New primary-care model gets modest support from advisory panel

A federal advisory panel on Thursday offered modest support for the launch of a new primary-care pay model that would pay providers fixed motnhly payments for care.

The Physician-Focused Payment Model Technical Advisory Committee, known as PTAC, voted to suggest limited testing for a primary-care capitation model that included two tiers fo fixed monthly payments to providers based on patients' risk level.

The Innovative Model for Primary Care Office Payment was meant to provide additional financial resources to support primary-care practices, reduce the administrative burden on primary-care practices and increase the flexibility of those practices to deliver additional services beyond traditional office visits.

Dr. Jean Antonucci, a family physician in Maine, developed the model. In her proposal, she said she hoped it makes it easier and simpler for small, independent, office-based practices to participate in an alternative payment model.

PTAC members liked that the model would offer easy entry to pay models, particularly for solo and small practices, and that it created greater flexibility for practices in how they care for their patients.

However, the committee was concerned that it wouldn't lead to improved safety or quality of care for patients since practices would be paid the same amount regardless of how many face-to-face visits or other services were provided.

The proposal also called for withholding 15% of payments until certain quality measure outcomes are met, but it didn't include the requirements for physicians to claw back the funds, according to Dr. Jeffrey Bailet, PTAC's chair and Blue Shield of California's executive vice president of health care quality and affordability.

"There so much creativity here, but it just not ready for prime time," said Len Nichols, a PTAC member and director of the Center for Health Policy Research and Ethics at George Mason University.

It's unclear when or if HHS will act on PTAC's recommendation. The panel was established by the Medicare Access and CHIP Reauthorization Act of 2015 to provide comments and recommendations to the CMS on physician payment models.

However, HHS has yet to act on any of the recommendations it has made.

In July, Health Subcommittee Chairman Michael Burgess (R-Texas) and ranking member Rep. Gene Green (D-Texas) said they supported holding a hearing where HHS can explain why it isn't embracing PTAC's ideas.

HHS Secretary Alex Azar, along with CMS Administrator Seema Verma and Adam Boehler, director of the Center for Medicare and Medicaid Innovation, all attended the meeting Thursday and gave remarks that they appreciated the panel's work and they would act on some of its suggestions soon.

"I see PTAC as a crucial avenue for ideas and input," Azar said. "You all are really advisors to me, helping to discern what needs to be done to make physicians' ideas a reality and inform HHS about how we can help."