Summaries of Recent PAC News

IMPACT Act Cross-Setting Measures

The IMPACT requires PAC providers to report standardized patient assessment data and quality measure data to the Secretary, which will facilitate cross-setting data collection, quality measurement, outcome comparison, and interoperable data exchange among LTCH, IRF, SNF, and HH providers.  CMS has recently proposed or acted on several cross-setting quality measures, which are also included in CMS’ Measures Under Consideration (MUC) List for 2016. Read more for a breakdown of these cross-setting measures.

Physician Fee Schedule Final Rule

On Wednesday, November 2, CMS issued the 2017 PFS final rule that updates payment policies, payment rates, and quality provisions for services provided on or after January 1, 2017. The PFS focused on the importance of primary care by improving payment for chronic care management, mental and behavioral health issues, and cognitive impairment conditions.  The rule also expanded the Medicare Diabetes Prevention Program (MDPP) model test to all eligible Medicare beneficiaries, finalized screening and enrollment requirements for providers and suppliers participating in Medicare Advantage, released certain Medicare Advantage bid data and Part C and Part D Medical Loss Ratio (MLR) data, and updated certain quality reporting requirements and beneficiary protection policies in the Medicare Shared Savings Program. Read More.

Hospital OPPS Final Rule

On November 1, CMS released the 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates final rule. In conjunction, CMS also issued an interim final rule with comment period (IFC) to establish the new payment rates for items and services provided by certain off-campus outpatient provider-based departments (off-campus PBDs), also known as the siteneutral
payment provision. Read More.

GAO Report: MACRA Quality Measure Report and Recommendations 

On October 13, 2016, GAO released a report on the use of health care quality measures across HHS and private payers, with a focus on identifying the extent and effects of quality measure misalignment, describing the key factors that contribute to misalignment, and evaluating HHS’s current efforts to address quality measure misalignment. GAO also issued recommendations to the Secretary of HHS to better align measures and reduce associated provider burden. Read More.

MACRA Final Rule: Quality Payment Program

On October 14, 2016, CMS finalized regulations implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions, collectively referred to as the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  The QPP will affect the more than 600,000 clinicians who provide care to more than 55 million Americans nationwide. Read More.

BPCI Year 2 Annual Eval Report

On September 19, 2016, CMS released the second annual evaluation report for Models 2-4 of the Bundled Payments for Care Improvement (BPCI) Initiative.  The report describes the characteristics of the participants and includes quantitative analyses of Phase 2 participants from the first year of BPCI and qualitative analyses of participants that joined during the first seven quarters. Read More.

CMS Announces Final Rule for LTC Facilities Reform of Requirements 

CMS' 700-plus page rule is the first comprehensive rewrite of Medicare and Medicaid quality and safety requirements for LTC facilities since 1991, and is intended to improve the safety, quality, and effectiveness of care delivered to facility residents.  The rule includes various revisions to staffing and training requirements, discharge and care planning rules, and infection prevention and control provisions.  The most notable provision, however, is the prohibition of pre-dispute binding arbitration agreements. Read More.

MedPAC Reviews Patient Outcome Measures under Proposed Unified PAC PPS 

In its June 2016 Report to Congress, MedPAC released a proposal for developing a unified payment system that would span the four post-acute care settings.  MedPAC determined that a Post-Acute Care Prospective Payment System (PAC PPS) was both feasible and could be implemented sooner than the timetable anticipated in the IMPACT Act, though an important concern in establishing such a system was the potential impact on patient outcomes.  This session, held at MedPAC’s September 2016 meeting, reviewed the planned analyses for two outcome measures – readmission rates and Medicare spending per beneficiary (MSPB). Read More

CMS Adopts Drug Regimen Review to Satisfy Reconciliation Domain Under IMPACT

CMS is adding quality measure, Drug Regimen Review Conducted with Follow-Up for Identified Issues, to satisfy the medical reconciliation domain required under the IMPACT Act. Read More.

Independence at Home Demonstration Performance Year 2 Results

On August 9, CMS announced the results from performance year (PY) 2 of the Independence at Home Demonstration (IAH).  IAH is a patient-centered model that supports providers to care for chronically ill patients in their own homes. Read More.

Senate Finance Committee Hearing on MACRA

On Wednesday, July 13th, members of the Senate Finance Committee gathered to question Andy Slavitt, the Acting Administrator of CMS, regarding the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). The bipartisan legislation was signed into law on April 16, 2015 and the comment period on the proposed rule (released April 27) ended approximately two weeks ago on June 27. Read more

Proposed Changes to Hospital Outpatient Prospective Payment System (OPPS) for CY 2017

On July 6th CMS announced a set of proposed changes to the Hospital Outpatient Prospective Payment System (OPPS) -- to take effect January 1, 2017 -- aimed at improving the quality of care Medicare patients receive by better supporting their care providers. In the proposed rule, CMS attempts to address concerns over the need to focus payments on patients rather than settings, opioid over-prescription, quality measures centered on patient outcomes and experience of care, and participation in the Medicare EHR Incentive Program. CMS will be accepting comments on the proposed changes through September 6, 2016. Read more

Senate Finance Committee Hearing on Medicare Part B Drugs Model

To the many questions and complaints of the members of the Senate Finance Committee, Dr. Conway stated that all public comments will be evaluated and taken into account in tweaking the proposed model through rulemaking – refraining to making specific comments about what aspects would be changed and what would remain the same. Read more

MedPAC June 2016 Proposal for Improving Medicare Part D

This proposal, which calls on both Congress and the Secretary to take action to change Medicare Part D, comes in response to the 60% increase in Part D spending (from $46 billion to $73 billion) from 2007 to 2014. Facing rising drug costs – particularly with the introduction of (often high-priced) specialty drugs, which have made up more than 50% of new FDA-approved drugs since 2009 – MedPAC aims to outline an approach to restrain overall drug costs. Read more

MedPAC June 2016 Report on Current State of Medicare Drug Spending

This examination of the broader context of Medicare drug spending is meant to be a stepping stone to larger conversations to address keeping medications accessible and affordable for beneficiaries, while maintaining the financial stability of Medicare. Moreover, with Medicare accounting for a large share of overall drug spending (1/3 of total U.S. pharmaceutical sales in 2013) any points raised have major influence on the pharmaceutical market and industry as a whole. Read more

MedPAC June 2016 Report on MACRA and physician payments

The core advice related to Advanced APMs is that clinicians should only receive the APM incentive payment (for 2019 through 2024) if the Advanced APM, in which they are participating Qualified Practitioners (QPs), is successful in controlling cost and/or in improving quality. MedPAC does not want Medicare payments to be determined by the status of the provider alone, but instead to be a reflection of the value of the service provided to the beneficiary. Read more

Brookings Event "The 2016 Medicare Trustees Report: One year closer to IPAB cuts?"

The CMS Chief Actuary Paul Spitalnic started off the morning summarizing key numbers and figures from the Medicare Trustees Report that came out on June 22nd. The report predicted Medicare depletion in 2028, two years earlier than the most recent estimate made in 2015 – though Spitalnic was quick to add that in 2028 income would still cover 87% of the cost of Medicare, certainly inadequate to fully fund expected benefits, but not a complete “depletion.” Read more