December 3, 2024 – Jacksonville, FL
The Centers for Medicare & Medicaid Services (CMS) is revolutionizing primary care management through the Advanced Primary Care Management (APCM) program, a groundbreaking approach that reimagines healthcare delivery for Medicare beneficiaries. Set to launch on January 1, 2025, this new model differs significantly from existing Chronic Care Management (CCM) and Principal Care Management (PCM) programs.
What is APCM?
APCM is a new care management model that introduces three risk-stratified billing codes, fundamentally different from existing Chronic Care Management (CCM) and Principal Care Management (PCM) programs. Unlike its predecessors, APCM focuses on comprehensive, patient-centered care without strict time-based requirements.
The Three APCM Codes
– Cost: $10 per patient per month
– Target: Patients with one or no chronic illnesses
– RVU Value: 0.17
– Focuses on preventative care and ongoing healthcare services
– Cost: $50 per patient per month
– Target: Patients with two or more chronic conditions
– RVU Value: 0.77
– Addresses patients at significant risk of health decline
– Cost: $110 per patient per month
– Target: Qualified Medicare Beneficiaries (QMBs) with complex health needs
– RVU Value: 1.67
– Provides intensive care for the most vulnerable patients
Key Differences from CCM and PCM
APCM distinguishes itself through several innovative features:
Unlike CCM and PCM, which focus on patients with specific chronic conditions, APCM can potentially cover every Medicare patient receiving primary care. Breaking from traditional models, APCM is not time-based, has no minimum time requirements and billing is based on patient risk stratification. For quality measurement, APCM requires mandatory participation in measuring care quality. Payments are linked to the Merit-based Incentive Payment System, with reporting set to begin in 2026 based on 2025 performance data.
These features represent a significant evolution in Medicare care management, offering a more flexible and comprehensive approach to patient care.
Who Can Participate?
While primarily designed for primary care specialties like family medicine, internal medicine, and geriatric medicine, the program is open to specialists managing primary care for complex patients. The critical requirement is serving as the primary coordination point for all patient healthcare needs.
Service Requirements
APCM mandates 13 comprehensive service elements, including:
APCM represents a transformative approach to Medicare care management, prioritizing patient-centered, flexible, and outcome-focused primary care. By introducing risk-stratified codes and emphasizing comprehensive care, CMS aims to improve healthcare accessibility and effectiveness for Medicare beneficiaries.
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