The Physician-Focused Payment Model Technical Advisory Committee (PTAC) released updated submission guidelines. Established by the Medicare Access and CHIP Reauthorization Act (MACRA), PTAC reviews proposals submitted by the public on physician payment models and provides comments and recommendations to the Secretary of the US Department of Health and Human Services (HHS) on physician payment models. The changes in the updated submission guidelines reflect public feedback on its processes and requirements.

The updated PTAC recommendation categories are:

• Not Recommended for Implementation as a Physician Focused Payment Model (PFPM)
• Recommended
  • Proposal substantially meets Secretary’s criteria for PFPMs. PTAC recommends implementing the proposal as a payment model.
  • PTAC recommends further developing and implementing the proposal as a payment model as specified in PTAC comments.
  • PTAC recommends testing the proposal as specified in PTAC comments to inform payment model development.
  • PTAC recommends implementing the proposal as part of an existing or planned CMMI model.
• Recommended for other attention by HHS

The Centers for Medicare and Medicaid Services (CMS) makes the final decision on which models to implement. While PTAC has recommended a number of models for implementation, CMS has yet to propose implementation of any of these models. In response to concerns that no PTAC models have yet to be implemented, CMS released a fact sheet titled “Value Considerations for Model Development and Testing.”

CMS indicated that they are working to develop new potential models that build on ideas from the proposed models recommended by PTAC. They also announced four areas of focus for payment model development: patients as consumers, providers as accountable patient navigators, payment for outcomes and prevention of disease before it occurs. It is anticipated that the agency will be proposing new payment models by the end of January or early February 2019.

More information on PTAC is available here.

More information on the CMS Innovation Center is available here.

For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 smadhani@mcdermottplus.com or Mara McDermott at 202-204-1462/mmcdermott@mcdermottplus.com.