The Medicare Payment Advisory Commission held policy and recommendation meetings April 5 and 6, covering ground on several proposals ranging from CMS demonstrations for dual-eligible beneficiaries to reforming Medicare's benefit design.
• CMS demonstrations for dual-eligible beneficiaries. Some states are proposing to enroll all or most dual eligibles in their state into a CMS demonstration (a capitated model between CMS, the state and a health plan or a managed fee-for-service model where states finance care coordination and can share in Medicare savings if they meet quality thresholds). MedPAC members said the automatic enrollment into managed care plans for these dual-eligible beneficiaries caused some concern that it could harm access to healthcare.
• Reforming Medicare's benefit design. MedPAC members said there should be a limit on out-of-pocket expenses for Medicare beneficiaries, and a new charge for Medicare beneficiaries who choose to buy insurance beyond their Medicare coverage would fund the out-of-pocket cap.
"The vast majority of the cost of the beneficiary's decision to buy supplemental coverage is, in fact, borne by the Medicare program and the taxpayers who finance it," said Glenn Hackbarth, JD, chairman of MedPAC. "And we think that at least there should be a supplemental charge — a charge on supplemental insurance, that is, that reflects at least a portion of that additional cost incurred by Medicare as a result of the private decision to buy more insurance."
• Medicare payment for ambulance services. In a report due June 15, 2013, MedPAC is directed to study the appropriateness of temporary ambulance add-on payments and the effect of add-on payments on providers' Medicare margins. In its analysis, MedPAC will need to determine if there is a need to reform the ambulance fee schedule and whether add-ons should be built into the base rate.
• Data and the physician fee schedule. The physician fee schedule relies on time estimates, like work relative value units. However, services can change, and fee estimates are sometimes based on survey by specialty societies that have financial stakes in the results. MedPAC recommended CMS collect current, objective data for RVUs, identify overpriced services and achieve an annual numeric goal of reductions equal to at least 1 percent of spending.
• Variation in private-sector payment rates. Private payors involved with Medicare Advantage have shown variation in their payments to hospitals since MA plans are not bound by Medicare FFS payment rates.
• Care coordination in FFS Medicare. MedPAC members want to develop recommendations for payment incentives to achieve better results, as they said the current FFS model does not provide the right amount of care coordination to improve patient outcomes.
• Update on Medicare electronic health record incentive payment program. Roughly 16 percent of hospitals have received EHR incentive payments through February 2012, and a steady growth of physicians have received EHR incentive payments.
MedPAC's analysis from the meetings will be used as it compiles its June report to Congress.
• CMS demonstrations for dual-eligible beneficiaries. Some states are proposing to enroll all or most dual eligibles in their state into a CMS demonstration (a capitated model between CMS, the state and a health plan or a managed fee-for-service model where states finance care coordination and can share in Medicare savings if they meet quality thresholds). MedPAC members said the automatic enrollment into managed care plans for these dual-eligible beneficiaries caused some concern that it could harm access to healthcare.
• Reforming Medicare's benefit design. MedPAC members said there should be a limit on out-of-pocket expenses for Medicare beneficiaries, and a new charge for Medicare beneficiaries who choose to buy insurance beyond their Medicare coverage would fund the out-of-pocket cap.
"The vast majority of the cost of the beneficiary's decision to buy supplemental coverage is, in fact, borne by the Medicare program and the taxpayers who finance it," said Glenn Hackbarth, JD, chairman of MedPAC. "And we think that at least there should be a supplemental charge — a charge on supplemental insurance, that is, that reflects at least a portion of that additional cost incurred by Medicare as a result of the private decision to buy more insurance."
• Medicare payment for ambulance services. In a report due June 15, 2013, MedPAC is directed to study the appropriateness of temporary ambulance add-on payments and the effect of add-on payments on providers' Medicare margins. In its analysis, MedPAC will need to determine if there is a need to reform the ambulance fee schedule and whether add-ons should be built into the base rate.
• Data and the physician fee schedule. The physician fee schedule relies on time estimates, like work relative value units. However, services can change, and fee estimates are sometimes based on survey by specialty societies that have financial stakes in the results. MedPAC recommended CMS collect current, objective data for RVUs, identify overpriced services and achieve an annual numeric goal of reductions equal to at least 1 percent of spending.
• Variation in private-sector payment rates. Private payors involved with Medicare Advantage have shown variation in their payments to hospitals since MA plans are not bound by Medicare FFS payment rates.
• Care coordination in FFS Medicare. MedPAC members want to develop recommendations for payment incentives to achieve better results, as they said the current FFS model does not provide the right amount of care coordination to improve patient outcomes.
• Update on Medicare electronic health record incentive payment program. Roughly 16 percent of hospitals have received EHR incentive payments through February 2012, and a steady growth of physicians have received EHR incentive payments.
MedPAC's analysis from the meetings will be used as it compiles its June report to Congress.
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