Apr 18, 2018
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Two new proposals address alternative payment models for patients in Palliative Care.

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The 11-member Physician-Focused Payment Model Technical Advisory Committee(PTAC) established by MACRA to consider whether models submitted by stakeholders qualify as Medicare alternative payment models voted to move forward on proposals for two alternative payment models for review by the HHS secretary.

One model, the Patient and Caregiver Support for Serious Illness model, was submitted by the American Academy of Hospice and Palliative Medicine. The second model is the Advanced Care Model Service Delivery and Advanced Alternative Payment Model, proposed by the Coalition to Transform Advanced Care.

The models reviewed by PTAC would similarly address alternative payment models for patients in advanced stages of illnesses, who would benefit from palliative care and are not yet at the hospice care level. Both could be merged together according to news reports since with both models, doctors, nurses, and spiritual providers would collaborate under such incentivized payment arrangements as risk payments or care-management fees to develop and execute a coordinated care plan for seniors in advance stages of illness. 

Model Excerpts from proposals:

Model 1: Patient and Caregiver Support for Serious Illness (PACSSI)

the American Academy of Hospice and Palliative Medicine proposes the (PACSSI) payment model, which is one initiative under its Payment Reforms to Improve Care for Patients with Serious Illness. This model would provide tiered monthly PACSSI care management payments to support interdisciplinary palliative care teams (PCTs) as they deliver community-based palliative care to patients who meet eligibility criteria that include a diagnosis of a serious illness or multiple chronic conditions, functional limitations, and health care utilization. PACSSI care management payments would replace payment for evaluation and management (E/M) services.

Model 2: Advanced Care Model (ACM), for a Physician-Focused Payment Model.
The Advanced Care Model provides a population health management approach for the advanced illness population, focused on the last year of life. The expected impact for ACM beneficiaries are improvements in (1) patient and family engagement, (2) shared-decision making among patients, families and their physicians, (3) coordinated care that aligns with patient preferences, (4) symptom management, (5) prevention of avoidable and unwanted hospitalizations or low value treatment, and (6) prevention of unwanted futile care at the end of life

 

Model 2:

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