June 17, 2020

MedPAC Issues June 2020 Report to Congress

On June 15, the Medicare Payment Advisory Commission (MedPAC) released its June 2020 Report to Congress. Among the chapters in the report, the Commission addressed topics including: change toward value-based payments in Medicare, strategies to increase savings in accountable care organizations (ACOs), replacing the Medicare Advantage quality bonus program and the impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees.

The Commission outlined a multiyear effort to identify changes that could broaden the use of value-based payment (VBP) by encouraging providers to organize into “accountable entities.” MedPAC contends that VBP provides stronger incentives than fee-for-service payment for maintaining or improving quality while controlling the unsustainable growth of Medicare per capita spending. Almost 24 million Part A and Part B beneficiaries are enrolled in Medicare Advantage Plans; about 13 million are assigned Accountable Care Organizations (ACOs).

Additionally, the commission addressed challenges in maintaining and increasing savings in ACOs, as thus far savings have been modest at 1% to 2%. In an effort to reduce unwarranted shared savings through potential mismatch between the clinicians considered in an ACO’s baseline years and its performance years, the commission recommends that the Secretary determine an ACO’s historical baseline spending using the same national provider identifiers that are used to compute the ACO’s performance-year spending.

The commission recommends that the Congress replace Medicare Advantage’s (MA) quality bonus program with the MA value incentive program. This is an effort to appropriately award high quality and ensure program dollars are wisely spent.

Although this report does not significantly mention imaging, it remains on the radar of members of the Commission. MedPAC Executive Director, Jim Mathews, told AuntMinnie.com, “Although this report doesn't specifically address imaging, we continue to be concerned about how it affects fee-for-service payments. Imaging is a poster child for why the commission has been recommending Medicare move away from fee-for-service and toward payment structures such as ACOs.”