CMS Announces Further Delay of Primary Care First-Seriously Ill Population Model

WASHINGTON, D.C. (March 12, 2021)—The Centers for Medicare & Medicaid Services (CMS) announced a further delay of its Primary Care First-Seriously Ill Population (PCF-SIP) physician payment model, a component of the PCF that has been closely followed by the hospice and palliative care community. PCF-SIP had previously been scheduled to begin on Jan. 1, 2021, but CMS announced a delayed (April 1, 2021) start date in June 2020.

The latest notice indicating a further delay provided no new start date for the model and comments that this component of the PCF model is currently under review.

In a recent meeting with the National Coalition for Hospice and Palliative Care, representatives of CMS’s Center for Medicare & Medicaid Innovations (CMMI) indicated that they continue to consider ways to address operational challenges associated with the model, including issues related to attribution of beneficiaries and ensuring the manner in which they solicit beneficiaries for involvement does not create confusion or create potential risk for beneficiaries given the many scams targeting Medicare beneficiaries that have proliferated during the COVID-19 public health emergency.

It has been known for some time that there are operational challenges associated with the PCF-SIP model, including concerns about how best to enlist Medicare beneficiaries, who must be deemed to be seriously ill and receive fragmented care based on review of claims data. The goal of the model is to provide coordinated care that leads to stabilization of a patient’s condition(s) and over time to move them to a more traditional group practice model for continuing treatment. There has been a great deal of interest in the model on the part of palliative care medical practices, and CMS created an opportunity for hospice clinicians to participate in the model by way of association with a medical practice that is a direct participant in the model.

CMMI staff also indicated that, as is routinely the case when a new administration takes over, they want to ensure that new leadership has a thorough understanding of the goals of the model. CMMI representatives underscored the importance of the seriously ill population and their expectation of continued work in this area, which may include a “next generation” Medicare Care Choices Model (MCCM).

—Via NAHC