MACRA committee now accepting APM proposals

Dive Brief:

  • Physician-Focused Payment Model Technical Advisory Committee (PTAC), established earlier this year by MACRA, has begun accepting proposals for alternative payment models (APMs), the committee announced Thursday at the National MACRA MIPS/APMS Summit in Washington, DC. 
  • There are a number of criteria that must be met in order for PTAC to include a proposal in its recommendations to the HHS Secretary, which it plans on issuing in Spring 2017. 
  • Committee members hope to receive as much input with proposals as it did when it was soliciting Letters of Intent. It received nine letters. 

Dive Insight:

Once Quality Payment Program participation documentation begins next year, qualifying clinicians will be required to choose from one of two quality payment paths - the Merit-based Incentive Payment System (MIPS) and APMs. The implementation final rule expanded the amount of physicians that would qualify to participate in an APM. There are currently seven different APMs that clinicians can choose from for 2017. Yet as CMS hopes to increase the number of APMs, it continues to seek feedback from providers who have experience with these payment models in the field.

PTAC was created with the sole purpose of providing comments and recommendations to the HHS Secretary of on these payment models. In order for it to recommend an APM for adoption, the proposal must touch on these criteria. The first three are considered to be high-priority:

  • Scope of proposed physician-focused payment model;
  • Quality and cost;
  • Payment methodology;
  • Value over volume;
  • Flexibility;
  • Ability to be evaluated;
  • Integration and care coordination;
  • Patient choice;
  • Patient safety; and
  • Health IT.

There are several APMs that are already being used in healthcare setting, though the exact number of existing APMs is unknown. CAPG, however, released a white paper last month with case studies on 16 different APMs that have proven to successfully work, which can be used as a reference. There will be no deadline for submitting proposals. Yet PTAC members encourage physicians and specialty groups to act sooner rather than later so that an approved APM can be adopted in the field.

"We would love to see more models in the field as soon as possible," PTAC co-chair and Network for Regional Healthcare Improvement President and Chief Executive Officer Elizabeth Mitchell told Healthcare Dive. "If we have a strong model that we can recommend to the secretary and have it in the field by Spring of 2018, I think that would be a success."

Many physicians, specialty groups and providers know how they could improve care formations, how they could change care delivery to make practice better, care better and they face barriers in the current payment system, Mitchell said. "If they can tell us what payment changes will enable them to provide better care, that's what we are looking for," she added.

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Filed Under: Payer Health Law Finance
Top image credit: Ana Mulero