On Thursday, November 4th, the Medicare Payment Advisory Commission (MedPAC) hosted the next public meeting of their current term. The topics of the meeting varied but heavily featured provider-related topics in Medicare. The meeting agenda and presentations can be found here.
Provider Consolidation: The Role of Medicare Policy
The first topic at the meeting was provider consolidation, both vertical and horizontal. Commissioners discussed site neutral policies, paying for results or corporate structure, and how this relates to MedPAC’s consideration of a premium support framework. Commissioners expressed interest in furthering site-neutral policies, but stated that the commission needs to make sure no access issues result from these policies. The Centers for Medicare and Medicaid Services (CMS) released their Calendar Year 2017 Hospital Outpatient Prospective Payment System Final Rule on Tuesday, November 1, which finalizes changes to certain site-neutral payment rates. Key stakeholders such as the American Hospital Association and Premier voiced their disappointment in CMS finalizing these new policies and continue to advocate for increased access to care especially for the most vulnerable communities. Expect the Commission to further discuss access issues along with potentially commenting on CMS’ final rule at the next MedPAC meeting.
Stand-Alone Emergency Departments
MedPAC commissioners also received a presentation about stand-alone emergency departments, which were previously put forward by MedPAC in its June 2016 report (following a September 2015 meeting) as a possible solution for isolated rural areas with concerns about access to care. While no official recommendations were made, the commissioners discussed the possibility of CMS tracking hospital-based off-campus emergency departments (OCEDs) in Medicare claims data, examining incentives that may be encouraging providers to serve patients in the ED setting, and re-examining the ED exemption within the site neutral law.
Determining Benchmarks and Beneficiary Premiums Under a Premium Support System for Medicare
While noting that a chapter would appear in MedPAC’s next report, the commissioners looked at determining benchmarks and beneficiary premiums under a premium support system for Medicare. Time was spent looking at the use of competitive bidding to establish benchmarks as well as possible options to mitigate any large increases in beneficiary premiums. No definitive recommendations were put forward, but commissioners explored the possibilities of using local market areas as bidding areas and treating the fee-for-service program like a competing plan and expressed that premium support was an area that MedPAC should explore further since competitive bidding programs for other areas of Medicare have mixed reviews.
Other topics discussed at the meeting include Medicare outlier payments, population-based outcome measures, payments from drug and device manufacturers to physicians and teaching hospitals. No official recommendations were made related to these topics, however future MedPAC work could be conducted in all of these areas.
The next public MedPAC meeting will be December 8-9, 2016 at the Ronald Reagan Building, International Trade Center.