Advocacy Council participates in AMA workshop on alternative payment models

On March 20, the Advocacy Council participated in the AMA-sponsored Workshop on Alternative Payment Models (APM).

The Advocacy Council’s APM sub-committee Chair, Stephen Imbeau, MD, FACAAI; Vice Chair, James Tracy, MD, FACAAI; and the Advocacy Council’s Executive Director of Advocacy and Governmental Affairs, James Sublett, MD, FACCAI; presented overviews of the College’s recently developed Patient-Centered Asthma Care Payment APM.

The day-long workshop included a presentation by Harold D. Miller, President and CEO, Center for Healthcare Quality and Payment Reform and chief consultant for our Advocacy Council’s APM sub-committee. Other specialty societies developing APMs and Patrick Conway, MD, MSc, Deputy Administrator for Innovation and Quality Director, Center for Medicare and Medicaid Innovation, Center for Medicare and Medicaid Services, also presented.

The Medicare Access and CHIP Reauthorization Act of 2015 replaced the flawed sustainable growth rate and provided the framework (and congressional mandate) for bonus payments for participation in APMs. APM’s, including the College’s asthma APM, provide for bundled payments that include high-value services that currently have no or inadequate payment, but which could be used to improve patient care and reduce total spending.

The following services are not currently billable under Medicare, even though appropriate use of these services could avoid the use of more expensive services:

Preventive medicine counseling (CPT 99401-4)

Telephone evaluation and management (CPT 99441-3)

Education and training for patient self-management (CPT 98960-2)

Telephone assessment by non-physician (CPT 98966-8)

Supervised exercise therapy

Shared decision-making with patients

One of the most important takeaways from the workshop is that the College is on track with our APM. On March 10, we submitted a Letter of Intent (LOI) for the Asthma APM to the Physician-Focused Payment Model Technical Advisory Committee (PTAC). PTAC makes recommendations to the Department of Health and Human Services regarding APM approval. Submission of the LOI is the first step in getting approval for the asthma APM. We are now ready to move into the next phase – to pilot the model in real practices.

Billing, Coding & Payments
APMs