Lawmakers Promise Help to Group Developing Medicare Pay Models

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By Mindy Yochelson

House lawmakers Nov. 8 said they would work to get more staffing and resources for the federal advisory group that’s reviewing alternative payment models for doctors participating in Medicare.

The Physician-Focused Payment Technical Advisory Committee (PTAC) vets applications from medical practices for alternative payment models. However,PTAC leaders told a hearing of the House Energy and Commerce Subcommittee on Health that the process is stymied by the technical needs of applicants and limited staff.

Jeffrey Bailet and Elizabeth Mitchell, chair and co-chair of the PTAC, said they have received 20 completed models since the committee began in December 2016. PTAC has sent five to the Department of Health and Human Services, which has the final say. But so far none has been approved.

Bipartisan Assistance Offered

Subcommittee Chairman Michael Burgess (R-Texas) and ranking member Gene Green (D-Texas) both said they would look for ways to get more support for PTAC.

Medical practices developing models to be presented to PTAC also need more technical assistance, data to support their applications, and the ability to test them out, the two told the committee.

Congress should look at obstacles faced by the PTAC applicants and respond with help, Bailet, executive vice president of health care quality and affordability at Blue Shield of California, told the subcommittee. Specifically, lawmakers should identify ways to offer technical assistance to providers seeking to develop and implement models, he said.

Conflict of Interest?

The PTAC walks a tightrope in that it can’t offer a lot of assistance to applicants because the 11-member panel is charged with recommending models to the HHS. The assistance could lead to potential conflicts of interest, Bailet said. He recommended “deployment of HHS resources to provide access to analytic, technical, and quality improvement support.”

PTAC also wants clarity about what happens to their recommendations once they are sent to the HHS. Having that insight will help members and applicants maintain “an excited willingness to move forward,” he said.

Burgess said he was pleased with the committee’s activities in the short time it has been in operation.

By contrast, the subcommittee chairman said, the Medicare agency’s Center for Medicare and Medicaid Innovation in 2016 pushed out a demonstration without cost analysis to test different methods to pay Medicare for drugs administered in a doctor’s office. The demonstration was never put in place.

PTAC’s careful analysis is the way to go, he said. Because PTAC is exploring new territory, there will be unexpected bumps in the road, but the committee will help with legislation, he said.

Better Patient Outcomes

One of the main goals of the 2015 physician payment law was to move doctors toward new models that better align with their unique practice needs and produce better patient outcomes, Burgess said.

The law, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), created a two-track quality payment system when it replaced the sustainable growth rate formula as the doctor payment methodology. However, there are few advanced alternative payment models for doctors to join that would make them become eligible for a 5 percent bonus on their Part B claims.

Those who don’t join an advanced alternative pay model but have enough Medicare business to be covered by MACRA are required to report quality measures under the other track, the Merit-based Incentive Payment System (MIPS).

Burgess said MIPS will be the subject of another hearing in the near future.

To contact the reporter on this story: Mindy Yochelson at

To contact the editor responsible for this story: Kendra Casey Plank at

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