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).
News
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The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the sustainable growth rate (SGR) system and established a new approach to updating payments to clinicians.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.
Models for preserving access to emergency care in rural areas
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.
Slow growth in Part D premiums is only part of the story
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.
BLS hospital price data should be used with caution
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.