June 25, 2020

ACEP’s Alternative Payment Model Strategic Initiative: An Update and Next Steps

While we are still actively working on COVID-19-related issues, including pushing HHS to provide emergency physicians with more funding through the Provider Relief Fund, I want to update you on ACEP’s important work to promote 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 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-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, we’re still waiting on the Centers for Medicare & Medicaid Services (CMS) to adopt the framework.

ACEP firmly believes the core principles of the AUCM are adaptable to other patient populations. Therefore, as you may remember, we started an initiative to promote participation in emergency medicine-focused APMs (based on the AUCM) by other payors beyond Medicare while we wait for CMS to act. Through this APM Strategic Initiative, ACEP is:

  • Creating awareness about the AUCM and emergency-medicine focused APMs;
  • Modifying the AUCM as necessary to fit Medicaid and private payor patient populations; and
  • Developing toolkits and resources to help emergency medicine groups implement the model.

We’ve already made significant headway since late last year when the initiative was launched. ACEP has since 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. You can find the following materials on ACEP’s APM website:

  • An issue brief;
  • A fact sheet;
  • Background on why the model was developed and key messages;
  • A frequently asked questions document;
  • Talking points for the AUCM framework;
  • A physician check list; and
  • A framework to support contract negotiations.

ACEP has also successfully tested out the materials during some recent conversations with multiple payors large and small. And, I’m happy to report that there is already early interest in the details of the AUCM to better understand how payors can integrate elements of the model into their existing programs and contracts with emergency physician groups.

While we are happy with the progress we’ve made thus far and encouraged by the general interest in the model, we know more work needs to get the AUCM off the ground.  The materials we produced establish an excellent foundation for understanding the core features of the AUCM. However, we know that each payor and emergency medicine group faces unique circumstances and challenges managing their individual patient populations. Therefore, we expect that they will have to do additional work to figure out exactly how to best tailor the model to meet the needs of their patients.

So, get excited about the promise of the awesome AUCM model! And please know that going forward I, as well as others from ACEP, can be used as a resource regardless of whether you are an AUCM novice and want to learn more about the basics of the model or you are an AUCM expert and are thinking about how your ED can actually operationalize the model.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs, and tune in today at 3pm ET during our live Capital (30) Minutes to hear more about our federal advocacy efforts and to get your questions answered!

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