April 12, 2018

MedPAC Recommends ED Payment Reductions

The Medicare Payment Advisory Commission (MedPAC) has unanimously agreed to recommend reducing Medicare payments to rural and urban off-campus emergency departments (OCEDs).

Despite reservations expressed by several commissioners, MedPAC adopted the following OCED-related recommendations at its April 5-6 meeting:

  • Congress should reduce Type A (urban) emergency department payment rates by 30 percent for off-campus stand-alone emergency departments that are within six miles of an on-campus hospital emergency department; and
  • Congress should allow isolated rural stand-alone emergency departments (more than 35 miles from another ED) to bill standard outpatient prospective payment system facility fees and provide such emergency departments with annual payments to assist with fixed costs.

The commission is expected to continue the discussion about the appropriate use of EDs and OCED growth.

In other business, MedPAC commissioners discussed the Hospital Value Incentive Program (HVIP) that merges the Hospital Readmission Reduction Program (HRRP) and Hospital Value-based Purchasing Program (HVBP). Commissioners were enthusiastic to continue building the HVIP.

Staff presented several examples of possible low-value Medicare services. They included early initiation dialysis, proton beam therapy, and H.P. Acthar gel (adrenocorticotropic hormone) for treating relapsing multiple sclerosis. MedPAC will revisit policy options for these services at a future meeting.