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Imagining a primary-care focused advanced APM

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An integral part of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP), the Alternative Payment Model (APM) is “a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.”

As reported by Modern Medicine Network, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) voted in late 2017 to recommend that Health and Human Services (HHS) test the Advanced Primary Care (APC) APM developed by the American Academy of Family Physicians (AAFP), an organization with a membership of more than 84,000 actively practicing physicians. AAFP notes that the potential impact of a primary-care focused advanced APM could be huge.

Interviewing representatives of AAFP, author David Raths asked several questions regarding the need, structure, and impact of the APC APM. Amy Mullins, MD, AAFP medical director for quality improvement, responded that “there needs to be an AAPM that will be available for the majority of primary-care physicians to participate in as an alternative to MIPS (Merit Based Incentive System). Dr. Mullins noted that “it is difficult to achieve wide adoption of a payment model if it is too complex and has a high reporting burden. This is magnified if physicians are not getting paid for doing this work on all of their patients.”

Michael Munger, MD, AAFP president, further explained that primary care physicians typically are paid based solely on the patient visit time. Inequities start to appear in the procedural codes when the visit might entail discussing several chronic conditions with the patient but a single procedure such as a colonoscopy is worth three times as much. Additionally, primary care physicians typically spend time coordinating care with specialty providers or managing conditions between visits, for which there is no procedural code.

The proposed APC APM model also addresses social determinants of health, important factors in primary care. Dr. Munger explains that “You cannot do effective population health management unless you are addressing social determinants of health. The ability to risk-stratify your population to look for individuals who have food insecurity or transportation needs or who don’t feel safe in their neighborhood lets you target your resources better. It also allows patients to better participate in their own chronic disease management.” He adds that the proposed APC APM model “really does recognize the importance of a prospective, risk-adjusted population-based payment.”