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.
News
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.
MedPAC releases drug briefings
When the Commission began its deliberations on drug policy, which ultimately shaped the contents of the June report, it started with two informational presentations that were intended to provide background and context for its discussions. The Commission is now releasing annotated versions of these presentations to serve as a resource for policymakers.
March 2016 report highlight: HRAs and risk adjustment
MedPAC’s March 2016 report contains two recommendations for the Medicare Advantage (MA) program. This post will focus on the MA recommendation pertaining to health risk assessments (HRAs).
Case mix, coding, and profitability in IRFs
The high margin for IRFs in 2014 indicates that, in aggregate, Medicare payments substantially exceed the costs of caring for beneficiaries. But margins differ considerably across IRFs. Since 2009, the aggregate margin for hospital-based IRFs—which account for 52 percent of IRF discharges—has been at or below 1 percent, while the aggregate margin for freestanding IRFs has been 20 percent or more. Further, since 2006, the disparity between hospital-based and freestanding IRFs’ margins has been widening. The growing disparity is likely due in part to differences in cost growth.
Including hospice benefit in the MA benefit package
The Medicare hospice benefit is not included in the Medicare Advantage (MA) benefits package. MA enrollees who elect hospice remain in their MA plans, but fee-for-service (FFS) Medicare pays for their hospice services. This carve-out of hospice from MA fragments care accountability and financial responsibility for MA enrollees who elect hospice.
Price growth of brand-name drugs and Part D
Evidence suggests that price growth for brand-name drugs is beginning to drive growth in average prices of all drugs covered under Part D.
MedPAC examines MA and Part D plan accessibility
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.
MedPAC presents new marginal cost analysis
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.
Understanding MACRA’s new approach to updating clinician payments
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.