What Hospices Need to Know About Primary Care First & SIP Program Benefits

Acclivity Health’s educational webinars cover application tips and planning for long-term success.

Acclivity Health recently partnered with NHPCO to present a two-part webinar series:Current and Emerging CMS Payment Models: Intersection between Hospice, Palliative and Primary Care. The team at Acclivity has experience with CPC+, ACOs, and other payment models similar to CMS’ forthcoming model, Primary Care First. If you couldn’t attend these online sessions, we’re providing overviews of what you missed, what you need to know, and how to prepare for Primary Care First.

The first webinar provided an understanding of Medicare’s urgency, and important considerations including economic model announcements, risk intermediaries, new expectations and requirements, new competition, and the economics of evolution.

To start, Acclivity’s CEO, Jeremy Powell, described why CMS was so urgent to create new payment models — in order to fund Medicare, which is increasing in beneficiaries much more quickly than people paying into the program. PCF is the third iteration of CPC, and in this version, there are fewer requirements to get through the application, fewer quality and reporting components that would exclude a practice from performing, and payments are made far earlier. Ultimately, PCF is designed to be more financially attractive to practices, while also being less process-laden.

Primary Care First participants will be assigned patients with a designated primary care provider, while Seriously Ill Population participants will receive patients without a discernible PCP. The SIP program lets hospices care for a significant part of the Medicare population, and allow them the opportunity to transition into primary care or hospice depending on their needs. After 12 months of care and relationship building with these patients, those eligible for hospice are more likely to choose yours.

CMS will also provide patient data surrounding the patients being assigned to you through PCF, including acuity, frailty, conditions, family availability and support, and more. This transparency makes it easier to fill gaps in people, processes and technology, and staffing models.

To participate in SIP, hospices must provide the following services: interdisciplinary care from a team including a physician/nurse practitioner, care manager, RN, and social worker, provide 24/7 access to a member of the care team, engage families, offer wellness and healthcare planning, offer care coordination (including ability to assess social needs of the patient), and have relationships with community partners for a strong referral network. If these criteria are met, a practice stands to earn more than $275 per beneficiary for services you already provide today for free, and secure a pipeline of eligible or soon-to-be-eligible hospice patients.

Part 2 of the webinar series dove deeper into how hospices should assess their readiness to provide SIP programming, as well as potential hurdles to address regarding staffing, care provision, documentation, on-call, data analysis, budgeting, internal culture, marketing, networking, and contracting.

Powell detailed the benefits of participating in the SIP program for hospices, which include unlocking new earning potential while diversifying programming, further embedding your practice within the community referral network, and preparing you for the forthcoming hospice carve-in and other value-based programs.

Hospices will also have the ability to serve different patient cohorts based on their current capabilities and the breadth of their services. Patients will be sorted into three cohorts:

• Near-term hospice appropriate (<6 months prognosis)
• Medium-term hospice appropriate (6-12 months prognosis)
• Primary care focused (>12 months prognosis)

Tips for preparing include choosing new branding that is not solely hospice related, being careful not to market the SIP program as a hospice program on patient-facing collateral. Most importantly, Powell advised that entering into a program like this without a data analytics program could be a recipe for disaster. Having technology to analyze the patient data, detailed in Webinar No. 1, gives your hospice the opportunity to determine the likelihood of admission and readmission, frailty, needs from an acuity perspective, and how much of your team needs to be involved in that patient’s care.

Now that the Request for Applications (RFA) have been released, hospice and palliative care organizations who want to apply must do so on or before January 22, 2020.  

Acclivity Health will present a third NHPCO educational webinar on November 15 at 2:00 p.m. ET, CMMI’s Primary Care First Model – Seriously Ill Population (SIP): Overview and Request for Applications.  To register, click here.

Acclivity Health is here to help your hospice apply for, and be successful throughout, the SIP program of Primary Care First. Visit www.acclivityhealth.com/primarycare first, call 904.562.1368, or email info@8kw.3ce.myftpupload.com. To stay up-to-date on Acclivity Health, follow us on Facebook, Twitter, or LinkedIn.