September 16, 2016

MedPAC Explores Misvalued Clinician Services

The consideration of misvalued clinician services at the Sept. 8 meeting of the Medicare Payment Advisory Commission (MedPAC) focused attention on policy proposals to “rebalance” the Medicare Physician Fee Schedule by shifting a portion of professional fees from specialty physicians to primary care. Expansion of the multiple procedure payment reduction (MPPR) for imaging services was among the suggested proposals.

To address misvaluation, MedPAC staff revisited its previous recommendations including the expansion of MPPR to all imaging services, establishing an expert panel to help the Centers for Medicare & Medicaid Services (CMS) identify mispriced services and collecting data from a cohort of selected practices to validate payment rates and establish more accurate rates.

The staff also identified new directions as potential recommendations for MedPAC’s March 2017 report to Congress, including a partial capitation payment model for primary care and combining CPT codes into families of codes, similar to methods applied to the Hospital Outpatient Prospective Payment System (HOPPS).

MedPAC commissioners made no mention of the MPPR during their open discussion, though the topic reappeared when an ACR staff member spoke during the public comment period. She reminded MedPAC that the Protecting Access to Medicare Act (PAMA) mandated that CMS publish the data it used to justify the 25 percent MPPR for the professional component of advanced diagnostic imaging services. CMS never complied with this mandate. The Consolidated Appropriations Act passed in December 2015 included a provision that reduced the professional component MPPR to a five percent discount. ACR staff said any future MPPR recommendations should be backed by supporting data.

All of the commissioners recognized that fee-for-service will continue to be a part of any payment model for the foreseeable future. They agreed the current process of validating relative value units (RVUs) should continue, though many were very critical of the RUC process which they see as a self-serving process where physicians set their own payment rates. The CPT code grouping (HOPPS methodology) seemed to receive the most traction, although there was no clear consensus among the commissioners.

ACR staff will continue to monitor MedPAC discussions and recommendations on misvalued services.