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    MedPAC Discusses Rural Payment Policies, Medicare Advantage, and Hospital at Home

    Brad Cunningham, Sr. Regulatory Analyst, Graduate Medical Education
    Katherine Gaynor, Hospital Policy and Regulatory Analyst
    For Media Inquiries

    The Medicare Payment Advisory Commission (MedPAC) met on March 7 and 8 to discuss rural hospital and clinician payment policies, Medicare Advantage (MA) encounter data and quality, and Medicare’s Acute Hospital Carel at Home (AHCaH) program.  

    In the March 7 session, MedPAC staff presented health care payment policies and the rising adoption of MA plans in rural areas. With 95% of rural hospitals benefiting from specialized payment programs, commission staff explored nuances specific to Medicare Fee-For-Service payment to certain hospital providers. Highlighting the significant growth of MA plans in rural America, commissioners and staff expressed the need to understand the impact on health care delivery and financial stability for rural providers. Proposed research areas for the upcoming cycle include investigating cost-sharing effects for certain rural provider types, the implications for MA plans to rural providers, and analyzing the combined financial impact on rural hospitals. 

    The commission also discussed MA encounter data and quality by revisiting their 2019 MA encounter data recommendations and reviewing an updated analysis on the completeness of MA encounter data based on service category, which found data to still be incomplete but improving. While the commission did not vote on any recommendations related to MA encounter data, there will be chapter on the topic in their June 2024 report to Congress. The commission also reviewed a preliminary analysis of MA quality data that evaluated MA quality using measures of ambulatory care-sensitive hospitalizations, with a plan to conduct additional analyses in upcoming cycles. Their review also included a systematic literature review of MA and Fee-for-Service Medicare quality comparison since 2020. However, data comparability/completeness, differences in coding intensity, and favorable selection in MA still presented challenges in comparing the two programs.  

    In the March 8 session, the commission reviewed and discussed an overview of Medicare’s AHCaH program. Key considerations around the program included extending the model, the potential impact of participation on a broader range of models, and further defining the program including the use of virtual visits, requirements of caregivers, improved data tracking, and additional safeguards. Commissioners also discussed how AHCaH may produce savings, impact clinical judgment, and create challenges around measuring quality and safety. A chapter on this review will appear in MedPAC’s June 2024 report to Congress.