June 24, 2021

MedPAC Releases June 2021 Report to the Congress

The Medicare Payment Advisory Commission (MedPAC) released its June 2021 Report to the Congress June 15. The document includes several required reports about Medicare spending trends, as well as opinions on alternative payment models (APMs) and a look at beneficiary access to care in rural areas. While none of the recommendations within the report are directly related to the practice of radiology, radiation oncology or nuclear medicine, the larger trends discussed impact all healthcare providers.

The report includes MedPAC’s recommendation to the secretary of the U.S. Department of Health and Human Services (HHS) to implement a more “holistic and harmonized” portfolio of APM models. In the past decade, the Center for Medicare and Medicaid Innovation (CMMI) has developed and tested 54 different payment models, some required by statute. CMMI tests models on a temporary basis before expanding into larger, permanent programs. Only models that either reduce spending without reducing the quality of care or improve quality without increasing spending may be expanded. CMMI typically operates a model for about five years and then either abandons the approach or relaunches a revised version of the model under a new name.

The MedPAC report also addressed a concern that the Hospital Outpatient Prospective Payment System (HOPPS) policies for separately payable drugs do not strike a balance between promoting access to high-cost innovative treatments and maintaining pressure on providers to be efficient. The commission made two recommendations to Congress:

  • Direct HHS to modify the pass-through drug policy in HOPPS so that it includes only drugs and biologics that function as supplies to a service, and applies only to drugs and biologics that are clinically superior to their packaged analogs.
  • Specify that the separately payable non-pass-through policy in HOPPS applies only to drugs and biologics that are the reason for a visit and meet a defined cost threshold.

MedPAC is an independent congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program. Questions about the MedPAC report should be directed to Katie Keysor, ACR Senior Director of Economic Policy.