The Medicare Payment Advisory Commission (MedPAC) held their second public meeting of the current term on October 5-6, 2017. While no recommendations were presented, the topics discussed by the Commissioners indicate areas where MedPAC may offer recommendations during this term.
The first session of the meeting looked at possible next steps for the Merit-based Incentive Payment System (MIPS). The staff presentation gave an overview of MIPS, highlighted the Commission’s concerns with MIPS, and gave a broad policy alternative. This alternative would eliminate MIPS and its reporting requirements and establish a new voluntary value program. In this voluntary value program, clinicians could elect to join with other clinicians in a sufficiently large entity to be eligible to receive a value payment and all clinicians in an entity would receive the same value payment adjustment. Staff noted that this could be like the virtual groups allowed under MIPS. In addition, through the value program, CMS would assess an entity’s performance using a set of population-based measures that would be comparable to those in advanced Alternative Payment Models (A-APMs). Additionally, all clinicians would have a portion of their fee schedule payments withheld and the value payment would be capped.
In the discussion that followed this presentation, Commissioners were in general agreement that MIPS was not sustainable and should be eliminated. Many commissioners also believed that a replacement was needed, but no strong consensus formed supporting the voluntary value program. Some commissioners felt that it was a good start, but it would need further adjustment and tinkering. However, there was a consensus that population health efforts should be advanced in whatever replacement was discussed. Commissioners also expressed support for A-APMs and wondered if participation in these entities could be encouraged as an alternative to MIPS. MedPAC commissioner Dr. Jay Crosson indicated that draft recommendations related to a MIPS replacement could be put forward in December, but that these recommendations could include tweaks to the voluntary value program and possibly be related to A-APM rules.
The 21st Century Cures law passed in late 2016 mandated a report from MedPAC about telehealth so commissioners received an update on the information staff has found from preparing this report. Staff looked at telehealth use in both Medicare and commercial insurance. Results from site visits and focus groups showed that Medicare beneficiaries were unfamiliar with telehealth and while they had concerns, beneficiaries did see some opportunities from the use of telehealth. In the commercial space, MedPAC staff found that coverage of telehealth services varied among plans. During the discussion, many commissioners were surprised at how low the utilization of telehealth services was. However, echoing the discussion during the September 2017 meeting, some commissioners said that a better understanding of what services are part of telehealth would be helpful. Multiple commissioners also remained hopeful that despite low utilization, better awareness and better policies could help demonstrate areas where telehealth services could be beneficial to both beneficiaries and practitioners.
Other topics discussed throughout the meeting include physician-owned distributors (PODs), a unified payment system for post-acute care, the hospital value incentive programs, and Medicare Part D exceptions and appeals. While discussing physician-owned distributors, MedPAC commissioners remained skeptical of these type of distributors, questioning what benefit they add. Staff suggested exploring Stark law implications for PODs, reporting under the Open Payments program, and allowing broader hospital-physician gainsharing in Medicare to reduce the incentives for creating and using PODs. Commissioners were supportive of exploring these ideas and a chapter on this topic in MedPAC’s annual report is expected.
The discussion of a unified payment system for post-acute care continues a large part of work that was done during the previous MedPAC term. The Commission is continuing to evaluate how to create this unified payment system and staff is currently evaluating how to pay for sequential stays and align regulatory requirements. Commissioners remain supportive of these efforts and also expressed interest in exploring how bundled payments could play into this idea.
The next public MedPAC meeting is scheduled for November 2-3, 2017 at the Ronald Reagan Building International Trade Center.