New Payment Model Deserves Quick Approval, AAFP Tells HHS

In a March 19 letter to HHS Secretary Alex Azar, the AAFP said the Advanced Primary Care Alternative Payment Model (APC-APM) would help more than 200,000 primary care physicians promote coordinated care and provide incentives for practices to change the way patient care is delivered. The Academy urged Azar to approve the model quickly so testing can proceed.

"The APC-APM proposal is wholly consistent with the administration's goals of preserving independent medical practices, lowering the cost of health care, and reducing the administrative burden for physicians and other health care providers," the AAFP stated in the letter, which was signed by Board Chair John Meigs, M.D., of Centreville, Ala.

In December, the Physician-Focused Payment Model Technical Advisory Committee (PTAC), formed by Congress to review new Medicare payment models, recommended that HHS test the APC-APM on a limited scale. Six committee members voted for testing, one for implementation and four for implementation as a high priority -- which, the AAFP pointed out, was just one vote shy of a recommendation to implement the model.

"In subsequent discussions, PTAC members, including those who voted for limited-scale testing, emphasized that the action on the model should be a high priority and undertaken urgently to support primary care and ensure robust access in all areas of the country," the letter stated.

PTAC members suggested that the APC-APM could be tested on a scale as large as or larger than that used for the Comprehensive Primary Care Plus (CPC+) model, and one member called the AAFP model superior to CPC+.

"As our nation grapples with the escalating costs of health care, we feel it is time to prioritize primary care, and wide-scale testing of the APC-APM is an important step toward achieving our mutual goals," the AAFP wrote to Azar.

Practices participating in the APC-APM would receive a monthly fee that covers face-to-face patient evaluation and management services. Separate monthly payments for population-based care would eliminate the need to bill for chronic care and transitional care management.

The traditional fee-for-service model asks primary care physicians to spend more time on administrative tasks without an increase in payment. The APC-APM, on the other hand, is designed to reduce administrative burden while supporting efforts to move into more advanced forms of patient care, and it includes both some risk and incentives for high performance.

"The overall goals of the APC-APM are to strengthen the primary care system in the U.S., improve outcomes for Medicare beneficiaries and reduce costs for the program," the letter stated.

The AAFP emphasized the urgency of approving the new model.

"There is comprehensive and compelling evidence showing that a health care system built on a foundation of primary care equates to healthier individuals and lower cost," the letter stated. "Current literature also demonstrates that primary care practices are collapsing under the weight of poor payment and an avalanche of administrative and regulatory mandates."