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Comprehensive Primary Care Plus (CPC+) Calculator

Comprehensive Primary Care Plus Consulting in Hackensack, New Jersey

ASSUMPTIONS

# of covered lives per provider 1000
# of providers per practice 4
E&M Billing PMPM($) 16.50
Multiple of procedure billing to E&M billing 1
Care Management Fee – Track 1($) 15
Care Management Fee – Track 2: PMPM($) 28

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 $ 198,000 $ 0 $ 198,000 $ 198,000 $ 0 $ 50,000 $ 0 $ 446,000
CPC+ Track 1 $ 198,000 $ 0 $ 198,000 $ 198,000 $ 19,800 $ 180,000 $ 30,000 $ 625,800
CPC+ Track 2-65% $ 51,975 $ 141,570 $ 193,545 $ 198,000 $ 19,577.25 $ 336,000 $ 48,000 $ 795,122.25

PER PRACTICE PER YEAR

E&M Billing PMPM Procedure Billing MACRA 5% Care Management Fee Cost/Quality Incentive Total
FFS $ 792,000 $ 792,000 $ 0 $ 200,000 $ 0 $ 1,784,000
CPC+ Track 1 $ 792,000 $ 792,000 $ 79,200 $ 720,000 $ 120,000 $ 2,503,200
CPC+ Track 2-65% $ 566,280 $ 792,000 $ 78,309 $ 1,344,000 $ 192,000 $ 3,180,489

Sample Pro Forma Per Provider Per Year

Per Beneficiary Per Month Estimated Cost/Year On Your Own Estimated Cost/Year PHA
Internal Staff
Care Coordinator (Full-time RN) $ 5.96 $ 71,500 $ 71,500
Internal Project Manager (Practice Manager level, full time to manage program from scratch, 25% $ 1.49 $ 17,875 $ 4,468.75
Required IT
Certified Electronic Health Record (annual fee) $ 0.67 $ 8000 $ 8,000
Certified Care Management Software $ 1.50 $ 18,000 Included
Claims Data and Practice Level Analytics $ 1.50 $ 18,000 Included
Analytics Support and Guidance $ 0.42 $ 5000 Included
Additional HIT For Track 2 (TBD-Patient Reported Outcomes and as directed by CMS) $ 0.08 $1000 Included
Interface Fees (over 5 years) $ 0.25a $ 3000 Included
Quality Reporting Module or QCDR (annual fee) $ 0.08 $ 1000 Included
Evidence-Based Care Plans $ 0.01 $ 63 Included
Services
Quality Improvement Training ( to get incentive) $ 0.21 $ 2500 Included
Care Coordinator Training and Support $ 0.33 $ 4000 Included
24/7 Nurse Advice Line with access to PCP $ 0.50 $ 6,000 Included
Program Participation Consulting Services to ensure compliance, prepare budgets, help guide PFAC, etc. $ 0.42 $ 5000 Included
CareVitality CPC+ Program 5.00 60000.00
Total Recommended Services $ 160,938 $ 143,968.75
Additional CPC+ Payments (Net of FFS)
Total Additional Income Track 1 $ 14.98 $ 179,800 $ 179,800
Total Additional Income Track 2 $ 29.09 $ 349,122.25 $ 349,122.25
Total Additional AWV/ACP Practice Income $ 14,625 $ 73,125
Net Physician Compensation (Track 1) Per Year $ 33,487 $ 108,956.25
Net Physician Compensation (Track 2) Per Year $ 202,809.25 $ 278,278.50

Contact Information

277 Prospect AvenueHackensack, New Jersey

855-544-0475

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