The Affordable Care Act contains scores of initiatives, demonstration projects and the like to “test” the effectiveness of changes in the health care system (Medicare initially)and invests hundreds of millions of dollars in doing so. The one described below will “test the effectiveness of doctors and other health professionals working in teams to improve care for up to 195,000 Medicare patients.” This test will cost $42 million.
On its face,as explained in the press release below, this test project is very similar to the goal that is part of another project, the Accountable Care Organization which provides an incentive for groups of health care providers including hospitals to provide coordinated care to Medicare beneficiaries.
In our zeal to save money it appears we are creating so many demonstrations and organizations to test them that they are tripping over one another. Only time (and a great deal of money) will tell of course and given these are worthy goals we should hope it all works as planned. However, I for one am not optimistic. I question whether a $6.00 monthly fee will cause a primary care health center to “transform into a person-centered, coordinated, seamless primary care practice.” At the same time I wonder what has discouraged or prevented such organizations from accomplishing that goal already.
We will test doctors working in teams and then pay them to coordinate their patients care and it will cost $42 million for 195,000 Medicare beneficiaries out of 40 million or so. I am not sure if “effectiveness” in this case means saving money or not, but for $42 million let’s hope someone is also testing the ROI and that $6.00 a month is a real motivator.
New Affordable Care Act Support to Improve Care Coordination for nearly 200,000 People with Medicare
Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) Demonstration Fact Sheet
The Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) demonstration project is a new Affordable Care Act initiative that will pay an estimated $42 million over three years to up to 500 FQHCs to coordinate care for Medicare patients. This demonstration project, operated by the Centers for Medicare and Medicaid Services (CMS) in partnership with the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to improve care for up to 195,000 Medicare patients. This initiative is part of a broader effort by the Obama Administration, made possible by the Affordable Care Act, to improve care and lower costs.
The FQHC Advanced Primary Care Practice demonstration will show how the patient-centered medical home model can improve quality of care, promote better health, and lower costs. Participating FQHCs must implement electronic health records, help patients manage chronic conditions, as well as actively coordinate care for patients. To help participating FQHCs make these investments in patient care and infrastructure, they will be paid a monthly care management fee for each eligible Medicare beneficiary receiving primary care services. In return, FQHCs agree to adopt care coordination practices that are recognized by the National Committee for Quality Assurance (NCQA). CMS and HRSA will provide technical assistance to help FQHCs achieve these goals.
Eligibility Requirements
FQHCs:
· FQHCs must have provided primary care medical services to at least 200 eligible Medicare beneficiaries in the most recent 12-month period (“look-back” period). This can include those with both Medicare and Medicaid coverage (Medicare-Medicaid enrollees or dual eligibles).
· All participating FQHCs must be listed in the Provider Enrollment Chain and Ownership System (PECOS) file and be able to receive electronic funds transfer (EFT). FQHCs that have not recently submitted an 855A form are not listed in PECOS and therefore will not be eligible to participate in the demonstration.
· FQHCs that currently do not receive claims payment through EFT must submit the necessary form to receive EFT or they will not be eligible to participate in the demonstration.
· FQHCs must submit claims for payment to National Government Services or to Noridian Administrative Services, the jurisdiction 3 Medicare Administrative Contractor (MAC).
Payment:
· Participating FQHCs will receive a monthly care management fee of $6.00 for each eligible Medicare beneficiary attributed to their practice. This fee is intended to help defray the cost of transformation into a person-centered, coordinated, seamless primary care practice. The fee, which will be made quarterly, is in addition to the usual all-inclusive payment FQHCs receive for providing Medicare covered services.
· FQHCs will automatically receive payments, without the need to submit a claim.
· Payment can only be made via Electronic Funds Transfer (EFT).
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