Proposed APMs will increase cost efficiencies, improve GI patient care
In this guest commentary, Digestive Health Physicians Association (DHPA) Health Policy Chair, Lawrence Kim, MD, discusses transformation of the health care market and two recent initiatives that could significantly and positively impact gastroenterologists and the patients they serve. Kim practices at South Denver Gastroenterology and serves on the Governing Board of the American Gastroenterological Association as well as the Board of Directors of the Accreditation Association for Ambulatory Health Care, the leading accreditor of ambulatory endoscopy centers.
Health care is shifting away from fee-for-service to a more value-based system, which has major implications for the delivery of health care in our country. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) established the Physician-Focused Payment Model Technical Advisory Committee (PTAC). This group advises the Centers for Medicare and Medicaid Services (CMS) on the development and implementation of new health care delivery models such as Alternative Payment Models (APMs).
At a recent Medicare Payment Advisory Commission meeting, several commissioners noted the severe lack of opportunities for specialists to enter into Advanced APMs. The DHPA supports two proposals that were submitted to PTAC, both of which will enable gastroenterologists to participate in Advanced APMs and allow the delivery of high quality care for reduced costs to Medicare.
The Illinois Gastroenterology Group (IGG) submitted the “Project Sonar Advanced APM” and the Digestive Health Network proposed its “Comprehensive Colonoscopy Advanced APM for Colorectal Cancer, Screening, Diagnosis and Surveillance” models to PTAC, which could allow specialty physicians to participate in APMs.
These initiatives could be of tremendous value in helping to improve health care quality on a population level while providing cost savings to the Medicare system, preserving patient choice and enhancing patient safety. Current APMs simply do not meet the unique needs of specialty medicine, which make these proposed models crucial in defining the path for specialists moving forward.
The Colonoscopy Advanced APM is a comprehensive bundled payment plan that will encourage physicians across specialties to coordinate and collaborate more effectively. Facilitating enhanced cooperation between providers will result in better patient care and improved outcomes in the diagnosis, surveillance and treatment of patients with colorectal cancer (CRC) — the third leading cause of cancer death in the country. Early screening is an important tool in fighting colorectal cancer, but according to the American Cancer Society, 40% of U.S. adults age 50 years and older are not up to date with their screenings. The Colonoscopy Advanced APM can help decrease disparities in early detection and prevention of colon cancer, by promoting coordination between providers in managing the treatment and diagnosis of patients with CRC, and providing savings to the patient.
Project Sonar is a care management program designed to improve the treatment of patients with Crohn’s disease. The Project Sonar Advanced APM allows for identification of high-risk patients before complications ensue and encourages a more connected and efficient channeling of patients to health care professionals who have the most knowledge and experience and improve engagement of patients in assessing early warning signs.
These two new advanced APMs will foster innovation, quality care and cost efficiencies for gastroenterologists, and will allow for improved patient outcomes. Physicians know that these are critical factors in ensuring our patients are receiving the best care possible. Both proposals are precisely the type of forward thinking Physician-Focused Payment Models that PTAC should embrace, and CMS should implement both proposed payment models as a high priority.
Lawrence Kim, MD, can be reached at firstname.lastname@example.org.
Disclosures: Kim reports no relevant financial disclosures.