ACEP’s Next Steps

The HHS secretary’s supportive response is an important step in the process of getting an EM-focused APM like the AUCM implemented, but ACEP’s work is not finished. Now it is up to CMMI to carry out the HHS secretary’s request.

Since the CMMI timeframe for incorporating the AUCM into the Medicare APMs is unclear, ACEP has started our own initiative to promote participation in EM-focused APMs being offered by other payers like Medicaid and private insurers. As Medicaid and private payers move away from fee-for-service contracts toward value-based payment arrangements, an appropriately modified non-Medicare version of the AUCM would be an ideal APM construct for these payers to pursue. However, while ACEP encourages Medicaid and private payers to incorporate core concepts of the AUCM into EM-focused APMs, we anticipate some features of the APM will be different from the AUCM, depending on the specific patient population.

Learn More

ACEP has developed resources to help emergency physicians and others understand more about the landscape of health care payment reform and how a model like the AUCM could help improve emergency care and lower costs; one such resource is a FAQ to help clarify any misperceptions about the AUCM, the QPP, or APMs in general. Dr. Bettinger, Dr. Pilgrim, and Dr. Nedza, along with Avi Baehr, MD, Heather Marshall Vaskas, MD, and Jennifer Wiler, MD, MBA, FACEP, co-authored an article in the Annals of Emergency Medicine called “Enhancing Appropriate Admissions: An Advanced Alternative Payment Model for Emergency Physicians,” which highlights the key features of the AUCM. All these materials and more are found on ACEP’s APM Strategic Initiative website.

Here to Help

As both public and private payers begin to explore developing EM-specific APMs, ACEP will help you make sense of it all. Email me your questions at jdavis@acep.org.

Mr. Davis is ACEP director of regulatory affairs.

What is an APM?

CMS defines an APM as a payment approach that gives physicians and other providers added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Examples of APMs include accountable care organizations (ACOs), medical homes, and bundled payment models.

Advanced APMs are a subset of APMs with additional requirements, such nominal financial risks. Financial risk means that a provider participant in the APM is held financially accountable if the services they provide wind up costing more than a predetermined target. In other words, participants must owe back some or all “losses” for which they are deemed responsible.

What is the AUCM?

ACEP created the Acute Unscheduled Care Model (AUCM, pronounced “awesome”), a Medicare Advanced APM proposal designed for emergency physicians.