June 10, 2021

Recent Opportunities to Highlight ACEP’s “Awesome” AUCM Model

It’s been awhile since I last updated you all on the status of the first, and only, emergency medicine-focused alternative payment model (APM), the Acute Unscheduled Care Model (AUCM)—fondly pronounced “awesome.” This model, developed by ACEP, puts emergency physicians in the driver seat as more payors move away from fee-for-service towards more value-based payments.

The goal of the AUCM is improve the ability of emergency physicians to reduce inpatient admissions and observation stays when appropriate. 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-emergency department (ED) services, and avoiding post-ED discharge safety events. 

The AUCM was originally constructed as a Medicare APM and was highly recommended by a federal advisory committee called the Physician-Focused Payment Model Technical Advisory Committee (PTAC) and endorsed by the Secretary of the Department of Health and Human Services (HHS). However, ever since the HHS Secretary endorsed the AUCM in 2019, we’ve been waiting on the Center for Medicare & Medicaid Innovation (CMMI) within the Centers for Medicare & Medicaid Services (CMS) to adopt the model’s framework.

During this long waiting period, ACEP has continually tried to advance and highlight the AUCM. We launched an initiative to promote participation in emergency medicine-focused APMs (based on the AUCM) by other payors beyond Medicare. We developed a suite of materials to educate emergency physician groups, private payors, and state Medicaid agencies about the AUCM and help key decision makers see the value of implementing an emergency medicine-focused APM.

ACEP also embraced opportunities to speak publicly about the model. In September 2020, I spoke on a panel during a PTAC public meeting on the role that telehealth can play in APMs, and especially in the AUCM. And today (June 10), I’m proud to announce that Dr. Susan Nedza—one of the authors of the AUCM (along with Drs. Jeff Bettinger and Randy Pilgrim)—will participate in another PTAC meeting.

Specifically, Dr. Nedza will join in a panel discussion, along with others who previously submitted model proposals to the PTAC, about the role and aims of care coordination in the context of value-based care and APMs. In her remarks, Dr. Nedza will highlight the core features of the AUCM and describe how it is specifically designed to advance care coordination when patients are discharged from the ED. I encourage you to register for the PTAC meeting and listen in to the panel discussion, which will take place from 1 pm to 2:30 pm EST today. However, I know this is extremely short notice, so if you can’t watch the discussion live, you can watch a recording of it—which will be posted on the PTAC website in the next few weeks.

While I urge you all to listen in, I also hope that CMMI will too. CMMI has a new director, Dr. Liz Fowler, who is currently undergoing a systematic review of all current CMMI models and considering what new models to introduce going forward. She recently stated publicly that she wants to promote mandatory payment models and create better incentives for improving patient outcomes. However, Dr. Fowler has yet to explicitly state whether or how CMMI will incorporate model recommendations from the PTAC (such as the AUCM) into future models (although Dr. Fowler is scheduled to give opening remarks at today’s PTAC meeting).

A top priority that ACEP, along with many other medical associations, believe that Dr. Fowler should take on is to create more opportunities for physicians to actively participate in meaningful APMs. Last month, ACEP signed onto a letter from the American Medical Association (AMA) that provides some useful recommendations that would help steer Dr. Fowler and CMMI towards accomplishing this goal. The letter includes examples “of the kinds of APMs that physicians have developed that we believe merit implementation by CMMI”—and includes the AUCM on that list.

We hope that CMMI will adopt the recommendations included in the AMA sign-on letter (including implementing the AUCM!) and will recognize how physician-focused models could benefit patients.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs.

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