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MedPAC Meets

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

The issues on MedPAC’s April agenda were:

  • Expanding the use of value-based payment in Medicare
  • Medicare Shared Savings Program performance
  • Redesigning the Medicare Advantage quality bonus program
  • Increasing the accuracy and completeness of Medicare Advantage encounter data
  • Evaluating patient functional assessment data reported by post-acute-care providers
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services
  • Options to increase the affordability of specialty drugs and biologics in Medicare Part D
  • Improving payment for low-volume and isolated outpatient dialysis facilities

Many of these issues are important to private safety-net hospitals.

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.

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

 

Administration Moving Away From Value Pay?

First, new Medicare programs for lump-sums payments for cardiac care and joint replacements were scaled back.

Then, additional doctors were exempted from a new payment system that would have paid them more for the results they produce than for the quantity of care they provide.

Next, the Department of Health and Human Services presented a document outlining a new direction for its Center for Medicare and Medicaid Innovation.

And it announced that it was seeking input from doctors on payment policy.

All suggest that if the Trump administration is not moving away for paying for quality rather than quantity it is at least considering pursuing value in different ways.

What ways?  A recent article in the New York Times looked at these recent changes and presented the views of experts on where the administration may be going with Medicare payment policy.  Go here to see that article.

New Book Addresses Social Risk Factors in Medicare

In the new book Accounting for Social Risk Factors in Medicare Payment, the National Academies of Sciences, Engineering, and Medicine addresses the question of what social risk factors might be worth considering in Medicare value-based payment programs and how those risk factors might be reflected in value-based payments.

The book, the culmination of a five-part NASEM process, focuses on five social risk factors:

  • socio-economic position
  • race, ethnicity, and cultural context
  • gender
  • social relationships
  • residential and community context

Addressing such factors in Medicare value-based payments, the book finds, can help achieve four important goals:

  • reduce disparities in access, quality, and outcomes
  • improve the qualify and efficiency of care for all patients
  • foster fair and accurate reporting
  • compensate provides fairly

Doing so also can help prevent five types of unintended consequences from a failure to address social risk factors in Medicare payment policy:

  • providers avoiding patients with social risk factors
  • reducing incentives to improve the quality of care for patients with social risk factors
  • underpaying providers that serve disproportionately large numbers of patients with social risk factors
  • a perception of different medical standards for different populations
  • obscuring disparities in care and outcomes

NAUH has long advocated appropriate consideration in Medicare payment policies of the special challenges poses by the patients and communities served by private safety-net hospitals.

Learn more about social risk factors and their potential role in Medicare value-based payment policy in the new book Accounting for Social Risk Factors in Medicare Payment, which can be downloaded free of charge here, from the web site of the National Academies of Sciences, Engineering, and Medicine.