MedPAC releases June 2016 report to Congress

Members | June 21, 2016

Each June the Medicare Payment and Access Commission (MedPAC) is mandated to produce a report for Congress that addressed refinements to Medicare payment systems and issues affecting Medicare including broader health system reform. The full report is located on . Of the nine chapters included in the June 2016 report, there are a few that touch on issues of interest for LeadingAge members.

Each June the Medicare Payment and Access Commission (MedPAC) is mandated to produce a report for Congress that addressed refinements to Medicare payment systems and issues affecting Medicare including broader health system reform. The full report is located on MedPAC’s website. Of the nine chapters included in the June 2016 report, there are a few that touch on issues of interest for LeadingAge members.

 

Prospective Payment System for Post-Acute Care

One of the components of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act requires MedPAC to develop a prototype prospective payment system (PPS) that spans the various post-acute care (PAC) settings. Those settings include skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies. MedPAC believes that a PAC PPS is both feasible and within reach as stated in the chapter and supplemental materials. The motivation behind the study includes concern over four separate PPS when there is a lot of similarity in patients across PAC setting, two of the payment systems incentivizing provision of therapy over treating medically complex patients, and the variation present in supply and utilization of PAC across different geographical areas. The chapter states that “a truly reformed PAC payment system will ultimately need to embrace episode-based payments to focus providers on the care need and outcomes of a patient throughout the episode of care and to dampen the incentives to furnish unnecessary services”. However, it goes on to state that prior to that type of reform payments that are uniformly based on patient characteristics can reduce program spending on unnecessary services. LeadingAge continues to be supportive of payment systems that accurately base reimbursement on patient characteristics. To accomplish that type of payment system it is of upmost importance that risk adjustment is done accurately and precisely, particularly in the cases of low volume and rural providers who lack the economy of scale to absorb large losses due to outliers. The next step in this process falls to the Secretary of Health and Human Services to collect and analyze common patient assessment information and submit a report to Congress recommending a PAC PPS. That report is expected in 2022.

 

Telehealth Services and the Medicare Program

An informational chapter on telehealth services is included to assist policymakers as they consider the role of telehealth in the Medicare program for the future. LeadingAge and the LeadingAge Center for Aging Services Technology (CAST) believe telehealth and telemedicine can help long-term services and supports (LTSS) and PAC providers carry out their mission to deliver integrated and person-centered care and services that support the health and wellness of residents and clients across the continuum. These technologies are key enablers of strategic partnerships between LTSS and PAC settings and hospitals, accountable care organizations (ACOs) and other coordinated care delivery models. While MedPAC has indicated mixed evidence of the efficacy of telehealth in the literature, the pool of evidence could be broadened. We believe that telehealth services ought to be more broadly available through the Medicare and other health payers, particularly as it can be a useful adjunct for our rural and frontier members. 

 

CMS’ Financial Alignment Demonstration

In a chapter focused on issues for dual-eligible Medicare and Medicaid beneficiaries, MedPAC provides a status report on the financial alignment demonstration project. This demonstration is a partnership between states and CMS to test new models of care for dual-eligible beneficiaries. There are currently 14 demonstrations in 13 states. The vast majority, 11 of 14, demonstrations are testing a capitated model using Medicare-Medicaid Plans (MMPs) that provide all Medicare and all or most Medicaid benefits. However, enrollment in participating states and plans has been lower than expected making it difficult to evaluate the effectiveness of the demonstration early on. These projects are worth following for lessons that can be learned of serving the dual-eligible population in a coordinated managed care environment.

 

Finally, a chapter is included that focuses on improving efficiency and preserving access to emergency care in rural areas. LeadingAge Kansas alongside public policy staff from LeadingAge facilitated a rural issues forum that focused on the particular challenges rural nursing homes face in caring for residents and serving their communities. We believe that rural issues need consideration across provider types and settings as our members seek to house and provide care for people in rural and frontier areas that pose their own public policy and regulatory issues. A full summary of that meeting can be found on the LeadingAge website