Q&A: Reimbursement under PCF model

Q: How will CMS reimbursement providers in the Primary Care First (PCF) model?

A: The PCF model will reimburse participants through a simple payment structure which has a payment mechanism that allows for clinical driven care, provides a population-based payment along with the primary care flat visit fee, and includes a performance-based adjustment. The adjustment can be a double-edged sword, as it provides an upside of up to 50% of revenue as well as a small downside of a 10% revenue reduction, which functions as an incentive to reduce costs and improve quality. The performance adjustment will be assessed and paid on a quarterly basis.

For more information, see "Note from the instructor: New demonstration model tests impact of advanced primary care on total cost of care," by Yvette M. DeVay, MHA, CPC, CPMA, CIC.