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.

  • 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

  • Data Requested by Preliminary Review Team (PRT)- The COPD and Asthma Monitoring Project (CAMP)

    • 1A-1B. Number of Chronic Conditions, Patients with COPD and Asthma, 2015; Presence of Chronic Conditions, Medicare Fee-for-Service Beneficiaries with COPD, Asthma and COPD-Asthma, 2015- PDF

    • 2A-2C. Medicare Reimbursement for Fee-for-Service Beneficiaries Newly Diagnosed with COPD, 2014; Medicare Reimbursement for Fee-for-Service Beneficiaries Previously Diagnosed with COPD, 2015; Medicare Reimbursement One Year Following Diagnosis, Fee-for-Service Beneficiaries Diagnosed with COPD in 2014- PDF

    • 3A-3C. Medicare Reimbursement for Fee-for-Service Beneficiaries Newly Diagnosed with Asthma, 2014; Medicare Reimbursement for Fee-for-Service Beneficiaries Previously Diagnosed with Asthma, 2015; Medicare Reimbursement One Year Following Diagnosis, Fee-for-Service Beneficiaries Diagnosed with Asthma in 2014- PDF

    • 4. Medicare Part D Reimbursement, Fee-for-Service Beneficiaries with COPD, Asthma, and COPD-Asthma, 2015- PDF

    • 5. Average Reimbursement for ED Visits for all COPD and/or Asthma Beneficiaries, 2015- PDF

    • 6. Distribution of Inpatient Part A Payments and Associated Part B Payments for DRGs Related to COPD and Asthma, 2015- PDF

    • 7A-7B. Top 50 Secondary Diagnoses (ICD-9) Recorded in Inpatient Stays and Stays with Septicemia as a Secondary Diagnosis, among Patients with COPD, 2013-2015; Top 50 Secondary Diagnoses (ICD-9) Recorded in Inpatient Stays and Stays with Septicemia as a Secondary Diagnosis, DRGs Related to Asthma, 2013-2015- PDF

    • 8. Average Length of Stay and Medicare Reimbursement for Selected DRGs, 2015- PDF

    • 9. ED Visits and Inpatient Stays for Beneficiaries with COPD or Asthma, by whether COPD and/or Asthma is the Principal or Secondary Diagnosis Code, 2015- PDF

    • 10A-10C. Beneficiaries with COPD and/or Asthma for Whom Telemonitoring Was Billed, by HCPCS Code and Claim Type, 2015; Medicare Reimbursement for Beneficiaries with COPD and/or Asthma, by Receipt of Telemedicine Services, 2015; Distribution of Medicare Reimbursement for Beneficiaries with COPD or Asthma, by Receipt of Telemedicine Services, 2015- PDF

  • Data Requested by Preliminary Review Team (PRT)- Project Sonar

    • 1. Percent of Medicare Beneficiaries with Inflammatory Bowel Disease, including Crohn's Disease and Ulcerative Colitis, 2015- PDF

    • 2A-2B. Number of Chronic Conditions among Medicare Fee-for-Service Beneficiaries with Inflammatory Bowel Disease, 2015; Prevalence of Selected Chronic Conditions among Medicare Fee-for-Service Beneficiaries with Inflammatory Bowel Disease, 2015- PDF

    • 3. Medicare Part A, B, and D Utilization and Expenditures, Fee-for-Service Beneficiaries with Inflammatory Bowel Disease, 2015- PDF

    • 4. Medicare Fee-for-Services Spending on Beneficiaries with Inflammatory Bowel Disease as a proportion of all Medicare Fee-for-Service Spending, 2015- PDF

  • Data Requested by Preliminary Review Team (PRT)- The Comprehensive Colonoscopy Advanced Alternative Payment Model for Colorectal Cancer Screening, Diagnosis and Surveillance

    • Table 1. Top 10 Physician Specialties Performing Colonoscopies, Medicare Fee-for-Service, 2015- PDF

    • 2. Colonoscopy-related Costs, Medicare Fee-for-Service Beneficiaries who Received a Screening or Diagnostic Colonoscopy, 2015- PDF

    • 3. Colonoscopy-related Costs, Medicare Fee-for-Service Beneficiaries who Received a Colonoscopy in an Ambulatory Surgical Center (ASC), Hospital Outpatient Department, or Physician Office, 2015- PDF

    • 4. Proportion of Medicare Fee-for-Service Medicare Beneficiaries who Received a Colonoscopy and were Treated in the Emergency Department within 7 Days of the procedure, 2015- PDF

  • 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).