HealthReformGPS is made possible through generous financial support from the RCHN Community Health Foundation. Visit them at

CMS selects 500 FQHCs for Advanced Primary Care Practice demonstration project

Posted on October 24, 2011 | Comment (1)

PDF Version
Key Developments

The Centers for Medicare and Medicaid Services (CMS) announced today that 500 Federally Qualified Health Centers (FQHCs) have been selected to participate in the Advanced Primary Care Practice demonstration project. These 500 centers will receive $42 million over three years to improve quality and coordination of health care delivery. The project is designed to evaluate the patient-centered medical home model. The goal of the model is to improve patient health and the quality of health care delivery while lowering the cost of of care. HRSA and the Center for Medicare and Medicaid Innovation Center developed the demonstration, which will be conducted from November 1, 2011 through October 31, 2014.

Comment (1)

  • William E Tierney, CPA says:

    Productivity screenings-Team & Non-Team

    Make sure the Medicaid model uses the team productivity standard, and not the non-team productivity standard. With the non-team productivity standard, a patient may never see a physician; they could be seen by midlevels only. The Medicaid non-team productivity standards are not a reasonable screening process.
    The Medicaid productivity screening is using the higher count of actual encounters, or standard encounters (4200 for docs & 2100 for midlevels) for each provider type.

    Medicare uses the higher of actual team encounters, or team standard encounters. Medicare is using the reasonable productivity screen.

    The Medicaid programs created the non-team standard after a 1994 Medicare printing error on the Medicare HCFA/CMS 222 productivity form. It must have been published at one of the State Medicaid director meetings. I would really like to find a presentation document.

    It is time for someone to step up and show how bad the non-team productivity standards methodology is.

    Let’s look at the productivity for 500 Health Center base PPS rates & actual encounter productivity using both methods.

    Did Medicaid apply productivity penalties when the FQHCs actually met team productivity standards?

    These 500 FQHCs would be a great case study.

    The form HCFA -222-92 (8/94) Worksheet B, Part I & II Line 1-3, col. 4 were not shaded, thereby causing the Non-Team practice of medicine in the USA FQHCs. The Medicare intermediary recorded the XXXX where it should have been shaded The Medicare computerized Form HCFA/CMS 222 was always correct.

    After 18 years, Medicaid now needs to use the more reasonable screening model.
    We now need to use the proper national productivity screening philosophy.


    The 2012 MEI % change from 1.8% to 0.60%; I know I did the right thing.


The Centers for Medicare and Medicaid Services (CMS) released a proposed rule impacting both federally qualified health centers (FQHC) and rural health clinics (RHC). Beginning in October 2014, the rule implements the prospective payment system (PPS) for FQHC under Medicare Part B in conjunction with the Affordable Care Act (ACA). The proposed rule also states that RHC may contract with nonphysician practitioners, such as nurse practitioners and physician assistants, as long as these practitioners meet the employment requirements for the health center. Lastly, the rule alters the Clinical Laboratory Improvement Amendments in regards to proficiency testing referrals.
The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced today the 500 practices in seven regions that will participate in its Comprehensive Primary Care Initiative. According to the CMS website, "the Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients." The 500 primary care practices participating in the CPC initiative will represent 2,144 providers serving an estimated 313,000 Medicare beneficiaries.
Today, the U.S. Department of Health and Human Services (HHS) announced awards of new grants to expand community health centers (CHCs). The grants were awarded to 219 CHCs to help expand access to care for more than 1.25 million additional patients and create approximately 5,640 jobs by establishing new health center service delivery sites. CHCs work to improve the health of the nation by ensuring access to quality primary health care services. The awards announced today total $128.6 million and will go to community health centers in 41 states, the District of Columbia, Puerto Rico and the Northern Mariana Islands. Through the Affordable Care Act’s (ACA's) commitment to expand access to high quality health care for all Americans, these grants will support establishment of new full-time service delivery sites. The 5,640 jobs created through the awards announced today will go to doctors, nurses, dental providers, and many other staff supporting services to more than 1.25 million new patients. Eligible applicants included public or nonprofit private entities, including tribal, faith-based and community-based organizations who meet health center funding requirements.
The Comprehensive Primary Care (CPC) initiative, a four-year program administered by CMS's Center for Medicare and Medicaid Innovation (CMMI), is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients. CMMI announced that about 75 primary care practices in seven markets will be selected to participate in the initiative. Applications are due on July 20 and applicants will be selected based on their ability to enhance and coordinate services for patients. 45 commercial, federal, and state insurers finalized memorandums of understanding yesterday to participate in the demonstration project with CMS. The resources will help doctors work with patients to ensure they manage care for patients with high health care needs, ensure access to care, delivery preventive care, engage patients and caregivers, and coordinate care across the medical neighborhood. The CPC initiative will test two models simultaneously: a service delivery model and a payment model.
The Affordable Care Act (ACA) reauthorized funding for numerous existing discretionary programs and created multiple new discretionary grant programs and provided for each an authorization of appropriations. Funding for all these discretionary programs is subject to action by congressional appropriators. A new report published by the Congressional Research Service (CRS) summarizes all the discretionary spending provisions in ACA. The ACA permanently reauthorized the federal health centers program and the National Health Service Corps (NHSC), which provides scholarships and student loan repayments to individuals who agree to a period of service as a primary care provider in a federally designated Health Professional Shortage Area. The ACA also reauthorized and expanded existing health workforce education and training programs under Titles VII and VIII of the Public Health Service Act (PHSA). In addition, the Act created several new programs to increase training experiences in primary care, in rural areas, and in community-based settings, and provided training opportunities to increase the supply of pediatric subspecialists and geriatricians. It also expanded nursing workforce development programs. The ACA authorized several new grant programs with a focus on preventable or modifiable risk factors for disease (e.g., sedentary lifestyle, tobacco use) and leveraged mechanisms to improve the quality of health care, develop and disseminate innovative strategies for improving the quality of health care delivery, and support for care coordination programs. The Congressional Budget Office (CBO) estimated that ACA’s discretionary spending provisions, if fully funded, would result in appropriations of approximately $100 billion by 2021.
A white paper recently released by The Pew Center on the States documents preliminary findings which underscore the urgency of dental workforce expansion. The paper reviews a study executed by the University of Connecticut which suggests that adding dental therapists to Federally Qualified Health Centers (FQHCs) could significantly expand dental care availability for Americans. The UConn study is the first of its kind and warrants further research. The paper also makes recommendations for policy makers regarding how they may facilitate the development and integration of dental providers in the U.S. health care delivery system.
The 2010 Affordable Care Act (ACA) boosted Medicare fees for primary care ambulatory visits by 10 percent for five years starting in 2011. Using a simulation model with real world parameters, the Commonwealth Fund evaluates the effects of a permanent 10 percent increase in these fees in their brief "Paying More for Primary Care: Can It Help Bend the Medicare Cost Curve?" The analysis shows the fee increase would increase primary care visits by 8.8 percent, and raise the overall cost of primary care visits by 17 percent. However, these increases would yield more than a sixfold annual return in lower Medicare costs for other services—mostly inpatient and postacute care—once the full effects on treatment patterns are realized. The net result would be a drop in Medicare costs of nearly 2 percent. These findings suggest that, under reasonable assumptions, promoting primary care can help bend the Medicare cost curve.
The federal health center program, authorized in Section 330 of the Public Health Service (PHS) Act, awards grants to support health centers: outpatient primary care facilities that provide care to primarily low-income individuals. The program—administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS)— supports four types of health centers: (1) community health centers; (2) health centers for the homeless; (3) health centers for residents of public housing; and (4) migrant health centers. According to HRSA data, there are over 8,633 unique health center sites (i.e., unique health center facility locations). Facilities must meet a number of requirements to receive a Section 330 grant, but receiving these grants enables health centers to receive services or in-kind benefits from a number of federal programs. This report released by the Congressional Research Service (CRS) provides an overview of the federal health center program including its statutory authority, program requirements, and appropriation levels. The report then describes health centers in general, where they are located, their patient population, and some outcomes associated with health center use. It also describes some federal programs available to assist health center operations including the federally qualified health center (FQHC) designation for Medicare and Medicaid payments. The report then concludes with a brief discussion of issues for Congress such as the potential effects of the ACA on health centers, the health center workforce, and financial considerations for health centers in the context of changing federal and state budgets. Finally, the report has two appendixes that describe (1) FQHC payments for Medicare and Medicaid beneficiaries served at health centers; and (2) programs that are similar to health centers but not authorized in Section 330 of the PHS Act.
A Commonwealth Fund international survey of adults living with complex care needs found that patients in the United States are much more likely than those in 10 other high-income countries to forgo needed care because of costs and to struggle with medical risk. In all of the countries surveyed, patients who have a medical home reported better coordination of care, fewer medical errors, and greater satisfaction as compared to those patients without one.
Patient-centered medical home models offer accessible, coordinated, comprehensive care focused on the needs of the patient. One of the most notable attributes of medical homes is the care coordination, which, if executed effectively, results in better health outcomes, reduced waste and duplication, and higher patient satisfaction. Yesterday, the Patient-Centered Primary Care Collaborative, an arm of the Commonwealth Fund, released a guide outlining seven key strategies to help health systems measure care coordination within medical homes. The seven strategies are 1) Work with a broad stakeholder group to reach consensus on measures; 2) Clarify purpose of measurement: quality improvement, accountability, evaluation; 3) Use standardized measures; 4) Incorporate patient feedback in assessing quality of care coordination; 5) Develop a tracking system that facilitates ongoing monitoring of performance; 6) Build and nurture relationships with providers outside of your medical home--the "medical neighborhood"--to facilitate data sharing, monitoring, and improvement; and 7) Use the data to improve care coordination. Share results at the practice and care-team levels.