AAFP to HHS: Let Physicians Transform Their Practices

Academy Seeks 'Timely, Broad, Clear Flexibility for AAPMs'

November 06, 2018 03:44 pm News Staff – Family physicians must have the flexibility to collaborate with other physicians and health care professionals to provide team-based, patient-centered care that incorporates new technologies and focuses on reducing the total cost of care.

Obvious, right?

Not so obvious that the Academy didn't spell out that imperative -- verbatim -- to HHS' Office of Inspector General (OIG) in a recent letter.

The call for flexibility was part of the AAFP's response to a request for information (RFI) titled "Medicare and State Health Care Programs: Fraud and Abuse" that was published in the Aug. 27, 2018, Federal Register.

The Oct. 25 letter, which was signed by AAFP Board Chair Michael Munger, M.D., of Overland Park, Kan., urged that HHS commit to, and invest in, physician-led advanced alternative payment models (AAPMs). Such practices, the AAFP advised, "effectively strengthen the long-term solvency of the Medicare program and deliver patient-centered care to beneficiaries."

The letter bolstered the Academy's August message to CMS about self-referral law and its impact on innovation -- including that represented by the AAFP's Advanced Primary Care Alternative Payment Model. In both communications, the AAFP recommended that CMS produce a simple decision tree for medical practices seeking to innovate or collaborate without drawing undue scrutiny.

"We urge the OIG to offer timely, broad and clear flexibility for AAPMs and for prompt and clear guidance on safe harbors," the letter said.

Addressing other elements of the RFI, the Academy recommended that

the "OIG allow for in-kind remuneration as a beneficiary incentive for wellness and managing chronic diseases";
HHS and Congress work "to eliminate the applicability of deductible and co-insurance requirements for primary care services in general and the non-fee-for-service portions of AAPMs";
the OIG ensure improved flexibility for care models "to address behavioral health issues across the full care continuum that may be currently prohibited under anti-kickback statute," with particular attention to social determinants of health;
the OIG develop a clear definition of "care coordination" that recognizes primary care as the "first point of contact for many patients" and as the specialty area "best positioned to coordinate care across settings and among physicians in most cases"; and
that the OIG set forth an explicit definition of risk that considers key elements in new models and is "based on knowledge of members' practices and their role in healthcare spending."

In its discussion of risk, the letter further noted that the AAFP "opposes putting primary care practices and their eligible clinicians at risk for anything beyond their own performance under a model."

Warning that not every primary care practice is equipped to accept the same level of risk at the same time, the letter added: "That particularly extends to insurance risk and utilization of services outside the control of the practice (e.g., total cost of care). Assumption of risk for total cost of care may also reduce participation in a model -- especially among small or independent practices."

Overall, the letter noted, "We urge the OIG to confirm that any action from CMS will allow for physician collaboration/new partnerships that improve care delivery and appropriate beneficiary incentives."

Social Determinants of Health, Alternative Payment Models
AAFP Unveils Principles for Fair Measurement, Payment in APMs
(5/18/2018)

FPM: The Stark Truth About the Stark Law: Part I
(November-December 2003)