MedPAC mostly silent on medical imaging in June report

2017 05 04 10 02 04 942 Capitol Hill2 400

The Medicare Payment Advisory Commission's (MedPAC) June 15 report to the U.S. Congress is mostly silent on imaging, focusing instead on improvements to the structure and function of accountable care organizations (ACOs) and the Medicare Advantage program.

But that doesn't mean imaging isn't on the commission's mind. In a press conference, MedPAC executive director Jim Mathews, PhD, outlined the group's suggestions for reducing inflated Medicare costs caused by the fee-for-service (FFS) system and further transitioning to a value-based payment system.

And although the new report doesn't particularly call imaging to the carpet for its part in healthcare cost inflation, it's still an element of why the payment system needs overhauling, he believes.

"Although this report doesn't specifically address imaging, we continue to be concerned about how it affects fee-for-service payments," Mathews told "Imaging is a poster child for why the commission has been recommending Medicare move away from fee-for-service and toward payment structures such as ACOs."

The report doesn't offer any new payment recommendations for physicians and other healthcare professionals for 2021, a position MedPAC took in its March report.

"Overall, access to clinician services for Medicare beneficiaries appears stable and comparable with that for privately insured individuals," the group wrote in March. "Other measures of payment adequacy are stable and consistent with prior years. Therefore, the Commission does not see a reason to diverge from the current-law policy of no update for 2021."

Accurate ACOs

ACOs are responsible for 23% of Medicare beneficiaries with both Part A and Part B coverage, according to the commission. Given the rapid growth of both areas, "it is important to evaluate whether they are generating savings for the Medicare program and thus helping to make the program more sustainable," it wrote.

So the June report focuses on ways to improve ACOs. MedPAC is proposing a change that would block a way of billing that doesn't accurately represent spending, Mathews said. If clinicians use a taxpayer identification number (TIN) that's not part of the ACO, or bills for patients with low spending under the ACO's TIN and bills for patients with higher service costs under a non-ACO TIN, the true costs of care aren't clear. To solve the problem, MedPAC is recommending that ACOs use the same national provider identifiers used to calculate performance-year spending.

"The current system allows an ACO to strategically change the composition of its TINs to increase the likelihood of receiving unwarranted shared savings relative to benchmarks, creating a vulnerability for the Medicare program," it wrote. "Properly matching the clinicians included in an ACO's baseline and performance years will allow a more accurate assessment of an ACO's performance and reduce opportunities for unwarranted shared savings."

Improving Medicare Advantage

In a similar improvement vein, the commission is recommending that Medicare Advantage's quality bonus program (QBP) payment structure be replaced by what MedPAC calls the Medicare Advantage Value Incentive Program (MA-VIP), a change that would address the problem caused when Medicare Advantage organizations that have at least four stars in the five-star quality rating system merge with lower-rated organizations -- thus not accurately reflecting the quality of service, Mathews said. MA-VIP would include specific quality assessment measures tied to clinical outcomes as well as patient experience.

"The MA-VIP produces a better way of measuring plan quality and, relative to the QBP, more fairly treats plans that disproportionately enroll populations with certain social risk factors," the commission said in a statement.

From FFS to value-based care

In any case, MedPAC's work in the coming years will continue to focus on shifting Medicare from the fee-for-service model to a value-based one, Mathews said.

"The commission continues to be concerned that the fee-for-service structure incentivizes providers to increase service volume," he said. "[Healthcare] needs to be detached from FFS payments and linked instead to value-based care. Over the next several years we will continue to do additional work on how ACOs and the Medicare Advantage program can be improved to achieve the goals articulated [in this report]."

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