Issue link: https://beckershealthcare.uberflip.com/i/827052
49 CODING & BILLING How Specialty Specific Alternative Payment Models Could Revolutionize ASC Care By Eric Oliver S pecialty physicians, including gastroenterologists, are struggling to participate as the healthcare arena adapts to alternative payment models. At a recent Medicare Payment Advisory Commission meeting, several commissioners noted the lack of opportunities for special- ists to enter into Advanced APMs. Proposals introduced in late 2016 could change that. The Illinois Gastroenterology Group submitted the "Project Sonar Advanced APM" and the Digestive Health Network proposed its "Comprehensive Colonoscopy Advanced APM for Colorectal Cancer, Screening, Diagnosis and Surveil- lance" models to the HHS Payment Model Technical Advi- sory Committee, which could allow specialty physicians to participate in APMs. e Digestive Health Physicians Association and its Vice Chair Dr. Michael Weinstein support the measures. Dr. Weinstein says the specialty fields need these models as APMs currently do not meet specialty medicine's unique needs. "Specialists, whether they're gastroenterologists or another kind, are le out of participating in these models because we don't do primary care," Dr. Weinstein says. "e problem with specialists working with primary care APMs is that we are sub- contractors with not enough risk to qualify for exemption from MIPS. We basically end up doing fee-for-service for an ACO." e proposals entered public comment in December 2016, and although CMS expressed interest in them, they are years away from implementation. Yet, Dr. Weinstein and the DHPA al- ready see the potential of these policies for gastroenterologists. For example, ASCs perform 50 percent of eligible colonosco- pies today, despite centers' abilities to perform the procedure at costs lower than hospital outpatient settings, Dr. Weinstein says. With specialty APMs, ASCs would be a more attractive option for colonoscopies as CMS lowers reimbursement. Dr. Weinstein believes up to 80 percent of colonoscopies could shi to ASCs as a result. "If the value is set there, it will be a huge driver to move the patients out of hospital outpatient departments," he says. e DHPA is not alone in its support. e Digestive Health Net- work, which draed the colonoscopy-facing proposal, pledged the support of the 1,000 physicians that make up the network. In a letter signed by DHPA President Fred Rosenberg, MD, and Chair of Health Policy Lawrence Kim, MD, the organization said of the colonoscopy-facing proposal, "is is precisely the type of forward thinking physician focused payment model that this Committee should embrace, and DHPA recommends that CMS implement this proposed payment model as a high priority."