The Medicare Payment Advisory Commission (MedPAC) Oct. 8-9 held its second meeting of the 2015-2016 session.
The two day meeting covered Medicare drug spending, implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that revises the physician payment system by focusing on physician participation in Alternative Payment Models (APMs) and the Merit-based Incentive Payments System (MIPS), Medicare Advantage, and preserving access to emergency care in rural areas.
MedPAC’s senior analyst, Kate Bloniarz, led the MACRA discussion by introducing concerns regarding how difficult it will be to measure and evaluate an individual clinician’s performance under MIPS. The Commission noted that current quality programs place a heavy emphasis on process based measures, and do not effectively assess outcomes. Such a system will make most clinicians look average and only identify persistent outliers which will further burden providers and CMS. Commission staff expressed similar concerns on whether the transition may be too complex and questioned whether physicians would switch back and forth between MIPS and APMs each year.
The commission also expressed concerns about the statutory requirement that APMs will be required to use comparable quality measures to MIPS. They also considered the challenges of the APM provision, such as physicians who participate in more than one APM. This was the first of many discussions that MedPAC will have and focused on understanding the legislation and identifying issues that CMS will need to resolve as it implements the law.
The commission also explored potential models to preserve access to emergency care in rural areas. MedPAC staff presented two models to support emergency care in rural areas. One model supports stand-alone emergency department that provides 24/7 emergency care, while the other substitutes primary care clinics with 24/7 access to ambulance services. For both models, the staff suggested that Medicare could provide a fixed grant per unit payment to help fund standby capacity.
Commissioner David Nerenz, Ph.D. suggested that MedPAC should have a broader discussion on how Medicare should reimburse maintenance of important services not directly tied to Medicare service volume, such as standby capacity and telemedicine. Questions were also raised on staffing requirements under the two models and whether physician shortages would be an impeding factor for future model adoption or was a contributing factor to closures of rural hospitals. Several commissioners suggested to evaluate the role of telemedicine in addressing access issues in rural areas.
MedPAC’s next meeting will be held November 5-6.