MedPAC Reviews Forthcoming
Work
September 26, 2003 - The Medicare Payment Advisory
Commission (MedPAC) met Sept. 11-12 to review work plans for
upcoming reports on several topics including hospital and
physician payment, medical quality, and disease management.
Several aspects of hospital payment will be examined in the
upcoming year, including the disproportionate share hospital
(DSH) adjustment and the payments for direct graduate medical
education (DGME) and indirect graduate medical education (IME).
The work will include:
- Examining the distribution of these payments;
- Analyzing the relationship between the IME & DSH
adjustments and Medicare cost per discharge; and
- Studying the relationship between DSH payments and
uncompensated care.
The Commission also plans to conduct a comprehensive analysis
on hospital charge-setting practices.
This year's work plan on physician payment will examine the
relationship between payment adequacy and both quality of
care and beneficiary access to care. Some of the issues that
will be considered include provider entry and exit; changes
in the volume of physician services; and changes in input
prices.
Commissioners heard a presentation on how the growth in volume
of physician services during 2002 led to the currently proposed
fee schedule decrease of 4.2 percent. The research focused
on the relationship between volume and Medicare payment for
physician services. Melinda Beeuwkes Buntin of Rand Health
presented a study examining the growth in Relative Value Unit
(RVU) volume between 1993 and 1998. The study concluded that
overall growth was 30 percent greater than expected during
this period. She noted that this growth could not be explained
by case mix or location of service, which are two factors
frequently suggested for inclusion in an improved Sustainable
Growth Rate (SGR) formula. The report concluded that there
was "no easy fix" for the flawed SGR.
Commissioners also heard from David M. Cutler of Harvard
University and Elliott S. Fisher, M.D., M.P.H., of Dartmouth
Medical School on spending and quality. Dr. Fisher presented
the results of a study showing that as spending increased,
quality decreased and concluded that increased spending would
not necessarily lead to better care for Medicare beneficiaries.
Both researchers concluded that future payment systems for
Medicare should be based on quality measures.
The Commission also agreed to include a chapter in the June
2004 report on disease management programs within Medicare.
The chapter will examine the five disease management demonstration
projects currently operated by the Centers for Medicare and
Medicaid Services (CMS).
Information:
Denise Dodero, Associate Vice President
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
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