MedPAC is meeting on December 15 and 16, 2011 to discuss payment adequacy of Medicare payment for a variety of provider types, along with ways to encourage the use of lower-cost medications by Medicare Part D low-income subsidy beneficiaries.
The Medicare Payment Advisory Commission (MedPAC) will be meeting November 3-4, 2011 to discuss a number of Medicare policy issues, including: reforming Medicare’s benefit design; Medicare Part D/beneficiaries with high drug spending; coordinating care for dual-eligible beneficiaries through the PACE program; reforming the Medicare SNF PPS; hospitals’ capacity to serve Medicare patients; payment rate differences across ambulatory sectors; and Medicare coverage of and payment for home infusion.
On October 6, 2011, the Medicare Payment Advisory Commission (MedPAC) voted to recommend that Congress repeal and replace the statutory sustainable growth rate (SGR) formula for updating the Medicare physician fee schedule (MPFS). Without legislative action, CMS estimates that the SGR formula would result in an almost 30% MPFS cut in 2012. As discussed in a previous blog posting, the controversial MedPAC plan – which would require Congressional approval -- would freeze current Medicare MPFS rates for primary care services for 10 years, while other services would be subject to annual payment reductions of 5.9% for 3 years, followed by a freeze. MedPAC offered a list of options for Congress to consider if it decides to offset SGR repeal costs (estimated at about $200 billion over 10 years) within the Medicare program. In addition to the SGR proposal, MedPAC endorsed budget-neutral changes to improve data on which MPFS relative value unit (RVU) weights are based and to redistribute payments to underpriced services. MedPAC also recommended that CMS increase the shared savings opportunity for physicians and health professionals who join or lead “two-sided” risk ACOs (where providers can receive bonuses or financial penalties based on performance).
At a recent meeting, the Medicare Payment Advisory Commission (MedPAC) discussed a recommendation to repeal and replace the statutory sustainable growth rate (SGR) formula for updating the Medicare physician fee schedule (MPFS). In recent years, the SGR formula has produced steep cuts in the MPFS update, which Congress has repeatedly blocked through legislation, For 2012, CMS estimates that the SGR formula would result in an almost 30% MPFS cut in the absence of Congressional action. MedPAC is considering an SGR reform proposal that would repeal the SGR and replace it with 10-years of statutory fee schedule updates. The plan would freeze current Medicare payment levels for primary care services, and all other services would be subject to annual payment reductions of 5.9% for 3 years, followed by a freeze. MedPAC also has released a list of potential offsetting Medicare cuts that would raise $235 billion over 10 years to finance the reforms. The proposals include, among others: reduced Medicare payments for many Medicare provider types and services; expanded DMEPOS competitive bidding; various reductions in payments to Medicare Advantage plans; prior authorization for certain imaging services; changes to certain Part D cost sharing; prepayment review of power wheelchairs; drug manufacturer rebates for dual eligibles; bundled payments for hospitals and physicians; payment of hospital outpatient evaluation and management visits at MPFS rates; establishment of least costly alternative authority; expansion of readmissions policies for additional provider types, and validation of physician orders for high cost services.
MedPAC has released its 2011 Data Book on “Healthcare Spending and the Medicare Program.” The Data Book provides information on national health care and Medicare spending, Medicare beneficiary demographics, Medicare quality and access, and Medicare beneficiary and other payer liability. It also includes data on various provider types, such as data on Medicare spending, beneficiary utilization of the service, number of providers, volume, length of stay, and margins.
The Medicare Payment Advisory Commission (MedPAC) has released its June 2011 "Report to the Congress: Medicare and the Health Care Delivery System." Most notably, the report includes a number of recommendations that have generated much controversy to address the growing use of ancillary services, particularly non-hospital diagnostic imaging services. According to the report, MedPAC seeks to “improve payment accuracy to reduce providers’ financial incentives to order more ancillary services, while strengthening clinical support tools to improve appropriate use of these services.” Recommendations in this area include the following: (1) the Secretary should accelerate and expand efforts to package discrete services in the physician fee schedule into larger units for payment; (2) Congress should direct the Secretary to apply a multiple procedure payment reduction to the professional component of diagnostic imaging services provided by the same practitioner in the same session; (3) Congress should direct the Secretary to reduce the physician work component of imaging and other diagnostic tests that are ordered and performed by the same practitioner; and (4) Congress should direct the Secretary to establish a prior authorization program for practitioners who order substantially more advanced diagnostic imaging services than their peers. In addition to the ancillary services recommendations, the report includes chapters examining: the Medicare physician fee schedule Sustainable Growth Rate formula; Medicare's fee-for-service benefit design; enhancing Medicare's technical assistance to and oversight of providers; coordinating care for dual-eligible beneficiaries; federally-qualified health centers; and variation in private-sector payment rates. Note that while MedPAC’s recommendations are not binding, Congress and CMS often take into account MedPAC’s assessments when updating Medicare payment policies.
This post was written by Paul Pitts.
On April 7, 2011, the Medicare Payment Advisory Commission (MedPAC) approved new recommendations to Congress regarding Medicare payment for imaging and other diagnostic tests. The recommendations reflect a shift in MedPAC’s policies from advocating for tighter controls on physician in-office services to addressing what MedPAC views as inaccuracies in payment and inappropriate use of diagnostic imaging. MedPAC approved the following recommendations: (1) the Secretary should accelerate and expand efforts to package discrete services in the physician fee schedule into larger units for payment; (2) the Congress should direct the Secretary to apply a multiple procedure payment reduction to the professional component of diagnostic imaging services provided by the same practitioner in the same session; (3) the Congress should direct the Secretary to reduce the physician work component of imaging and other diagnostic tests that are ordered and performed by the same practitioner; and (4) the Congress should direct the Secretary to establish a prior authorization program for practitioners who order substantially more advanced diagnostic imaging services than their peers. The recommendations will appear in MedPAC’s June report to Congress.
Several Congressional committees have held hearings on various aspects of the ACA, including: A House Oversight Health Care Subcommittee hearing on “Obamacare: Why The Need For Waivers?"; a Senate Finance Committee hearing on "Health Reform: Lessons Learned During the First Year"; a Senate Health, Education, Labor and Pensions Committee hearing examining "Health Insurance Exchanges and Ongoing State Implementation of the Affordable Care Act” and House Energy and Commerce Health Subcommittee hearings on "The Implementation and Sustainability of the New, Government-Administered Community Living Assistance Services and Supports (CLASS) Program" and on the "Patient Protection and Affordable Care Act in Pennsylvania: One Year of Broken Promises." Looking ahead, the Energy and Commerce Committee has scheduled a March 30 hearing on the ACA’s impact on budget and jobs, and an April 1 hearing on the ACA’s “High Risk Pool Regime: High Cost, Low Participation," and the House Appropriations Committee is holding a hearing on April 1 to discuss health reform funding. In other areas, the House Homeland Security Emergency Preparedness Subcommittee held a hearing on "Ensuring Effective Preparedness, Response, and Recovery for Events Impacting Health Security." The House Ways and Means Committee held a hearing to examine the Medicare Payment Advisory Commission's (MedPAC) annual report to Congress on Medicare payment policies (discussed in greater detail below). The House Budget Committee held a hearing on "Fulfilling the Mission of Health and Retirement Security."
On March 15, 2011, MedPAC released its annual report to Congress on Medicare Payment Policy. The report includes MedPAC’s recommendations on payment rate updates and other policies, such as distribution of payments and program integrity, for Medicare fee-for-service payment systems. It also includes an overview of the status of the Medicare Advantage and Medicare Part D prescription drug programs. Major recommendations include the following:
The Medicare Payment Advisory Commission (MedPAC) has released a report, "Report to the Congress: Regional Variation in Medicare Service Use," with related appendices. The report looks at regional variation in Medicare spending and in the use of Medicare-covered services. According to MedPAC, service use in higher-use areas (90th percentile) is 30% greater than in lower-use areas (10th percentile), and spending is about 55% greater in higher spending areas compared to lower spending areas. Regional variation is particularly high for post-acute sector services, although areas that are high use in one sector (such as inpatient, ambulatory, and post-acute) tend to be high use overall. The MedPAC report does not include policy recommendations, but MedPAC warns policymakers that "[e]xtremely high levels of service use in certain areas may be driven by overuse and, possibly, fraud and abuse. Additional policy measures may have to be taken in those areas beyond those used to address variation in general."
On January 13 and 14, 2011, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss Medicare payment adequacy for a number of Medicare providers, including: physicians and other health professionals, ambulatory surgical centers, hospital inpatient and outpatient services, outpatient dialysis providers, home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, long term care hospitals, and hospice providers. The meeting will also address Medicare Advantage program quality. MedPAC’s assessments will be presented to Congress later this year; while the panel’s recommendations are not binding, they often help shape federal policy.
On December 2-3, 2010, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss the adequacy of Medicare payment for a variety of services, including hospital (inpatient and outpatient), physician, ambulatory surgical center, outpatient dialysis, hospice, skilled nursing facility, home health, inpatient rehabilitation facility, and long-term care hospital services
On September 13 and 14, 2010, MedPAC met to discuss a variety of Medicare policy issues, including the following: the context for Medicare payment policy; Medicare’s shared savings program for accountable care organizations (ACOs); recent changes that affect Medicare beneficiaries’ financial liability; retainer-based physician practice; Medicare’s authority to apply least-costly alternative policies; growth in hospital observation care; the growth of ancillary services in physicians’ offices; and accountability for DME, home health, and hospice services.
MedPAC has released its June 2010 Data Book on “Healthcare Spending and the Medicare Program.” The Data Book provides information on national health care and Medicare spending, Medicare beneficiary demographics, Medicare quality and access, and Medicare beneficiary and other payer liability. It also includes data on various provider types, such as data on Medicare spending, beneficiary utilization of the service, number of providers, volume, length of stay, and margins.
The House Energy and Commerce Health Subcommittee has held hearings on MedPAC’s recent report to Congress on “Aligning Incentives in Medicare, and on "The Battle Against Diabetes: Progress Made, Challenges Unmet." In addition, the Senate Aging Committee held a hearing on prescription drug waste and disposal and the Senate Appropriations Agriculture Subcommittee examined the FDA’s review process for products to treat rare diseases and neglected tropical diseases.
On June 15, 2010, the Medicare Payment Advisory Commission (MedPAC) issued a report to Congress on “Aligning Incentives in Medicare.” Among other things, the report addresses: Medicare payment accuracy and moving away from volume incentives in fee-for-service Medicare; the Stark law in-office ancillary exception policy and options to change incentives that induce physicians to provide more ancillary services; performance-based payments; impediments to coordinated care for beneficiaries dually eligible for both Medicare and Medicaid; improvements to graduate medical education; ways to redesign Medicare benefit to encourage beneficiaries to seek higher value services; informing beneficiaries about their health care choices; and the role of CMS in a reformed delivery system.
The Medicare Payment Advisory Commission (MedPAC) has released its March 2010 Data Book on the Medicare Part D Program. Among other things, the report includes data on Part D enrollment, spending and utilization, Part D risk scores, top therapeutic classes, generic dispensing levels, and pharmacy participation levels.
The next MedPAC meeting, scheduled for April 1-2, 2010, will address the following issues: enhancing Medicare’s ability to innovate; medical malpractice; graduate medical education financing; Medicare shared decision-making; improving traditional Medicare’s benefit design; coordinating care for dual eligible beneficiaries; and trends in inpatient psychiatric care.
On March 1, 2010, the Medicare Payment Advisory Commission (MedPAC) issued its recommendations to Congress regarding Medicare provider payment updates for 2011. Among other things, MedPAC recommends:
The MedPAC report also reviews the status of MA plans and Part D prescription drug plans, and it provides recommendations on comparing quality among MA plans and between MA and fee-for-service providers. Note that while MedPAC’s recommendations are not binding, policymakers often consider MedPAC’s assessments when updating Medicare payment policies.
The Medicare Payment Advisory Commission (MedPAC) recently voted on recommendations it will make to Congress regarding Medicare payment updates for 2011. At the meeting, MedPAC voted to recommend increasing acute inpatient and outpatient prospective payment system reimbursement in 2011 by the projected rate of increase in the hospital market basket index (MBI). This rate increase would be coupled with implementation of a quality incentive payment program, along with an offset in 2011 through 2013 to recover payments attributable to hospital documentation and coding improvements. MedPAC also recommends that Congress increase payments for physician services in 2011 by 1.0%. For ambulatory surgical centers (ASCs), MedPAC recommends a 0.6% increase in rates, together with a requirement that ASCs to submit cost and quality data. MedPAC recommends updating the end stage renal disease (ESRD) composite rate by the ESRD MBI increase minus a productivity growth adjustment. MedPAC approved a series of recommendations regarding home health services, including elimination of the inflation update for 2011, rebasing of home health rates with provisions to protect quality of care, development of quality outcomes measures, and implementation of certain program integrity safeguards. With regard to other post-acute services, MedPAC recommends no payment update in 2011 for skilled nursing facilities, inpatient rehabilitation facilities, or long-term care hospitals. MedPAC also recommends updating hospice rates by the projected MBI for 2011, minus an adjustment for productivity gains. These recommendations will be included in MedPAC's March 2010 report to Congress. While the recommendations are not binding, MedPAC’s assessments often help shape federal policy.
The Medicare Payment Advisory Commission (MedPAC) has issued a report to Congress on “Measuring Regional Variation in Service Use.” The report is designed to help policymakers compare differences in the use of health care services in Medicare across the country, adjusted to remove the effects of differing wages, payment rates, and health status among geographic areas. Among other things, MedPAC found that while regional variation in service use is smaller than regional variation in Medicare spending, it is substantial: Service use in higher use areas (90th percentile) is about 30% greater than in lower use areas (10th percentile); according to MedPAC, “fraud and abuse may drive some of the highest reported service use.”
The Medicare Payment Advisory Commission (MedPAC) met on October 8 and 9, 2009 to discuss a variety of Medicare payment and policy issues, including the in-office ancillary exception to the physician self-referral law, provider consolidation, physician fee schedule prices, and medical education.
The Medicare Payment Advisory Commission (MedPAC) has released its June 2009 Data Book on Healthcare Spending and the Medicare Program, which includes detailed data for various provider settings .
MedPAC has issued its June 2009 "Report to the Congress: Improving Incentives in the Medicare Program." Among other things, the report addresses follow-on biologicals, chronic care management, physician self-referrals involving imaging services, physician resource use measurement, graduate medical education, accountable care organizations, Medicare benefit design, and Medicare Advantage payment policy.
The Medicare Payment Advisory Commission (MedPAC) is meeting April 8-9, 2009 to discuss a variety of Medicare payment and policy issues, including the impact of physician self-referral on use of imaging services, potential Medicare savings associated with follow-on biologics, and Medicare Advantage payments, among others.
A number of Congressional panels have held hearings recently on health policy issues, including the following:
On March 12-13, 2009, MedPAC is meeting to discuss a number of health policy issues, including: accountable care organizations; physician resource use measurement; MIPPA Medicare Advantage payment report; improving Medicare’s chronic care demonstration programs; the effects of secondary coverage on Medicare spending; medical education; and follow-on biologics.
The Medicare Payment Advisory Commission (MedPAC) is meeting January 8-9, 2009 to discuss a variety of Medicare payment and policy issues, including payments to hospitals, physicians, ambulatory surgical centers, dialysis providers, skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, long-term care hospitals, hospices, and Medicare Advantage plans.
On November 6 and 7, 2008, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss a number of health care policy issues, including reporting of physicians’ financial relationships, medical imaging services, the Medicare Part D and Medicare Advantage programs, hospice payments, and physician resource use.
On October 27, 2008, the GAO published a notice soliciting nominations for Medicare Payment Advisory Commission (MedPAC) members for appointments effective May 1, 2009. Letters of nomination should be submitted between January 1 and March 31, 2009.
On October 2-3, 2008, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss a number of health care policy issues, including reporting of physicians’ financial relationships, medical education training, MA payment and quality, frequently-rehospitalized skilled nursing facility patients, the use of drug data in risk adjustment, the psychiatric hospital prospective payment system, and health care sector growth.
MedPAC met on September 4 and 5, 2008 to discuss a range of Medicare policy issues, including physician financial relationships, MIPPA provisions on DME bidding and ESRD payment, imaging policy, Medicare Advantage, and Part D. Details regarding the meeting, including a transcript, are available at the MedPAC web site.
On June 13, 2008, the Medicare Payment Advisory Commission (MedPAC) released its June 2008 report to the Congress on "Reforming the Delivery System." MedPAC discusses a variety of payment and delivery reforms to improve Medicare quality, coordinate care, and reduce cost growth.
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