The Society for Vascular Surgery Alternative Payment Model Taskforce document explores the drivers and implications for developing objective value-based reimbursement plans for the care of patients with peripheral arterial disease (PAD). The Alternative Payment Model (APM) is a payment approach that highlights high-quality and cost-efficient care and is a financially incentivized pathway for participation in the Quality Payment Program (QPP), which aims to replace the traditional fee-for-service payment methodology. Currently, the participation of vascular specialists in APMs is hampered due to the absence of dedicated models. The increasing prevalence of PAD diagnosis, technological advances in therapeutic devices and the rising cost of care of the impacted patients has financial consequences on care delivery models and population health. The document summarizes the existing measurement methods of cost, care processes, and outcomes using payor data, patient reported outcomes, and registry participation. The document also evaluates the existing challenges in the evaluation of PAD care including intervention overuse, treatment disparities, varying clinical presentations, and the effects of multiple comorbid conditions on the cost that is potentially attributable to the vascular interventionalists. Medicare reimbursement data analysis also confirmed the prolonged need for additional healthcare services after vascular interventions. The Society for Vascular Surgery proposes that a PAD APM should provide patients with comprehensive care using a longitudinal approach with integration of multiple key medical and surgical services. It should maintain appropriate access to diagnostic and therapeutic advancements while eliminating unnecessary interventions. It should also decrease variability in care but must consider the varying complexity of the presenting PAD conditions. Enhanced quality of care and physician innovation should be rewarded. In addition, provisions should be made within an APM for high risk patients who carry the risk of exclusion from care due to naturally associated high costs. Although the document demonstrates clear opportunities for quality improvement and cost savings in PAD care, continued PAD APM development requires assessment of more granular data for accurate risk adjustment in addition to large scale testing before public release. Collaboration between payors and physician specialty societies remains key.
Copyright © 2020. Published by Elsevier Inc.