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Tuesday Jan 09, 2018

AAFP Payment Model Wins Committee's Support

"Be at war with your vices, at peace with your neighbors, and let every new year find you a better man."
-- Benjamin Franklin

Happy new year! I hope you had a nice holiday and were able to secure a few hours to enjoy time with family and friends. I hope this new year brings you good health. I want to start it with some good news.  

[stethoscope on paper money]

One of the highest strategic priorities for the AAFP is the development and implementation of payment models that provide greater financial resources to family physicians and primary care. It is widely acknowledged that primary care is both underfunded and overregulated. The AAFP has been aggressively pursuing the development of payment policies that attack these two issues directly.

In April 2017, the AAFP published a proposal titled Advanced Primary Care: A Foundational Alternative Payment Model (APC-APM) for Delivering Patient-Centered, Longitudinal and
Coordinated Care.(38 page PDF)
As noted in the opening paragraph of the proposal, "The Advanced Primary Care-Alternative Payment Model (APC-APM) embodies the principle that patient-centered primary care is comprehensive, continuous, coordinated, connected and accessible from the patient's first contact with the health system. The APC-APM aims to improve clinical quality through the delivery of coordinated, longitudinal care and uses the approach to deliver care that improves patient outcomes and reduces health care spending."

The APC-APM would create a new payment structure for participating primary care practices that would combine the following four mechanisms:

  • a prospective, risk-adjusted, primary care global payment for direct patient care;
  • fee-for-service limited to services not included in the primary care global fee;
  • a prospective, risk-adjusted, population-based payment; and
  • performance-based incentive payments that hold physicians appropriately accountable for quality and costs.

In addition, because the APC-APM eliminates traditional coding, the proposal dramatically reduces administrative burden by allowing physicians to focus more time on patient care instead of paperwork. We also have placed greater focus on risk-adjustment in the proposal, which allows for greater alignment of financial resources to the complexity of patients' health conditions and social determinants.

On Dec. 19, AAFP President Michael Munger, M.D., formally presented the APC-APM to HHS' Physician Payment Model Technical Advisory Committee(aspe.hhs.gov) (PTAC).

I am pleased to report that PTAC has recommended to HHS that the APC-APM be tested. The PTAC decision is an important and extremely positive step toward better payment for primary care. The APC-APM proposal received strong support from PTAC, and many members commented on the need to test and scale a primary care delivery and payment model in short order.

PTAC member Len Nichols, Ph.D., summarized the committee's decision on the proposal as follows: "It (APC-APM) should be tested on a scale large enough to reflect its potential value. It's a better model than CPC+ (CMS' Comprehensive Primary Care Plus program), and it's better for our country."

Harold Miller, also a member of PTAC, stated, "We know patients need primary care, and we need to do something fast."

AAFP News posted an excellent article summarizing the PTAC hearing and actions.

Congress Returns

Congress returns from its holiday recess this week for the second session of the 115th Congress. On arriving in Washington, D.C., Congress will pick up right where it left off in December, facing a deadline and a potential government shutdown.

Before adjourning on Dec. 22, Congress passed a short-term bill to maintain operations of the federal government until Jan. 19. Included in that short-term funding package was a short-term extension of funding for the Children’s Health Insurance Program (CHIP), as well as the Teaching Health Center Graduate Medical Education (THCGME) program, community health centers (CHCs), and the National Health Service Corps (NHSC). Congress now has fewer than 10 days to develop and pass a funding measure that extends the operations of the federal government and reauthorizes these important health care programs.

Several factors are impacting negotiations on funding. The first is a desire among some lawmakers to revise the so-called budget caps, established by the Budget Control Act of 2011(www.google.com), that limit spending on domestic and defense programs. The second is an extension of the Deferred Action for Childhood Arrivals(www.google.com) (DACA) immigration policy established in 2012 -- an issue that has strong bipartisan support but is fraught with political calculations. The third is a renewed push to cut federal spending and the desire among some lawmakers to put a stake in the ground as part of this legislative package. Not to be overlooked are the November mid-term elections, which will influence and complicate all policy/political decisions.

The AAFP continues to pressure Congress to pass legislation that ensures continued operations of the federal government. In addition, we are putting increased pressure on Congress to reauthorize the CHIP and THCGME programs immediately. Congress' failure to provide long-term stability through reauthorization is starting to impact both programs negatively. In December, a teaching health center program announced it was closing due to the lack of stability, and others are poised to take similar actions should a solution not be enacted soon.

Additionally, several states have started issuing letters to CHIP beneficiaries informing them that their coverage will expire in the coming weeks. Both of these developments are deeply concerning, and the AAFP is committed to preventing any further damage to these two programs.

On Jan. 10, Dr. Munger will be in Washington to meet with several senators and representatives, advocating for the reauthorization of the CHIP, THCGME, CHC and NHSC programs. He will join the presidents of five other physician organizations -- the American Academy of Pediatrics, American College of Obstetricians & Gynecologists, American College of Physicians, American Osteopathic Association, and American Psychiatric Association -- to deliver a clear message of support for these important programs to a bipartisan group of legislators. This advocacy effort would benefit greatly from your voice. I encourage you to take a few minutes to engage your elected officials using the AAFP's Speak Out resources to express your support for these important health care, training and education programs.

Save the Dates

Each year, the AAFP plays host to or sponsors events that provide you opportunities to engage in educational, practice transformation and advocacy activities. I would like to flag three such events for you:

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.