Innovation and Quality Highlights from MedPAC April 2019 Meeting

The Medicare Payment Advisory Commission (MedPAC) met on April 4 to 5, 2019, in Washington, DC. MedPAC discussed a number of innovation and quality topics at this meeting.

  • Medicare Advantage Encounter Data: MedPAC voted to recommend that Congress authorize the Centers for Medicare and Medicaid Services (CMS) to withhold payments to Medicare Advantage (MA) plans that fail to report complete and accurate encounter data. Penalized plans would be able to recoup their payments once they report a satisfactory amount of data. Plans could choose to report their data to Medicare audit contractors.
  • Emergency Care Encounter Data: MedPAC voted to recommend that Congress direct the US Department of Health and Human Services secretary to develop and implement by 2022 a set of national guidelines for coding hospital emergency department visits. The intent of the recommendation is to slow the growth of Medicare fee-for-service spending on emergency department services.
  • Expanding the use of value-based payment in Medicare: Beginning in the next reporting cycle, MedPAC will explore pathways to expand value-based payment in Medicare with a focus on expansion of MA and Accountable Care Organizations.
  • Changes to Medicare Part D Benefit: The percentage of Medicare Part D spending comprised of specialty drugs and biologics has risen rapidly. MedPAC is concerned that the current Part D model may contribute to growth in drug prices. MedPAC discussed potential options for restructuring the Part D coverage gap and the catastrophic phase. Material presented at the April 2019 meeting will be included in the upcoming June 2019 MedPAC report.

Meeting agenda, briefs and presentations are available here. MedPAC is next scheduled to meet in September 2019.

MedPAC is an independent congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the US 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/