The Medicare Payment Advisory Commission (MedPAC) met virtually April 13–14 to discuss several payment policies. MedPAC is a non-partisan, independent legislative branch commission created to advise Congress about Medicare-related issues.
Medicare’s wage indexes currently adjust national base payment rates for geographic differences within the inpatient prospective payment system (IPPS). Commissioners voted during the April meeting in support of a recommendation to Congress to repeal the existing wage indexes system and to phase in a new system for hospitals and other types of providers that: uses all-employer, occupation-level wage data with different occupation weights for each provider type; reflects local area-level differences in wages between and within metropolitan statistical areas and statewide rural areas; and smooths wage index differences across adjacent local areas.
MedPAC also addressed aligning fee-for-service payment rates across ambulatory settings. Commissioners agreed with the recommendation that Congress more closely align payment rates across ambulatory settings for selected services that are safe to provide in all settings, when doing so does not pose a risk to access. Commissioners commented that the MedPAC report chapters that support this recommendation should include policy updates to clarify which specific procedures would be aligned, as well as considerations for rural and lower socioeconomic status beneficiaries. Concerns surrounding access continue to be highlighted when discussing the alignment of payment rates.
The Consolidated Appropriations Act, 2021 requires the Commission to submit a report by June 2023 about the use of telehealth services during the COVID-19 public health emergency (PHE), the impact of expanded telehealth coverage on access and quality, and Medicare payment policy for telehealth services. It became evident to MedPAC that more evidence is needed before making any permanent decisions regarding telehealth, as its analysis in collaboration with American Institutes for Research yielded mixed results due to confounding data.
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