CMS seeks to simplify the process and pay physicians a monthly fee per patient. While this proposed plan is in its infancy, the idea is that physicians could generate as much as 50% more revenue by participating. In theory, the more patients a practice can keep out of the hospital, the higher their CMS payments will be.

The goal, as with all value-based reimbursement programs, is to improve patient outcomes while decreasing utilization and cost. Any participating practice also takes on a certain level of risk. With Primary Care First, a practice may lose as much as 10% of their revenue if patient outcomes don’t improve, or get worse.

How can I plan for Primary Care First?

Small and medium-size physician practices can begin to implement proven processes to keep patients healthy. Medication adherence, patient education, and easier access to care will all impact patient health.

Many of the most important factors in patient health are based on communication. Patients need to understand and communicate with their physician and care team about their health issues. The easier a practice makes communication both during and between visits, the less likely a patient is to land in the hospital.

As Primary Care First continues to be refined for a January 2020 launch, your practice should work to understand how you can improve simple communication with your patients.

Here are the states and regions Primary Care First will be offered in 2020:

  • Alaska (statewide)
  • Arkansas (statewide)
  • California (statewide)
  • Colorado (statewide)
  • Delaware (statewide)
  • Florida (statewide)
  • Greater Buffalo region (New York)
  • Greater Kansas City region (Kansas and Missouri)
  • Greater Philadelphia region (Pennsylvania)
  • Hawaii (statewide)
  • Louisiana (statewide)
  • Maine (statewide)
  • Massachusetts (statewide)
  • Michigan (statewide)
  • Montana (statewide)
  • Nebraska (statewide)
  • New Hampshire (statewide)
  • New Jersey (statewide)
  • North Dakota (statewide)
  • North Hudson-Capital region (New York)
  • Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky)
  • Oklahoma (statewide)
  • Oregon (statewide)
  • Rhode Island (statewide)
  • Tennessee (statewide)
  • Virginia (statewide)

Why does patient communication matter?

Improving patient communication is the single most impactful step a practice can take towards keeping patients healthy. Providing patients with a simple tool that allows them to get answers to their questions will guarantee a decrease in hospitalizations.