Tuesday, 13 December 2016 18:29

PTAC to Play Pivotal Role in Move Toward VBP Featured

Written by Kim Charland, BA, RHIT, CCS with contributor Rhonda Taller, MHA

While there has been and will be a great deal of focus on the movement from volume-based to value-based payments in healthcare, less publicized is the work of an advisory committee with an important role in this journey. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created the Physician-Focused Payment Model Technical Advisory Committee (PTAC) with a charter directing that the group comment and make recommendations to the Secretary of the U.S. Department of Health and Human Services  (HHS) on physician-focused payment model (PFPM) proposals submitted.  PTAC is an 11-member committee assembled via appointment.

While PTAC recommends on proposals, the Secretary of HHS decides on whether and when to implement PFPMs. PTAC approximates that the review and recommendation process will take 16 weeks. PTAC began accepting letters of intent as of Oct. 1, and proposals as of Dec. 1.

PTAC anticipates that recommendations on initial proposals submitted will occur in spring of 2017. Options that PTAC could consider for PFPMs include: a) not recommending a model to move forward to the Secretary of HHS for consideration; b) limited-scale testing of a proposed model; c) implementation of a proposed model; and d) implementation of a proposed model as a high priority. Each proposal will be assessed on criteria for PFPMs established by the Secretary of HHS, as required by MACRA. There are 10 criteria for model consideration, three of which are considered a high priority for each proposal to meet. The criteria are noted below, with high-priority items bolded:

  • Scope of proposed PFPM: Does the model broaden or expand the Centers for Medicare & Medicaid Services (CMS) alternative payment model (APM) portfolio by addressing a payment policy issue in a new way, or does the model include entities that have had limited opportunities to participate in APMs?
  • Quality and cost for model: Does the model improve healthcare quality at no additional cost, maintain healthcare quality while decreasing cost, or both improve healthcare quality while decreasing cost?
  • Payment methodology: Does the model pay APM entities with a methodology that would achieve goals overall as it pertains to PFPM criteria? Questions to be answered would include how the PFPM payment methodology is different than current methodologies available for payment and why the model cannot be tested under current payment methods.
  • Value over volume
  • Flexibility
  • Ability to be evaluated
  • Integration and care coordination
  • Patient choice
  • Patient safety
  • Health information technology

PTAC uses a public comment process for review of documents released, as well as meetings open to the public on a quarterly basis. PTAC’s next public meeting is scheduled for Dec. 16. Additional information on PTAC, including its charter, FAQs, biographical information for members, guideline documents for submission of PFPMs, archives of past meetings, etc. can be found online at: https://uspe.hhs.gov/ptac-physician-focused-payment-model-technical-advisory-committee.

About the Author

Kim Charland is the editor of VBPmonitor and the senior vice president of clinical innovation with Panacea Healthcare Solutions. Kim has 30 years of experience in health information and reimbursement management for hospitals and physician offices. Kim’s primary role with Panacea is publisher of VBPmonitor.com, which is the company’s newest online monitor and is focused on value-based purchasing and quality. She is also co-host of ICD10monitor.com’s Internet news broadcast Talk-Ten-Tuesdays. In addition, she assists with product development for Panacea’s consulting and software divisions, as well as the MedLearn publishing division. Kim is also recognized as a national speaker who has spoken for numerous organizations. Kim is also the president-elect for the New York Health Information Management Association.

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Last modified on Wednesday, 14 December 2016 23:12