Everything doctors need to know about CPC+ changes in 2018

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lori E. Rousche, MD, a family physician in Souderton, Pennsylvania. She is also the hospice medical director for Grand View Health in Sellersville, Pennsylvania. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

The past year was one of phenomenal reformation of our practice trying to provide more intensive care for our sickest patients, and trying to help our patients navigate the health care system to their own benefit as encouraged by the Comprehensive Primary Care Plus (CPC+) program. CPC+ is a Centers for Medicare & Medicaid Services initiative that is attempting to improve the quality of healthcare along with the value by transforming how physicians take care of patients. Our first year of involvement saw many improvements in our care, including the hiring of an in-office behavioral health specialist and dietician. We also hired two new care coordinators, clinical staff members that reach out to our most complicated patients on a regular basis to be sure they are taking their medications, doing their blood work, and going to their specialists’ appointments. We met with patients over dinner to discuss what they liked and did not like about our practice with the hopes of making positive changes.

MORE FROM DR. ROUSCHE: This is how CPC+ impacted my physician practice

For 2018, there are changes to the requirements of CPC+. I will focus on the CPC+ electronic clinical quality measures (eCQMs). These are the metrics that we are graded on at year’s end and that will affect our pay. Remember that in the first year of CPC+, we received 100 percent of the available money, but up to 10 percent had to be paid back in part or in full to the government at the end of the year if we did not meet the listed metrics. In 2018, the split is 75 percent guaranteed payments, but up to 25 percent of the money goes back to the insurer if we don’t meet the metrics.

The eCQMs that will be tracked by CPC+ for the year of 2018 include outcome measures that MUST be reported, which include controlling high blood pressure, and diabetes control (per innovation.cms.gov). Practices must report on these measures and perform to a certain standard, or money needs to be returned. For high blood pressure, it is patients aged 18-85 with a diagnosis of hypertension, and to meet the measure, the blood pressure must be less than 140/90. For the diabetes measure, it includes diabetics aged 18-75 who have hbgA1cs greater than 9 percent.

Next: Breaking down the measures

The other outcome measures include 17 metrics of which a practice needs to report on seven. Some of these measures should be easy to meet the minimum requirement, while some will be very difficult. These measures include:

 1. Depression screening and follow-up, which is for all patients 12 years old and over who are asked the PHQ-9 questions if they are positive on the initial PHQ-2 screen and have a plan documented. 

2. Depression utilization of the PHQ-9. This is the percentage of patients 18 or older who are already diagnosed with depression who have the PHQ-9 in a four month period.

3. Dementia: cognitive assessment. This is the percentage of patients with a diagnosis of dementia who have a Mini-Mental Status Exam or AD8 done in a 12-month period.

RELATED READING: Dipping a toe into the world that is CPC+

4. Smoking screening and intervention. This is the percentage of patients 18 and older who were screened for tobacco use in the past 24-month period, and were counseled, if positive.

5. Initiation of alcohol and other drug dependence treatment.

6. Falls-risk screening, which is for 65 and over patients who need to be screened once per year.

7. Influenza immunization: percentage of patients six months and over seen between October 1 and March 31 who received a flu shot.

8. Pneumococcal vaccine: this is the percentage of patients 65 and over who received a pneumonia shot.

9. IVD (ischemic vascular disease)-use of aspirin or other antiplatelet: this is the percentage of patients 18 and over who were diagnosed with heart attack, had a CABG or cardiac stent in the twelve months prior to the measurement period or who were diagnosed with IVD and are taking aspirin or antiplatelets.

Next: Thank you CPC+!

 10. Statin therapy for prevention and treatment of ischemic vascular disease: this includes adults 21 or older with atherosclerotic heart disease or with an LDL equal to or greater than 190 or with a diagnosis of familial pure hypercholesterolemia, or adults 40-70 years old with a diagnosis of diabetes and an LDL of 70-189 who are taking a statin.

11. Breast cancer screening: women 50-74 who had a mammogram within two years.

12. Colorectal screening: percentage of patients 50-75 who had any screening, colonoscopy, sigmoidoscopy, hemoccult or cologuard.

13. Cervical cancer screening: percentage of women 21-64 who had a pap within three years or a pap with hpv within five years.

14. Diabetes eye exam: the percentage of diabetic patients aged 18-75 who had a retinal exam: within one year if known retinopathy, within two years if negative for retinopathy.

15. Diabetes: medical attention for nephropathy: the percentage of patients aged 17-75 who had a positive urine screen for nephropathy and are receiving treatment.

IN CASE YOU MISSED IT: Why physicians may want to apply for the CPC+ program

16. Closing the referral loop: percentage of patients with referrals to specialists for which a consult report is received.

17. Use of high-risk medications in the elderly.

All of these measures are reportable through the electronic health record. Regardless of what your idea of quality happens to be, there should be at least seven among the above 17 that you feel are worth pursuing for the good of your patient. If you are not a big believer in mammograms, maybe you feel statins are important in heart disease and diabetes. If you don’t think the flu shot is important, perhaps you believe in screening for and counseling against smoking.

Fortunately, there are enough measures available to choose from that most offices should be able to find seven to champion. Whichever metrics you choose to chase, it should improve the quality of care you are providing and keep your patients healthier. Thank you CPC+ for allowing us to provide better care.