Last July, the College joined American Medical Association (AMA) President-elect Jack Resneck, Jr., MD, and a few other specialty society physician leaders in a meeting with Liz Fowler, Director of the Center for Medicare and Medicaid Innovation (CMMI). James Tracy, DO, FACAAI, Chair of ACAAI’s Advocacy Council and Alternative Payment Model (APM) Subcommittee, represented the College at this meeting.
The purpose of the meeting was to discuss the status of various APMs recommended to CMMI by the Department of Health and Human Services (HHS) Physician Focused Payment Model Technical Advisory Committee (PTAC). Dr. Tracy was invited to speak on behalf of the College’s Asthma APM, which PTAC referred to HHS for further consideration and testing.
The physician-developed models were evaluated by PTAC on their potential for quality care improvements and their potential for lowering the cost of care to the Medicare program. Over the past few years, PTAC has recommended that CMMI undertake further testing and action on more than 20 APMs, including the College’s Asthma APM.
Unfortunately, CMMI has yet to act on or implement any of the physician developed APMs recommended by PTAC. This has caused great concern within the physician community, as many physician specialty societies have invested considerable time, resources and attention to the development of the APMs. Seeing no progress on the models already submitted has had a chilling effect on other specialty societies that were considering developing their own APMs.
Director Fowler has only been in her current position for a few months. She was one of the first health policy appointees put forward by President Biden in late January. As such, she is not responsible for past inaction on the physician developed APMs. She said she and her staff would be taking a fresh look at the models recommended by PTAC as well as some of the models already being tested.
Director Fowler said she believes it might be beneficial for CMMI to be more selective in how it goes about testing APMs. She also reinforced previous statements she’s made that models must also be viewed through a “health equity” lens. Director Fowler has said it is not enough that APMs improve quality and potentially save money. They must do so without harming access to care or exacerbating preexisting health disparities.
During the course of the meeting, each physician leader spoke briefly about their APM, highlighted important aspects of their payment model and recommended steps CMMI can take to advance patient-centered care as it develops the Biden Administration’s strategy for health care transformation.
“I was gratified Director Fowler took time to meet with me and other specialty societies that responded to the call for physician-developed APMs,” Dr. Tracy said. “The College’s Asthma APM model meets all the criteria Congress and HHS established when this initiative was announced.” Dr. Tracy added, “We are confident that if CMMI will agree – as was recommended by PTAC – to test the Asthma APM, significant quality improvements and financial savings will be realized.”
Director Fowler, a veteran of health policy debates in Washington, DC, going back to her time on Capitol Hill during development of the Affordable Care Act, observed this meeting as only the beginning of a conversation about APMs with the provider community. She stated she would like an ongoing, regular dialogue with physician stakeholders to ensure the voice of medicine is at the table as CMMI makes decisions about how future APMs are developed and implemented.
The Advocacy Council will continue to work with the AMA, Congress and governmental agencies like CMMI to advocate for testing of the Asthma APM. The Advocacy Council – we have you covered.