News, Skilled Nursing Facility

MedPAC weighs in on several topics affecting post-acute care in public meeting

The Medicare Payment Advisory Commission (MedPAC) held their public meeting over two days this week at the Ronald Reagan Building, International Trade Center in Washington to discuss multiple topics impacting post-acute care. The meeting agenda included the following:

Medicare Advantage encounter data validation and potential uses:

  • ISSUE: During public sessions, Commissioners regularly highlight situations in which both FFS and MA payment policies could be informed by information on MA plan practices. In this paper, we expand on how MA encounter data could be used to improve various program functions necessary for administering the MA program and how the data could be used to inform potential refinements to the traditional, fee-for-service Medicare program.
  • KEY POINTS: The paper discusses the uses of MA encounter data, the data submission and screening process, and our efforts to validate the MA encounter data.
  • ACTION: Commissioners will discuss the analyses, conclusions, and potential next steps.

Uniform outcome measures for post-acute care

  • ISSUE: In its 2016 and 2017 reports to the Congress on the unified prospective payment system for post-acute care, the Commission discussed the need to monitor provider responses and adopt companion policies, such as value-based purchasing. To begin to compare performance measures across PAC settings, staff will report on two cross-setting measures—readmission rates to an acute care hospital and a resource use measure (Medicare spending per beneficiary for PAC providers, or MSPB–PAC).
  • KEY POINTS: This presentation reviews work on cross-setting outcome measures.
  • ACTION: Commissioners will discuss the analyses and future work. 

Medicare coverage for policy and use of low-value care

  • ISSUE: Some researchers contend that a substantial share of Medicare health care dollars is not spent wisely. Many new services disseminate quickly into routine medical care in fee-for-service Medicare with little or no basis for knowing whether they outperform existing treatments, and to what extent.
  • KEY POINTS: At the April meeting, we will review the literature on low-value care and present case studies of services that are low value or of unknown value.
  • ACTION: Commissioners will discuss the material and provide feedback to staff, prior to its inclusion in the forthcoming June report.

Long-term issues confronting Medicare Accountable Care Organizations

  • ISSUE: This paper briefly reviews Medicare ACO programs and issues that may challenge the continuation of ACOs that assume responsibility for both savings and losses. It also serves as an outline for a possible June report chapter on ACOs.
  • KEY POINTS: We review the current ACO programs (Medicare Shared Savings Program, Next Generation ACO Model, End-Stage Renal Disease (ESRD) Seamless Care Organizations) and the two new ACO programs (Track 1+ ACO Model, Vermont All-Payer Model) that began in 2018. We then consider issues confronting two-sided ACOs, including: potential conflicting incentives between ACOs and hospitals; asymmetric risk-sharing; the five percent incentive bonus for clinicians; specialist involvement in ACOs; and the potential for two-sided ACOs to continue to be an entity separate from Medicare Advantage.
  • ACTION: Commissioners should review the material in preparation for a discussion at the April 2018 meeting.

Managed care plans for dual-eligible beneficiaries

  • ISSUE: We review and compare the various types of Medicare health plans that serve dual-eligible beneficiaries: Medicare Advantage dual-eligible special needs plans, Medicare-Medicaid Plans, and the Program of All-Inclusive Care for the Elderly.
  • KEY POINTS: Many states are enrolling more dual eligibles in Medicaid managed care plans, and interest in developing integrated plans that provide both Medicare and Medicaid services to this population is likely to increase. Medicare has several types of plans that serve dual eligibles but they differ in a number of key respects.
  • ACTION: Commissioners will discuss the material and implications for future analytic work.