The Medicare Payment Advisory Commission (MedPAC) called for streamlining Medicare alternative payment models in its annual report to Congress released late Wednesday. The new MedPAC report follows up on last year’s report that suggested reducing the number of APMs, but this time offered up specific ways to accomplish that. The suggestions include:
- Implementing a foundational population-based payment approach that reduces the number of accountable care organization (ACO) model tracks from seven down to a smaller number. Each could each be geared toward provider organizations of different sizes and involve different degrees of financial risk.
- Moving away from “rebasing” ACOs’ spending benchmarks every few years based on actual spending, and instead relying on periodic administrative updates to benchmarks using a growth factor that is unrelated to ACOs’ own spending performance and is known to ACOs in advance.
- Requiring certain providers to participate in the national episode-based payment model for all their fee-for-service Medicare patients, including beneficiaries already attributed to an ACO.
- For beneficiaries in both the episode-based payment model and an ACO, allocating episode-based payments incentivizing providers to offer efficient, high quality care and incentivizing ACOs to refer patients to low-cost, high-quality, episode-based providers.
The commission said implementation of those ideas “would reduce the complexity and uncertainty that providers face when deciding to participate in an APM.” It also said the changes could increase provider participation in the models and incentivize providers to furnish care more efficiently.
MedPAC also issued its final report on people living in medically underserved areas, which was requested by the House Ways and Means Committee two years ago. The commission found rural beneficiaries living in MUAs generally received the same volume of services, including home healthcare, as beneficiaries living outside those areas. It also found that beneficiaries dually eligible for both Medicare and Medicaid used more services, as did those beneficiaries with numerous chronic conditions.
The commission said further research is needed to better understand how sufficiently dual-eligibles and other vulnerable beneficiaries are accessing care. It is also examining how to better identify vulnerable Medicare populations and evaluating Medicare policies to better support safety-net providers.
