MedPAC Reviews Issues Affecting PFS Payment Accuracy and MA Provider Networks

The Medicare Payment Advisory Commission (MedPAC) met on Nov. 5 and 6 to discuss recent changes in the Medicare Physician Fee Schedule (PFS) that affect primary care, charge-based coinsurance at rural health clinics, aberrant patterns of care among hospice and home health providers, findings from MedPAC’s focus groups with Medicare patients, Medicare eligibility notification, and the State Health Insurance Assistance Program operations and funding.  

MedPAC staff reviewed an analysis of recent changes implemented in the Physician Fee Schedule impacting primary care payment and care patterns. Commissioners emphasized the importance of primary care in providing preventive services and ensuring continuity of care and discussed different approaches to improving primary care delivery. These approaches included improving care management services, rethinking population-based per-member per-month payment, and reimagining primary care payment altogether.  

Commissioners heard from staff on Nov. 6 on Medicare beneficiary, physician, nurse practitioner, and pharmacist focus group findings. Related to Medicare Advantage (MA), clinicians described the plans as being more administratively complex, expressed concerns with provider network changes impacting access, and had challenges with prior authorization and payment denials. They highlighted that coverage did not impact clinicians’ treatment approach, but some did note how these complexities impact practice. Generally, clinicians shared mixed feelings about quality reporting, remarking that while accountability is important, it is frustrating when quality measures do not provide clear feedback and are not aligned with their specialty.