The College’s Value-Based Care (VBC) Task Force is on a mission for allergists. Previously known as the APM Task Force, it has been renamed the Value-Based Care Task Force in recognition of its expanded role. This expert group is now looking at a variety of value-based care arrangements that can benefit allergists, including specialty-focused Accountable Care Organizations (ACOs), episode-based payment models and, of course, alternative payment models (APMs) – including the College’s own Asthma APM.
Recently, the VBC Task Force has been working with the Maryland Medical Society and the Maryland Allergy Society to educate Maryland allergists about a unique opportunity. The state of Maryland has a CMS-approved alternative payment model (APM) called EQIP, which is an episode-based payment program that covers multiple specialties. It was implemented on a limited basis in 2022, and new episodes were added in 2023 – including asthma and allergic rhinitis/chronic sinusitis. There are now 28 different episodes of care for a variety of specialties. To our knowledge, the asthma episode in EQIP is the first active asthma APM opportunity available anywhere.
Earlier this year, Amar Dixit, MD, MBA, FACAAI, Chair of the VBC Task Force, gave a presentation to the Maryland Allergy Society about APMs and EQIP. The Task Force believes the EQIP APM is a good opportunity for Maryland allergists for several reasons:
- Participating allergists can opt out of MIPS (and avoid a potential 9% penalty) since EQIP qualifies as an APM.
- In 2024, APM participants will receive a positive 0.75% Medicare conversion factor (CF) update, while others will receive only a 0.25% CF update.
- Allergists are rewarded for providing efficient and high-quality care.
- EQIP provides upside bonus potential to allergists with no downside financial risk.
- There is minimal practice administrative burden.
After our outreach, approximately 15 allergists signed up for EQIP for 2024. The VBC Task Force plans to work with these allergists to help them be successful, and we hope to gather data and learn from this project to help us optimize future APM episodes for allergists – specifically, for asthma and possibly allergic rhinitis.
More about value-based care
Historically, most physician payment models have been “fee for service,” meaning physicians get paid for each service they provide. This model financially rewards physicians for providing more services but doesn’t focus on providing the best or most efficient care for patients. It has also resulted in dramatic growth in Medicare spending.
As a result, CMS and other payers are increasingly interested in Value-Based Payment Programs to reduce spending. These programs are designed to save CMS and insurers money while continuing to provide quality care to patients. They also reward physicians who provide excellent quality, value, and patient experiences by sharing in the savings. Value-Based Payment Programs:
- Tie physician earnings to the results they deliver for patients (quality, cost savings, equity goals) rather than the number of services.
- Financially incentivizes physicians to meet goals related to quality, cost, patient experience, and equity.
- Lower payer costs through reduced ED/urgent care visits, hospitalizations, and medication costs.
- Provide better quality care for patients through improved outcomes and experiences.
“Health care sits at a precipice with physicians facing more demands from all directions and increasing financial challenges. Our specialty is no exception to this environment,” said Dr. Dixit. “One change in this environment is the increasing adoption of value-based care. The College realizes physicians not only need to be part of this conversation, but also to be leaders in this conversation. As such, the College has formed The Value-Based Care Task Force to take the lead.”
Are you interested in working on value-based care options for allergists? Our task force is looking for new members to help further this important work for allergists. Help define future payment models for our specialty! Contact jenniferpfeifer@acaai.org for more information.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
