Resources for Public Comment: PHYSICIAN-FOCUSED PAYMENT MODEL TECHNICAL ADVISORY COMMITTEE

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Telehealth and Alternative Payment Models

PTAC explored telehealth in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs) for its September 2020 public meeting.

Review of Proposed Models

Two reports and a set of slides that review the proposed models deliberated and voted on by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) as of December 2019 are available below:

Coming Soon

  • The Common Alternative Payment Model (APM) Approaches Reference Guide will be posted shortly. The Proposal Submission Instructions reference a guide that summarizes typical payment methodologies for alternative payment models.

  • Federal Public Data: A Guide for Navigating Publicly Available Files for Those Developing Physician-Focused Payment Models
    This document highlights publicly available data sources that could be used in the development of Physician-Focused Payment Model (PFPM) proposals.

  • Illustrative Data on Medicare Utilization and Reimbursement for Fee-for-Service Beneficiaries with Certain Medical Conditions (PDF and Excel)

    • Table 1A: Medicare Utilization and Reimbursement for Fee-for-Service Beneficiaries Newly Diagnosed with Congestive Heart Failure, Calendar Year 2014- PDF

    • Table 1B: Medicare Utilization and Reimbursement for Fee-for-Service Beneficiaries Ever Diagnosed with Congestive Health Failure, Calendar Year 2015- PDF

    • Table 1C: Medicare Utilization and Reimbursement in the One-Year Period Following Diagnosis Fee-for-Service Beneficiaries with a 2014 Diagnosis of Congestive Heart Failure- PDF

    • Table 2A: Average Total All-cause Medicare Fee-for-Service Spending for Selected Chronic Conditions, 2015- PDF

    • Table 2B: Average All-cause Part A Medicare Fee-for-Service Spending for Selected Chronic Conditions, 2015 (Based on the CMS 5% Limited Data Set) - PDF

    • Table 2C: Average All-cause Part B Medicare Fee-for-Service Spending for Selected Chronic Conditions, 2015 (Based on the CMS 5% Limited Data Set) - PDF

    • Appendix A: CHMS Chronic Conditions Data Warehouse (CCW)- CCW Condition Algorithms (rev. 7/2016) - PDF

    • Excel Workbook - All Tables, Illustrative Data on Medicare Utilization and Reimbursement for Fee-for-Service Beneficiaries with Certain Medical Conditions

  • Link to the Quality Payment Program (QPP) Website 
    This website includes more information on the Quality Payment Program (QPP) including a description of the program, information on participation, a detailed implementation timeline, and a description of how QPP will change Medicare payments.

  • Information from the Specialty Payment Models Opportunities and Design Initiative by MITRE

    • RAND’s Specialty Payment Model Opportunities and Assessment Oncology Simulation Report
      This report describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by  the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS).

  • RAND’s Specialty Payment Model Opportunities and Assessment: Gastroenterology and Cardiology Model Design Report
    This report describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible  testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS).

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