MedPAC Addresses Physician
Issues, New Technologies, Outpatient Drugs
September 20, 2002-The Medicare Payment Advisory Commission
(MedPAC) met Sept. 12 and 13 to review several topics of importance
in preparation of MedPAC's March 2003 report to Congress.
During the meeting, commissioners reviewed issues of access
to care for Medicare beneficiaries, comparisons of private
payments for physician services with Medicare payments, payment
policies for new technologies, and payments for Medicare covered
outpatient drugs.
The commissioners discussed survey data collected for MedPAC
supporting some of the findings of the recent American Medical
Association (AMA) survey regarding physician intentions to
decrease acceptance of new Medicare patients. Although the
trend was not as pronounced as that predicted by the AMA data,
there was some indication that decreasing reimbursements were
causing physicians to stop accepting new Medicare patients.
The commissioners felt that the data presented painted an
ambiguous picture of the situation and recommended further
study focusing on whether Medicare beneficiaries are able
to obtain care and whether they obtain the right care. There
were also concerns over whether changes in the Medicare fee
schedule reduce access to care and push physicians to provide
care in settings where they normally would not. Overall, the
commission requested further study of these issues in order
to incorporate a more informed comment in their March 2003
recommendation.
The Commission also began a discussion on Medicare's payment
policies for new technologies. This issue has become increasingly
important due to current legislation and questions about how
Medicare pays for new technologies in the hospital inpatient
and outpatient setting. Commissioners heard a presentation
comparing various policies used by other payers to reimburse
providers for using new technology. A more in-depth discussion
is planned for the October meeting.
Finally, the Commission considered the issue of the payment
method for Medicare covered outpatient drugs. The primary
concerns presented in the report involved access for patients
and administrative burdens for CMS as well as the effects
on the overall cost of drugs for all providers. Following
the report, the commissioners discussion focused on the overall
pricing mechanism based on Average Wholesale Price (AWP) and
the possibility for abuse in that payment arrangement. Many
of the commissioners expressed concern over the fact that
the AWP is used, but is not defined in the law. Additional
concerns were expressed because Congress and the Bush administration
will be acting on this issue before the March 2003 report.
Overall, the commissioners agreed that MedPAC should make
a statement on this issue quickly, rather than waiting to
comment in the March 2003 report.
Also on the Commission's agenda were the framework for assessing
payments adequacy, competitive bidding for durable medical
equipment, and choice of SNF services in the Medicare+Choice
program.
Information:
Denise Dodero, Associate Vice President
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
Jeff Patyk, Staff Specialist
AAMC Health Care Affairs
jpatyk@aamc.org
(202) 828-0498
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