Ingrid Hein

November 11, 2016

SAN FRANCISCO — A draft proposal of an Alternative Payment Model for allergists, specifically focused on the treatment of asthma-like symptoms, was presented here at the American College of Allergy, Asthma & Immunology (ACAAI) 2016 Annual Scientific Meeting.

The model is being proposed as an alternative to Merit-based Incentive Payment Systems (MIPS).

"We want to focus on opportunities where allergists have control of care and costs; where they should and can be accountable," said James Tracy, DO, from Allergy, Asthma & Immunology Associates in Omaha, Nebraska.

The MIPS reporting system, which will be required in 2017, is cumbersome, especially for smaller clinics, and allergists fear it is not likely to measure quality in a way that best serves patients. If allergists don't participate in MIPS, their reimbursements can be docked at a rate of 4% in 2019, which will increase to 9% in 2022.

The alternative is to submit reimbursement requests under an Alternative Payment Model, but currently, there are none for allergists. So the ACAAI advocacy council formed a committee to develop one for asthma.

The draft model is now ready for testing.

"Large numbers of our practices are run by one to three people. Many allergists, especially those in solo and small practices, will find it difficult to meet MIPS reporting requirements," Dr Tracy told the audience. "A well-designed APM for allergists could be a better financial option and a better way to deliver care to patients."

The draft model, dubbed the Patient-Centered Asthma Care Payment, would pay care providers a bundled monthly payment per patient, instead of evaluation and management payments for office visits.

The new system would give healthcare providers more flexibility to offer services that make more sense than bringing the patient into the office at every touch point. And with a "bundled payment" per month per patient, care teams could offer services that better address patient needs. For example, a visit could be made to the patient's home to inspect for irritants, such as mold, which can trigger asthma exacerbations. Currently, there is no way to be reimbursed for that.

But there is a risk for the care team — allergists would become accountable for factors like overall spending on medications, emergency department visits, hospitalizations related to asthma, and outpatient visits as a measure of quality of care.

"We'd like to be ahead of the curve, instead of being told how we should do it," said Dr Tracy. "If we can show, using our APM, that we had 30% fewer ER visits, that's important information. And you can use that to extrapolate other cost savings."

Under the new model, the monthly payment would be higher for patients with severe symptoms or challenging medication regimens.

The draft model divides patients into three treatment categories: diagnosis and initial treatment for patients with poorly controlled asthma-like symptoms; continued care for patients with difficult-to-control asthma; and continued care for patients with well-controlled asthma.

 
Shifting to value would mean we would be paid for quality of care, not for the number of patients we treat.
 

The committee is in the process of finding suitable practices to test the model for effectiveness and cost-saving probabilities, Dr Tracy reported.

"We're hoping to have three to five pilot practices around the country" that are using electronic health records and are motivated, he explained. Discussions are planned with potential practices at the ACAAI meeting.

After the presentation, Matt Smith, MBA, executive director of the Northwest Asthma & Allergy Center in Seattle, approached Dr Tracy to discuss the possibility of his office taking part. He said he is very interested by the proposed model. "Shifting to value would mean we would be paid for quality of care, not for the number of patients we treat," Smith told Medscape Medical News.

"If we can keep an asthmatic out of the hospital and control their asthma, we don't have to see them every week or every month; we can check in with them at home over the telephone," he explained. "Now, we're not paid unless we bring them in."

"The alternative payment model they're proposing is not fully baked yet — it's still in the ingredient stages," said Smith, "but it makes sense."

American College of Allergy, Asthma & Immunology (ACAAI) 2016 Annual Scientific Meeting. Presented November 10, 2016.

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