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Energy & Commerce Health Subcommittee Holds Hearing on APMs but Ignores Barriers to Participation for Specialty Medicine

On Wednesday, the House Committee on Energy and Commerce Subcommittee on Health held a hearing, “MACRA and Alternative Payment Models: Developing Options for Value-based Care,” to discuss Alternative Payment Models (APMs). The chairman and vice chairman of the Physician-Focused Payment Technical Advisory Committee (PTAC), a body created by MACRA to review and propose new APMs, asked Congress for more resources to accelerate the process of creating APMs, including access to technical assistance, access to claims data, and limited scale testing of models. In addition, PTAC expressed frustration with CMS that none of their recommendations had been approved or implemented. Members of the committee suggested holding a hearing with CMS officials to get an update.

A second panel during the hearing featured physicians who have developed APMs. Witnesses included the American College of Physicians (ACP), American College of Surgeons (ACS), and other medical societies who had developed their own APMs. However, not all of these APMs have been approved, including ACS’ general surgery APM. PTAC and CMS have prioritized developing and approving primary care models, instead. Despite the fact that the majority of specialties, including ophthalmology, do not have APMs or have had difficulty in developing them, when a committee member asked if specialty medicine groups have a difficult time participating in APMs, the witnesses from PTAC indicated that they have seen no evidence of this.

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