Five Takeaways from March 2019 MedPAC Meeting

March 12, 2019


At their public meeting on March 7 and 8, the Medicare Payment Advisory Commission (MedPAC) considered a range of Medicare payment issues. Five takeaways from the meeting are as follows:

1. Potential Part B drug payment models such as reference pricing and drug models have the potential for savings, but implementation would be highly complicated for all actors involved (i.e. Medicare, manufacturers, physicians/providers and patients).

In 2017 MedPAC recommended a package of reforms for Part B drug payment, including the establishment of a drug value program as an alternative to the average sales price methodology. MedPAC continues to look for approaches to improve price competition and value for Part B drugs.

Meeting presentation is here.

2. PFS volume growth would be higher if services had not migrated settings over time.

MedPAC staff conducted an analysis where they looked at volume growth over time in the Medicare physician fee schedule (PFS) and held site of service constant. They concluded that their measure of volume growth in the PFS would be higher if services had not changed settings (from the non-facility or office environment to the hospital outpatient department or facility environment) over time. This analysis will be included in their June 2019 Report to Congress.

Meeting presentation is available here.


3. MedPAC wants national guidelines for coding emergency department visits.

Commissioners considered a draft recommendation for the June 2019 report that said, “The secretary should consider developing and implementing a set of national guidelines for coding hospital emergency department visits under the hospital outpatient prospective payment system by 2022.”

Meeting presentation is available here.


4. Medicare needs to get creative in developing solutions to ensure there is an adequate supply of primary care clinicians for Medicare beneficiaries.

Attracting new clinicians to primary care may need to address intangibles and go beyond loan forgiveness programs and payment adjustments to the Medicare physician fee schedule.

Meeting presentation is available here.

5. MedPAC considered draft recommendation to incentivize improving the completeness and accuracy of MA encounter data.


The Balanced Budget Act of 1997 required the collection of encounter data for inpatient hospital services and permitted the Secretary to collect encounter data for other services. In 2012, CMS began collecting encounter data from Medicare Advantage (MA) plans.

Meeting presentation is available here.


MedPAC is next scheduled to meet April 4-5, 2019.


MedPAC is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise Congress on issues affecting the Medicare program. More information on MedPAC is available on their website.


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459/

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