Last fall, CMS requested public comments on the CMS Innovation Center’s “New Direction,” under which CMS will seek to “promote patient-centered care and test market-driven reforms.” In the interest of transparency and to facilitate discussion, CMS has posted a summary of the more than 1,000 comments it received from medical societies, providers, manufacturers, and other organizations in response to this solicitation.
CMS also has outlined its next potential innovation model — the “direct provider contracting” (DPC) model. Under this concept, CMS would directly contract with primary care or multi-specialty group practices that would agree to be accountable for the cost and quality of care of a defined beneficiary population. For instance, under a primary care-focused DPC model, CMS could pay primary care practices a fixed per beneficiary per month (PBPM) payment to cover applicable primary care services (e.g., office visits, certain office-based procedures, and other non-visit-based services covered under the physician fee schedule), and CMS would provide “flexibility in how otherwise billable services are delivered.” In addition to the fixed PBPM payment, practices could earn performance-based incentives linked to cost and quality. CMS also could test ways to reduce administrative burden through changes to claims submission processes for related services. CMS notes that it could consider multiple models, including Medicare Advantage and Medicaid models. CMS poses a series of detailed questions intended to guide development of the DPC model in a request for information (RFI); comments on the RFI are due May 25, 2018.