CHA News Article

MedPAC’s June Report Evaluates Quality Measurement, Post-Acute Site-Neutral Payment

The Medicare Payment Advisory Commission (MedPAC) last week released its annual report to Congress on Medicare and the health care delivery system. MedPAC’s June 2014 report examines a variety of Medicare payment system issues, such as synchronizing Medicare policy across payment models, improving risk adjustment in the Medicare program, measuring quality of care in Medicare, financial assistance for low-income Medicare beneficiaries, per beneficiary payment for primary care, site-neutral payments in post-acute care settings, and measuring the effects of medication adherence for the Medicare population.

In its chapter on measuring the quality of care, MedPAC expresses concern that current quality measurement programs rely primarily on clinical process measures, which are not often well correlated to better health outcomes. MedPAC also notes that the many Medicare and private payer measures overall place a heavy burden on providers and suggests using population-based outcome measures to compare quality within a local area across Medicare’s three payment models as an alternative.

MedPAC continues to explore site-neutral payments, devoting a chapter to site-neutral payments for conditions treated in inpatient rehabilitation facilities (IRFs) and skilled-nursing facilities (SNFs). MedPAC reviewed select conditions to assess feasibility of paying IRFs the same rates as SNFs and recommended that two conditions, major joint replacement and other hip and femur procedures, be paid for with a site-neutral policy. MedPAC recommends that if such site-neutral payments are implemented, the Centers for Medicare & Medicaid Services should evaluate waiving certain regulations for IRFs, such as requirements for intensive therapy and physician supervision.