2017-04-12 11:06:38 UTC

PTAC Payment Model Recommendations Include a GI Option

April 12, 2017

An advanced Alternative Payment Model for IBD will be tested as a potential physician-focused payment model.

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) considered three physician-focused payment model (PFPM) proposals for potential future development into advanced Alternative Payment Models (APMs) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) during a public meeting on April 10 and 11 in Washington, DC: 

  • Project Sonar for chronic disease management for IBD
  • The COPD and Asthma Monitoring Project (CAMP)
  • The ACS-Brandeis Advanced APM

Of the models presented, PTAC voted to recommend Project Sonar to the HHS Secretary for limited scale testing across providers and patients prior to consideration of implementation as an advanced APM. The proposal was supported by public comments from AGA and the American Medical Association. 

Project Sonar is the first gastroenterology-specific PFPM to be recommended by PTAC. The model is based on AGA’s IBD clinical service line, which contains evidence-based care guidelines and other clinical decision support tools for IBD to help engage both providers and patients to change behavior and improve outcomes.

PTAC voted to recommend the ACS-Brandeis Advanced APM model to the secretary for limited scale testing and voted not to recommend the CAMP model. PTAC will submit a report containing its recommendations to the Secretary and the Secretary will post a response on the CMS website.

A fourth model, the Comprehensive Colonoscopy Advanced Alternative Payment Model for Colorectal Cancer Screening, Diagnosis and Surveillance, was originally submitted for consideration at this meeting, but was postponed to a future PTAC meeting at the request of the submitter.

AGA has long been a leader in the development of episodes of care and value-based care models, even before the passage of the MACRA legislation. We provided critical feedback on the Project Sonar and colorectal cancer PFPM proposals, which offer new ways for CMS to pay physicians for the care they provide to Medicare beneficiaries. We will continue to take an active role in the PTAC process to ensure that gastroenterologists are not limited to MIPS, but have advanced APM options to maximize quality of patient care and physician reimbursement. 

What is the PTAC?

PTAC is a federal advisory committee created by MACRA to review and make recommendations to the HHS Secretary on PFPM proposals submitted by individuals and stakeholder entities. It is important to note that the secretary is not required to accept the committee’s recommendation.

PTAC meets publicly on approximately a quarterly basis. Requests for public input on PFPM proposals and notification of meeting, along with the meeting agenda and materials, are available on the PTAC website

A transcript of PTAC’s April meeting will be available on the PTAC website and a video recording of this meeting will be added to the HHS YouTube Channel in the next week. PTAC’s reports to the Secretary regarding specific proposals will be posted to the PTAC website as they are transmitted. PTAC’s next public meeting is June 5, 2017.

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