In its 2021 healthcare delivery system report, released June 16, MedPAC makes the following recommendations to Congress:
- The current Medicare Advantage benchmark policy should be replaced with one that applies a rebate of at least 75 percent, a discount rate of at least 2 percent and a relatively equal blend of per capita local area fee-for-service spending with price-standardized per capita national fee-for-service spending. It should also use geographic markets as payment areas, use the fee-for-service population with both Part A and Part B in benchmarks, and eliminate the current pre-Affordable Care Act cap on benchmarks.
- CMS should implement a more harmonized portfolio of fewer alternative payment models, designed to work together to reduce spending and improve quality.
- Medicare’s current skilled nursing facility value-based purchasing program should be replaced with a value incentive program that scores a small set of performance measures, incorporates strategies to ensure reliable measure results, establishes a system to distribute rewards that minimize cliff effects, accounts for differences in patient social risk factors using a peer-grouping mechanism, and completely distributes a provider-funded pool of money. CMS should also begin to report patient experience measures for skilled nursing facilities.
- Congress should require CMS to transition to empirically justified indirect medical education adjustments to both inpatient and outpatient Medicare payments.
- Congress should cover all appropriate preventive vaccines and their administration under Part B instead of Part D without beneficiary cost sharing, as well as modify Medicare’s payment rate for Part B-covered preventive vaccines to be 103 percent of wholesale acquisition cost. Congress should also require vaccine makers to report average sales price data to CMS for analysis.
- Congress should direct CMS to modify the pass-through drug policy in the hospital outpatient prospective payment system so that it includes only treatments that function as supplies to a service and applies only to treatments that are clinically superior to their packaged analogs. CMS should also specify that the separately payable non-pass-through policy in the hospital outpatient prospective payment system applies only to treatments that are the reason for a visit and meet a defined cost threshold.
