The Medicare Payment Advisory Commission (MedPAC) published their June Report to the Congress: Medicare and the Health Care Delivery System, in which they evaluate several Medicare payment issues in order to make recommendations to Congress. Issues addressed include:
Implementation of a unified payment system for post-acute care. Given the overlap among PAC settings (skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals) in the patients they treat, MedPAC has long promoted the idea of moving to a unified PAC PPS that spans the four settings, with payments based on patient characteristics rather than the site of service. The Commission recommends the implementation of a PAC PPS sooner than the timetable outlined in the IMPACT Act.
Medicare Part B drug payment policy issues. The Commission recommends a series of regulatory and market-based reforms (both short and long term) to improve Medicare payment for Part B drugs.
Premium support in Medicare. The Commission makes no recommendation regarding using a premium support model for Medicare (a model that would require the government to pay a fixed dollar amount for each beneficiary’s Medicare coverage) but examines some of the key issues that policymakers will need to resolve if they decide to used premium support in Medicare.
The relationship between physician and other health care professional services and other Medicare services. The Commission found that the relationships between clinician services and other services under Part A, B, and D of Medicare prove to be neither clear complements nor clear substitutes.
Redesign of the Merit-based Incentive Payment System and strengthening advanced alternative payment models. The Commission finds the current design for MIPs and advanced alternative payment models to be unhelpful in the following areas:
- Beneficiaries choosing clinicians
- Clinicians changing practice patterns to improve value
- Rewarding clinicians based on value
Therefore, the Commission recommends an alternative model for MIPs, including instituting a quality withhold for all services under the physician fee schedule and eliminating the current set of MIPS measures and instead relying on population-based outcome measures.
Hospital and skilled nursing facility use by Medicare beneficiaries who reside in nursing facilities. This section of the report focuses on potentially preventable transfers from the SNF or nursing facility (NF) to a hospital. To address this issue, the Commission makes several recommendations, including that CMS consider developing measures of hospital and SNF use to incorporate into nursing facilities’ public reporting requirements. If successful, the Commission recommends that CMS could expand the SNF value-based purchasing program to include additional measures, such as a long-stay NF resident-hospital admission measure.
Provider consolidation and the role of Medicare policy. The Commissions found that consolidation among and between hospitals and physicians has increased prices without any increase in quality.
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