The MACRA legislation called for physicians to design their own advanced alternative payment models based on how care is actually delivered. The Physician-Focused Payment Model Technical Advisory Committee (PTAC) was set up in 2015 to provide recommendations to the Health and Human Services (HHS) Secretary about new alternative payment models. But none of its 16 recommendations has been approved. On Nov. 20, PTAC member Len Nichols, Ph.D., director of the Center for Health Policy Research and Ethics at the College of Health and Human Services at George Mason University, resigned in frustration. Joining him in quitting PTAC was Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform.
“I have concluded that the PTAC is ineffective at its mission and that fundamental change is necessary, and I hope my resignation will be seen as the cry for help that it is,” Nichols wrote in his resignation letter. “I want to make clear that my judgment is far from a partisan one. PTAC’s struggles have far more to do with executive branch vs. legislative branch tensions than they do with Democrats vs. Republicans.”
Nichols, who was nominated in 2015 and reappointed in 2017, noted that PTAC has reviewed 32 proposals and recommended either testing or implementation for 16 of them. “Every single one of those recommendations has been declined by the Secretary of HHS,” he wrote.
“Of late, public language has been used praising PTAC’s various efforts and contributions, but the outcome is the same: HHS/CMS/CMMI remains opposed to implementing ideas submitted from the field. And also lately, some of the language used insinuates that PTAC proposals were similar to models being promulgated by CMMI, and that is inaccurate to the point of being disingenuous.”
In his resignation letter, Miller wrote that he did "not want to be part of a process that misleads physicians and other stakeholders into thinking that if they develop a good physician-focused payment model, go through the rigorous review process PTAC has established, and receive a positive recommendation, they will have a chance of seeing their work implemented."
An example of the type of proposal PTAC recommended testing was developed by the American Academy of Family Physicians, which has more than 84,000 actively practicing physicians as members. In December 2017 PTAC voted to recommend that HHS test its Advanced Primary Care APM, but the recommendation was rejected.
Noting that the models PTAC recommended were developed by practitioners, not PTAC itself. “The fact that HHS/CMS/CMMI has rejected all of them over a three-year period leads me to the conclusion that they are not pursuing Congressional intent, and our work has been fruitless.”
Nichols closed by saying that he hopes his resignation (and those of others) might “spur a re-examination of departmental priorities and processes so that a more fruitful process of taking physician payment reform ideas from the field may be created as soon as possible.”
