The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created new ways for the Medicare program at CMS to pay physicians for the care they provide to Medicare beneficiaries. MACRA also creates incentives for physicians to participate in Alternative Payment Models (APMs), including the development of physician-focused payment models (PFPMs).
MACRA created the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to make comments and recommendations to the Secretary of the Department of Health and Human Services (the Secretary, HHS) on proposals for PFPMs submitted by individuals and stakeholder entities.
The Secretary is required by MACRA to establish criteria for PFPMs and to respond to the recommendations of PTAC. Ten criteria were outlined in the MACRA final rule with comment period that was made public on October 14, 2016 and published in the Federal Register on November 4, 2016.
Definition of a PFPM
The MACRA final rule published in the Federal Register on November 4, 2016 defines a PFPM as an APM in which:
Ten Criteria Outlined in MACRA
PTAC intends to evaluate the extent to which proposed models meet the Secretary’s criteria and to make recommendations regarding the proposed model including limited-scale testing, implementation, high priority implementations, or not recommend. The PTAC provides a unique opportunity for individuals and stakeholders to have a key role in the development of new APMs and to ensure that proposals recommended to the Secretary meet the established criteria and are well-developed.
CMS expects that the PTAC will assist HHS with improving the process for model development. By engaging with stakeholders early in the development of criteria and review processes, HHS anticipates that PTAC will encourage and facilitate submission of models that have a high likelihood of being implemented and represent the diversity of care provided by physicians across the country.
In future performance years, CMS anticipates that the following models may be Advanced APMs:
For more information on the PTAC including where to find information on the background of the Committee and its members, information on how to submit a proposal to PTAC, how PTAC will review and evaluate proposals, and information for upcoming and past public meetings go to the U.S. Department of Health and Human Services, Office of The Assistant Secretary For Planning And Evaluation website at https://aspe.hhs.gov.
To learn more about key elements that stakeholders are considering in designing Alternative Payment Models—and to stay on track for optimum APM reimbursement—pick up your copy of Guidebook to Medicare Access and CHIP Reauthorization Act of 2015.