AMA HoD Passes Policy to Develop PALTC Alternative Payment Models

June 15, 2018
Policy Snapshot
Centers for Medicare and Medicaid (CMS), Alternative Payment Models (APM), Practitioners

At its Annual House of Delegates (HoD) meeting, the American Medical Association (AMA) passed policy to develop post-acute/long-term care (PALTC)-specific alternative payment models (APMs). Rajeev Kumar, MD, CMD, the Society’s delegate to the AMA, brought the resolution forward and testified, asking for the AMA to advocate for a PA-only type model within the Advanced Bundled Payment for Care Initiative (BPCI). Rather than adopting that policy, the AMA Council on Medical Service recommended that AMA work with interested specialty societies to develop PALTC-specific APMs. The exact language of the adopted policy read:

RESOLVED, That our American Medical Association work with interested national medical specialty societies to help develop and advocate for one or more Medicare alternative payment models focusing on post-acute and/or long-term care. (New HoD Policy)

The Society looks forward to working with its AMA colleagues on developing and advocating for such models.

Further, the AMA HoD reaffirmed its existing policy on waiver for the 3-day hospital stay requirement for risk bearing payment models based on a Society resolution asking that physicians be able to ask for such a waiver in these models.

The Society was also able to testify and help defeat a resolution dealing with mandatory vaccinations for all healthcare workers. The Society has a policy that all PALTC workers should be vaccinated, but the resolution as presented argued that workers could not be fired solely on the basis of refusing to get vaccinated due to religious or other concerns. Many societies opposed the resolution that was ultimately not adopted by the AMA.

Among other PALTC-related items considered at the meeting were the following resolutions:

  • Ensuring Medicare Coverage for Long-Term Care – Asks AMA to identify additional mechanisms by which patients’ out-of-pocket costs for Skilled Nursing Facility (SNF)care can be fairly covered. The resolution dealt with the 20-day Medicare coverage limit before a co-pay is applied.
  • Council on Medical Services Report 5 – Financing of Long-Term Care Services and Supports: The policy outlines concrete steps that need to be taken. Policies are in line with Society policies.
  • Alternative Payment Models and Vulnerable Populations – Asks AMA to study the impact of current APMs and risk adjustment on providers caring for vulnerable populations; and advocate legislatively that advanced APMs examine the evaluation of quality performance of providers caring for vulnerable populations in reference to peer group (similarities in SES status, disability, percentage of dual eligible population).  This item was referred to the Board for study prior to advocating for these items.
  • Medicare Coverage for Dental Services  - Asks AMA to advocate for improved access to dental services for Medicare beneficiaries. The testimony on the resolution was supportive but some raised concerns that since Medicare is a budget neutral program, other services may be reduced. 

The AMA debated a number of current controversial issues including opioids, gun safety, immigration, physician aid in dying, and physician orders for life-sustaining treatment (POLST), and adopted new policies and/or asked the AMA Board of Trustees for further study on these issues.

For full coverage of the meeting, please visit https://www.ama-assn.org/hod-annual-overview