CHA News Article

MedPAC Discusses Freestanding EDs for Rural Communities, MACRA Implementation

The Medicare Payment and Advisory Commission (MedPAC) held its October meeting this week in Washington, D.C., covering a number of topics important to hospitals. Among the sessions, MedPAC provided an overview of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirements that implement the merit-based incentive payment system, as well as updated payments for physicians participating in alternative payment models under MACRA. MedPAC also held a session on freestanding emergency departments (EDs) as a means to preserve access to services in rural areas. The commission considered two models for rural hospitals: hospital conversion to a freestanding ED open 24 hours, seven days a week and paid under the outpatient prospective payment system with an additional fixed grant to fund stand-by costs; or a clinic-with-ambulance model that would be paid similarly to federally qualified health centers. 

MedPAC’s discussion focused on possible definitions of eligible rural hospitals, including distance and staffing requirements, as well as the broader health care policy implications of allowing freestanding EDs in rural communities. The commission’s feedback will inform MedPAC’s future research direction on the topic. Issue briefs and presentation materials from the October meeting are available at