The payment system for health care services is changing in the United States, with the Medicare Access and CHIP Reauthorization Act driving it away from fee-for-service reimbursement toward a value-based system centering around the alternative payment model (APM).
Responding to the forthcoming transition, LUGPA is working to develop and gain approval for multiple urology-specific APMs so that urologists can be compliant with and thrive in the new system as soon as it is rolled out, said Alec Koo, MD, at the LUGPA annual meeting in Chicago.
At the time of the meeting, LUGPA had already submitted one APM—“Positive Biopsy/Localized Prostate Cancer” —for review by the Physician-Focused Payment Model Technical Advisory Committee of the Center for Medicare & Medicaid Innovation (CMMI). This APM proposes episode-based payments for patients with newly diagnosed, localized prostate cancer.
Work on a “Prostate Cancer Biopsy Taking Risk on Sepsis” APM was well underway. Other APMs relating to prostate cancer and those for BPH and overactive bladder were also in various earlier stages of development.
“In multiple writings, the Centers for Medicare & Medicaid Services has stated it would like 80% to 90% of all health care delivery to be administered through an APM system. Many practicing physicians do not understand the changes that are coming and the impact they will have,” said Dr. Koo, of Skyline Urology, Torrance, CA.
“LUGPA is the only urology entity developing APMs that are based on recognition that most care delivered by urologists occurs in the outpatient or office-based setting rather than in the operating room. And, the APMs being designed by LUGPA allow for participation by all urologists regardless of their practice setting or affiliation.”