AAFP president: CPC+ reactions mixed due to 'change fatigue'

Early reactions from family physicians to the upcoming Comprehensive Primary Care Plus program have been mixed, with some appearing to suffer from “change fatigue,” according to Wanda Filer, MD, MBA, president of the American Academy of Family Physicians.

Speaking to Healio Family Medicine following CMS’ April announcement of the new primary care delivery and payment model, also known as CPC+, Filer said that although many physicians and AAFP officials are optimistic about the program, some remain skeptical of yet another proposal promising sweeping change for the better.

“I’ve got some [AAFP] members, especially those who were in the CPC originally, who generally seem to be quite favorable,” Filer said. “I’ve got others who I think are not there yet, who do not completely understand it clearly, and they’ve seen so much change that there is what I would probably call change fatigue. To them, it’s ‘one more thing.’ There is a healthy dose of cynicism out there. So, from our members, we are getting mixed reviews.”

One source of cynicism, according to Filer, has been the often expensive process many family physicians have taken over the past 5 years to transform their practices to better align with the patient-centered medical home (PCMH). She added that the work required to update practices in preparation for the shift to value-based payment, rather than one based on volume, can be difficult, and may not offer much in short-term financial gain.

“If I hear one complaint more than any it is that they’ve done this hard work, but no one is paying them for this new value that they’re giving, specifically the opportunity to save this country an awful lot of money as well as improve the health of their patients,” Filer said. “They are not getting the resources to sustain that hard work.”

However, Filer maintained her optimism for CPC+, stating it would allow physicians “get off that hamster wheel” of focusing on patient volume, and instead spend more time with patients who really need to be seen, such as those with multiple chronic illnesses and are at risk for hospitalization.

Filer also said CPC+ will not only address the current, “very flawed” fee-for-service system, but also the issue of physician overwork.

“Instead of seeing 25 to 30 people a day, for a small amount of time for each patient, physicians will maybe see eight or 10 people, the ones who most critically need it, for about 30 to 45 minutes,” Filer said. “There is an awful lot of data out there that says the more time you can spend with a patient, the better the outcomes, and the better the quality. The other benefit of that is you can also reduce the physician burnout factor.”

The new CPC+ model builds on the previous Comprehensive Primary Care program, which launched in late 2012 and was made available to approximately 500 practices in seven markets around the United States.

Under both tracks of the new model, primary care practices would be required to:

  • Support patients with serious or chronic diseases achieve their health goals;
  • grant 24-hour access to care and health information for patients;
  • provide preventive care;
  • engage patients and their families in their own care; and
  • collaborate with hospitals and specialists to better coordinate care.

Practices in Track 2, in addition to the above, would also be required to deliver more comprehensive services for patients with complex medical and behavioral health needs, including an assessment of their psychosocial needs and an inventory or resources to support those needs.

CMS accepted proposals from payers regarding CPC+ from April 15 through June 1, and will select 20 regions throughout the United States in which to roll out the new model based on payer interest. In all, CMS hopes to introduce CPC+ in 5,000 practices, including 20,000 physicians and clinicians serving 25 million patients. – by Jason Laday

Early reactions from family physicians to the upcoming Comprehensive Primary Care Plus program have been mixed, with some appearing to suffer from “change fatigue,” according to Wanda Filer, MD, MBA, president of the American Academy of Family Physicians.

Speaking to Healio Family Medicine following CMS’ April announcement of the new primary care delivery and payment model, also known as CPC+, Filer said that although many physicians and AAFP officials are optimistic about the program, some remain skeptical of yet another proposal promising sweeping change for the better.

“I’ve got some [AAFP] members, especially those who were in the CPC originally, who generally seem to be quite favorable,” Filer said. “I’ve got others who I think are not there yet, who do not completely understand it clearly, and they’ve seen so much change that there is what I would probably call change fatigue. To them, it’s ‘one more thing.’ There is a healthy dose of cynicism out there. So, from our members, we are getting mixed reviews.”

One source of cynicism, according to Filer, has been the often expensive process many family physicians have taken over the past 5 years to transform their practices to better align with the patient-centered medical home (PCMH). She added that the work required to update practices in preparation for the shift to value-based payment, rather than one based on volume, can be difficult, and may not offer much in short-term financial gain.

“If I hear one complaint more than any it is that they’ve done this hard work, but no one is paying them for this new value that they’re giving, specifically the opportunity to save this country an awful lot of money as well as improve the health of their patients,” Filer said. “They are not getting the resources to sustain that hard work.”

However, Filer maintained her optimism for CPC+, stating it would allow physicians “get off that hamster wheel” of focusing on patient volume, and instead spend more time with patients who really need to be seen, such as those with multiple chronic illnesses and are at risk for hospitalization.

Filer also said CPC+ will not only address the current, “very flawed” fee-for-service system, but also the issue of physician overwork.

“Instead of seeing 25 to 30 people a day, for a small amount of time for each patient, physicians will maybe see eight or 10 people, the ones who most critically need it, for about 30 to 45 minutes,” Filer said. “There is an awful lot of data out there that says the more time you can spend with a patient, the better the outcomes, and the better the quality. The other benefit of that is you can also reduce the physician burnout factor.”

The new CPC+ model builds on the previous Comprehensive Primary Care program, which launched in late 2012 and was made available to approximately 500 practices in seven markets around the United States.

Under both tracks of the new model, primary care practices would be required to:

  • Support patients with serious or chronic diseases achieve their health goals;
  • grant 24-hour access to care and health information for patients;
  • provide preventive care;
  • engage patients and their families in their own care; and
  • collaborate with hospitals and specialists to better coordinate care.

Practices in Track 2, in addition to the above, would also be required to deliver more comprehensive services for patients with complex medical and behavioral health needs, including an assessment of their psychosocial needs and an inventory or resources to support those needs.

CMS accepted proposals from payers regarding CPC+ from April 15 through June 1, and will select 20 regions throughout the United States in which to roll out the new model based on payer interest. In all, CMS hopes to introduce CPC+ in 5,000 practices, including 20,000 physicians and clinicians serving 25 million patients. – by Jason Laday