A five-step process
When physicians, through their specialty societies, approach the development of an APM to address specific patient conditions, the AMA has recommended a five-step process:
- Establish a committee of physicians who are willing to spend the time.
- Identify specific opportunities to improve patient care that are likely to result in specific types of spending reductions, and identify the specific barriers in existing payment systems.
- Identify the payment changes needed to overcome those barriers. Not all APMs actually overcome the barriers, and some have unintended consequences that can create new problems.
- Analyze whether the benefits for patients and the savings for payers and patients are sufficient to justify any costs associated with appropriate payment changes.
- Design a payment model that removes the barriers to improving care so that physicians can improve outcomes for patients and achieve savings for payers.
There are many areas where physicians can find ways to improve care and reduce spending through an APM. Some examples of work underway by specialty societies to develop APMs for patient conditions include:
- Reduce unnecessary use of stress tests and cardiac imaging
- Help patients quickly and accurately determine the causes of chest pain and their risk of heart attack
Chronic kidney disease
- Slow progression to end-stage renal disease and improve treatment planning
- Plan ahead for hemodialysis patients’ vascular access to create and maintain arteriovenous fistula and avoid use of multiple catheters
- Improve accuracy of diagnosis
- Reduce frequency and severity of seizures
- Reduce injuries and complications requiring emergency visits and hospitalizations
- Improve outcomes through accurate diagnosis and staging, as well as appropriate use of treatments
- Help patients manage psychological, physical and financial challenges of cancer
- Reduce complications requiring emergency visits and hospital admissions
- Improve appropriateness of imaging during surveillance for progression and recurrence of disease
The above are only a few of the condition-specific areas that physicians and specialty societies could address with effective APMs. You can find more on the AMA’s Medicare Alternative Payment Models web page. Also, take a look at the AMA’s Medicare and Medicaid web page for more tools and resources.
MACRA created the Physician-Focused Payment Models Technical Advisory Committee (PTAC) to review and make recommendations on proposals for new Medicare APMs under the QPP. The PTAC is now accepting APM submissions and will review on an ongoing basis.
- Why MACRA matters for your practice
- Who’s using new health care delivery and payment models: AMA report
- 3 traits of successful alternative payment models for physicians
- Alternative payment models help physicians better care for patients