Surgeon Leader to Congress: Make CMMI Test Physician-Developed APMs

In April 11 testimony before the U.S. Senate Finance Committee, American College of Surgeons (ACS) CEO and CEO Patricia L. Turner, MD, MBA, said surgeons seeking Going beyond fee-for-service still find few physician-centered alternative payment models (APMs) available as none of the models presented to the Physician-Centered Payment Model Technical Advisory Committee (PTAC) have been tested as proposed .

In his testimony, Turner called on Congress to address cuts already expected in 2025 and do more to make alternative payment models available that incentivize access to timely, high-quality care for all surgical patients. He said APMs can facilitate better care and could also be used to incentivize doctors to practice in rural or underserved areas.

“Unfortunately, efforts to implement advanced APM were hampered by a failure of the process envisioned in MACRA. Along with dozens of other groups, ACS developed and submitted proposals that were reviewed, revised and evaluated by the PTAC,” he said in his written testimony. “The PTAC has recommended fourteen proposals for testing or implementation, but CMS has not tested a single model through the Center for Medicare and Medicaid Innovation (CMMI) as proposed,” he said. “This bottleneck has created a disincentive for stakeholder investment in APM development, as evidenced by the lack of new proposals on the PTAC website since 2020.”

The ACS-Brandeis Advanced APM proposal included shared responsibility for the cost and quality of defined episodes of surgical care and allowed the entire care team, including the primary care physician, to work together to achieve shared goals, Turner explained. “Information about the breadth of a quality program, along with comparable information about the price of that care, are prerequisites for a valid description of the value of care.”

The ACS has supported the development of standardized episode definitions to encourage alignment of price and quality measurement and create shared responsibility for the provider team. Turner said the ACS proposal would provide the data and incentives needed to drive value improvement in specialty care. “While we are under the impression that Congress has provided CMS and the Innovation Center with the necessary resources to stand up and test the APMs recommended by the PTAC, there is nothing within the law that requires CMS to test new programs “, said. “This creates more barriers for those looking to move to value-based care. “Congress should require that, at a minimum, a portion of the CMS Innovation Center budget be dedicated to testing APMs developed by physicians and specialists recommended by the PTAC.”

Most surgeons in the current fee-for-service system are evaluated on measures that do not reflect the care they provide to patients or the conditions they treat, Turner explained, and the current model of individual, disconnected measures is insufficient to achieve coordinated and patient care. -Focused and high-value attention. Turner emphasized that the system should incentivize high-quality, patient-centered, coordinated care. Without congressional action, continued cuts to Medicare will pose challenges to doctors’ ability to provide adequate services and high-quality care to all patients, including those with chronic diseases, he said.

“We believe medicine should move toward a system that rewards high-quality, value-based care,” Turner testified. “This transformation is underway and would benefit from efficient investments in the partnership between CMS and subject matter experts committed to improving how quality is measured and incentivized, and improving the calculation of physician fees.”

In early 2023, ACS submitted a programmatic measure, the Age-Friendly Hospitals Measure, to CMS’s list of Measures Under Consideration (MUC) to demonstrate how programmatic measures could be implemented in CMS programs, Turner explained . “We are optimistic that this measure will be included in the FY 2025 Inpatient Prospective Payment System (IPPS) proposed rule and will hopefully be available for hospital reporting in future years.”

He said the measure considers the entire program of care necessary for geriatric patients. Encourages hospitals to take a holistic approach to providing care to older adults by implementing multiple data-driven modifications across the clinical care pathway spanning the emergency department, operating room, inpatient units, and more . The measure emphasizes the importance of defining patient (and caregiver) goals, not only from the immediate treatment decision, but also for long-term health and functional status.

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