The American Academy of Family Physicians submitted an alternative payment model proposal titled "Advanced Primary Care: A Foundational Alternative Payment Model for Delivering Patient-Centered, Longitudinal and Coordinated Care" to the Physician-Focused Payment Model Technical Advisory Committee.
Here are six things to know about the proposal:
1. The APM aims to improve healthcare quality and provide "coordinate, longitudinal care" through four components including:
● Conducting monthly, prospective, risk-adjusted primary care global payments for direct patient care;
● Fee-for-service payments that reimburse providers for services not included in the global payment;
● Having monthly, prospective population-based payments covering non-face-to-face patient services;
● Quarterly prospective, performance-based incentive payments correlating to clinical quality, patient experience and utilization measures.
2. The proposal applies to any physician with primary care specialty designation such as family medicine, geriatric medicine, general internal medicine, general pediatric medicine and general practice. With this scope in mind, the AAFP projects approximately 195,000 primary care physicians could participate in this advanced APM.
3. If the committee implements the proposal on a national scale, the AAFP estimates it could impact more than 30 million Medicare patients.
4. The AAFP said the proposal could increase primary care spending to at least 12 percent. Current estimates predict spending between 6 percent and 8 percent.
5. The proposal meets PTAC criteria in the following ways:
● In the quality and cost section, the AAFP highlights the proposal's value and goes into how it addresses care delivery, various risks, evaluation strategies and data concerns.
● The AAFP addresses financial risk, coding and claims as well as obstacles the fee-for-service payment system has created in the committee's payment methodology section.
● In the integration and care coordination section, the organization speaks to the proposal's team-based care model where primary care physicians operate as team leaders.
6. The AAFP wrote in its proposal, "Given the evident merits of the model, the push from CMS to tie more Medicare payments to quality and value, and the current small number of advanced APMs under MACRA, we anticipate that many of these physicians would express interest and willingness to participate in the model if it is approved and expanded to scale."