June 21, 2018

HHS Secretary Responds to PTAC APM Submissions

Alex Azar, secretary of Health and Human Services (HHS), responded on June 13, 2018, to comments and recommendations transmitted to HHS from fall 2017 to spring 2018 by the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

Azar announced none of the twelve proposed Alternative Payment Models (APMs) put forth by PTAC will be implemented as proposed, though he expressed interest in the Coalition to Transform Advanced Care’s (C-TAC) Advanced Care Model (ACM) and the American Association of Hospice and Palliative Medicine’s (AAHPM) Patient and Caregiver Support for Serious Illness (PACSSI) model.

PTAC is statutorily mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It is tasked with reviewing proposals for physician-focused payment models, preparing comments and recommendations on such proposals and explaining whether they meet criteria established by the HHS secretary. These comments and recommendations are then provided to the secretary for consideration.

PTAC uses 10 criteria from the 2016 MACRA final rule for evaluating APM submissions. These criteria are value over volume, flexibility, quality and cost, payment methodology, scope, ability to be evaluated, integration and care coordination, patient choice, patient safety, and health information technology. Though Azar’s comments touched on many of these criteria, most of his concerns involved proposed payment methodologies, the comprehensiveness of quality measures, patient eligibility and the use of proprietary software.

PTAC has been waiting for the secretary’s feedback to determine how to steer its future submissions toward better success and hopefully acceptance leading to testing by the Center for Medicare and Medicaid Innovation. PTAC will continue to evaluate proposed models to determine if they meet the secretary’s criteria for approving them for limited-scale testing, implementation or implementation with a high priority, or if his criteria lead the secretary to not recommend its proposals. PTAC will meet again in early September.