For the first two to three years, the model will focus on episodes around four high-volume emergency department conditions: abdominal pain, chest pain, altered mental status, and syncope. More episodes will be added over time. Performance on a set of quality measures will determine a participant’s eligibility for savings as well as the size of a discount percentage, which is built into the target price. That discount guarantees at least some savings for the Medicare program.

The AUCM model will be flexible enough to allow the full spectrum of emergency physicians to participate, should they so choose. Ideally, participation will range from those with dedicated infrastructure and experience with reporting and meeting quality metrics and taking downside risk to smaller groups of physicians who do not have as much experience in these areas. Specifically, it will include an alternative quality-scoring methodology with more achievable standards as well as three options for risk sharing that enable emergency physicians to either take on downside risk immediately or accept more risk over time.

Next Steps

A preliminary review team within the PTAC is currently reviewing the model, and ACEP has been actively engaged in answering all of the team’s technical questions. After the preliminary review team finishes its review, the model will be considered by the full PTAC during a public meeting. The next PTAC public meeting is in June, and ACEP hopes that the AUCM model will make it on the agenda. Even if the PTAC does discuss the AUCM model in June and decides to recommend it to the secretary of Health and Human Services, there is still a long road ahead before the model would be operationalized. However, we are prepared to continue to push for this model to be developed and implemented either through the PTAC process or, if necessary, through some other legislative or regulatory vehicle.

While there is still much work to do to get this model across the finish line, we are encouraged by the considerable progress to date. Most importantly, we feel privileged to have had the opportunity to design a payment model that reflects and values the significant role that emergency physicians play in the health care system. Stay tuned for more as the process moves forward.

Dr. Bettinger and Dr. Pilgrim are co-chairs of the ACEP APM Task Force.