A committee formed by Congress to review new Medicare payment initiatives gave the green light today to initial testing of a primary care payment model proposed by the AAFP.
The Physician-Focused Payment Model Technical Advisory Committee (PTAC) voted to recommend that HHS test the AAFP's Advanced Primary Care Alternative Payment Model (APC-APM)(38 page PDF) on a limited scale. Committee members praised the concept while noting that details about some elements of the proposal, such as monthly payments, care coordination and core measures, still need to be refined.
"I love this model and I love this idea, but it is not ready," said committee member Len Nichols, Ph.D. "It 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."
Nichols said the model will help independent physician practices survive in an environment of continuing consolidation. PTAC Chair Jeffrey Bailet, M.D., said the strength of the model is its "inclusiveness" and potential to expand, and he emphasized that the committee wants it to be successful.
- The Physician-Focused Payment Model Technical Advisory Committee recommended that HHS begin testing the AAFP's Advanced Primary Care Alternative Payment Model on a limited scale.
- The model includes a monthly per-member payment that covers face-to-face evaluation and management services, as well as a monthly population-based payment to cover consultations by email and phone.
- To pay for the program, the AAFP recommends doubling spending on primary care from the current 6 percent to 12 percent.
The APC-APM is informed partly by early results of the CPC and CPC+ programs, as well as by input from AAFP members. The Colorado, Ohio and North Carolina chapters informed PTAC that they support the proposal.
AAFP leaders, including President Michael Munger, M.D., of Overland Park, Kan., answered the committee's questions about the model today.
"We're pleased the PTAC has opened the way to demonstrating the potential positive impact the APC-APM will have on patient outcomes and efficiency of care," Munger said. "This is the first step in a long process, and we look forward to working with the PTAC, HHS and CMS to implement this program."
Committee members probed for details such as how much physicians would be paid per month under the program, and whether core measures would provide an accurate barometer for practice performance. They made their recommendation after grading the proposal in 10 different categories including payment methodology, patient choice, care integration and value over volume.
Each member recognized the urgent need to change the way primary care is paid for and how patients receive care.
"We know patients need primary care, and we need to do something fast," said committee member Harold Miller.
If the model is eventually rolled out nationwide, it would be open to about 200,000 physicians -- specialists in family medicine, general practice, geriatric medicine, pediatric medicine and internal medicine -- and could affect the care of 30 million Medicare patients.
"The APC-APM is equally applicable to physicians who are employed or independent, which is especially critical for increasing participation in advanced alternative payment models among rural and/or small practice physicians," the AAFP said in its proposal.
Under the new model, practices would receive a monthly per-member payment that covers face-to-face evaluation and management services, as well as a monthly population-based payment to cover consultations by email and phone. The model assumes that at least 50 percent of participants would use certified electronic health records (EHRs).
Some committee members questioned the complexity of two different monthly payments and one questioned whether EHRs could adequately track patient progress.
The proposal cites as a starting point the CPC+ model, in which monthly payment for care management averages between $15 and $28 per patient. Payment for patients with more complex needs could reach as high as $100 per month. In addition, separate monthly payments would cover costs associated with extra staffing and medical home activities. The AAFP emphasized that monthly fees should be paid at no risk to the physician and with no cost-sharing requirements from patients.
Such up-front bundled payments would greatly reduce the administrative burden of filing claims.
The model includes quarterly incentive payments based on quality, and fee-for-service payments would be made as needed.
Performance would be measured using a risk assessment tool that includes social determinants of health and accounts for patients who require more complex care.
To pay for the program, the AAFP recommends doubling spending on primary care from the current 6 percent to 12 percent. One study cited in the proposal noted that a 10 percent increase in Medicare payments for primary care would yield a six-fold annual return in lower Medicare costs.
The committee, which was established as part of the Medicare Access and CHIP Reauthorization Act of 2015 to review and approve proposed new payment models, recognized the strengths of the AAFP's proposal.
"We need to move forward with a model that supports primary care, and patients need other ways to get access," said committee member Grace Terrell, M.D.
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