Health Reform WK-EDGE Move beyond MIPS, MedPAC tells Congress
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Wednesday, March 28, 2018

Move beyond MIPS, MedPAC tells Congress

By Sheila Lynch-Afryl, J.D., M.A.

The Merit-based Incentive Payment System (MIPS) should be eliminated, advised the Medicare Payment Advisory Commission (MedPAC) in its annual report to Congress on Medicare payment policy. In addition, it again advocated for reform of the post-acute care payment systems, warning that "the cost of inaction is mounting." MedPAC also gave a report on telehealth services, as mandated by the 21st Century Cures Act of 2016 (P.L. 114-255) (MedPAC Report, March 20, 2018).

MIPS. MedPAC concluded that MIPS "will not fulfill its goals and therefore should be eliminated" as soon as possible because the basic design of MIPS is "fundamentally incompatible with the goals of a beneficiary-focused approach to quality measurement." It recommended the establishment of a new voluntary value program in fee-for-service (FFS) Medicare in which: (1) clinicians can elect to be measured as part of a voluntary group; and (2) clinicians in voluntary groups can qualify for a value payment based on their group’s performance on a set of population-based measures.

Post-acute care payment systems. MedPAC again urged Congress to make changes to the post-acute care payment systems (skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitations facilities (IRFs), and long-term care hospitals (LTCHs)) (see ‘Concerned’ MedPAC suggests improvements to MACRA programs, Part B drug payments, June 21, 2017; MedPAC makes 2018 payment recommendations, March 16, 2017). This unified payment system would base payments on patient characteristics and could lower costs and ensure access for patients who are less desirable financially under current payment systems. MedPAC recommended in 2019, as an initial step, to blend the relative weights in each of the setting-specific payment systems with those of the unified post-acute care system.

MedPAC also made the following payment recommendations:

  • no update to SNF payment rates for two years (2019 and 2020) and the implementation of a revised SNF PPS in 2019;
  • no payment update in 2019 for LTCHs;
  • a 5 percent reduction in the home health prospective payment system base payment rate for 2019 and a two-year rebasing beginning in 2020;
  • a 5 percent reduction in the IRF payment rate for fiscal year 2019;

MedPAC also reiterated its 2016 recommendations to expand the IRF outlier pool and review IRF patterns of case mix and coding.

Other Medicare FFS payment systems. For 2019 MedPAC recommended that Congress update the acute care hospital, physician and other health professionals, and outpatient dialysis rates by the amount determined under current law. It recommended no payment update in 2019 for the hospice and ambulatory surgical center (ASC) payment systems. It also suggested that the HHS Secretary could begin collecting cost data from ASCs.

Health spending. In 2016, total national health care spending was $3.3 trillion, or 17.9 percent of gross domestic product (GDP). Private health insurance spending was $1.1 trillion, or 6.0 percent of GDP. Medicare spending was $672.1 billion, or 3.6 percent of GDP. Actuaries estimated that national health care spending grew 5.4 percent from 2013 to 2015 and Medicare spending grew 4.9 percent. The increase in the national health care spending growth rate was largely due to the continued effects of coverage expansions for health insurance that commenced in 2014 under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).

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