The Medicare Payment Advisory Commission has released its June 2018 report on Medicare and healthcare delivery to Congress, which includes two recommendations to ensure appropriate access to and use of hospital emergency department services in rural and urban areas.
Here are seven takeaways from MedPAC's June report:
1. MedPAC recommends Congress creating an outpatient-only hospital voluntary option, saying this would help ensure isolated rural communities maintain access to needed ED services. The commission also recommends Medicare pay urban off-campus EDs the Type A payment rates (for EDs open 24 hours a day, 7 days a week) reduced by 30 percent. This recommendation "would better align payments with costs and make off-campus ED rates similar to Type B rates [for EDs open less than 24 hours a day, 7 days a week]," according to MedPAC, noting there would be at least one needed exception, for urban off-campus EDs more than 6 miles from on-campus EDs.
2. The commission expressed concern that ambulatory evaluation and such management services as office visits are underpriced compared to other services in the Medicare fee schedule for health professionals. It recommends a budget-neutral approach for rebalancing the fee schedule that it says "would increase payment rates for ambulatory E&M services while reducing payment rates for other services (e.g., procedures, imaging, and tests). Under this approach, the increased payment rates would apply to ambulatory E&M services provided by all clinicians."
3. MedPAC is considering refining a unified post-acute care prospective payment system. The refinements would specifically focus on increasing Medicare payment accuracy for cases that involve sequential post-acute care.
4. The commission discusses advocating for use of higher quality post-acute care providers. "At discharge from an inpatient stay, the selection of a provider within a PAC category can be crucial because the quality of care varies widely among providers," according to MedPAC.
5. The commission addresses Medicare's medical device payment policies, and making improvements to such policies for certain items, including durable medical equipment, prosthetic devices and prosthetics. MedPAC said it also looks at "how to constrain the risks posed by physician-owned distributors by making them more transparent to beneficiaries, enforcement agencies and others."
6. The commission is considering policies for managed care plans for people who receive Medicare and Medicaid. MedPAC said the policies would specifically encourage the creation of plans that integrate care for those beneficiaries.
7. The commission reviews the coverage processes used in fee-for-service Medicare and Medicare Advantage plans and by Part D sponsors. "Coverage policies often are based on little evidence and usually do not include an explicit consideration of a service's cost-effectiveness or value relative to existing treatment options. As a result, the coverage process does not prevent the use of low-value services," MedPAC concluded. The commission describes tools Medicare could consider to reduce the use of low-value care.
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