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Tags Posts tagged with "Medicare Payment Advisory Commission"

Medicare Payment Advisory Commission

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During the September 5–6, 2019 Medicare Payment Advisory Commission (MedPAC) public meeting, the agenda included a presentation that focused on a value incentive program (VIP) for post-acute care (PAC) providers. During the presentation, MedPAC reviewed their intention to develop this PAC-VIP over the coming months, which will tie providers’ payments under a unified PAC prospective payment system (PPS) to their performance on uniform cross-setting metrics. MedPAC feels PAC-VIP is essential to incentivize provider improvement. Some of the proposed measures to be included:

  • All-condition hospitalization within the PAC stay;
  • Successful discharge to the community; and
  • Medicare-spending per beneficiary (MSPB).

Performance will be scored using absolute, prospectively set targets, and a five percent withhold will fund the incentive payments, which is consistent with Medicare’s existing value-based programs. In addition, because there is variation in performance across settings, there will be an initial need to score within each setting.

Next steps include modeling the PAC-VIP based on the Commission’s feedback and presenting their results in the spring. MedPAC also seeks feedback on the design of the PAC-VIP, such as measure set, scoring methodology, and size of the withhold. Contact RCPA Director of Rehabilitation Services, Melissa Dehoff, with questions.

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One of the topics on the agenda at the March 2019 Medicare Payment Advisory Commission (MedPAC) public meeting focused on the evaluation of an episode-based payment system for post-acute care (PAC). MedPAC advises Congress about the federal programs (Medicare and Medicaid). Over the years, there have been many discussions regarding whether the federal government should implement one payment system across post-acute providers, which vary greatly in how they are paid. Post-acute providers include inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home health agencies, and long-term care hospitals (LTCHs). During the March presentation, MedPAC shared that they favor a stay-based system, rather than one tied to a whole episode of care for fear that the episode of care would encourage providers to discharge patients early. The Department of Health and Human Services (HHS) will work with an outside vendor to build a unified PAC payment model with a goal to submit it to Congress by 2022. Contact Melissa Dehoff, RCPA Director of Rehabilitation Services, with questions.

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During the January 2018 Medicare Payment Advisory Commission (MedPAC) public meeting, the agenda included the topic of the Merit-based Incentive Payment System (MIPS). MedPAC members voted in favor of recommending Congress eliminate this system, stating the program was burdensome and complex. The presentation also cited that the program “Replicates flaws of prior value-based purchasing programs.” It was recommended that MIPS be replaced with a new model known as the voluntary value program (VVP). The VVP would include an across-the-board withhold for all fee schedule payments, and performance would be assessed using uniform measures across three categories, which include clinical quality, patient experience, and value. Those in favor of the new program indicated it would better prepare physicians to participate in the Medicare Access and CHIP Reauthorization Act’s (MACRA) Advanced Alternative Payment models.

The agenda included many additional topics of interest, some of which referenced increasing the equity of Medicare’s payments within each setting, mandated report on telehealth services and the Medicare program, and a status report on Medicare Accountable Care Organizations.

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The Medicare Payment Advisory Commission (MedPAC) has released its June 2017 Report to Congress: Medicare and the Health Care Delivery System. This report includes, among other topics, a chapter focusing on implementing a unified payment system for post-acute care. Specifics in this chapter includes implementing a post-acute care prospective payment system (PAC PPS) beginning in 2021 with a three-year transition, lower aggregate payments by five percent, absent prior reductions to the levels of payments, start to align setting-specific regulatory requirements, and periodically revise and rebase payments to keep payments aligned with the cost of care.

Some of the topics included in the other chapters include Medicare Part B drug payment policy issues; redesigning the merit-based incentive payment system (MIPS) and strengthening advanced alternative payment models, etc. MedPAC also released a fact sheet on the report.

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