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MedPAC’s March 2019 Report to Congress: Quality, Innovation and Transparency Updates

March 19, 2019

McDermott+Consulting

On Friday, March 15, 2019, the Medicare Payment Advisory Commission (MedPAC) released their March 2019 Report to Congress. The principal focus of the March report is MedPAC’s recommendations for annual payment rate adjustments (or “updates”) under Medicare’s various fee-for-service payment systems. MedPAC also addressed some key quality, innovation and transparency issues as part of this report.

  • Hospitals: Inpatient and Outpatient Services: MedPAC recommended that Congress should replace Medicare’s current multiple hospital quality programs with a new single hospital value incentive program.
  • Ambulatory Surgical Center Services: MedPAC recommended that the Secretary should require ambulatory surgical centers to report cost data. MedPAC has made this recommendation multiple times.
  • Medicare Advantage Program: MedPAC has concerns with the Medicare Advantage star rating system, which is determined at the contractor level and serves as the basis for plan quality bonuses and public reporting of plan quality. MedPAC discussed using encounter data as the source of quality metrics in MA and moving to market areas as the reporting unit.
  • Mandated Report: Opioids and Alternatives in a Hospital Setting: In this report mandated by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018, MedPAC looked at how opioid use is monitored through Medicare claims data. The Centers for Medicare and Medicaid Services monitors opioid use through tracking programs in Part D, but Medicare does not operate similar tracking programs in Part A or Part B. MedPAC discusses three options for implementing a Part A and Part B opioid tracking program: (1) require prescription drug event-type reporting, (2) require hospitals to report all pain management drugs on Part A and Part B claims, and (3) link Part D opioid use to any prior hospital stays in which opioid use was initiated.

The March 2019 Report factsheet is available here.

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/smadhani@mcdermottplus.com or Mara McDermott at 202-204-1462/mmcdermott@mcdermottplus.com.

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