Secretary Responds to PTAC Recommendations from Sept. and Dec. 2018 Public Meetings

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to review and assess physician-focused payment models (PFPMs) based on stakeholder proposals submitted to the committee. The Secretary of Health and Human Services (HHS) is required to review the comments and recommendations submitted by the PTAC and post a detailed response to these recommendations.

The Secretary posted comments on five recent PTAC recommendations from the September and December 2018 public meetings. The Secretary did not recommend moving forward with implementation for any of the proposed models but indicated that concepts from the proposed models reviewed by PTAC are being considered as the Centers for Medicare and Medicaid Innovation (Innovation Center) develops their own payment models. Excerpts from their comments are below.

Acute Unscheduled Care Model: Enhancing Appropriate Admissions, American College of Emergency Physicians

PTAC Recommendation: Implementation (9/2018)

  • The proposal addresses emergency department (ED) policies related to the safe discharge of patients, follow-up care for 30 days post-ED visit, and hospitalizations or other avoidable post-ED visit events and their associated costs
  • Agree with PTAC that patients who visit the ED and are discharged home could benefit from the proposed model
  • Secretary has asked the Innovation Center to assess how key elements in this model could operate as a component in a larger model dedicated to improving population health

An Innovative Model for Primary Care Office Payment, Jean Antonucci, MD

PTAC Recommendation: Limited Scale Testing (9/2018)

  • The proposal focuses on an approach to deliver primary care via a capitated payment model
  • Secretary appreciates the basic premise of capitation for primary care services, driven by patient input that underpins this model
  • Representatives from CMS and the Innovation Center had a discussion on the proposed model with Dr. Antonucci in March 2019

APM for Improved Quality and Cost in Providing Home Hemodialysis to Geriatric Patients Residing in Skilled Nursing Facilities, Dialyze Direct

PTAC Recommendation: Attention (9/2018)

  • This model proposes to improve quality and reduce cost through on-site home hemodialysis therapy for beneficiaries with end-stage renal disease residing in skilled nursing facilities
  • The Secretary is not convinced that the proposed payment model would overcome the current payment system barriers or ensure that higher quality and lower spending would be achieved

Comprehensive Care Physician Payment Model, University of Chicago Medicine

PTAC Recommendation: Limited Scale Testing (9/2018)

  • The focus of this model is on improving primary care delivery for beneficiaries with serious illnesses and complex medical conditions
  • Secretary has asked the Innovation Center to assess how key elements in this model could operate as a component in a larger model dedicated to improving population health

Making Accountable Sustainable Oncology Networks, Innovative Oncology Business Solutions, Incorporated

PTAC Recommendation: Further development and implementation (12/2018)

  • This proposal utilizes an approach to cancer payment that relies on machine learning algorithms to define groups of patients, or Oncology Payment Categories, based on disease state, comorbidities, and treatment plan
  • CMS is considering next steps for models in oncology care, the Secretary will ask the Innovation Center to engage further with the submitter and other stakeholders to discuss enhancements to the existing Innovation Center oncology model and other potential models intended to improve oncology care

The McDermottPlus PTAC Proposal Tracker is available here.


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 or