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FEDERAL | Making MACRA Work for Plastic Surgeons – Working to Develop Alternative Payment Models

Over the last nine months, ASPS has partnered with the American College of Surgeons, Brandeis University and the Center for Surgery and Public Health at the Brigham and Women's Hospital to develop a comprehensive Alternative Payment Model (APM) framework, spanning across the phases of care.

APMs can offer greater flexibility in care delivery, but may also include financial losses if the cost of care exceeds what is expected. Many specialties currently lack opportunities to meaningfully participate in APMs due to their geography, practice patterns or a lack of models covering their specific specialty or the specific type of care they provide.

The patient-focused philosophy of the Brandeis APM model does not require a hospitalization, which allows the framework to be applicable to multiple care settings. It also recognizes that surgical care is team-based, and that coordination with specialists, primary care physicians and all the other segments of the delivery system plays an important role in improving outcomes. Further, it recognizes that all surgical patients experience the same phases of surgical care during the course of their treatment. These phases involve: key processes, shared decision making, critical care coordination with primary care physicians, anesthesia and other specialists, as well as the technical components of surgical care relating to: safety, outcomes and prevention of avoidable harms. Metrics that broadly apply to almost all surgeons, span across the various phases of surgical care, and can have a real impact at the point of care have been identified.

As required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the proposal was recently submitted to the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which makes comments and recommendations to the Secretary of the Department of Health and Human Services (HHS) on the feasibility of all APM proposals.

Letters of support sent to the PTAC have recognized the value of this new model, which represents an effective way to improve quality, coordinate care and lower cost while increasing both patient and provider engagement. While it focuses primarily on procedural episodes, future goals include extending the program to other forms of specialty care including care for acute and chronic medical conditions.

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