December 5, 2019

Two PTAC Members Resign: What does this mean for the AUCM?

The week before Thanksgiving there were rumblings in DC, and it wasn’t just people’s hungry stomachs. Right before the holiday, two members of the Physician-Focused Payment Model Technical Advisory Committee (PTAC)—a federal advisory committee that recommends Medicare alternative payment models (APMs) to the Department of Health and Human Services (HHS)—resigned.

In their letters of resignation, Dr. Len Nichols and Mr. Harold Miller both emphasized their disappointment in the lack of action that HHS and the Centers for Medicare & Medicaid Services (CMS)’ Innovation Center (CMMI) have taken on the APMs the PTAC has recommended. While HHS claims that PTAC recommendations are seriously considered when CMMI develops new Medicare APMs, Dr. Nichols and Mr. Miller stressed that none of the PTAC-recommended models have been adopted thus far, and even went as far to say that HHS is misleading the public by stating that PTAC models have a chance of being implemented. While there hasn’t been much reaction from HHS—apart from a spokesperson thanking them for their service and noting that PTAC’s recommendations are “invaluable”—their resignations sent a strong message to the health policy community that the PTAC process is broken and needs to change.

How does this news impact ACEP and our members? As I mentioned in a previous blog post, ACEP submitted an APM proposal to the PTAC in 2017 called the Acute Unscheduled Care Model—fondly referred to as AUCM or “awesome.” The PTAC recommended that the HHS Secretary fully implement the AUCM in 2018. One year later, the HHS Secretary finally responded by stating that he believes the core concepts of the AUCM should be incorporated into the APMs CMMI is developing. However, we’ve yet to meet with CMMI since the Secretary’s response in September, despite us reaching out to the office to try to start discussing how the AUCM could be incorporated into other APMs.

One reason for the notable silence could be that CMMI is in-between directors right now, so it may be waiting for new leadership to come on board before deciding which new APMs to pursue. However, the recent resignations definitely fuel my doubts about the effectiveness of the process and make me wonder whether the AUCM will ever be adopted by CMMI.

So where does this leave us? The fact remains that we submitted our Medicare APM to the PTAC in 2017 and are still are waiting for it (or some “core concepts” of it) to be implemented two years later and counting. We are therefore not putting all of our eggs in the CMMI basket and have started a new initiative to promote participation in emergency medicine-focused APMs for other payers beyond Medicare.

As for the PTAC, it was scheduled to have a public meeting next week, which I would have attended to see how or if the PTAC and HHS/CMMI would more formally respond to the resignations. But curiously, the PTAC just announced the meeting was cancelled—with the next scheduled meeting not until March 2020.

We shall see what action, if any, is taken on our APM or the others  recommended by the PTAC—but it’s clear the process isn’t working as smoothly as anyone had hoped.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!

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