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PTAC seeking input on physician-focused payment models

June 27, 2023


The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to review and assess physician-focused payment models based on stakeholder proposals.

PTAC recently put out a request for input (RFI) on “integrating specialty care in population-based models.” In response to the RFI, the American Medical Association (AMA) is urging the committee to engage specialists in value-based care by adopting the Payments for Accountable Specialty Care (PASC) approach in the Medicare program.

Many patients who are insured by Medicare and assigned to an accountable care organization (ACO) have health problems that require diagnosis or treatment from a specialist, but these physicians often face challenges delivering the highest quality care to ACO patients due to barriers in both the regular Medicare and ACO payment systems.

Under PASC, specialists would enter into agreements with ACOs in which they would receive extra payments from Medicare to deliver enhanced services to patients with particular conditions who are referred to them by the ACO’s participating primary care physicians. For patients with chronic conditions, for example, care delivered under the PASC agreement could focus on avoiding the use of unnecessary and unnecessarily expensive medications and reducing exacerbations that can result in emergency visits and hospital admissions. Specialists with PASC agreements would also commit to providing feedback to and collaborating with the referring primary care physicians.

PTAC is expected to develop a report for the Center for Medicare and Medicaid Innovation on specialist integration in population-based alternative payment models.

 

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