Trailblazing Medicare Doctor Pay Panel Hits Barriers

It's not easy being a trailblazer. Ask the Lewis and Clark of Medicare’s new doctor payment system, Jeffrey Bailet and Elizabeth Mitchell, chairs of the Physician-Focused Payment Technical Advisory Committee (PTAC).

PTAC began less than a year ago vetting applications to create new ways to pay physicians. These alternative payment models reward providers for delivering high-quality and cost-efficient care. As the bureaucrats say: “value over volume” of services.

The 11 PTAC members have their hands full combing through 20 proposals spanning different specialties.

“This is new and we’re all learning,” Bailet, PTAC’s chairman, told a House subcommittee hearing last week on the new payment models.

Mitchell, PTAC’s vice chairman, told the hearing that the evaluations are more than were anticipated.

As I was writing this, two more applications popped into my email courtesy of PTAC:

Marshfield Clinic is teaming up with Contessa Health and wants to offer “An Alternative Payment Model for Delivering Acute Care in the Home.”

A rehab company is going solo on this mouthful: “CMS Support of Wound Care in Private Outpatient Therapy Clinics: Measuring the Effectiveness of Physical or Occupational Therapy Intervention as the Primary Means of Managing Wounds in Medicare Recipients.”

As they thrash through the regulatory underbrush, like trailblazers before them, PTAC members have been bumping up against unexpected obstacles. The two chairs said that while doctors might be proficient at designing the medical aspects of the models, when it comes to building the payment/financial business side, they are not so good.

They have to turn thumbs up or down and send the recommendations to the Health and Human Services Department.

Mitchell told me earlier this year that, for example, if PTAC gets a proposal that doesn’t have the downside risk that’s required, it won’t qualify. (Under a downside risk system, doctors can get dinged financially for increased spending and for care that fails to meet quality and efficiency standards.)

PTAC says the clinicians submitting models need technical assistance and greater access to shared data, far more than PTAC can offer.

HHS seems OK with offering assistance to applicants but how it could be delivered “remains an open question,” Bailet said at the hearing.

Some aid could be on its way, including more PTAC staff.

Michael Burgess (R-Texas), chairman of the House Energy and Commerce Subcommittee on Health, and ranking member Gene Green (D-Texas) told the hearing they would look for ways to get more support for PTAC.

Burgess said he’s asked HHS to explore the feasibility of an exemption for PTAC to a federal hiring freeze.

Read my full article on the hearing here.

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