Evidence suggests that price growth for brand-name drugs is beginning to drive growth in average prices of all drugs covered under Part D.
Every year, the Commission provides a status report on the Medicare Advantage (MA) and Part D programs. These reports were presented at our December and January meetings. To monitor each program’s performance, we examine enrollment trends, and plan availability for the coming year, as well as a variety of other factors.
This year, in addition to its traditional margin calculation, the Commission is considering a new aspect of the relationship between Medicare payments and providers’ costs: Medicare payments relative to providers’ marginal costs, i.e. marginal profit.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the sustainable growth rate (SGR) system and established a new approach to updating payments to clinicians. In order to implement MACRA, CMS will need to conduct rulemaking over the next two years to establish specific definitions for the APM and MIPS payment paths. This post provides a guide to some of the key requirements of the law.
The Commission has consistently stated that rural beneficiaries’ access to emergency services needs to be preserved. Since January 2013, there have been 41 hospital closures in rural counties and rural parts of urban communities. While some closures reflect excess capacity in areas, in other cases, the closed hospital has been the sole emergency room in the area. It is both the concern over maintaining access to care and concerns over inefficiencies in the current delivery system that motivated the Commission’s October session on preserving rural access to emergency services.
At the end of July, CMS announced that enrollee premiums for Medicare’s outpatient prescription drug benefit, known as Part D, will remain stable for 2016 at an average of $32.50 per month. It marks continued good news for Part D enrollees, whose average premiums have remained at about $30 to $32 per month for the past 7 years. However, other trends are more worrisome for the taxpayers supporting the Part D program.
This post points out some technical caveats when using BLS hospital price data. These technical issues may explain the divergence between BLS data and the pricing data reported by insurers and hospitals for their privately insured patients. We will discuss technical issues with three different BLS measures of hospital price inflation.
Today the Commission released a contractor report that looked at the question: does the hospice benefit increase or reduce Medicare spending? Hospice proponents often argue that hospice is a valuable service not only because it provides coordinated, patient-centered end-of-life care, but also because it reduces Medicare spending for patients at the end of life. However, today’s report concludes that hospice does not appear to produce lower aggregate Medicare spending.
Today, the Commission published its comment letter to the Centers for Medicare and Medicaid Services (CMS) on the fiscal year 2016 hospice proposed rule. In the rule, CMS proposed modifying the structure of payment rates for hospice routine home care. The proposed changes, though modest, are consistent with the Commission’s March 2009 recommendation for hospice payment reform. The Commission urges CMS to proceed with implementing these changes.
The issue of wasteful or “low-value” health care has attracted a lot of attention in the policy community because it represents an opportunity to reduce health care spending while maintaining or even improving quality for patients. The Commission has been working on ways to measure the incidence of low-value care within Medicare. The most recent iteration of this work, which was presented at our April meeting [link to presentation], contributes to the evidence that Medicare beneficiaries are receiving a significant amount of low-value care.