Federal committee approves asthma-related value-based pay model
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The federally appointed Physician-Focused Payment Model Technical Advisory Committee said Tuesday it has recommended HHS consider a payment model focused on asthma care.
The payment model, if approved by HHS, would provide allergists, immunologists and pulmonologists a value-based payment option. A longstanding complaint of the movement to alternative payment models is it has excluded many specialists from participating because quality metrics don’t apply to their practice. The model can also be used by primary care doctors who also treat patients with asthma.
Asthma is among the most chronic common conditions in the U.S., affecting 19.2 million adults and 5.5 million children. And it led to 1.6 million emergency department visits in 2017.
The proposed model is a bundled payment approach that determines payment by spending and outcomes such as avoiding hospitalizations for patients with asthma. It was developed by the American College of Allergy, Asthma, and Immunology, the American Medical Association and the Center for Healthcare Quality and Payment Reform.
In its letter to HHS Secretary Alex Azar, the Physician-Focused Payment Model Technical Advisory Committee, also known as PTAC, said while “many aspects” of the proposed model “lack sufficient development for implementation,” it has elements that warrant consideration and with adjustment it holds promise.
PTAC also said that this model could lead to more advanced alternative payment models specific to specialties.
“PTAC believes that attention to this model, which focuses on asthma, could facilitate development of APMs for a wider range of specialties beyond asthma,” the letter said.
PTAC was established under the Medicare Access and CHIP Reauthorization Act of 2015 along with the Quality Payment Program, which created two value-based payment models in Medicare. The committee makes recommendations to HHS on advanced alternative payment models it should consider. PTAC is made up of 11 members appointed by the Comptroller General of the U.S. The current chair is Dr. Jeffrey Bailet, who is CEO of Altais, a subsidiary of Blue Shield of California that offers support services for physicians.