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Physician-Focused Payment Model Technical Advisory Committee (PTAC) Votes on Four Proposals

March 30, 2018

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PRESS CONTACTS
Kate Ogden, Physician Payment & Quality Specialist

March 26, 2018, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) met to discuss and vote on four proposals for physician-focused payment models. MACRA created the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to provide physicians with an avenue to develop new care models that would qualify as Advanced Alternative Payment Models (APMs) under the Quality Payment Program.

Two models were recommended to the Secretary of HHS for limited-scale testing:

  • Patient and Caregiver Support for Serious Illness submitted by the American Academy of Hospice and Palliative Medicine (AAHPM)
    • Five year demonstration of payment for team-based palliative care services for beneficiaries who meet specific diagnostic, functional status, and utilization criteria. Payment for this model is either through tier-based monthly care management payments, or financial incentive tracks.
  • Advanced Care Model (ACM) Service Delivery and Advanced Alternative Payment Model submitted by the Coalition to Transform Advanced Care (C-TAC)
    • Payment model for palliative care services for beneficiaries in the last twelve months of life who meet specific criteria, provided by a care team that includes health care providers, as well as other providers to address social/mental/emotional needs. Payment for this model is made through a per member per month payment, and bonus payments or shared losses based on total cost of care.

Two models were recommended to the Secretary of HHS for implementation:

  • Home Hospitalization: An Alternative Payment Model for Delivering Acute Care in the Home submitted by Personalized Recovery Care, LLC
    • Payment model to allow beneficiaries who would otherwise require inpatient hospitalization to receive hospital-level acute care services in the home. Thirty days of services, encompassing both an acute care and post-acute care phase would be supported by a bundled home hospitalization payment, and a performance-based payment.
  • Intensive Care Management in Skilled Nursing Facility Alternative Payment Model submitted by Avera Health
    • A geriatrician-led team would partner with skilled nursing facilities (SNFs) and nursing facilities to supplement the facilities’ on site staff via telehealth, with the goal to reduce avoidable emergency department visits and hospitalizations, and lower costs for patients in SNFs and nursing facilities (based on a CMMI Health Care Innovation Round Two Demonstration project).

These models will be submitted to the Secretary to consider for implementation. It is unclear when the Secretary will make a decision regarding whether or not to implement these models.

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