How to propose a model as an alternative payment model (apm) by steven lash

1
Steven lash
2
How to propose a model as an Alternative Payment
Model (APM)

• Center for Medicare and Medicaid Services (CMS)
  has begun to develop the application which could
  be made to propose an APM for the Technical
  Advisory Committee (TAC) to consider. According
  to noted healthcare consultant Steven Lash the
  proposed questions seek information on how the
  proposed APM would improve quality and lower
  costs, along with some technical details of its
  operation.
• Steven Lash has put together a list of criteria
  and data points which must be included in any
  proposal to the TAC.
• Target population, its definition and size
• Ways in which the model would improve quality and
  efficiency of care
• Whether the model would provide for payment for
  covered professional services based on
• quality measures, and if so, whether the measures
  are comparable to quality measures under
• the Merit based Incentive Payment System (MIPS)
  quality performance category

3

• Quality measures in the model and their prior
  validation including
• experience of care
• quality of life
• and functional status
• How the model would affect access to care for
  Medicare and Medicaid beneficiaries.
• How the model will affect disparities (race,
  ethnicity, gender, and disabilities)
• Proposed geographical location(s) of the model.
• Scope of Eligible Participants for the model,
  including participation by specialists
• The number of Eligible Participants expected to
  participate, their support
• Requirements for certified EHR technology.
• An assessment of financial opportunities for
  model participants including a business case for
• their participation
• Mechanisms for how the model fits into existing
  Medicare payment systems, or replaces them

4

• in part or in whole and would interact with or
  complement existing alternative payment models
• Payment mechanisms (such as incentive payments,
  performance-based payments, or shared savings)
• Whether the model would include financial risk
  for monetary losses for participants in excess of
• a minimal amount and the type and amount of
  financial performance risk assumed by model
• participants.
• Method for attributing beneficiaries to
  participants.
• Estimated percentage of Medicare spending
  impacted by the model and expected amount of
• any new Medicare/Medicaid payments to model
  participants.
• Mechanism and amount of anticipated savings to
  Medicare and Medicaid from the model, and any
  incentive payments, performance-based payments,
  shared savings, or other payments made from
  Medicare to model participants.
• Information about any similar models used by
  private payers, and how the current proposal is
• similar to or different from private models and
  whether and how the model could include
• additional payers other than Medicare, including
  Medicaid.
•  

5

• Whether the model engages payers other than
  Medicare, including Medicaid and/or private
• payers. If not, why not? If so, what proportion
  of the models beneficiaries is covered by
• Medicare as compared to other payers?
• Potential approaches for CMS to evaluate the
  proposed model (study design, comparison
• groups, and key outcome measures).
• Opportunities for potential model expansion if
  successful.
• According to Steven Lash while the process may
  seem daunting is totally achievable and can and
  will provide significant upside in future
  financial viability and stability for a physician
  practice.