The Medicare Payment Advisory Commission’s (MedPAC’s) initial public meeting of the new term, which was held on September 8, may telegraph what the Commission may make recommendations to Congress on in the upcoming year. The meeting featured presentations and discussions on a wide range of issues, including a context for Medicare payment policy, an overview of the medical device industry, a unified post-acute care payment system, physician affiliation and practice size, and avoidable hospitalizations of residents in long-stay nursing facilities. MedPAC is an independent Congressional agency that was established in 1997 to advise Congress on issues affecting the Medicare program. In addition to advising Congress on payments to Medicare providers and suppliers (including Medicare Advantage and Medicare Part D plans), MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.

No official recommendations were presented to the members of the Commission or voted upon. Much of the discussion instead focused on what issues the commission would like to further explore and gather more information about. MedPAC submits reports to Congress each March and June; therefore, it is possible that these issues may reemerge within one of those reports.

The Commissioners heard a presentation concerning the context for Medicare payments generally. While the presentation contained no official recommendations, it was used to encourage discussion about possible topics for future MedPAC exploration. Comments from the members of the Commission were very varied so multiple topics were indicated as possibilities for future exploration, including:

• Areas of possible fraud within Medicare;
• Per beneficiary spending growth in lab tests performed in physician offices and independent labs;
• Evolving definitions in the medical profession and how that impacts diagnosis and treatment; and
• Exploring high priority outcomes measures for health care.

During the public meeting, the commissioners engaged in a lengthy discussion on a presentation about the medical device industry that provided an overview of the industry as a whole. Noting the this was an area where MedPAC had previously done little work, the Commission members indicated that they would like to see further exploration of this industry as it relates to Medicare payment, particularly because of the large size of the device industry.  Topics of particular interest include price transparency, use of UDIs for claims data, and gain sharing agreements. In addition, quality of devices and their appropriate use was mentioned by multiple Commission members as possible topics that MedPAC could explore.

Additional presentations that were given at the public meeting were mostly informative and served to keep the Commission members aware of the ongoing research interests of MedPAC that will see more updates in future meetings. The presentation on preventing avoidable hospitalizations of long-stay nursing facility residents, which will be followed by more information at the meeting next month, highlights next steps of continuing to monitor the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents (RAH-NFR) and developing risk-adjusted measures of potentially avoidable hospital use.

Commission members also heard a presentation about the continuing effort on a PAC PPS to ease payment for a variety of services. An additional update will follow in future months and there will also be a chapter in the June report. Next steps for this will include developing and analyzing variation in readmission rates and Medicare spending per beneficiary (MSPB) throughout care settings.

Finally, a presentation that utilized data from the SK&A physician database to analyze physician affiliation and practice size was met with mixed reviews. Some Commission members were supportive of efforts using SK&A while others were more skeptical. With varied confidence in the tool, the suggestion was to possibly discuss with CMS what could be done to help develop a stronger source of data that could then be used to aid future policy decisions.

The next public MedPAC meeting will be held from October 6-7, 2016.