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

Below are resources for use by stakeholders and potential proposal submitters. PTAC encourages feedback from stakeholders. Please submit comments, questions, and suggestions regarding available resources and informational support needed to PTAC@hhs.gov.

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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:

The Proposal Submission Instructions reference a guide that summarizes some typical payment methodologies for alternative payment models. This document is in development and will be posted to this page when available.

  • 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).