MedPAC’s November 2022 public meeting was held virtually via video conference on the GoToWebinar platform.
Agenda
11/03/2022 . 10:15 am - 12:00 pm
Differences in quality measure results across Medicare populations
Staff Contacts:
ISSUE: Health outcomes can be adversely influenced by social risk factors such as income, housing, social support, transportation, nutrition, and race/ethnicity.
KEY POINTS: We analyze quality measure results for different Medicare fee-for-service beneficiaries grouped by two social risk factors: race/ethnicity categories and income level.
ACTION: Commissioners will review and discuss the analyses and findings and provide direction for future work.
11/03/2022 . 1:15 pm - 2:40 pm
Policy options for increasing Medicare payments to primary care clinicians
Staff Contacts:
ISSUE: The Commission has found that the number of primary care physicians billing Medicare’s physician fee schedule has declined slightly in recent years, while the number of specialists has steadily grown. Half of U.S. medical school graduates say that income expectations influenced their choice of specialty, and the compensation of primary care physicians ($264,000) is well below that of various types of specialists, such as non-surgical procedural specialists ($450,000).
KEY POINTS: Staff will present policy options to increase Medicare payments to primary care clinicians.
ACTION: Commissioners will discuss the policy options.
11/03/2022 . 2:45 pm - 3:55 pm
Aligning fee-for-service payment rates across ambulatory settings
Staff Contacts:
ISSUE: Medicare payment rates often differ for the same service among ambulatory settings, which include physician offices, ambulatory surgical centers (ASCs), and hospital outpatient departments (HOPDs). These payment variations across settings encourage arrangements among providers that result in care being provided in the settings with the highest payment rates, thereby increasing total Medicare spending and beneficiary cost sharing.
KEY POINTS: If the same service can be safely provided in different settings, a prudent purchaser should not pay more for that service in one setting than in another. Some ambulatory services cannot be safely provided in freestanding offices or ASCs and should be provided only in HOPDs. However, for services that can be provided in multiple ambulatory settings, payment rates could be aligned across the settings to more closely match the payment rate of the lowest cost setting without adversely affecting beneficiaries’ access.
ACTION: Commissioners will review and discuss the material and provide guidance for future work.
11/03/2022 . 4:00 pm - 5:30 pm
Mandated report: Evaluation of a prototype design for a post-acute care prospective payment system
Staff Contacts:
ISSUE: The Congress required that the Commission and the Secretary of Health and Human Services (HHS) develop prototypes for a unified PAC payment system that sets payments based on characteristics rather than setting for all PAC providers. The Improving Medicare Post-Acute Care Transformations (IMPACT) Act of 2014 mandated three reports. The first report was completed by the Commission in 2016 and recommended features of a design. The second report was issued by CMS/ASPE in the Department of Health and Human Services (HHS) in July 2022 and included a prototype design. The Commission is required to submit the third report, with recommendations, by June 30, 2023. To meet this mandate, we will include a chapter in the June 2023 report to the Congress.
KEY POINTS: We compare the key features of a PAC PPS design to the HHS prototype and discuss the prototype’s accuracy and impacts.
ACTION: Commissioners will discuss the differences between MedPAC’s preferred features and the prototype design.
11/04/2022 . 9:00 am - 10:25 am
Supporting Medicare safety-net hospitals
Staff Contacts:
ISSUE: The Medicare program strives to ensure access to care for all beneficiaries. However, some beneficiaries, such as those with low incomes, may have more difficulty accessing care than others. At the same time, providers that treat high shares of low-income beneficiaries may face financial challenges.
KEY POINTS: An alternative framework could be used to better identify safety-net providers and provide financial support for hospitals serving low-income Medicare beneficiaries.
ACTION: Commissioners will discuss the material and provide guidance on future work.
11/04/2022 . 10:30 am - 12:00 pm
Standardizing benefits in Medicare Advantage plans: Non-Medicare supplemental benefits
Staff Contacts:
ISSUE: MA plans can offer a wide variety of supplemental benefits, potentially confounding beneficiaries’ ability to meaningfully choose a plan.
KEY POINTS: This session will build on the Commission’s discussion of standardized benefits at our early September meeting. MA plans can offer a wide range of non-Medicare supplemental benefits and they play an important role in plans’ efforts to attract enrollment. However, the variation in those benefits can also make it difficult for beneficiaries to compare plans and select the one that best meets their needs. Standardized benefits could be used as a way to make that process easier. We examine some ways that policymakers could make supplemental benefits more standardized while preserving plan flexibility.
ACTION: Commissioners will discuss the material and provide guidance on future work.