January 12-13, 2023

01/12/2023 . 10:00 am - 10:45 am

Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services; and supporting Medicare safety-net hospitals

Staff Contacts:

ISSUE:  By law, each year the Commission reviews Medicare’s fee-for-service payment policies and makes payment update recommendations. For our March 2023 Report to the Congress, we consider whether Medicare inpatient and outpatient payments to general acute care hospitals are adequate and how they should be updated in 2024.

KEY POINTS:  We examine beneficiaries’ access to hospital care, quality of care, hospitals’ access to capital, and the relationship between Medicare’s payments and hospitals’ costs.

ACTION:  Commissioners will review the payment adequacy indicators. They will then vote on recommendations to update Medicare payment rates and to use a Medicare safety-net index to distribute safety-net payments to hospitals.

01/12/2023 . 10:50 am - 11:20 am

Assessing payment adequacy and updating payments: Physician and other health professional services; and supporting Medicare safety-net clinicians

Staff Contacts:

ISSUE:  By law, each year the Commission reviews Medicare’s fee-for-service payment policies and makes payment update recommendations. We consider whether payments to physicians and other health professionals are adequate and how they should be updated in 2024. This year, we also consider a new Medicare safety-net add-on payment to support physicians and other clinicians who treat beneficiaries with low incomes.

KEY POINTS:  We assess beneficiaries’ access to clinician care, quality of care, and the relationship between clinicians’ revenues and costs. We also provide a rationale and impact analysis for new add-on payments for clinicians who treat low-income Medicare beneficiaries.

ACTION:  Commissioners will review the findings and vote on a draft update recommendation for physician and other health professional services and a draft recommendation to create new Medicare safety-net add-on payments for primary care clinicians and other clinicians.

01/12/2023 . 11:25 am - 12:00 pm

Assessing payment adequacy and updating payments: Outpatient dialysis services; hospice services; skilled nursing facility services; home health agency services; inpatient rehabilitation facility services

Staff Contacts:

Dialysis

ISSUE:   By law, each year the Commission is required to review Medicare payment policies and to make recommendations to the Congress. The Commission asks whether payments for outpatient dialysis services are adequate and how they should be updated in 2024.

KEY POINTS:  At this meeting, we will examine information about the adequacy of current aggregate outpatient dialysis payments. We will look at information about:

• Access to care: supply of providers and volume of services
• Quality of dialysis care
• Access to capital
• Medicare payments and costs.

ACTION:  Commissioners will review the findings and vote on the draft payment update recommendation

Hospice

ISSUE:  By law, each year the Commission is required to review Medicare payment policies and make recommendations to the Congress. The Commission asks whether payments to hospice providers are adequate and how they should be updated in 2024.

KEY POINTS: We use the Commission’s payment adequacy framework to discuss the update for hospice services for 2024.  The framework considers:

• Access to care: supply of providers, volume of services, and marginal profit
• Quality of care
• Providers’ access to capital
• Medicare payments and providers’ costs

ACTION:  Commissioners will review the findings and vote on the draft recommendations for hospice services at the January meeting.

Skilled nursing facilities

ISSUE:  MedPAC assesses the adequacy of current payments and develops an update recommendation for skilled nursing facilities in 2024. Key questions to consider:

• Are Medicare payments for skilled nursing facility (SNF) care adequate?
• How should Medicare’s payments change for fiscal year 2024?

KEY POINTS:  We use the Commission’s payment adequacy framework to discuss the payment update for SNF services for 2023. This framework considers:

• beneficiary access to care (including the supply of providers and volume of services),
• indicators of the quality of care furnished to beneficiaries,
• access to capital markets, and
• changes in Medicare costs and payments.

ACTION:  Commissioners will discuss the findings and vote on the draft update recommendations at the January meeting.

Home health agencies

ISSUE:  MedPAC assesses the adequacy of current payments and develops an update recommendation for home health care services in 2024. Key questions to consider:

• Are Medicare payments for home health agencies (HHAs) care adequate?
• How should Medicare’s payments change for calendar year 2024?

KEY POINTS:  We use the Commission’s payment adequacy framework to discuss the payment update for home health care services for 2023. This framework considers:

• beneficiary access to care (including the supply of providers and volume of services),
• indicators of the quality of care furnished to beneficiaries,
• access to capital markets, and
• changes in Medicare costs and payments.

ACTION:  Commissioners will discuss the findings and vote on the draft update recommendations at the January meeting.

Inpatient rehabilitation facility services

ISSUE:   By law, each year the Commission is required to review Medicare payment policies and make recommendations to the Congress. The Commission asks whether payments to inpatient rehabilitation facilities (IRFs) are adequate and how they should be updated in 2024.

KEY POINTS:  At this meeting, we will review information about the adequacy of Medicare’s current payments to IRFs. We will look at information about: beneficiaries’ access to care, the supply of IRFs, changes in the volume of services furnished, quality of care, providers’ access to capital, and Medicare’s payments and costs.

ACTION:  Commissioners will review and vote on a draft recommendation to update Medicare payment rates for inpatient rehabilitation services.

01/12/2023 . 1:15 pm - 2:40 pm

The Medicare Advantage program: Status report

Staff Contacts:

ISSUE:  We present our annual update on the status of the Medicare Advantage (MA) program.

KEY POINTS:  We present the most recent information on MA enrollment, beneficiary access to plans, Medicare payments to plans, risk adjustment, and coding practices.

ACTION:  Commissioners will review the findings and discuss the direction of any additional work on these issues.

01/12/2023 . 2:45 pm - 4:10 pm

Congressional request: Medicare clinician and outpatient behavioral health services

Staff Contacts:

ISSUE:  In January 2022, the Chairman of the Committee on Ways and Means asked the Commission to conduct an analysis on the utilization and availability of behavioral health services for Medicare beneficiaries.

KEY POINTS: In this second presentation on this topic, we provide an overview of Medicare coverage of behavioral health services, and report on the utilization of clinician and outpatient-provided behavioral health services to Medicare beneficiaries, including tele-behavioral health services and utilization by enrollees in Medicare Advantage.

ACTION:  Commissioners will discuss the material.

01/12/2023 . 4:15 pm - 5:30 pm

Mandated report: Updates on telehealth use and beneficiary and clinician experiences

Staff Contacts:

 ISSUE:  Historically, Medicare’s physician fee schedule has covered a limited set of telehealth services in rural locations. During the COVID-19 public health emergency (PHE), the Congress and CMS temporarily expanded Medicare’s coverage of telehealth services and increased payment rates for these services.

KEY POINTS: In the March 2021 report, the Commission presented a policy option for the Congress and CMS to temporarily continue some of the telehealth expansions to gather more evidence of their impact on access, quality, and cost. In the Consolidated Appropriations Act, 2023, the Congress extended Medicare’s telehealth flexibilities until December 31, 2024. In earlier legislation, the Congress also mandated that MedPAC submit a report by June 2023 on the utilization of telehealth services during the PHE and the impact of expanded telehealth coverage on access to care and quality.  This is the second public presentation of our work in response to this mandate.

ACTION:  Commissioners will discuss the material.

01/13/2023 . 9:00 am - 10:25 am

Medicare Part D: Status report

Staff Contacts:

ISSUE:  Each year, MedPAC presents the annual status report of the Part D program.

KEY POINTS:  Staff will present information about Part D enrollment in 2022, plan offerings for 2023, and trends in indicators of program operations including drug pricing, aggregate spending levels, access, and quality.

ACTION:  Commissioners will discuss the scope and substance of the material.

01/13/2023 . 10:30 am - 12:00 pm

Addressing high prices of drugs covered under Medicare Part B

Staff Contacts:

ISSUE:  Historically, Medicare has had only an indirect influence on how drugs are priced. Medicare has lacked or has not used tools to strike a balance between providing financial rewards for innovation with value and affordability of care for beneficiaries and taxpayers. Medicare also lacks tools to promote price competition among drugs with therapeutic alternatives.

KEY POINTS: In the Commission’s June 2022 report to the Congress and more recently at the September 2022 meeting, we described alternative approaches for Medicare to address (1) high prices for new Part B drugs with limited clinical evidence, (2) lack of price competition for drugs with similar health effects, and (3) financial incentives associated with the percentage add-on to Medicare Part B’s payment rate.

ACTION: Commissioners will review and discuss the three policy approaches to address high prices of Part B drugs.