Tag Archives: Alternative Payment Models

Why You Should Medicare about Alternative Payment Models

Early in my career, around 1995-96, I was selected by Vice President Al Gore to sit on a senatorial/congressional Sub-Committee to talk about reimbursement for “video teleconferencing for medicine.” I remember Senator John D. “Jay” Rockefeller, IV, the chair, telling us all in the first meeting that “one day, this will be the biggest thing in medicine.” After putting the first “payment plan”11280389_s legislation in motion for telemedicine, we are all still waiting for his statement to come true! Today, at last, we are a few steps closer to his famous statement…

“Simplicity is the soul of efficiency.” –Austin Freeman

If this quote is true, and I believe it is, it is not surprising that telemedicine had a slow start when it was introduced to health care. The technology itself has never been overly complicated, however navigating the ever winding web of HIPPA compliance and the insurance systems payment models stifled any growth that telemedicine was poised to show early on.

As of late, that has all started to change. Many technologies now actively address patient privacy, encryption, and secure data storage that mitigate any potential threats to the security of patient’s medical information. Many states are also now passing legislation to make sure that telemedicine services are paid by insurance companies just like in person visits would be. And the Centers for Medicare and Medicaid Services, (CMS), have put quotas into place for services that need to be billed using Alternative Payment Models (APM).

What is an APM exactly and what is the purpose of promoting them?

“All alternative payment models (APM) and payment reforms that seek to deliver better care at lower cost share a common pathway for success: providers, payers, and others in the health care system must make fundamental changes in their day-to-day operations that improve quality and reduce the cost of health care.” –CMS

The take away here is that better care at a lower cost requires “fundamental changes” in the way healthcare providers run their operations. And as we all know, change is never easy. There must be some promise of reward to drive it forward, which is why APMs are so important. They provide the pathway for change by providing stronger incentives to do so.

Telemedicine services fall squarely in the wheelhouse of APMs as they promote physician efficiency, improve access to and potential quality of care, and can be provided for a fraction of the cost of face to face visits. It is for these reasons that CMS is aiming to grow payment of services paid through APMs to 30% of all services by the end of this year (2016) and to 50% of all services by 2018. The 2018 goal also links 90% of all payments through all payment models to quality of care, not just a fee for a service.

No longer will patients be paying for “time” in front of a medical professional, but their care and the payment of it will be more directly linked to the value of the service provided. Providers will be incentivized for providing the best quality of care in the most efficient manner possible or they may not be paid at all.

The question then is not whether or not healthcare practices and facilities will be substantially affected by APMs, but rather if they are ready to provide services like telemedicine that fit the bill. With the amazing advantages in technology like those in Web RTC and several technology grant programs being offered today, there really are very few reasons that forward thinking healthcare organizations shouldn’t be ramping up their telemedicine services ASAP.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.


#1: https://www.cms.gov/

#2: https://innovation.cms.gov/initiatives/Health-Care-Payment-Learning-and-Action-Network/

#3: http://blog.avidex.com/breaking-through-the-telemedicine-payment-barrier/

#4: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

#5: http://blog.avidex.com/just-browsing-webrtc-for-healthcare/

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com