January 21, 2021

MedPAC Discusses Medicare Payment, Access and Quality

Last week, the Medicare Payment Adequacy Commission (MedPAC) held their first meeting of 2021. During the two-day meeting, the commissioners discussed varying topics relating to Medicare payment, access and quality.

The first session, “Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services; and Mandated report: Expanding the post-acute transfer policy to hospice,” discussed payment adequacy and beneficiary access for hospital inpatient and outpatient services. The MedPAC staff found that Medicare beneficiaries continue to have adequate access to care. The staff also found that hospitals’ Medicare margin remains negative but has improved, while efficient providers margin is near zero. The staff also addressed how the COVID-19 public health emergency (PHE) has had mixed effects on hospitals. The staff found that hospitals’ access to capital remained strong in 2020 due to federal funding opportunities and do not expect any long-term changes to remain after the end of the PHE. The commissioners had one draft recommendation to consider:

  • For the fiscal year 2022, the Congress should update the 2021 Medicare base payment rates for acute hospitals by 2%.

The commissioners unanimously supported the draft recommendation.

Following, the MedPAC staff presented on “Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services; and Mandated report: Expanding the post-acute transfer policy to hospice.” In this session, the staff presented on the payment adequacy to Medicare providers. The staff found that Medicare beneficiaries over 80 were least likely to be dissatisfied with their care. They also found that volumes for primary care visits and other services have largely recovered by summer from the dramatic drop seen in early spring. The commissioners were presented with one draft recommendation:

  • For calendar year 2022, the Congress should update 2021 Medicare payment rates for physician and other professional services by the amount determined under current law.

This recommendation should not affect beneficiaries’ access to care or lead to a change in spending compared to current law. The commissioners unanimously supported the recommendation. 

There was also a session on the Center for Medicare and Medicaid Innovation’s (CMMI’s) development and implementation of alternative payment models (APMs) entitled “CMMI’s development and implementation of alternative payment models.” During the presentation, the MedPAC staff presented three possible policy options for CMMI APMs including:

  1. To implement a smaller suite of coordinated models designed to support a clear set of strategic goals;
  2. To only develop second-generation models when specified criteria demonstrating promise have been met; and
  3. Reduce or eliminate change to a model’s features once they are in the field.

There was overwhelming support among the commissioners for policy option 1 and general support for the other two policy options, although policy options 2 and 3 were deemed more tactical than strategic policy options. The MedPAC plans to make this topic a multi-cycle activity. Other discussion themes among the commission included: the inclusion of equity within models, amending CMMI’s statute and strategic plan, mandatory models vs. voluntary models, and harmonizing quality measures and overlap of models, among others.

The MedPAC staff also focused on the future on telehealth in a session entitled “Telehealth in Medicare after the public health emergency.” MedPAC held a session on the future of telehealth in Medicare after the PHE. During the presentation, MedPAC staff explained the telehealth regulatory changes during the PHE (e.g., expansion of telehealth from rural areas only to all beneficiaries, expansion of services on the telehealth list, payment for audio-only interactions), and then proposed policy options for after the PHE. There was significant agreement among the commission that telehealth is going to continue to grow and offers great value, however, there was also concern surrounding the potential for fraud and abuse. The commissioners also discussed the importance of providing adequate payments to telehealth services, without providing an incentive for overuse of these services. The commissioners agreed that certain regulations and services should stay temporary as more evidence develops. Other themes of the discussion included the importance of audio-only visits, experimenting opportunities for safeguards and building telehealth into APMs.

The next MedPAC meeting will be held on March 4 and 5.