AMA raves about College’s asthma Alternative Payment Model

The College recently submitted a proposal for an asthma Alternative Payment Model (APM) to the Physician-Focused Payment Model Technical Advisory Committee (PTAC). PTAC was established by the Department of Health and Human Services (HHS) to make recommendations to HHS about APMs. The APM would provide an alternative way to compensate physicians caring for asthma patients.

The American Medical Association (AMA) recently submitted comments to PTAC supporting our APM. It stated, “Several foundational elements of this model represent significant advances in the design of physician-focused payment models that the AMA has advocated in comments to the PTAC, meetings with the Center for Medicare & Medicaid Innovation and discussions with stakeholders and policymakers.”

The AMA noted the College’s asthma APM:

  • Is designed both to ensure an accurate diagnosis of asthma and improve management after diagnosis.
  • Incorporates an innovative approach to risk stratification based on the severity of a patient’s asthma and co-morbidities that exacerbate asthma.
  • Incorporates PTAC’s previously endorsed approach to asthma care payment, while also addressing specific issues raised by PTAC and HHS two years ago.
  • Addresses PTAC’s and HHS’ requests for an APM with more focus on COPD/asthma.
  • Includes other features not found in current CMS APMs:
    • A separate bundled payment for allergy testing. This would avoid overuse of multiple tests without penalizing physicians for using testing when appropriate.
    • Patient-reported outcome measures.
    • Accountability elements to ensure small practices are not subjected to changes in payment due to random variations in patient characteristics or outcomes.
    • Options for higher levels of payment bundling instead of a one-size-fits-all approach.

The AMA commented that implementation of the College’s APM would not only improve care for patients but also would achieve reductions in Medicare spending. And that the APM could be modified to improve care for patients with other chronic conditions.

The AMA encouraged PTAC members to recommend the College’s asthma APM to the Secretary of HHS for consideration and rapid implementation.

The College’s APM subcommittee, in partnership with the AMA and the Center for Health Care Quality Payment Reform, worked diligently for the past few years to develop the asthma APM. Its primary goals are improved care for patients and a reduction in overall health care spending (via reduced emergency department visits, hospital admissions and unnecessary tests and medications). The proposal is being considered by a preliminary review team. Deliberation and voting will occur at a public PTAC meeting, which College representatives will attend.

Advocacy Issue: 
Billing, Coding & Payments