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Tag Archive | "MedPAC"

Capital Thinking Podcast

After a solemn week in the House of Representatives devoted to recognizing and remembering the victims of the Arizona shootings, the White House has instructed that Congress get back to work and on with its legislative business.  Therefore, Majority Leader Eric Cantor announced that the House will resume “thoughtful consideration” of the health care reform repeal bill this week.  Beginning Tuesday, seven hours of debate will be allowed on the bill with the final vote to occur on Wednesday.  The rules will also allow for one Democratic amendment by Rep. Jim Matheson (D-UT) that would provide for a permanent fix to Medicare’s sustainable growth rate formula, preventing dramatic cuts in physician reimbursements under Medicare.  Congressional Democrats were vocal in their opposition to the repeal bill, noting that it would eliminate important consumer protections, leave millions without insurance, and add to the deficit. Preliminary analysis by the Congressional Budget Office supported this position by determining that repealing the overhaul bill would cost $230 billion over ten years.  It is largely expected to pass due to the Republican majority, but will likely not gain any traction in the Senate.  On Thursday, House Republicans plan to bring up their bill instructing the committees to draft replacement legislation.  Committee organization is also expected to resume, and announcements on Democratic Members’ placement on Committees and subcommittees should be announced this week.

Analysis from the Institute of Medicine’s public meeting last week on what constitutes the definition of “essential benefits” is expected to be a hot topic.  The health reform law required that the IOM analyze and develop criteria for a definition of benefits that all plans sold through an insurance exchange will have to offer.  The IOM will likely publish a report of its findings in September.  However, the process is still in its early stage.  The Bureau of Labor and Statistics is required to find out what the typical employer-sponsored health plan covers, while the Department of Health and Human Services will ultimately determine the final definition.

Last week the Medicare Payment and Advisory Commission (MedPAC) finalized its recommendations for its upcoming March report to Congress.  Of note, the Commission voted to recommend to Congress that inpatient and outpatient Medicare hospital payments rise by 1 percent in fiscal 2012, that payment rates under the physician fee schedule should increase by one percent, and backed a first-ever co-pay for home health care services, despite concerns about the financial burden it might affect beneficiaries.  Chairman Glenn Hackbarth noted that there is ample evidence that the use of co-pays deter over-use of a service. Home health use has increased by 50 percent since 2001 and Medicare spent $19 billion on home health services in 2009. 

Finally, it is also important to note that the National Quality Forum (NQF) has opened a Call for Nominations for organizations and individual subject matter experts to serve on the advisory workgroups of the Measure Applications Partnership (MAP).  MAP will provide recommendations to the Department of Health and Human Services on selecting measures for public reporting and performance-based payment programs.

The multistakeholder workgroups will advise the MAP Coordinating Committee on quality issues and the use of measures to encourage improvement for specific care settings, care providers, and patient populations.  Although the workgroup structure will need to be flexible to respond to the needs of HHS, NQF anticipates the potential for as many as four advisory workgroups in the following areas: clinician, hospital, post-acute care/long-term care, and dual eligible beneficiaries. All nominations must be submitted by Monday, February 7, at 6:00 pm ET.

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MedPAC Releases June 2011 Report to Congress

The Medicare Payment Advisory Commission (MedPAC) released its June 2011 Report to Congress. The report includes recommendations on two areas: (1) improving payment accuracy and appropriate use of ancillary services; and (2) enhancing Medicare’s technical assistance to and oversight of providers. To improve technical assistance of oversight of Medicare providers, MedPAC’s recommendations focus on the restructuring of Medicare’s Quality Improvement Organization (QIO) program.

Specifically, MedPAC makes the following recommendations:

  • Congress should resign the QIO program to allow the Department of Health and Human Services (HHS) Secretary to provide funding for technical assistance directly to providers and communities.
  • Congress should authorize the HHS Secretary to define criteria to qualify technical assistance agents so that a variety of entities can compete to assist providers. The Commission recommends that Congress eliminate the requirements that agents be physician sponsored, serve a specific state, and have regulatory responsibilities.
  • The HHS Secretary should make low performing providers a high priority in allocating resources for technical assistance for quality improvement.
  • The HHS Secretary should regularly update the conditions of participation so that the requirements incorporate and emphasize evidence-based methods of improving quality of care. Congress should require the Secretary to expand interventions that promote systemic remediation of quality problems for persistently low-performing providers.
  • The HHS Secretary should establish a public recognition program for high performing providers that work to improve the quality of lower performing providers.

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Capital Thinking Podcast

This week will begin with the Medicare Advisory and Payment Commission (MedPAC), which advises Congress on Medicare payment policy, releasing its annual March report to Congress.  MedPAC is required to review and make recommendations on payment policies for specific provider groups, such as home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and outpatient dialysis services, among others.  The House Ways and Means Health Subcommittee will hold a hearing on Tuesday and will hear from MedPAC’s Chairman, Glenn Hackbarth.  Additionally, the Senate Finance Committee will hold a hearing in which HHS Secretary Sebelius will testify on lessons learned from health reform during its first year of implementation.

Secretary Sebelius outraged Republican lawmakers last week for writing that the House-passed FY 2011 spending bill, H.R.1, would prohibit the Centers for Medicare and Medicaid Services to use funds to administer payments based on any rate calculated on the basis of the provisions in the Affordable Care Act.  Additionally, she stated that if the bill became law CMS would not have the legal authority to pay Medicare Advantage plans, claims for wellness visits (a new requirement under the health reform law) would not occur, and anti-fraud programs would be halted.  House Ways and Means Chairman Dave Camp and Senate Finance Committee Ranking Member Orrin Hatched called her claims baseless and referred to her letter as a senior scare tactic.

Last week, the Department of Health and Human Services held a press conference call to discuss efforts to support state flexibility in implementing the Affordable Care Act.  HHS and Treasury released a Proposed Rule detailing a process for approval of “State Innovation Waivers” under the Affordable Care Act.  Starting in 2017, States that meet specified standards for providing comprehensive and affordable coverage without increasing the federal budget deficit may be exempted from major requirements of the law.  State flexibility has been a major topic of discussion after several Governors testified on Capitol Hill about their concerns about a lack of flexibility under Medicaid.  Sens. Ron Wyden and Scott Brown introduced a bill, that President Obama has publicly supported, that allows stated to apply for waivers to set up their own health care exchanges, rather than implement the exchange model authorized in the health reform law.

The Congressional Budget Office (CBO) released the latest version of its report on spending and revenue options.  It includes a range of potential targets to offset new spending or reduce the deficit, although most are likely to provoke significant political and/or stakeholder opposition.  Among the health-related provisions of potential interest are proposals to block grant Medicaid long-term care payments; reduce GME funding for teaching hospitals; eliminate the Medicare critical access hospital and sole community hospital programs; impose limits on medical malpractice liability awards; and reduce Medicare payment rates in “high-spending” areas of the country.

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MedPAC Recs Revisited

On Wednesday, June 23, 2010, the House Energy and Commerce Subcommittee on Health held a hearingentitled “MedPAC’s June 2010 Report to Congress:  Aligning Incentives in Medicare.”  The hearing examined the findings and recommendations proposed in the report submitted by the Medicare Payment Advisory Commission (MedPAC) to Congress on June 15, 2010.

MedPAC Chairman Glenn Hackbarth testified that the Commission has offered 26 recommendations in two reports to Congress this year.  He highlighted areas where MedPAC commissioners have reached strong consensus, such as the unsustainability of Medicare and the need to look for ways to slow the growth rate of expenditures, while improving access and quality.  He stated that there needs to be consistent pressure applied to all health care services to look for ways to change relative values of payments and opportunities need to be examined that signal the type of care beneficiaries need and to reward that type of care.  As an example, he highlighted the medial home concept.  Additionally, Chairman Hackbarth stated that there still needs to be a robust and value-focused Medicare Advantage (MA) program because private plans have the ability to provide care in ways that traditional Medicare does not.

He explained that it is important to reform how Medicare pays for Graduate Medical Education (GME).  Chairman Hackbarth stated that the Commission believes the GME system is the envy of the world, but the current system is not consistently producing physicians that the system needs to move towards a value-based health system.  He noted two types of deficits in the system: 1) the mix of physicians being produced (i.e. lack of racial and ethnic diversity; and 2) content of training, evidence-based medicine, team coordination, or shared decision making is not focused on.  Chairman Hackbarth stated his support for The Accreditation Council for Graduate Medical Education (ASCGME) for working on an outcomes project to refocus training on new skills and a focus on higher value health care, but urged rapid movement on implementing value-based standards.

Republican Members of the Committee largely used the hearing as a platform to air its grievances about the health reform law.  Chairman Waxman described the Republican comments as “propaganda.”

The majority of members were concerned that MedPAC’s recommendation to restructure GME funds would actually take money away from teaching hospitals.  Chairman Hackbarth reiterated that MedPAC was not recommending that money be taken away from hospitals, but that greater accountability be established for the funds.  Specifically, MedPAC recommended that the GME funds move away from being contingent upon fee-for-service and move towards value-based care.  He stated that the proposed standards for value-based GME payments would take effect in three years, which would give institutions time to conform.  Chairman Hackbarth declared that  Medicare could be the lever for this change.

Rep. Donna Christensen (D-VI) stated that when CMS institutes a least costly alternative (LCA) policy, providers often face a financial loss when they prescribe a product that is more expensive.  She asked to the extent that Congress grants CMS explicit authority to institute LCA policies for drugs and biologics, what safeguards does MedPAC recommend so that access to medically needed therapies are appropriately observed.  Chairman Hackbarth stated that least costly alternative policies and reference pricing need to be informed by the best clinical evidence and the process needs to be transparent where all interested parties have the opportunity to present information to CMS.  He noted that MedPAC reported that it would be advantageous to give CMS and the Secretary of HHS more flexibility to execute these policies, but it does not mean abdication by Congress.  Chairman Hackbarth noted that Congress could reserve the right override policies.

Rep. Gene Green (D-TX) inquired whether there will be a problem within the Agency for the newly created Center for Medicare and Medicaid Innovation (CMI).  Chairman Hackbarth explained that the health reform law took a major step in giving the Secretary broader authority for testing new ideas in Medicare, but that in order to meet the challenges that Medicare faces, CMS will need to change the process for testing new ideas.  He noted that currently innovation is painfully slow, but that the health reform law could accelerate the process.  Chairman Hackbarth stated that his greatest concern is that resources will be needed to implement successful demonstrations. He also asked about self-referral and imaging services.  Chairman Hackbarth stated that there is variability among the different types of imaging services, but that the combination of physician ownership, fee-for-service, and mispricing of services leads to over-utilization.

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Capital Thinking Podcast

After another turbulent week in the Senate, Senate Majority Leader Harry Reid was only able to pass a six month SGR extension by unanimous consent. The fix applies through November 30, 2010 and is fully offset using various revenue raisers. The significantly trimmed down bill only addresses physician payments under Medicare and does not include unemployment compensation, Medicaid FMAP funding, COBRA insurance subsidies, or any of the other health provisions included in the previous versions of a substitute amendment that failed to garner enough votes to pass though the Senate.

Because the House of Representatives adjourned last weekend, the lower chamber must consider the legislation early next week before the payment changes take effect. Subsequently, the Center for Medicare and Medicaid Services (CMS) has directed Medicare contractors to begin processing physician reimbursements for the month of June with the scheduled 21.2% cut mandated by law. With regard to the broader extenders package, Senator Reid did not signal when or how the majority intends to proceed on that measure.

The Office of the National Coordinator for Health Information Technology issued a final rule to establish a temporary certification program for electronic health record technology. The temporary certification program establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify EHR technology. ONC said it expects to release a final rule on the permanent EHR certification program this fall.

The week the House Energy and Commerce Health Subcommittee will hold a hearing on the Medicare Payment Advisory Commission’s June 2010 Report entitled Aligning Incentives in Medicare. The report will address MedPAC’s recommendations on Graduate Medical Education payments, policy options to address the increase of in-office ancillary services, and coordinating care for dual eligibles.

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