In January 2019, the Commission recommended the Congress replace the four current hospital quality payment programs with a single alternative program—the Hospital Value Incentive Program (HVIP). The HVIP encourages the delivery of better-quality hospital care for beneficiaries, catalyzes change in the delivery system, considers differences in providers’ patient populations, and reduces provider burden.
News
Improving Medicare’s payment for Part B drugs: Requiring pharmaceutical manufacturer reporting of sales price data
In 2017, MedPAC recommended a policy that requires all Part B drug manufacturers to report ASP data and gives the Secretary the authority to apply penalties to manufacturers who do not report required data. This policy would improve the accuracy of Medicare’s payments and protect beneficiaries and taxpayers from paying higher prices.
Improving Medicare’s payment policies for Advanced Practice Registered Nurses and Physician Assistants
The Commission recommends Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs) bill Medicare directly, eliminating “incident to” billing for their services.
The Hospital Readmissions Reduction Program has succeeded for beneficiaries and the Medicare program
The Hospital Readmissions Reduction Program (HRRP) contributed to declines in readmissions but has not caused material increases in outpatient observation stays or emergency department visits, nor has the HRRP had a net adverse effect on mortality.
Geographic Variation in Medicare Spending and Service Use
Today, MedPAC released a report on regional variation in both spending and service use under Medicare, updating a previous analysis from 2011. There is little evidence that higher service use results in higher quality. Moreover, it is likely that health care service use and spending could be substantially reduced without harming quality if service-use patterns of high-use areas were brought into line with those of lower-use areas.
Why have Medicare costs grown so much slower than the costs of employer-sponsored insurance?
In Medicare, the prices paid to providers are set by law. In contrast, commercial insurers usually negotiate prices with providers. As we discuss below, prices negotiated by commercial insurers vary wildly across providers and insurers, and prices have grown faster for providers with more market power.
Factors increasing Part D spending for catastrophic benefits
From 2010 to 2017, Medicare spending on the monthly prospective payments grew rather slowly, and average premiums for Medicare Part D enrollees remained between $30 and $31 per month. However, Medicare spending on reinsurance payments for enrollees with high drug costs grew on average more than 20% per year since 2010. In this blog post, we discuss several factors that have contributed to that high growth in recent years.
Trends in Medigap Enrollment, 2010 to 2015
The number of beneficiaries with Medigap policies has been growing, both in absolute terms, and as a share of beneficiaries in fee-for-service (FFS) Medicare. At the same time, a greater share of those with Medigap have chosen Medigap policies that include some significant amount of beneficiary liability for cost sharing. This blog post examines these trends using annual Medigap policy sales data from the National Association of Insurance Commissioners (NAIC) covering the years 2010 to 2015.
Meeting highlight: hospital consolidation and its implications for Medicare
At its November public meeting, the Commission held a session to discuss hospital consolidation and its implications for the Medicare program. The Commission has been tracking trends in provider consolidation, Medicare and private insurer payment rates, and provider costs for many years. In this post, we pull together a variety of analyses from MedPAC and others for a comprehensive backgrounder on hospital consolidation and Medicare.
Data book highlight: Rates of low-value service use and spending in Medicare
On Friday, MedPAC released its July 2016 data book. The data book is an annual MedPAC publication filled with charts and tables presenting much of the information from our March report, plus more, in a convenient and accessible reference guide. In this post, we’re highlighting two charts (5-7 and 5-8) about low-value care that can be found in this year’s edition.