ARLINGTON HEIGHTS, Ill. (September 16, 2020) – The Physician-Focused Payment Model Technical Advisory Committee (PTAC) unanimously voted to refer the American College of Allergy, Asthma & Immunology’s (ACAAI’s) Patient-Centered Asthma Care Payment model (PCACP) to the Department of Health and Human Services (HHS) proposal for special attention and further consideration.
“The ACAAI PCACP model is a value-based care model that gives physicians specializing in asthma care (primarily allergists, immunologists, and pulmonologists, but also primary care physicians) the resources and flexibility they need to better diagnose and manage patients with asthma,” says allergist J. Allen Meadows, MD, ACAAI president. “The model seeks to save costs and improve the quality of patient care by avoiding unnecessary hospitalizations and emergency department visits through better diagnosis and management of patients with asthma. The architects of the model are hopeful that implementation by Medicare will be followed by implementation by private payers so non-Medicare patients can benefit as well.”
PTAC noted the PCACP model “offers a potentially promising approach for specialty-focused Physician Focused Payment Models." PTAC’s letter also “commends the submitter’s efforts to improve care for patients with asthma by developing a specialty-based alternative payment model (APM) that would expand APM participation to multiple specialties involved in caring for asthma patients, particularly since asthma patients may be commonly misdiagnosed in primary care or not currently managed efficiently across specialties.”
According to PTAC, “A specialty-focused APM may be attractive to rural or smaller asthma-focused specialty practices that may not have opportunities to participate in other existing models such as accountable care organizations (ACOs) or Comprehensive Primary Care Plus (CPC+).”
Physicians treating patients with asthma and asthma-like symptoms are paid based on the number of times the patient comes to the physician’s office or the number of tests the patient receives. As a result, patients may be inaccurately diagnosed or incorrectly treated, they may experience continued asthma symptoms or side effects of medication that could have been avoided, and they may be hospitalized or be seen in an emergency department for asthma exacerbations that could have been prevented.
PCACP would provide an alternative way to compensate physicians caring for asthma patients that is based on quality and efficiency of patient care provided. In order to receive Patient-Centered Asthma Care Payments, physicians would be required to meet certain quality standards and would be accountable for maintaining good performance on measures of service utilization, spending, patient care quality, patient outcomes, and patient experience. The payments physicians receive under PCACP would be adjusted up or down based on their performance on these measures, so physicians would assume a level of risk under this model.
PTAC was created by The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which was enacted, in part, to improve how the federal Medicare program pays physicians for the care they provide to Medicare beneficiaries. PTAC’s mission is to make comments and recommendations to the HHS Secretary on proposals for PFPMs submitted to PTAC by individuals and stakeholder entities. PTAC was created to help improve the efficiency and effectiveness of the U.S. health care delivery system by reviewing and recommending PFPMs that can substantially enhance quality, improve affordability and influence policy development and system transformation.
PCACP was developed by ACAAI in conjunction with the American Medical Association and the Center for Healthcare Quality and Payment Reform.
The letter from the Physician-Focused Payment Model Technical Advisory Committee can be found here.