HHS sets 3 priorities for new physician-focused payment models

Physicians and physician groups that hope to get approval for new physician-focused payment models will want to keep some new guidance in mind.

The Department of Health and Human Services (HHS) released guidance (PDF) that outlined its priorities for new payment models to help stakeholders who are crafting proposed models to submit to its advisory committee that reviews and recommends those new ideas.

HHS outlined three priorities for models submitted to the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

In addition to the 10 criteria established by regulation, HHS said it will give priority to models that are expected to increase quality, reduce expenditures and empower the beneficiary as a consumer.

Priority will be given to models that meet the following criteria:

  • Reduce avoidable events by at least 10% and/or mortality by at least 2%.
  • Reduce expenditures by $10 billion a year once expanded nationally.
  • Empower beneficiaries by increasing choice and access

In the guidance, HHS said that it is currently working to develop new potential models that build on ideas from proposals recommended by PTAC.

They include the following proposals:

  • A model to provide care to seriously ill patients proposed by the Coalition to Transform Advanced Care and the American Academy of Hospice and Palliative Medicine.
  • A model to provide a more holistic approach to primary care developed by the American Academy of Family Physicians, the University of Chicago Medicine, and Jean Antonucci, M.D.
  • A model to encourage improved transitions of care from the American College of Emergency Physicians.
  •  A model for providing safe and appropriate hospital-level care at home from the Icahn School of Medicine at Mt. Sinai and Marshfield Clinic and Personalized Recovery Care LLC.
  • Models that support customized, patient-centered care to improve the well-being and medical management of patients with chronic kidney disease or end-stage renal disease from the Renal Physicians Association and Dialyze Direct.

However, the slow start to approve new models that have been approved by PTAC—a committee created by the MACRA legislation to make comments and recommendations to the secretary of HHS on proposals for physician-focused payments models submitted by physicians and physician groups—has frustrated many practices.

There aren’t enough advanced alternative payment models and opportunities for doctors and physician practices to participate in them remain stifled, the Medical Group Management Association's government affairs staff has said.

HHS has yet to implement any of the options recommended by the PTAC, resulting in growing frustration, MGMA said.