We continue our review of MedPAC’s annual report to Congress on Medicare program concerns. (link in yesterday’s post) The next topic addressed by MedPAC relates to payments for durable medical equipment. Some of these items are now covered by competitive bidding, which has substantially reduced Medicare spending. MedPAC recommends moving additional high-volume items into the competitive bidding program. It also expressed concerns about the use of physician-owned distributors for these items, specifically the potential for fraud and abuse. In the 7th item, the report tackles the difficulties with Medicare’s quality measurement and improvement programs. It again suggests a smaller list of measures and the use of peer groupings to determine rewards or penalties, and explored combining the various hospital programs into one, with a social factor adjustment. The Commission made some observations around measures for potentially preventable admissions and home and community days. Next up was ACO performance. Medicare has relied on this concept to improve quality and reduce spending, but results are mixed and few providers seem interested in taking on downside risk. MedPAC identified some issues in regard to benchmarking and sharing of savings, and generally seems supportive of the ACO concept. The ninth item the Commission reviewed was coverage for dual eligibles–people with Medicare and Medicaid coverage. It reviewed the demonstrations attempting to integrate this coverage and identified ways to encourage more use of comprehensive management approaches for these beneficiaries. The last topic was how to reduce low-value care delivery to beneficiaries. That assumes everyone can agree on what is low-value. Several potential methods for reducing low-value care were discussed, including prior authorization, higher cost-sharing, provider education and new payment models. The report always gives you a good sense of where Medicare may be headed, since Congress and CMS often act on MedPAC’s recommendations.
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
What do you get when you combine a company with a commodity business model, that out of desperation massively overpays for another company that has a commodity business model? $10...
July 27, 2022
The “stupid” model for health care venture capital investing is alive and well. Everside health, which operates primary care clinics and has grown by acquiring other failing health care businesses,...
July 26, 2022
Apparently not even a cute name can save you if you have a stupid business. I constantly bemoan the mis-application of capital and health care is Exhibit A. Olive, another...
July 26, 2022
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace