The long wait is over! After a year, the Secretary of the U.S. Department of Health and Human Services (HHS) responded to the PTAC’s recommendation on ACEP’s Medicare alternative payment model (APM), the Acute Unscheduled Care Model—fondly referred to as AUCM or “awesome.” ACEP developed the AUCM because there are currently no opportunities for an emergency physician to participate in an APM and potentially receive a 5 percent Medicare payment bonus available under the Quality Payment Program.
As I wrote in a previous blog post , the PTAC—the federal advisory committee in charge of recommending Medicare APMs to the HHS Secretary—recommended that the HHS Secretary fully implement AUCM back in September 2018. Since then we’ve been awaiting the Secretary’s response, as the Centers for Medicare & Medicaid Services (CMS)’ Innovation Center (CMMI)—the entity that would ultimately oversee the implementation of the AUCM—has repeatedly told ACEP that it can’t discuss or work on our APM until that response is issued.
Well, the HHS Secretary’s response is now in…and it is great! In short, the HHS Secretary believes that core concepts of the AUCM should be incorporated into APMs that CMMI is developing. The response paves the way for emergency physicians to finally be in a Medicare APM that is meaningful to you and your patients and that may get you that 5 percent payment bonus.
Highlights of the HHS Secretary’s Response
- The AUCM is a creative proposal to address ED payment policy that focuses on the safe discharge of patients, follow-up care for 30 days post-ED visit, and hospitalizations or other avoidable post-ED visit events and their associated costs.
- HHS recognizes the opportunity to incentivize improved quality and decreased cost associated with ED discharge decisions and appreciates the proposal's goal of enhancing an ED provider's ability to be an effective patient navigator.
- The HHS Secretary agrees with PTAC that ED providers can influence transitions of care from the hospital and serve as one critical link in broader efforts to deliver coordinated, value-based care.
- The HHS Secretary is interested in exploring how the concepts in the AUCM for care management by emergency physicians after an ED encounter could be incorporated into models under development at CMMI. He has asked CMMI to assess how key mechanisms of action in this model could operate as a component in a larger model dedicated to improving population health.
- The HHS Secretary is encouraged by submitters like ACEP who continue to help drive transformative innovation in American health care toward a value-based delivery system.
This is very exciting news, and an important step in the process of getting an emergency medicine-focused APM like AUCM implemented. However, we can’t do our touchdown dance quite yet. It’s now up to CMMI to actually conduct the work to carry out the HHS Secretary’s request.
Since it could take months for CMMI to begin incorporating the AUCM into the APMs it is developing, ACEP has started our own initiative to promote participation in emergency medicine-focused APMs for other payers beyond Medicare. Now that we know the HHS Secretary thinks the AUCM is awesome for Medicare, hopefully other payers will think so too! Stay tuned for information and resources to help you engage with Medicaid offices and private payers on APMs, decide whether or not to participate in an APM, and learn how to be successful in an APM.
Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!