MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

Among the issues on MedPAC’s October agenda were:

  • Medicare Advantage benchmark policy
  • indirect medical education:  current Medicare policy, concerns, and principles for revising
  • the evolution of Medicare’s advanced alternative payment models
  • vertical integration and Medicare payment policy

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.  Because so many patients of private safety-net hospitals are insured by Medicare, MedPAC’s deliberations are especially important to those hospitals.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues and here for a transcript of the proceedings.

Azar: More Value-Based Care Coming

Medicare may add more value-based care initiatives and alternative payment models to those it already operates, Health and Human Services Secretary Alex Azar suggested at a recent event in Washington, D.C.

During his remarks, Azar spoke about population health benefits, global budgeting for Medicare patients, more primary care programs, and new models that address kidney care and opioid use and hinted at future efforts that address social determinants of health.

Learn more about Azar’s remarks about Medicare value-based purchasing and alternative payment models and other current federal health policy matters in the Healthcare Dive article “HHS chief keeps focus on alternative payment models.”

Administration Slows Movement Toward Medicare Quality Payments

The Trump administration is slowing Medicare’s movement toward making greater use of quality in its payment system.

The Obama administration’s goal of having 50 percent of Medicare payments made through a quality or alternative payment model by the end of 2018 now appears to be out of sight.  Instead, the Centers for Medicare & Medicaid Services has partially canceled two bundled payment programs – one for joint replacement and another for cardiac rehabilitation programs – and announced that before introducing new programs it wants to take a closer look at the successes and failures of the alternative payment model programs that have been implemented in recent years.

The Washington Post’s “The Health 202” feature offers an in-depth look at CMS’s current approach to Medicare quality programs and reimbursement system changes.  See it here.

MedPAC Delivers Annual Report to Congress

The Medicare Payment Advisory Commission has issued its annual report and recommendations to Congress.

The major issues addressed in the report include:

  • implementing a unified payment system for post-acute care
  • reforming Medicare payment for drugs under Part B
  • redesigning the merit-based incentive payment system (MIPS) and strengthening advanced alternative payment models
  • using premium support for Medicare
  • the relationship between clinician services and other Medicare services
  • payments from drug and device manufacturers to physicians and teaching hospitals in 2015
  • the medical device industry
  • stand-alone emergency departments
  • hospital and skilled nursing facility use by Medicare beneficiaries who reside in nursing facilities
  • the role of Medicare policy in provider consolidation

To learn more about MedPAC’s annual report to Congress, see this MedPAC news release, this fact sheet, and the report itself.

Participation in Alternate Payment Models Rises

In 2017 nearly 360,000 clinicians will participate in Medicare and Medicaid Alternative Payment Model programs sponsored by the Centers for Medicare & Medicaid Services.

CMS also reports that this year 570 accountable care organizations, including 131 that bear risk, will serve more than 12.3 million Medicare and Medicaid beneficiaries.

In addition, nearly 3000 primary care practices will participate in advanced primary care medical home models.

Find more about the growth of participation in CMS’s alternative payment models, including descriptions of the different models and breakdowns in the numbers of participants, in this CMS news release.

Medicare Proposes New Way to Pay Docs

Clinicians would be paid based more on the quality of care they provide than on the quantity of services they deliver under a new Medicare quality reporting and payment proposal released last week by the Centers for Medicare & Medicaid Services.

The proposal, required by Congress last year as part of the Medicare Access and CHIP Reauthorization Act that constituted the final “Medicare doc fix” and spelled the end of the sustainable growth rate formula that constrained Medicare payments to physicians for more than a decade, would be phased in over a period of years, would end so-called meaningful use requirements for physicians, and would compensate most clinicians based on their performance on quality measures, some of them of their own choosing, in four categories – quality, advancing care information, clinical practice management, and cost – that would be part of a new Merit-Based Incentive Payment System.

iStock_000008064653XSmallClinicians who assume financial risk as part of what CMS is calling Advanced Alternative Payment Models – programs such as the Next Generation ACO model, the Comprehensive Primary Care Plus program, and tracks 2 and 3 of the Medicare Shared Savings Program – would participate in a separate quality reporting and payment program that would respond to the greater financial risks such providers shoulder with greater potential financial rewards.

Learn more about the latest Medicare proposal from the following resources:

Medicare Hits Payment Target

Medicare has achieved its goal of tying 30 percent of all Medicare payments to alternative payment models a year early, the Centers for Medicare & Medicaid Services has announced.

As of January of 2016, 30 percent of Medicare payments are tied to alternative payment models. In January of 2015, Health and Human Services Secretary Sylvia Mathews Burwell announced the target but said she hoped Medicare could achieve it by 2017.

Among the alternative care models to which Medicare payments are now tied are:

  • Medicare Shared Savings Program (MSSP)
  • Pioneer ACOs
  • Next Generation ACOs
  • Comprehensive End Stage Renal Disease (ESRD) Care Model
  • Comprehensive Primary Care Model
  • Multi-Payer Advanced Primary Care Practice
  • End Stage Renal Disease Prospective Payment System
  • Maryland All-Payer Model
  • Medicare Care Choices Model
  • Bundled Payment Care Improvement

Learn more about these alternative payment models here.

Another new alternative payment model, which mandates bundled payments for hip and knee replacements, begins in about 25 percent of the country on April 1.

To learn more about how Medicare achieved this goal and why federal officials believe moving in this direction is so important, see the CMS fact sheet “Better Care. Smarter Spending. Healthier People: Improving Quality and Paying for What Works.”