Alternative Payment Models

News in Urology Alternative Payment Models Deepak A. Kapoor, MD,1 Neal D. Shore, MD, FACS2 1Chairman, Health Policy, LUGPA; Chairman and CEO, Integrated Medical Professionals, PLLC; Clinical Associate Professor of Urology, Icahn School of Medicine at Mount Sinai, Melville, NY; 2President, LUGPA; Medical Director, CPI, Carolina Urologic Research Center; National Urology Research Director, 21st Century Oncology, Atlantic Urology Clinics, Myrtle Beach, SC [Rev Urol. 2017;19(3):198–199 doi: 10.3909/riu193NewsinUro] ® © 2017 MedReviews , LLC A lternative payment models (APMs) present a significant opportunity to engage the physician community as partners in our healthcare system’s critical evolution to value-based care. However, the development of APMs is costly and time consuming; after submission, the proposals are subject to a cumbersome multilayered review process. To date, not a single such model has been approved for implementation; consequently, most physicians are excluded from participation in valuebased care payment structures. As a specialty, urology is particularly impacted—Centers for Medicare & Medicaid Services (CMS) reports that only 0.8% of urologists nationally will participate in value-based payment models in 2017. Ironically, perhaps no disease state is more suited for alternative payment models than prostate cancer, a disease diagnosed and managed almost universally by urologists. Although prostate cancer remains a leading cause of cancer related death in the United States, contemporary data suggests that as many as 40% of men newly diagnosed with prostate cancer will have relatively low-risk disease and may be able to safely defer immediate intervention. Active surveillance affords a select group of patients the opportunity to avoid unnecessary costs and potential side effects associated with prostate cancer therapy without a long-term negative impact on their health outcome. 198 • Vol. 19 No 3. • 2017 • Reviews in Urology However, active surveillance itself is a rigorous clinical pathway that requires close follow-up and ongoing patient education and counseling. Unfortunately, the current Medicare payment systems have not evolved synchronously with scientific advances in our understanding of prostate cancer—there is no compensation to providers for the resources needed to appropriately surveil prostate cancer patients. This has created a misalignment of incentives that promotes intervention—data suggests that 77% of men undergo immediate treatment when diagnosed with localized prostate cancer. The misalignment of payment incentives with clinical best practices in newly diagnosed prostate cancer patients is well recognized by urologists. As will be presented at the national meeting, LUGPA has designed an episode-based APM that corrects this misalignment in incentives, thereby encouraging physicians to recommend active surveillance in clinically appropriate patients with low-risk localized prostate cancer. The proposal, strongly endorsed by the both the American Urological Association and American Association of Clinical Urologists, promotes patient-physician shared decision making, compensating physicians for the time required to responsibly manage patients on surveillance protocols. In addition to optimizing outcomes, increasing beneficiary satisfaction and reducing utilization Alternative Payment Models of unnecessary services, the shared savings in this model enhances revenues for providers while simultaneously saving the Medicare program hundreds of millions of dollars. Over 1400 urologists in LUGPA member practices have voiced their commitment to value-based care in prostate cancer treatment. As an organization, LUGPA is committed the development of APMs that will leverage the quality outcomes and cost savings delivered by independent, integrated practices nationwide. The LUGPA APM for Initial Therapy of Newly Diagnosed Patients with Organ-Confined Prostate Cancer represents the first of many proposals under development, and is one example of value-added benefit to LUGPA membership. Vol. 19 No. 3 • 2017 • Reviews in Urology • 199