March 7-8, 2024

03/07/2024 . 10:45 am - 12:15 pm

Rural hospital and clinician payment policy: A workplan for 2024–2025

Staff Contacts:

ISSUE: Rural communities across the U.S. are diverse, with some experiencing extreme levels of poverty and low life expectancies, while others outperform their urban counterparts. Common challenges among all rural areas are low population density and travel times for medical care. To address some of the effects of these challenges on beneficiaries’ access to care, the fee-for-service (FFS) Medicare program has instituted several enhancements to payment rates for rural hospitals and clinicians.

KEY POINTS: Coinsurance based on provider charges increases beneficiary cost sharing liability at critical access hospitals and rural health clinics. The expansion of Medicare Advantage in rural areas has implications for beneficiaries and providers.

ACTION: Commissioners will discuss suggested approaches to evaluating rural hospital and clinician payment policies over the next cycle.

03/07/2024 . 1:30 pm - 2:55 pm

Assessing data sources for measuring health care utilization by Medicare Advantage enrollees: Encounter data and other sources

Staff Contacts:

ISSUE: 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. Analysis of MA encounter data could inform improvements to MA payment policy, provide a useful comparator with the FFS Medicare program, and generate new policy ideas that could be applied more broadly to the Medicare program.

KEY POINTS: The Commission has previously compared encounter records for 2014 through 2019 to other sources of information about MA enrollees’ use of services and found evidence of missing encounter records for each type of service examined. In 2019, the Commission recommended steps that CMS should take to improve encounter data completeness and accuracy.

ACTION: Commissioners will review and discuss updated findings on encounter data accuracy and completeness for services provided by acute care hospitals, home health agencies, skilled nursing facilities, and outpatient dialysis facilities.

03/07/2024 . 3:00 pm - 4:30 pm

Preliminary analysis of Medicare Advantage quality

Staff Contacts:

ISSUE: Information about the quality of care provided in Medicare Advantage (MA) is important for the Medicare program to monitor MA plan performance and for beneficiaries to make informed coverage decisions.

KEY POINTS: The Commission previously monitored a subset of measures used in the MA 5-star rating program but in recent years has determined that it is not possible to provide an accurate description of the quality of care across MA plans on this basis.

ACTION: Commissioners will discuss the material and provide guidance on future work on MA quality.

03/08/2024 . 9:00 am - 10:10 am

Medicare’s Acute Hospital Care at Home program

Staff Contacts:

ISSUE: Concerns about a shortage of ACH capacity during the COVID-19 pandemic led CMS to establish the Acute Hospital Care at Home (AHCaH) program in November 2020. Though the program was originally developed for the circumstances of the public health emergency, the Congress extended the program through December 31, 2024.

KEY POINTS: Assessing the value of the AHCaH program to beneficiaries and the program is critical for informing the future direction for the program.

ACTION: Commissioners will review updated information about the AHCaH program, including findings from interviews with participating providers.

03/08/2024 . 10:15 am - 11:15 am

Update on trends and issues in Medicare inpatient psychiatric services

Staff Contacts:

ISSUE: In the June 2023 report to the Congress, the Commission explored Medicare beneficiaries’ use of behavioral health services and identified some important areas for continued monitoring.

KEY POINTS: Under Medicare, coverage of treatment in freestanding IPFs is subject to a lifetime limit of 190 days. A substantial share of inpatient psychiatric hospitalizations occur in general acute care hospitals (“scatter-bed stays”).

ACTION: Commissioners will review and discuss updated information on use of inpatient psychiatric services under Medicare.