March 11, 2021

MedPAC Presents on Access to Care and CMS Payments

On March 5 and 6, the Medicare Payment Advisory Commission (MedPAC) held their March public meeting. Topics of discussion included access to care in rural areas, the Centers for Medicare and Medicaid Services (CMS)’s portfolio of alternative payment models (APMs) and indirect medical education payments. American College of Radiology® staff attended the meeting virtually.

On March 5, MedPAC staff presented the congressional request report surrounding beneficiaries’ access to care in rural areas. Staff found that rural and urban beneficiaries have similar access to care. Research also showed that there were similar levels of care satisfaction among rural and urban beneficiaries, however, differences in ease of getting care in rural areas (e.g. greater difficulty getting to specialty care and less availability on nights and weekends). MedPAC staff explained Congress’ provisions in the Consolidated Appropriations Act, 2021, which created the category of rural emergency hospitals to begin in 2023 and substantially increased payment rates for certain rural health clinics. MedPAC will continue this work into the next cycle.

The Commission continued their discussion regarding streamlining CMS’s APM portfolio. The Chair’s Draft Recommendation was shared, which states, “The Secretary should implement a more coordinated portfolio of fewer alternative payment models that support the strategic objectives of reducing spending and improving quality.” There was significant support for the draft recommendation among the Commission, however, members will formally vote on the recommendation at the April meeting, with an accompanying chapter in the June Report. This will also be a multicycle topic.

On day two of the MedPAC meeting, staff presented on Medicare’s payments for medical education in inpatient versus outpatient settings. The draft recommendation outlined that “The Congress should require CMS to transition to empirically justified indirect medical education adjustments to both inpatient and outpatient Medicare payments.” There was significant discussion among commission members with concerns brought up, and the draft recommendation will be re-evaluated, and voting will take place during a future meeting.