What Is The New Geographic Direct Contracting Model?
CMS has introduced a new payment and care delivery model that is also referred to as “Geo”. The model will test whether a geographic-based approach will help providers to provide quality and less-expensive patient care services. It is proposed for Medicare Beneficiaries across an entire geographic region.
CMS has provided opportunities to its beneficiaries to leverage the best practices. After learning lessons from prior Innovation Center models, they have proposed the Geo model. It will enable Direct Contracting Entities (DCEs) to build integrated relationships with the healthcare community and organizations.
Thus, payers can better coordinate with medical care providers and address the social and clinical needs of Medicare Beneficiaries. This model reinforces DCEs to take the responsibility for total expenditures of healthcare services. Remember that! It is only applicable for Medicare Beneficiaries of a particular region.
What Does It Require To Be A DCE(Direct Contracting Entities)?
Any HIPAA Covered Entity can participate in the Geo Model as a DCE. If you want to learn about an entity that is covered under the HIPAA act then get the further details from the following link;
Mostly, the term “HIPAA covered entity” refers to a wide range of healthcare organizations. Also, it is used for a multitude of health plans. Now, CMS is expecting attention from multiple healthcare facilities that have significant experience taking risks in value-based models.
What Are The Responsibilities Of Direct Contracting Entities (DCEs)?
After this act, DCEs have become able to perform the following tasks;
- They are capable of implementing region-wide patient care services and value-based payment systems.
- Their primary objective is to provide high-quality and affordable healthcare services to Medicare beneficiaries.
Remember that CMS has grouped Accountable Care Organizations (ACOs), health systems, health care provider groups, and health plans as DCEs. Now, they have the flexibility to implement a variety of strategies to offer quality patient care services.
In light of the Geo Model, CMS requires DCEs participants to take a full risk with 100% shared savings/shared losses. This loss is only meant for Medicare Part A and B services for aligned Medicare FFS beneficiaries in a defined particular region.
Federal regulatory bodies will test GEO over a six-year period in four to ten regions. Also, it will include 2-3 years of the performance period. Although, this period starts from January 1, 2022, and the second one will start from January 1, 2025.
CMS introduced Geographic Direct Contracting Model to test DCEs for the following purposes;
- Primarily, the purpose of Geo is to improve the quality of healthcare services and reduce the expenses for patients as well.
- It is supposed to invoke flexibility for Medicare Beneficiaries across an entire region.
- In this way, beneficiaries in a particular region will maintain all their Original Medicare Benefits. Although, they may have received improved benefits and pay lower costs for their services than in Original Medicare.
- Particularly in a specific-region, providers have the option to choose whether or not to align their practice with a DCE group. Hence they are able not to arrange with DCE . While they can continue to collect reimbursements at 100% Medicare FFS rates.
What is the difference between the Geo Model and Professional Options of Direct Contracting?
CMS has driven insights into the Geographic Direct Contracting Model from the Direct Contracting Global and Professional Options. Therefore, the legislative bodies have produced this model on the basis of the design of previous Direct Contracting Global and Professional Options.
Although, the basic difference is that the Geo Model requires DCEs to take the financial risk of a portion of all Medicare FFS beneficiaries. However, Beneficiaries are categorized on the basis of a particular geographical area.
That’s why it allows DCEs to take risks on the broader level. Also, the Geo Model offers DCEs a wide range of tools. So they can use it to serve Medicare Beneficiaries all across a specific region.
CMS has decided to provide 2 to 3 years of the performance time period for the Geo model. According to CMS, the first performance will start in 2021. It will have a first performance period from January 1, 2022, through December 31, 2024. The second performance period will start in 2024 and it will execute from January 1, 2025, through December 31, 2027.
Now, you’ve learned that this model is applicable to particular regions. So, it’s also important to learn which regions are included in the Geo Model. Specifically, CMS has introduced the term “Core Based Statistical Area (CBSA)” to define those regions_ included in the Geo model.
Which Regions Are Included In This Model?
For the Model, CMS will define a region as a Core Based Statistical Area (CBSA). It also includes a wide range of metropolitan and micropolitan communities. For this model, CMS has to abide by the instructions prescribed by the U.S. Office of Management and Budget.
You can also get the list of all those regions that are included in this Model from the official website of CMS.
Stay on top of the updates about the healthcare industry with the live healthcare newswire. Medical Billing Benefits is an insightful and informative platform about the medical industry news. Subscribe to our E newsletter to get the latest news in your inbox immediately.