HHS taking applications for Primary Care First alternative payment model

Population-based payment (PBP)

The use of prospective, risk-adjusted population-based payments for primary care services is structurally sound, as research shows that capitation at or above approximately 60% allows practices to gain revenue through shifting to team- and non-visit-based care.

The PBP is based on the average hierarchical condition category (HCC) risk score of your attributed Medicare fee-for-service patients. Gauge the accuracy of the HCC scores of your patients. If you plan to apply, ensure all traditional Medicare patients in your practice receive an annual wellness visit before the program starts January 2021.

Flat visit fee for primary care services

The flat visit fee, in combination with the PBP, allows for flexibility of care delivery to meet the specific needs of a practice’s patient population.

The flat visit fee is billed for primary care, including evaluation and management services, the annual wellness visit, advance care planning, and transitional care management. Evaluate the impact on your practice of shifting to alternative revenue streams in PCF.

Performance-based adjustment (PBA)

Downside risk capped at -10% with a potential upside of up to 50%.

Reaching the 50% bonus will be challenging and only the top-performing practices will do it. Use the PCF Dashboard (available 11/20) to assess the impact of a range of more likely PBA scenarios (-10%, 0%, 10%, and 20%).