DateApril 13, 2017
 
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PTAC Recommends Two Payment Models for Limited-Scale Testing

The Physician-Focused Technical Advisory Committee (PTAC) met April 10-11, 2017, in Washington, DC, to review three proposed payment models. PTAC recommended two of the models, Project Sonar and the ACS-Brandeis Advanced Alternative Payment Model (APM), to CMS for limited-scale testing. PTAC rejected the third proposal, the COPD and Asthma Monitoring Project. A fourth proposal, the Comprehensive Colonoscopy Advanced APM for Colorectal Cancer Screening, Diagnosis and Surveillance, was scheduled to be reviewed but was withdrawn prior to the meeting.

 

While PTAC did not recommend the COPD Asthma Monitoring Project, PTAC felt it had promise but needed to be further developed before it could be implemented, even on a limited-scale.

PTAC Process

A vote by PTAC results in one of the following decisions directed to CMS:

  • Not recommended;
  • Recommended for limited-scale testing;
  • Recommended for implementation; or
  • Recommended for implementation as a high priority.
Proposal Preliminary Report Team Final PTAC Vote
Project Sonar
Specialty-based intensive home for “high beta” chronic disease such as Crohn’s Disease
Does Not Recommend Recommend for Limited-Scale Testing
PTAC believes technical assistance is needed
COPD and Asthma Monitoring Project 
COPD and asthma patients receive Bluetooth peak flow meter; data transmitted to central server, which through monitoring and management could trigger clinical intervention to reduce early exacerbation and provide for a timely response to infection detection
Does Not Recommend Does Not Recommend
Final report will include very supportive language; PTAC believes model has promise but needs to be further developed before implementation
ACS-Brandeis Advanced APM
Episode-based payment model using updated version of Episode Grouper (EGM) developed by CMS and Brandeis
Does Not Recommend Recommend for Limited-Scale Testing
PTAC believes technical assistance is needed
Comprehensive Colonoscopy APM
For colorectal cancer screening, diagnosis and surveillance
Does Not Recommend Withdrawn


Path to Model Implementation

CMS will make the final decision on which models to implement. A detailed response to the PTAC recommendations will be posted on the CMS website. Models approved by CMS will be implemented by the Innovation Center.

While practically speaking, the internal dynamics for selection and implementation of PTAC recommended models is still being determined, a number of factors, beyond the PTAC recommendation, may influence their ultimate decision.

  • MACRA Criteria: Does this model meet the MACRA criteria for an Advanced APM?
  • Ease of Implementation: How difficult will it be to implement this model?
  • Overall CMS Strategy: How does this model fit into the overall CMS strategy for APM development? Will this model address
  • Timing: What is the capacity and priorities of the agency at the specific time the model is proposed?

PTAC is next scheduled to meet in June 2017.

 

Established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), PTAC is tasked with providing comments and recommendations to CMS on physician payment models. The Committee includes 11 members who are nationally recognized for their expertise in physician-focused payment models and related delivery of care. More information on PTAC is available on their website.

 

The McDermottPlus PTAC Proposal Tracker is available here.

McDermottPlus presentation on the PTAC proposal process is available here.

 


For more information visit the McDermottPlus MACRA Resource Center or contact Sheila Madhani at 202-204-1459, smadhani@mcdermottplus.com.