School of Medicine and Health Sciences Poster Presentations

Title

The Current and Future State of Alternative Payment Models (APMs) in Emergency Medicine

Poster Number

251

Document Type

Poster

Status

Medical Student

Abstract Category

Health Policy and Management

Keywords

Payment, emergency medicine, quality, measures

Publication Date

Spring 2018

Abstract

With the recent push for the U.S. healthcare system to improve the quality and cost-efficiency of care, the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 was signed into law. MACRA shifted U.S. healthcare payment structures from a traditional volume-driven fee for service (FFS) model to value-based alternative payment models (APMs). However, the utilization, impact, and future of APMs in the emergency department (ED) is still ambiguous. This study aims to provide an overview of the current and future state of APMs in emergency medicine, through qualitative interviews with key opinion leaders such as healthcare administrators and leaders of emergency physician groups.

Interviews were semi-structured, following a basic outline and modified according to the participants’ specific expertise and direction of discussion. All transcripts were reviewed by three investigators to identify general themes and generate a codebook using grounded theory for qualitative analysis. Preliminary analysis revealed several unifying themes. A common sentiment among participants was that current quality measurements focused heavily on process rather than outcome measures. Other common themes included the ED being overlooked by other stakeholders in the APM space, inadequate financial incentives to modify physician behavior, and hesitation among some emergency physicians to transition away from traditional fee for service models. In regards to future outlook, opinions were mixed. Some participants viewed the transition to APMs as a loss of compensation and autonomy of practice, while others viewed value-based payments as an opportunity to transform and enhance the role of emergency medicine. By revealing the barriers and opportunities of APMs in ED, we hope to provide direction for future studies on how to address common issues and facilitate a successful transition for emergency medicine into value-based care.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

1

Comments

Presented at GW Annual Research Days 2018.

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The Current and Future State of Alternative Payment Models (APMs) in Emergency Medicine

With the recent push for the U.S. healthcare system to improve the quality and cost-efficiency of care, the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 was signed into law. MACRA shifted U.S. healthcare payment structures from a traditional volume-driven fee for service (FFS) model to value-based alternative payment models (APMs). However, the utilization, impact, and future of APMs in the emergency department (ED) is still ambiguous. This study aims to provide an overview of the current and future state of APMs in emergency medicine, through qualitative interviews with key opinion leaders such as healthcare administrators and leaders of emergency physician groups.

Interviews were semi-structured, following a basic outline and modified according to the participants’ specific expertise and direction of discussion. All transcripts were reviewed by three investigators to identify general themes and generate a codebook using grounded theory for qualitative analysis. Preliminary analysis revealed several unifying themes. A common sentiment among participants was that current quality measurements focused heavily on process rather than outcome measures. Other common themes included the ED being overlooked by other stakeholders in the APM space, inadequate financial incentives to modify physician behavior, and hesitation among some emergency physicians to transition away from traditional fee for service models. In regards to future outlook, opinions were mixed. Some participants viewed the transition to APMs as a loss of compensation and autonomy of practice, while others viewed value-based payments as an opportunity to transform and enhance the role of emergency medicine. By revealing the barriers and opportunities of APMs in ED, we hope to provide direction for future studies on how to address common issues and facilitate a successful transition for emergency medicine into value-based care.