Creating New Doctor Payment Models: ‘It Don't Come Easy’


HHS Secretary Tom Price put out an all-points bulletin last week for doctors to come up with innovative ideas for payment models in their areas.

The fee-for-service system that many say encourages quantity of services over quality should begin to take a back seat. Innovation in how doctors collaborate, administer their practices and get paid is the new name of the game.

The Health and Human Services chief made the request to doctors before the first voting meeting of a new multisyllabic federal advisory panel: the Physician-Focused Payment Model Technical Advisory Committee, or PTAC for short.

Members spent two days weighing three of the six models that medical groups have so far submitted to them. They were deciding whether to recommend them to Price’s department as improving health-care quality at no extra cost, maintaining health-care quality while lowering cost, or both.

But asking for ideas and finding models that pass federal muster are two very different things. As Ringo Starr wrote, “You know it don't come easy.”

The committee members poked at aspects of the lengthy proposals and prodded submitters with questions on myriad issues about whether they’d actually work in real life for professionals and beneficiaries.

They painstakingly debated and took individual votes on each of 10 criteria before voting on the proposals as a whole.

In the end, they said they’d recommend that HHS test a mini version of two but turned thumbs down on a third.

Their recommendations will be reviewed by the Centers for Medicare & Medicaid Services, which has to post a detailed response to them on the agency’s website.

The remaining three proposals that have been submitted by medical groups—on colorectal cancer screening, caring for patients with advanced illness, and a bundled payment oncology program—go to a PTAC preliminary review team. It’ll look at public comments and gather additional information before reporting to the full committee.

One or more may be up for voting round two when the committee meets in June.

For more details, read my full article here.

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