The Physician-Focused Payment Model Technical Advisory Committee (PTAC) was established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to review proposals for physician focused payment models (PFPMs). The committee comments and makes recommendations to the Secretary of Health and Human Services regarding whether such proposals meet established criteria. PTAC recommendations include limited-scale testing, implementation, implementation with a high priority, or not recommend.
Committee members are appointed by the Comptroller General of the United States and will generally serve three-year terms. PTAC members include both physicians and non-physicians. A list of current PTAC members and their areas of expertise can be found here.
PTAC’s PFPM Review Process
PTAC began accepting proposals on December 1, 2016 and will continue to consider submissions on an ongoing basis. . A non-binding LOI must be submitted to PTAC at least 30 days prior to the submission of a full proposal. The Committee will discuss proposals, deliberate, and make recommendations in public meetings. You can find more information on the submission, review and recommendation process on the PTAC website.
PTAC welcomes multi-stakeholder input and invites public comment on all of its processes. Interested parties can find out about PTAC’s work by visiting the committee’s website. You can receive notification about PTAC’s processes by subscribing to the PTAC listserv.
For a schedule of upcoming public meetings, to view past meetings, review resulting recommendations and read responses from the Secretary of Health and Human Services, click here.
Definition and Criteria for PFPMs
- Medicare is a payer,
- Clinicians that are eligible professionals (EPs), as defined in section 1848(k)(3)(B) of the Social Security Act (SSA), are participants and play a core role in implementing the APM’s payment methodology, and
- Targets are the quality and costs of services that EPs participating in the APM provide, order, or can significantly influence.
Ten criteria were outlined in the MACRA final rule.
- Value Over Volume: Provide incentives to practitioners to deliver high-quality healthcare.
- Flexibility: Provide the flexibility needed for practitioners to deliver high-quality healthcare.
- Quality and Cost: PFPMs are anticipated to improve healthcare quality at no additional cost, maintain healthcare quality while decreasing cost, or both improve healthcare quality and decrease cost.
- Payment Methodology: Pay APM Entities with a payment methodology designed to achieve the goals of the PFPM criteria. Addresses in detail through this methodology how Medicare and other payers, if applicable, pay APM Entities, how the payment methodology differs from current payment methodologies, and why the Physician-Focused Payment Model cannot be tested under current payment methodologies.
- Scope: Aim to either directly address an issue in payment policy that broadens and expands the CMS APM portfolio or include APM Entities whose opportunities to participate in APMs have been limited.
- Ability to be Evaluated: Have measurable goals for quality of care, cost, and any other goals of the PFPM.
- Integration and Care Coordination: Encourage greater integration and care coordination among practitioners and across settings where multiple practitioners or settings are relevant to delivering care to the population treated under the PFPM.
- Patient Choice: Encourage greater attention to the health of the population served while also supporting the unique needs and preferences of individual patients.
- Patient Safety: Aim to maintain or improve standards of patient safety.
- Health Information Technology: Encourage use of health information technology to inform care.