MACRA panel recommends 2 physician-focused payment models to HHS: 6 things to know

A committee of experts on physician-focused payment models recommended two new programs to HHS on Oct. 20 to potentially become future Alternative Payment Models under the Medicare Access and CHIP Reauthorization Act.

The Physician-Focused Payment Model Technical Advisory Committee, which was created under MACRA to recommend physician-focused payment models to HHS, flagged two submissions for implementation and testing last month. Here are six things to know about those submissions.

1. The committee recommended HHS implement the Hospital at Home Plus model. This model, submitted by the Icahn School of Medicine at Mount Sinai in New York City, outlines a way to provide home-based, hospital-level acute care and tie it to value. This is the first model the committee has recommended for full implementation to HHS.

2. The HaH-Plus model was recommended because it offered an alternative to hospitalization and promotes integrated and coordinated care, the panel said in a letter to HHS Acting Secretary Eric Hargan. With a few updates, such as adding formalized training for providers in the program, external monitoring for adverse events and some refinement in the payment system, the model would likely be of interest to many providers and patients, the panel believes.

3. HaH-Plus would provide a payment system and value-based care model for in-home care for carefully selected Medicare patients. The model would include at-home care for the illness plus 30 days of transition services "post-discharge." Care teams would be tasked to beat spending during this episode of care compared to that of hospitalized patients in the same area in the same diagnosis-related group.

4. The second model recommended by the committee was a bundled payment model for cancer patients, called the Oncology Bundled Payment Program Using CNA-Guided Care. This model was flagged for limited-scale testing by the committee. It was submitted by Edison, N.J.-based Hackensack Meridian Health and Cota, a precision analytics company. This partnership — and the model's support for precision medicine — gave it merit, the committee said in a letter to the secretary.

5. The Oncology Bundled Payment Program focuses on the most common types of cancer, including breast, colon, rectal and lung cancers. HMH and Cota developed 27 bundles for the model that would cover the oncology episode and all related services for a fixed period of time. HMH also developed a model to build more bundles in other medical specialties.

6. The panel recommended HHS consider rolling the oncology bundle proposal into another proposal submitted earlier this year, the ACS-Brandeis Advanced Alternative Payment Model. The ACS-Brandeis Advanced APM was submitted by the American College of Surgeons and was also flagged for limited-scale testing by the committee. The model is episode-based and includes more than 100 procedures and conditions with a broader focus than the oncology proposal.


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