November 10, 2017

House Energy and Commerce Health Subcommittee Reviews APM

The House Energy and Commerce Committee heard testimony Nov. 8 exploring how enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) encourages physicians to move away from traditional fee-for-service and into risk-based alternative payment models (APMs).

The hearing came on the heels of the Centers for Medicare & Medicaid Services’ (CMS’s) Nov. 2 release of the Calendar Year 2018 Quality Payment Program final rule.

The movement toward risk-based APMs continues as part of a federal strategy to reimburse physicians for the value of health care for their patients instead of the volume of delivered services. Federal lawmakers recognized, however, as they crafted The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that many classic APMs, such as two-sided Accountable Care Organizations (ACOs) and the primary care Comprehensive Care Plus model, were too narrowly focused toward primary care physicians to be easily adopted by medical specialists.

As a result, MACRA includes provisions incentivizing providers to develop physician-focused payment models (PFPMs). To facilitate PFPMs, MACRA established the Physician-Focused Payment Model Technical Advisory Committee (PTAC), an 11-member panel of physician and non-physician payment model experts, to make comments and recommendations to the Department of Health and Human Services (HHS) and CMS on the merits of these innovative ways to deliver patient care.

House Energy and Commerce Health Subcommittee Chairman Michael Burgess, MD, (R-TX) invited Jeffery Bailet, MD, and Elizabeth Mitchell, who are chair and vice chair of PTAC, respectively, to describe their ongoing efforts to foster the adoption of innovative payment models. Bailet and Mitchell reported that PTAC received 33 letters of intent and 20 full proposals spanning many specialties, payment types and practice sizes, since starting to accept formal applications on Dec. 1, 2016. PTAC has also held nine days of public meetings, deliberated on six proposals, voted on five models and submitted reports on these pending concepts to the HHS Secretary. Fourteen pending payment model applications are still under active review, as well.

Despite the promising start, Bailet and Mitchell urged Congress to consider modest changes to the MACRA statute to permit PTAC to more easily meet its mandate. PTAC requested formal legislative authority to provide applicants with technical assistance on pending APMs, greater access to shared data to provide better advice on how to properly manage financial risk and the ability to conduct limited-scale testing of innovative payment models.

Burgess also invited representatives from various medical specialty societies and hospital organizations to testify about their interaction with the PTAC. Witnesses included:

  • Frank Opelka, MD, medical director, Quality and Health Policy, American College of Surgeons
  • Bill Wulf, MD, chief executive officer, Central Ohio Primary Care Physicians; CAPG
  • Colin Edgerton, MD, American College of Rheumatology
  • Brian Kavanagh, MD, MPH, FASTRO, professor and chair, Department of Radiation Oncology, University of Colorado School of Medicine, and president, American Society for Radiation Oncology (ASTRO)
  • Daniel Varga, MD, chief clinical officer, Texas Health Resources; Premier Inc.
  • Louis Friedman, MD, American College of Physicians  

All six witnesses expressed strong support for PTAC and described their excitement about the opportunity to develop APMs. The various medical specialty societies and hospital organizations believe their innovative delivery system reforms will lead to better care at lower costs. As a result, they anticipate positive PTAC recommendations.

Despite favorable accounts, witnesses expressed uncertainty about what CMS will ultimately permit following a positive review by PTAC. Under current law, CMS is ultimately responsible for permitting implementation of an APM within Medicare, irrespective of PTAC’s recommendation. Since no HHS representative was invited to testify, lawmakers pledged to get better information about the agency’s plans for APMs that receive favorable PTAC recommendations.

Burgess also indicated that a similar hearing is likely soon to gain an update on the process for implementation of MACRA’s Merit-based Incentive Payment System (MIPS).

American College of Radiology (ACR) members are encouraged to monitor ACR Advocacy in Action eNews for ongoing reports on MACRA implementation.