The Medicare Payment Advisory Commission (MedPAC) last week released its annual report to Congress on Medicare payment policy, offering recommendations on several aspects of the program.
The commission recommends that Congress eliminate the Merit-based Incentive Payment System (MIPS), citing concerns that evaluating quality based on clinician-selected criteria is inequitable.
MedPAC recommends that Congress instead establish a new, voluntary value program (VVP) in Medicare FFS that would allow clinicians to elect to be measured as part of a group. Value payments would hinge on groups’ performance on population-based measures. The commission also noted that payment adjustments resulting from measures in a VVP should “take into account, as necessary, differences in the social risk factors for each group’s population.”
Medicare Advantage Recommendations
In a chapter on Medicare Advantage, MedPAC recommends curtailing plan consolidation to improve the accuracy of star ratings and curb unwarranted quality bonus payments for lower-rated plans that merge with high-rated plans. The commission said Congress should require plans to report pre-consolidation quality data and that the Centers for Medicare & Medicaid Services should use pre-consolidation data to calculate ratings and bonus payments.
MedPAC recommends that Congress require drug manufacturers to provide beneficiaries in the Medicare Part D coverage gap with discounts to encourage the use of biosimilar products over originator biologics, which are costlier.
MedPAC also offers several recommendations for rate adjustments under Medicare fee-for-service (FFS) payment rates (FFS) payment systems, including for hospital inpatient and outpatient services.
The final chapter provides a report, mandated by the 21st Century Cures Act of 2016, on the state of telehealth under both Medicare FFS programs and commercial insurance plans. The commission recommends that policymakers evaluate individual telehealth services on cost, access, and quality before adoption as part of Medicare coverage.
Contact Senior Director of Policy Erin O’Malley at email@example.com or 202.585.0127 with questions.