The American Medical Association and Center for Healthcare Quality and Payment Reform have published this guide to physician-focused alternative payment models. Alternative payment methods are the broad term being used for payment methods other than fee-for-service. Under the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) APMs will be used in determining future Medicare payments to physicians, which usually also influence physician payments by other payers.
The guide describes seven APMs that can help physicians in every specialty redesign the way they deliver care in order to control spending, improve quality for patients, and qualify for APM-based payments:
- Payment for a high-value service
- Condition-based payment for a physician’s services
- Multi-physician bundled payment
- Physician-facility procedure bundle
- Warrantied payment for physician service
- Episode payment for a procedure
- Condition-based payment
Not all of these APMs are currently being used, or have a strong evidence base that they result in increased health care value (improved quality of care outcomes, and neutral or reduced costs).
Meanwhile, there is ongoing, active work by the Centers for Medicare and Medicaid Services’ convened Health Care Payment Learning & Action Network and other stakeholders on developing APMs for’ implementation under MACRA.