These physicians don't qualify for any Medicare APMs

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Although CMS has shown significant support to move Medicare payments to value-based care models, not all providers have access to an alternative payment model, according to an analysis from Leavitt Partners, a Salt Lake City-based healthcare intelligence firm.

"While providers without access to a Medicare APM could potentially participate in a commercial APM, a provider's access to a Medicare APM is important. There are currently 56 million Medicare patients, and that number is expected to grow to 81 million by 2030," the authors wrote in a whitepaper. "Also, many providers are more likely to try a CMS model before engaging in a commercial APM because CMS models have de­fined rules and don't require individual negotiation."

The analysis shows certain provider types lack access to APMs entirely or have limited options. For example, audiologists and emergency physicians have no Medicare APM options and respiratory therapists have just three, compared to the six models available for primary care physicians. While some of these providers could participate in CMS' preparatory models, they will likely not be incentivized to do so if no APMs appear available for future participation, according to Leavitt Partners.

The nature of the work of other provider types, particularly emergency physicians, may pose challenges for developing suitable APMs. Leavitt Partners cites an article from the American Journal of Emergency Medicine noting several challenges to creating a value-based payment model for emergency physicians, namely that they typically see their patients just once, diagnoses are often uncertain and they must treat all patients regardless of ability to pay.

However, APMs can be developed with these challenges in mind, according to the analysis. These providers and stakeholder organizations representing providers who lack APM access can encourage the creation of new or more inclusive models through CMS' proposal or comment process, according to the report.

Leavitt Partners conducted the analysis on CMS' 63 current Medicare demonstration projects, 45 of which are specific to payment models. Of those 45 models, 18 qualified as APMs because they were linked to quality and value.


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