September 15, 2017

PTAC Recommends Physician-Focused Payment Models

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) has recommended two of three proposed Physician-Focused Payment Models (PFPMS) considered at its Sept. 7-8 meeting. This was the second PTAC meeting where the committee deliberated and voted on three PFPMs submitted by stakeholders.

“HaH Plus” (Hospital at Home Plus) Provider-Focused Payment Model, submitted by the Ichan School of Medicine at Mount Sinai (New York City) received a favorable recommendation to the secretary of the Department of Health and Human Service (DHHS) for implementation. The HaH Plus model allows Medicare beneficiaries with acute illness or exacerbated chronic disease to receive hospital-level acute care services in the home instead of standard acute care hospitalization. The model includes the acute episode and an additional 30 days of transition services.

Oncology Bundled Payment Program Using CNA-Guided Care, submitted by Hackensack Meridian Health (New Jersey) and Cota Inc. (Portland, OR), was recommended to the secretary for limited-scale testing. The model proposes a bundled payment method for care of patients with newly diagnosed episodes of breast, colon, rectal and lung cancer. Bundled payments will consist of prospective, comprehensive, bundled payments that include cost of care for the oncology services in the four cancer categories and “unrelated services.” The bundle starts on the day of pathologic cancer diagnosis and covers up to 12 months of services. The model proposes 27 bundles for the four cancer types and these bundles are themselves composed of aggregations of Cota nodal addresses (CNAs). There may be hundreds of CNAs within a bundle, and the assignment of a person to a CNA is determined by numerous demographic, biologic and treatment decision factors.

Advanced Care Model (ACM) Service Delivery and Advanced Alternative Payment Model, submitted by the Coalition to Transform Advanced Care (Washington, DC) was not recommended to the secretary due to changes to the proposal in response to the proposal review team’s (PRT) report a week prior to the PTAC meeting. The ACM alternative payment model would address payment for curative treatment and palliative care of individuals in the last 12 months of their lives. It has two key components: A $400, wage-adjusted per member per month payment (replacing fee-for-service payments to palliative care providers) for up to 12 months; and a shared-risk component based on total cost of care in the last 12 months of life. After much deliberation, PTAC recommended that the submitter revise and resubmit the proposal.

PTAC was authorized by MACRA to make recommendations to the Department of Health and Human Services secretary on the creation, development and operation of PFPMs. Its 11-member board is comprised of physicians and national health care policy experts appointed by the U.S. Comptroller General. Visit the DHHS Office of the Assistant Secretary for Planning and Evaluation website to learn more about PTAC.