Comprehensive Primary Care Plus (CPC+) Calculator

ASSUMPTIONS

# of covered lives per provider
# of providers per practice
E&M Billing PMPM($)
Multiple of procedure billing to E&M billing
Care Management Fee - Track 1($)
Care Management Fee - Track 2: PMPM($)

PER PROVIDER PER YEAR

E&M Billing E&M Up-Front E&M Up-Front Procedure Billing Macra 5% Care Management Fee Cost/Quality Incentive Total
FFS
CPC+ Track 1
CPC+ Track 2-65%

PER PRACTICE PER YEAR

E&M Billing PMPM Procedure Billing Macra 5% Care Management Fee Cost/Quality Incentive Total
FFS
CPC+ Track 1
CPC+ Track 2-65%

Sample Pro Forma Per Provider Per Year

Per Beneficiary Per Month Estimated Cost/Year On Your Own Estimated Cost/Year CareVitality
Internal Staff
Care Coordinator (Full-time RN)
Internal Project Manager (Practice Manager level, full time to manage program from scratch, 25%
Required IT
Certified Electronic Health Record (annual fee)
Certified Care Management Software
Claims Data and Practice Level Analytics
Analytics Support and Guidance
Additional HIT For Track 2 (TBD-Patient Reported Outcomes and as directed by CMS)
Interface Fees (over 5 years)
Quality Reporting Module or QCDR (annual fee)
Evidence-Based Care Plans
Services
Quality Improvement Training ( to get incentive)
Care Coordinator Training and Support
24/7 Nurse Advice Line with access to PCP
Program Participation Consulting Services to ensure compliance, prepare budgets, help guide PFAC, etc.
CareVitality CPC+ Program 5.00 60000.00
Total Recommended Services
Additional CPC+ Payments (Net of FFS)
Total Additional Income Track 1
Total Additional Income Track 2
Total Additional AWV/ACP Practice Income 14625 73125
Net Physician Compensation (Track 1) Per Year
Net Physician Compensation (Track 2) Per Year
  • Care Coordinator: One FTE per provider, RN level (CareVitality experience)
  • Program Manager: One FTE per practice if self-guided (CareVitality experience)
  •  Saas EHR: Per provider (HealthIT.gov)
  • Care Management Software: Per life (RFP range: $0 .42-$2.00 PMPM)
  • Claims Data Software: Per life (RFP range: $0.70 – $2.00 PMPM)
  • Analytics Support: Per practice (CareVitality estimate, $5,000 per quarter)
  • Additional Software: Requirements unknown, rough estimate only
  • Interface Fees: Per practice (RFP range: $6,000 – $27,000 amortized over five years, does not include practice EHR fees)
  • Quality reporting: QCDR survey: range from $395 – $1100 per provider, vendor survey range from $2,000 to 10,000 per
  • Care Coordinator training and support: vendor survey:  cost of training program, conference attendance including travel
  • 24/7 Advice Nurse, Per life  (RFP range: $0.25 – $2.00 PMPM)
  • Quarterly on-site evaluation and advice, vendor survey $5,000 – $10,000 per practice per quarter
  • Based on practice implementing fee-schedule population health programs using non-physician staff. CareVitality quarterly workshops