The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress.

Among the findings included in the report by the Medicare Payment Advisory Commission are:

• Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays.
• Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted.
• MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities.
• MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for skilled nursing facilities.

MedPAC’s recommendations include:

• Authorizing outpatient-only hospitals in isolated rural communities to ensure access to emergency care.
• Reducing payments to off-campus emergency departments in certain urban areas.
• Rebalancing Medicare’s physician fee schedule to increase payments for ambulatory evaluation and management services while reducing payments for procedures, imaging, and tests.
• Paying for sequential stays in a unified prospective payment system for post-acute care.
• Establishing new ways to help patients, families, and hospitals identify higher-quality post-acute care providers for their patients.
• Establishing new principles for measuring quality that address both population-based measures and quality incentives.
• Encouraging the development of managed

In support of its proposal that Medicare adopt a unified payment system for post-acute-care services, the Medicare Payment Advisory Commission is exploring how to develop uniform outcome measures to support such a new payment system.

Under the MedPAC vision, articulated at its early April public meeting, skilled nursing facilities, home health agencies, long-term-care hospitals, and inpatient rehabilitation facilities would see their outcomes quantified based on their performance on a series of quality measures.

Meanwhile, there has been little congressional interest in the unified post-acute payment proposal so far.  While some aspects of such a proposal could be implemented administratively, the comprehensive system would require legislation.

Learn more about the Medicare uniform outcomes measures proposal, the unified post-acute care payment proposal, how they interact, and the prospects for both from this article in Provider magazine.…

The Medicare Payment Advisory Commission has urged Congress to reduce Medicare payments to freestanding emergency departments 30 percent.

The recommendation, approved by MedPAC earlier this month and to be included in its June report to Congress, notes that such facilities have a lower cost structure because they typically lack some of the equipment, personnel, and standby capabilities of hospital ERs.  In making its recommendation, MedPAC also noted that freestanding ERs typically treat patients whose conditions are not as severe as hospital ERs and tend to be located in areas that already have adequate access to hospital ERs.

While MedPAC’s recommendations are not binding on either Congress or the administration, its views are highly respected and often find their way into future Medicare policy development efforts.

Learn more about the MedPAC recommendation on Medicare payments to freestanding ERs and the reasons behind it in this Kaiser Health News report.

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The Medicare Payment Advisory Commission met last week in Washington, D.C. to address a number of Medicare reimbursement-related issues.

Among the subjects on MedPAC’s agenda were:

• using payments to ensure appropriate access to and use of hospital emergency department services
• uniform outcome measures for post-acute care
• applying MedPAC’s principles for measuring quality: hospital quality incentives
• Medicare coverage policy and use of low-value care
• long-term issues confronting Medicare accountable care organizations
• managed care plans for dual-eligible beneficiaries

While MedPAC’s policy and payment recommendations are not binding on Congress or the administration, its views are respected and influential and often become the basis for new public policy.

Go here to see the policy briefs and presentations offered to help guide MedPAC commissioners’ discussions about these and other issues.…

The Medicare Payment Advisory Commission has issued its 2018 report and recommendations to Congress.

The report includes MedPAC’s recommendations for next year’s Medicare fee-for-service payments; a review of the Medicare Advantage and Medicare Part D programs, with recommendations; and a report telehealth required by the 21^st Century Cures Act.

For Medicare fee-for-service rates, MedPAC proposes:

• the inpatient and outpatient rate increases, physician and other health professional rate increases, and outpatient dialysis increase included under current law
• no increase for ambulatory surgical centers, long-term-care hospitals, and hospice providers
• no rate increase for skilled nursing facilities
• a five percent reduction of payments for home health providers and the introduction of a two-year rebasing of home health rates beginning in 2020
• a five percent reduction of inpatient rehabilitation facility payments

In addition, MedPAC recommends that Medicare base future payments to post-acute providers on a blend of “each sector’s setting-specific relative weights and the unified post-acute care prospective payments system’s relative weights.”

MedPAC also recommends that Medicare abandon its merit-based incentive payment system (MIPS) in favor of an alternative approach for achieving “the shared goal of high-quality clinician care for beneficiaries in traditional Medicare.”

MedPAC is a non-partisan legislative branch agency that advises …