PDF Technical Advisory Committee (Ptac) Public Meeting - Aspe

PHYSICIAN-FOCUSED PAYMENT MODEL TECHNICAL ADVISORY COMMITTEE (PTAC)

PUBLIC MEETING

The Great Hall The Hubert H. Humphrey Federal Building

200 Independence Avenue, SW Washington, D.C. 20201

Friday, September 8, 2017 9:00 a.m.

PTAC COMMITTEE MEMBERS PRESENT: JEFFREY BAILET, MD, Chair ROBERT BERENSON, MD PAUL N. CASALE, MD, MPH TIM FERRIS, MD, MPH RHONDA M. MEDOWS, MD HAROLD D. MILLER ELIZABETH MITCHELL, Vice Chair LEN M. NICHOLS, PhD KAVITA PATEL, MD, MSHS BRUCE STEINWALD, MBA STAFF PRESENT: ANN PAGE, Designated Federal Officer, Office of Assistant

Secretary for Planning and Evaluation (ASPE) KATHERINE SAPRA, PhD, MPH, ASPE MARY ELLEN STAHLMAN, ASPE

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AGENDA

PAGE

Hackensack Meridian Health and Cota, Inc.: Oncology Bundled Payment Program Using CNA (Cota Nodal Addresses)-Guided Care Preliminary Review Team (PRT): Tim Ferris, MD, MPH (Lead); Robert Berenson, MD; and Bruce Steinwald, MBA

Opening Remarks by John Michael O'Brien, PharmD, MPH, Deputy Assistant Secretary for Health Policy, ASPE........3

Committee Member Introductions and Disclosures............6

PRT Report to the Full PTAC ? Tim Ferris, MD, MPH........11

Clarifying Questions from PTAC...........................33

Submitter's Statement....................................59

- Elena Castaneda - Stuart Goldberg, MD - Laura Kudlacik, RN

- Morey Menacker, DO - Andrew Norden, MD, MPH, MBA - Andrew Pecora, MD, FACP,

CPE

Comments from the Public................................108

Committee Deliberation..................................114

Voting - Criterion 1..........................................140 - Criterion 2..........................................140 - Criterion 3..........................................141 - Criterion 4..........................................142 - Criterion 5..........................................142 - Criterion 6..........................................143 - Criterion 7..........................................143 - Criterion 8..........................................144 - Criterion 9..........................................147 - Criterion 10.........................................147

- Final Vote...........................................149

Instructions to Staff on the Report to the Secretary....150

Public Comment..........................................167

Adjourn.................................................171

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1

PROCEEDINGS

2

[9:08 a.m.]

3*

DR. O'BRIEN: Good morning, everyone, and welcome

4 back. I'm still John O'Brien, Deputy Assistant Secretary

5 for Health Policy here at ASPE, and welcome back to Day 2

6 of the PTAC meeting. I know you all had a very productive

7 day yesterday discussing the Hospital at Home proposal

8 submitted by the Icahn School of Medicine at Mount Sinai

9 and the Advanced Care Model Service Delivery and Advanced

10 Alternative Payment Model submitted by the Coalition to

11 Transform Advanced Care.

12

I'd say there were a number of interesting firsts

13 yesterday. I continue to be excited by the quality and

14 depth and unexpected nature of the discussions that we had

15 yesterday, and I am sure today will be just as productive

16 and exciting.

17

I know there is a third proposal to discuss

18 today, the Oncology Bundled Payment Program Using CNA (Cota

19 Nodal Addresses)-Guided Care, submitted by Hackensack

20 Meridian Health and Cota, Inc. We're looking forward to

21 the results of your deliberation and voting on this

22 proposal as well.

23

The Secretary will shortly be posting his

24 response to PTAC's comments and recommendations on the CMS

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4 1 (Centers for Medicare and Medicaid Services) website, and

2 they will also be posted on the ASPE website. I don't know

3 if it will be by the conclusion of my remarks, or at some

4 time during this meeting. I can't discourage you from

5 refreshing your browsers and missing the conversation that's

6 happening here, but I do believe that they will be posted

7 very shortly. And as the statute directs, not only are the

8 responses posted, but I also just wanted to share a bit of

9 insight and be sure that the following messages are clear.

10

The Secretary has a great deal of appreciation

11 for the submitters, those who have carved time out of their

12 hectic practice schedules to develop these payment models.

13 It's a testament to their dedication to the profession that

14 they've crafted these proposals to improve outcomes for

15 patients across the country.

16

The Secretary expresses his thanks to the PTAC

17 members for the incredible amount of work that you put in

18 evaluating these proposals and advising the Secretary on

19 the challenges and opportunities that these models may

20 represent if tested and put into practice. He knows that

21 you have day jobs as well and that this work requires a lot

22 of time and effort. Your expertise and willingness to use

23 that knowledge and serve as members of PTAC is a testimony

24 to your commitment to improving U.S. health care. Again,

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5 1 thank you for being here.

2

Related to the first three proposed physician-

3 focused payment models, some messages from the letters may

4 be worth calling out this morning. The Secretary was clear

5 about several things. I think one is he doesn't want to

6 hide the ball. The letters are intended to be very clear

7 in what he either finds exciting or concerning in the

8 proposal. For example, there's a reference to a concern

9 about proposals that rely on a particular piece of

10 proprietary technology in order for the model to be tested

11 or successful.

12

He's also concerned about proposed models that

13 may only be implemented by the submitter. The Secretary is

14 most interested in proposals that many physicians and

15 patients could benefit from. Over 900,000 clinicians,

16 including over half a million physicians, deliver services

17 worth over $70 billion to 50 million Medicare beneficiaries

18 a year. So the Secretary is looking for ideas that many

19 physicians could participate in and help those

20 beneficiaries, not just individual submitters.

21

Proposed models that include particular

22 proprietary items or that are tailored to work only for one

23 practice or hospital or only for the submitter will not be

24 as effective in achieving the outcomes we desire. And

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