The Physician-Focused Payment Model Technical Advisory Committee (PTAC), established by Congress to recommend new physician payment models in government programs, is leaning on the Department of Health and Human Services (HHS) and the Center for Medicare and Medicaid Innovation (CMMI) to act on its recommendations. The PTAC has effectively been up and running for 20 months and has received 27 proposals for consideration. To date, PTAC has recommended 10 proposals to the Secretary for CMMI to test in various ways. However, the Secretary has not yet favorably acted upon any of these recommendations. If HHS does not act before the end of the year, the whole initiative could come apart, its members recently suggested.
PTAC Concerns
If the agency doesn’t act, “I think some of us would leave,” Kavita Patel, MD, MPH, a committee member, practicing primary care internist at Johns Hopkins Medicine, and nonresident fellow at the Brookings Institution told MedPage Today. According to MedPage Today, it would not be the first time Patel has contemplated leaving. When HHS Secretary Alex Azar, announced in June that HHS would not be implementing any of the 10 alternative payment models for Medicare recommended by the PTAC, Patel almost quit.
As was pointed out in a recent Health Affairs article, it is understandable CMS would not be in position to test every model that the PTAC recommends to the Secretary. The value-transformation agenda must be executed with finite resources, and it is within the Secretary’s purview to set the priorities. No matter how mature a model proposal may be before the PTAC, the reality is that it would take CMS at least a year and likely longer to further develop that proposal into an operational model.
However, it is reasonable for the PTAC and Congress to expect that HHS would commit to testing some of its recommendations. While the authorizing statute does not impose specific obligations on the Secretary to do so, it is hard to fathom that Congress intended for the Secretary to be able to pass on all recommendations. Given the track record to date, it would be understandable if the PTAC stopped considering additional proposals until there is a better understanding as to whether HHS will accept any recommendations for testing.
One suggestion from the Health Affairs piece? It argues PTAC could better serve the Secretary in support of his stated goal of advancing value transformation. PTAC members should have the authority to advise the Secretary on which types of models are most needed or desirable in the marketplace, which hold the most promise for success of lowering cost and improving outcomes, and which models are mostly likely to effectively synchronize with each other to create a seamless value-based payment and care delivery landscape.