The AUCM would provide a voluntary alternative to the traditional fee-for-service payments for Medicare patients who receive emergency care. It is structured as a bundled payment model, focusing on specific “episodes” of unscheduled acute care. Under a bundled payment approach, if the cost of an episode of care is less than a predetermined price for that episode, then a participating provider or group can keep that difference. However, if the cost winds up being more than the predetermined price, participants would be responsible for those losses and owe Medicare the difference.
Explore This IssueACEP Now: Vol 39 – No 02 – February 2020
The AUCM is designed to last five years and be flexible enough to allow the full spectrum of emergency physicians to participate, should they choose, from those with dedicated infrastructure and experience accepting financial risk to smaller groups of physicians who do not have as much experience in this area. Emergency physicians and groups could participate regardless of employment model (independent group, regional group, national group, employed physicians).
The overall goal of the AUCM is to improve the ability of emergency physicians to reduce inpatient admissions and observation stays when appropriate through enhanced care coordination. Emergency physicians would become key members of the continuum of care as the model focuses on ensuring follow-up care for emergency patients, minimizing redundant post-ED services, and avoiding post-ED discharge safety events that lead to follow-up ED visits or inpatient admissions.
Effect of ACOs on EM Payment and Care Redesign
A recent qualitative study in Annals of Emergency Medicine interviewed emergency department leaders and Accountable Care Organization (ACO) participants to assess how accountable care has affected emergency care redesign and payment. The study found a lack of evidence-based policy solutions to inform accountable and value-based care in the emergency department. The Acute Unscheduled Care Model is designed to address this critical gap. Read “Effect of Accountable Care Organizations on Emergency Medicine Payment and Care Redesign: A Qualitative Study”.