What FITs Must Know About ACC's APM Framework
The practice of medicine is shifting toward value-based care, making it crucial that physicians play an active role in developing and participating in payments models that are flexible, innovative and outcome-focused. Fellows in Training should inform themselves on whether they will be scored in the Merit-Based Incentive Payment System (MIPS) or in an Advanced Alternative Payment Model (A-APM) track for the Quality Payment Program. Advanced APMs are a subset created by the Medicare Access and CHIP Reauthorization Act (MACRA) that provide a five percent bonus for participation in certain APMs from 2019 through 2024. ACC's APM Framework is composed of closed-ended questions that provide an overview of considerations for providers when determining whether to participate in a particular APM and what steps should be taken to prepare for successful participation.
An APM is a payment approach that incorporates accountability for cost and quality. APMs typically build on fee-for-service payment architecture and are used by payers across health care settings including Medicare, Medicaid and commercial insurers. Examples of APMs include Accountable Care Organizations, where providers are responsible for the cost and quality associated with a defined population of patients, and bundled payments, where providers are responsible for the cost and quality of a defined episode of care such as percutaneous coronary intervention or coronary artery bypass surgery.
Participation in an APM yields an opportunity to improve patient care through clinical practice transformation and application of quality data. It is a potential for shared savings payments if cost and quality targets are met and, in the case of Advanced APMs, an opportunity for bonus payments. However, it may not be without its costs. There is the cost of investing in infrastructure, clinical practice transformation efforts, electronic health record technology, data and analytics capabilities, and quality reporting. In some APMs, providers even assume the downside financial risk.
When preparing for APM participation, it is important to select an appropriate APM and contemplate many practical factors. Consider your organization's readiness and the clinical practice transformation efforts necessary for successful APM participation. Weigh the financial risk (both upside and downside) associated with APM participation and ensure familiarity with the requirements for data and analytics reporting.
This article was authored by Sena Kilic, MD, editor-in-chief of the ACC On-Call For FITs Newsletter and Fellow in Training (FIT) at Brown University in Providence, RI.