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The “Exit Polls”: Initial Thoughts on PTAC’s First Meeting

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May 11th, 2017

Background

The Centers for Medicare and Medicaid Services (CMS) has initiated a process whereby physicians and other stakeholder entities can design physician-focused payment models (PFPMs) that fit with their clinical practices, while also providing better outcomes for patients, and recommend such models to the Health and Human Services Secretary (the Secretary) for consideration and/or further testing. This bottom-up approach recognizes that the current list of Advanced Alternative Payment Models (Advanced APMs) identified by CMS under MACRA is not representative of the universe of APMs and does not necessarily include models that work for all provider types, thereby excluding them from the financial benefits of participation.

PTAC

The Physician-Focused Payment Model Technical Advisory Committee (PTAC), created under MACRA, determines which PFPMs to recommend to the Secretary. This decision is based, in large part, on whether the proposed PFPMs meet certain criteria set forth by the Secretary. The PFPM criteria were intentionally designed to be broad enough to consider all physician specialties and provide flexibility in designing PFPMs. Three of the ten criteria are deemed “high priority,” and are expected to be given particular emphasis during PTAC deliberations:

  • Scope of Proposed PFPM – The model should directly address an issue in payment policy that broadens and expands the CMS APM portfolio.
  • Quality & Cost – The model should aim to improve health care quality at no additional cost, maintain health care quality while decreasing cost, or both improve health care quality and decrease cost.
  • Payment Methodology – The model should address how Medicare and other payers, if applicable, pay APM Entities and how the payment methodology differs from current payment methodologies.

April 2017 PTAC Meeting

The PTAC met on April 10-11, 2017 to deliberate and vote on three proposed models. HHS Secretary Price attended the meeting and voiced his support for provider-focused model development.[1] A brief overview of each model and the committee’s recommendation is outlined below:

  • Project Sonar: A care management program that uses a web-based or mobile-based platform to ‘ping’ patients at least once per month to submit self-assessment data, enabling nurse care managers to better meet their needs. Recommended with limited-scale testing.
  • ACS-Brandeis Advanced Alternative Payment Model: An episode-based payment model that uses claims data to innovatively nest acute episodes within chronic episodes of care. This model is broadly applicable to clinicians, regardless of specialty. Recommended with limited-scale testing.
  • COPD & Asthma Monitoring Project (CAMP): Participating COPD and asthma beneficiaries receive care through remote interactive monitoring and transmission to a central server, which can trigger early clinical interventions to reduce negative outcomes. Not recommended due to uncertainty with payment methodology and risk adjustment details.

Implications for Future PFPMs

Although it is still early, the first PTAC meeting sends some key signals about the future of PFPMs. Secretary Price’s comments at the PTAC meeting, along with CMS Administrator Verma’s comments at a recent LAN forum indicating strong CMS support for the PTAC, signal continued interest from the current administration for the creation of provider-focused models.

Bottom-up innovation can lead to increased physician buy-in as well as a better informed and more diverse model portfolio. Leavitt Partners believes that it will only be through a large and diverse portfolio of payment model options that APMs can become the dominant payment/delivery model. Providers, including specialists, need options and PFPM’s provide a vital opportunity for them. However, smaller organizations that do not have the ability to effectively evaluate all the payment technicalities still appear to be at a disadvantage. Leavitt Partners sees value in tracking all submitted proposals, regardless of the PTAC vote. We will begin to better understand what the industry wants from APMs, what model elements and payment types are most desired, and which types of providers are most engaged.

The next PTAC public meeting will be held on Monday, June 5, 2017 from 9:00 am to 4:00 pm ET. Additionally, there is a three-week period for submission of public comments via email.

[1] Department of Health & Human Services. “Remarks to the Physician-Focused Payment Model Technical Advisory Committee.” Accessed on May 6, 2017. Available at: https://www.hhs.gov/about/leadership/secretary/speeches/2017-speeches/remarks-to-physician-focused-payment-model-technical-advisory-committee/index.html

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