6 considerations before joining an APM

Chances are, many independent medical practices are participating in Medicare’s Quality Payment Program through the Merit-based Incentive Payment System (MIPS) in 2017.

The Centers for Medicare & Medicaid Services has made no secret that it would like to see these physicians eventually team up for the program’s other track-advanced alternative payment models (APMs)-through care models such as the Comprehensive Primary Care Plus.

For physicians looking to join an APM, there are more incentives and opportunities for bonus payments, but several issues to consider before making the leap.

Here are 6 questions a practice should ask as it considers becoming part of an APM.

1. Why does your practice want to participate in the APM track?
First, it’s important for physicians and practice owners to determine how the chosen model will benefit both the practice and its patients. “Ultimately, you should participate in MIPS or an APM because it is also going to help your practice and care for patients improve,” says David J. Zetter founder of Zetter Healthcare Management Consultants in Mechanicsburg, Pennsylvania. “A practice needs to understand what they are getting into and what is in it for them.”

2. Will the APM require changes to the practice and/or additional resources?

Zetter says practices should understand their responsibilities in the APM, including what type of reporting is required and what resources partners are required to have. Examining the changes needed and ensuring they are in line with the goals and values of practice ownership is a must, he says.

3. Are the operations of the APM feasible-both for the practice and for others?

Kim Sweet, CHSPA, CHP, healthcare resource administrator for healthcare consultancy ScrogginsGrear, says practices need to determine the ease or difficulty when building the system, processes and infrastructure that make the APM operational. One example Sweet cites is the possibility of having to add staff such as diabetes educators or nutritionists. This would be staff practices would not normally hire without cost justifications, but could be necessary to participate in the APM. There could also be the cost and time to add new technology for the administrative side of the practice. This doesn’t generate immediate revenue and could be a pretty large initial expense. Practices should also inquire what support the APM will provide to help the practice through the process of implementation.

4. Will APM participation affect profits?

Knowing this-and whether the practice can sustain the model either way-is essential, says Zetter. “Practices need to know what additional costs can be absorbed or made up to ensure its bottom line doesn’t suffer,” he says. It’s also important to know how revenue changes will affect each owner’s stake in profits.

He advises determining all reasons for and effects of implementing or participating in an APM, including any additional costs. Practices can determine costs and possible revenue effects to build out a business plan to determine to the possible impact on their profits.

5. What is the scale of the APM?

Practices should understand the size and scope of the APM in terms of the services it provides to participants as well as how many other partners are in the model. “Evaluate how your practice would participate with an APM, such as those that may target end-stage renal disease and dialysis treatments or those whose core is in metropolitan and urban areas. The difference on a practice could be success or failure if you are not set up to work with the right environment or not in line with the costs that may be incurred due to the APM’s requirements,” Sweet says.

6. Is there payer support?
Sweet advises practices to investigate whether there are enough payers - outside of Medicare - participating in the model or aligned with it to create a strong, supportive relationship for practices. She notes that the answer will depend on specialty or location, for example, but practices should consider payer support when gauging the potential for success.