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Commissioners Discuss Approaches for Updating the Medicare Physician Fee Schedule and to Incentivize Clinician Participation in A-APMs

The Medicare Payment Advisory Commission (MedPAC) convened a session to discuss various approaches to updating payments under the Medicare Physician Fee Schedule (MPFS). Under current law, starting in 2026, eligible clinicians engaged in advanced alternative payment models (A-APMs) will see their payment rates under the physician fee schedule rise by 0.75 percent annually, while all other clinicians will experience a 0.25 percent increase. However,… (Colocho, April 12, 2024) #Insurance Reform, #Medicare Access and Chip Reauthorization Act of 2015 (MACRA), #Physicians, #Primary Care, #Quality

Committee Begins Discussion on Potential Medicare Physician Payment Reforms

The Senate Finance Committee convened a hearing to begin discussions on a potential overhaul of the Medicare physician payment system. The hearing highlighted concerns regarding low physician adoption rates for Medicare reimbursements related to advance care planning, administrative burdens like prior authorization, and disparities in Medicare Advantage (MA) payments compared to traditional Medicare. Committee members heard from the following witnesses… (Colocho, April 12, 2024) #Accountable Care Organizations, #Chronic Diseases, #Costs, #Demonstration Programs, #Insurance Reform, #Medicare Access and Chip Reauthorization Act of 2015 (MACRA), #Medicare Advantage, #Physicians, #Prevention, #Primary Care, #Rural Health, #Telehealth, #Transparency, #Value-Based Insurance Design

Commissioners Discuss Ways to Lower Payments for Inpatient Rehabilitation Facilities for Select Conditions

The Medicare Payment Advisory Commission (MedPAC) convened a session to discuss alternative approaches to lower payments for services provided in inpatient rehabilitation facilities (IRFs) for select conditions that are also treated in skilled nursing facilities (SNFs). This work builds upon MedPAC’s 2023 report on a unified payment system for post-acute care in which the Commission stated that policymakers may want… (Llamas, April 11, 2024) #Inpatient Rehabilitation Facilities, #Skilled Nursing Facilities

MedPAC Commissioners Continue to Discuss MA Encounter Data Completeness and Advocate for Further Research into Encounter Data as the Singular Data Source for Comparison

The Medicare Payment Advisory Commission (MedPAC) convened a follow-up session to examine Medicare Advantage (MA) encounter data completeness. In March, MedPAC staff compared encounter data to provider-reported data which showed that while data completeness is increasing, gaps remain (Impact Summary). In this session, MedPAC staff compared encounter data to plan-reported data, bid data and HEDIS data, which highlighted incremental improvements… (Eisen, 1/1/70) #Medicare Advantage, #Quality

FY 2025 IPPS and LTCH PPS Proposed Rule Proposes 2.6 Percent Overall Increase for Hospitals; Includes New Episode-Based CMMI Model

Today, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2025 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule (press release, fact sheet), which applies to acute care hospital and LTCH payments beginning Oct. 1, 2025. Under the proposed rule, acute care hospitals would receive a 2.6 percent increase ($3.2 billion… (McClurg, April 10, 2024) #Demonstration Programs, #Disproportionate Share Hospitals (DSH), #Graduate Medical Education (GME), #Health Equity, #Hospitals, #Long-Term Care, #Long-Term Care Hospitals, #Quality

Senate Finance Health Subcommittee Explores Barriers to SUD Treatment in Medicare and Medicaid

The Senate Finance Health Subcommittee hosted a roundtable panel discussion on opportunities to improve substance use disorder care in federal health programs. Roundtable participants shared their expertise in the treatment of substance use disorder, with particular insights on treatment for adolescents and providing care in community-based settings. The participants shared their collective frustration with barriers to prescribing methadone, prior authorization… (Marceno, April 10, 2024) #Health Equity, #Mental and Behavioral Health, #Opioids

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