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.