On March 1, 2018, the Medicare Payment Advisory Commission (MedPAC) hosted the next public meeting of their current term. The meeting covered a variety of topics including sequential stays in post-acute care settings, encouraging use of higher-quality post-acute care providers, appropriate access and use of emergency departments, and a demonstration for dual-eligible beneficiaries from the Centers for Medicare and Medicaid Services (CMS).

The sessions on the first morning of the meeting was a continuation of ongoing work the Commission is conducting to build a unified payment system for post-acute care (PAC) settings. These include skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and home health agencies. One of these sessions specifically look at how to pay for sequential stays in the unified payment system while the other explored ways to encourage Medicare beneficiaries to use higher-quality post-acute care providers. When discussing payment for sequential stays, commissioners expressed an interest in getting more information about using a bundled payment for these stays and the possibility of conveners in this space. In the second discussion about encouraging use of higher-quality providers, commissioners wanted to further explore the factors that impact patient preferences and what type of information should be provided to beneficiaries.

A later session explored appropriate access and use of hospital emergency department services in both rural and urban areas. The presentation looked at stand-alone emergency departments versus on-campus departments. The following two draft recommendations were presented to the commissioners:

• Draft recommendation 1- The Congress should:
  • Allow isolated rural stand-alone emergency departments (more than 35 miles from another ED) to bill standard outpatient prospective payment system facility fees, and
  • Provide such emergency departments with annual payments to assist with fixed costs
• Draft recommendation 2- The Congress should reduce hospital outpatient payments for off-campus stand-alone emergency departments that are within six miles of an on-campus hospital ED
  • By 30 percent OR
  • By paying Type B ED payment rates

Commissioners expressed support for the first recommendation but were less sure about the second although were more enthused the 30 percent option than paying Type B ED rates. Again, the commissioners hoped to see more information at the next meeting about urgent care utilization and how this relates to problems facing primary care. The Commission will likely vote on these recommendations with minor changes at the next public meeting in April.

Commissioners also received an update on CMS’ financial alignment demonstration for dual-eligible beneficiaries that included health plan participation, payment methodology, and beneficiary enrollment. Many commissioners shared frustrations that evaluation of the early program years has not been completed yet, but many were hopeful about the entire demonstration and hoped that these evaluations would serve as useful tools to continue finding innovations for the dual-eligible population. The April public meeting will likely include another presentation on this topic and a chapter is expected in the June report.

The next public MedPAC meeting, which will be the final of the current session, will be held on April 5-6, 2018.