April 11-12, 2024

04/11/2024 . 10:30 am - 11:40 am

Telehealth in Medicare: Status report

Staff Contacts:

Issue: During the COVID-19 public health emergency, Medicare temporarily expanded coverage of telehealth. Some of those expansions have been made permanent or temporarily extended through 2024.

Key points: In the June 2023 report to the Congress, the Commission responded to a congressional mandate to study this expansion. The Commission has continued to track clinicians’ use of telehealth services in fee-for-service Medicare.

Action: Commissioners will review and discuss updated information on telehealth in Medicare.

04/11/2024 . 11:45 am - 1:00 pm

Alternative approaches to lowering Medicare payments for select conditions in inpatient rehabilitation facilities

Staff Contacts:

Issue: Medicare beneficiaries who require recuperative or rehabilitative care are treated in skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals. Despite the overlap among the patients treated in these settings, Medicare uses separate payment systems that result in different payments for similar cases.

Key points: In its report to the Congress on a unified payment system for post-acute care (PAC), the Commission stated that policymakers may want to look for opportunities to adopt more targeted policies that would align payments more closely across PAC settings for similar cases.

Action: Commissioners will review and discuss alternatives to lower payments for services provided in inpatient rehabilitation facilities for select conditions that are also treated in skilled nursing facilities.

04/11/2024 . 2:15 pm - 4:15 pm

Considering approaches for updating the Medicare physician fee schedule

Staff Contacts:

Issue: Under current law, starting in 2026, payment rates under the physician fee schedule will increase by 0.75 percent per year for qualifying clinicians participating in advanced alternative payment models (A-APMs) and by 0.25 percent for all other clinicians. By contrast, clinicians’ input costs are expected to increase by more than 2 percent per year from 2025 through 2033.

Key points: The Commission’s annual payment adequacy analyses continue to find that Medicare beneficiaries’ access to clinician care is as good as, or better than, that of privately insured individuals. But concerns have been raised that, under current-law updates, Medicare’s payments under the physician fee schedule may not remain adequate to continue to ensure access to care for beneficiaries.

Action: Commissioners will discuss various approaches to updating payments under the physician fee schedule.

04/11/2024 . 4:20 pm - 5:30 pm

Assessing consistency between plan-submitted data sources for Medicare Advantage enrollees

Staff Contacts:

Issue: Medicare Advantage (MA) plans are required to submit to CMS a record of each health care item or service provided to their enrollees. These “encounter” data include much of the same information that is on FFS claims.

Key points: Analysis of MA encounter data could inform improvements to MA payment policy, provide a useful comparator with data from the FFS Medicare program, and generate new policy ideas that could be applied more broadly to the Medicare program. In March, the Commission discussed an analysis that compared encounter data with other data sources submitted directly to Medicare by providers and found evidence of missing encounter records for each type of service examined.

Action: Commissioners will review and discuss other plan-reported data that might be used to assess encounter data completeness.

04/12/2024 . 9:00 am - 10:25 am

Generic drug pricing under Part D

Staff Contacts:

Issue: Previous studies have found that generic prices in Part D are often higher than cash prices and can vary widely.

Key points: Higher prices may increase costs for both beneficiaries and the Medicare program, and wide price variation may cause confusion and frustration for enrollees because it is difficult to plan for their medication costs. But previous studies looking at generic prices have generally focused on point-of-sale (POS) prices, which may not reflect the final prices Part D plans paid.

Action: Commissioners will review and discuss initial findings from an analysis of generic pricing under Part D and responses from stakeholder interviews conducted to better understand generic drug marketplace dynamics.

04/12/2024 . 10:30 am - 11:45 am

Initial findings from analysis of Medicare Part B payment rates and 340B ceiling prices

Staff Contacts:

Issue: The Health Resources and Services Administration’s 340B drug pricing program requires drug manufacturers to provide outpatient drugs to eligible hospitals at reduced prices. Currently, Medicare’s payment for most Part-B covered drugs, including those acquired through the 340B program, is equal to each drug’s average sales price (ASP) plus 6 percent. Until recently, the Commission lacked access to the confidential pricing data used to calculate the ceiling prices set for 340B drugs. Using a proxy to estimate 340B discounts, we previously estimated that Medicare payments likely exceeded 340B price ceilings by at least 35 percent, on average, in 2013.

Key points: Recently, the Consolidated Appropriations Act, 2021, gave MedPAC access to the data needed to calculate 340B ceiling prices, allowing a closer examination of the relationship between Medicare’s payments for 340B drugs and hospitals’ costs of acquiring them.

Action: Commissioners will review and discuss the material.