Lowder JL, Barker MA, Ferzandi T, Gardiner H, Hall EF, Nihira M, Holzberg A, Hurtado E, Patton S, Rathbun J, Shepherd JP, Biller D. Developing an Advanced Alternative Payment Model for Stress Urinary Incontinence. Female pelvic medicine & reconstructive surgery. 2021 Dec 1;27(27). 217-222. PMID: 33315626 [PubMed]
Historically, our health care system has been based on a fee-for-service model, which has resulted in high-cost and fragmented care. The Center for Medicare & Medicaid Services is moving toward a paradigm in which health care providers are incentivized to provide cost-effective, coordinated, value-based care in an effort to control costs and ensure high-quality care for all patients. In 2015, the Medicare Access and Children's Health Insurance Program Reauthorization Act repealed the Sustainable Growth Rate and the fee-for-service model, replacing them with a 2-track system: Merit-based Incentive Payment System and the advanced Alternative Payment Model (aAPM) system. In 2016, the American Urogynecologic Society Payment Reform Committee was created and tasked with developing aAPMs for pelvic floor disorders. The purpose of this article is to describe the stress urinary incontinence aAPM framework, the data selected and associated data plan, and some of the challenges considered and encountered during the aAPM development.