Get to know the PTAC and its significance

by Valerie Rinkle, MPA

What is PTAC? PTAC is the “Physician-Focused Payment Model Technical Advisory Committee,” a committee established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to accelerate the development of alternative payment models (APM) under which clinicians can participate and earn the MACRA-APM incentive bonus. The APM track is one of two available in Medicare’s Quality Payment Program (QPP) applicable to professionals (i.e., not applicable to institutional or facility providers). The second track is the Merit-based Incentive Program or MIPS. To avoid a 4% payment-decrease to their Medicare Physician Fee Schedule (MPFS) payments in 2019, physicians and certain non-physician practitioners or clinicians will be required to participate in one of the two tracks in 2017.

MACRA incentivizes participation in the APM track by establishing a 5% bonus payment for APM participation. To qualify for this incentive payment in the first possible time frame (i.e., 2019) clinicians must be enrolled and participating in a qualifying APM in the performance year that begins in 2017. In the MACRA final rule, CMS specifies the types of APMs that qualify for the bonus as those meeting “Advanced APMs” criteria. Criteria include use of certified electronic health technology, quality data reporting, and having clinician compensation based, at least in part, on quality scores and two-sided financial risk.

One of the most common criticisms of the MACRA proposals is that the criteria to be a qualifying Advanced APM were too strict and would significantly limit the number and scope of clinicians who would qualify for the APM incentive payments. CMS listened and responded to these comments in the final rule by reducing the requirements for qualifying as Advanced APMs. On October 25, CMS announced additional Advanced-APM opportunities for clinicians to become “qualifying participants” and earn the QPP APM-bonus payments.

For the 2017 performance year, clinicians thought that the Advanced-APM models were “closed,” meaning that all the clinicians who could qualify for the Advanced-APM bonus were already determined. However, CMS announced that it will re-open applications for new practices and payers to participate in the Comprehensive Primary Care Plus (CPC+) model and the two-sided risk Oncology Care Model for 2017. Also, if finalized as proposed in the Cardiac Episode Payment proposed rule, certain Comprehensive Joint Replacement and Cardiac Episode Payment Models that meet certified electronic health record requirements will qualify as Advanced APMs in 2017. The CMS website lists all the possible qualifying Advanced-APMs for 2017.

CMS also announced that it will accept new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year and that the PTAC is likely to grow the list of qualifying APMs. Therefore, CMS estimates that by 2018, 25% of clinicians will be participating in Advanced APMs for purposes of receiving the APM bonus in 2020.