Despite the pandemic, MedPAC advised some changes to 2022 provider payments

The coronavirus pandemic may require a temporary increase in Medicare funding for providers, but an influential congressional advisory group has recommended against dramatically increasing payments by 2022, although lobbyists continue to call for more help.

Whether or not it is one of the most unusual years for Medicare payments, the Medicare Payment Advisory Board is making “relatively conservative recommendations,” largely due to a lack of data on how the national health insurance program, COVID- 19, as Jim Mathews, Executive Director of MedPAC, told reporters on Monday.

Since the effects of the pandemic are temporary and will vary from provider to provider, it is better to address them through specific but temporary funding guidelines rather than costing more to permanently increase all provider payment rates over time, he said. MedPAC in its annual report released Monday.

Congress has already provided significant financial assistance to cash-strapped providers in a wave of COVID-19 laws last year and beginning this year. Lawmakers voted last year to increase Medicare payers by 2% to rid them of the worst financial impact of the pandemic, though aid ends later this month.

Donor groups have also raised concerns that the approval of the $ 1.9 trillion bailout package signed by President Joe Biden on Thursday could trigger a decade of neutrality regulations. The measure, known as “pay-go,” would require an automatic reduction in payments if the legislation resulted in a net increase in the deficit.

The Budget Office estimates that the payment could require a 4% reduction in Medicare spending by 2022 if Congress does not intervene.

The American Hospital Association, the American Medical Association, and the Federation of American Hospitals, among others, are pushing for higher Medicare payments as the pandemic slows in 2021.

However, large health systems generally have strong sales despite fluctuations in volume over the last year. And the indicators for 2019 suggest that increasing payments for Medicare, a program that tens of millions of Americans rely on to quickly address disability, may not be the best solution for financial gain, according to the MedPAC report.

The researchers analyzed the Medicare payment gaps for services to determine how Congress should update Medicare payment rates in 2022. MedPAC, which is required by law to make recommendations each year, bases its suggestions on factors such as patient access and care. Care and other data like supplier costs.

MedPAC included some previous effects of the pandemic in its report, but the researchers noted that last year’s data was still being collected and was mostly based on data from 2019.

The recommendations aim to reduce Medicare spending while ensuring beneficiaries access care, MedPAC says. This is an important task: According to the CBO, the trust fund that finances Medicare hospital services will be depleted by 2024, two years earlier than expected due to the effects of COVID-19, with no legislative action or significant spending.

MedPAC recommends that Medicare payments to acute and long-term hospitals for inpatient and outpatient services increased by 2%, which is expected to result in a small net increase in Medicare hospital revenues in 2022.

The group recommends that the payment rates for doctors, outpatient surgery centers, outpatient dialysis centers, intelligent care facilities, and palliative care services remain unchanged from the applicable law. When asked about the surge in medical spending during COVID-19, Mathew stated that it was a legitimate concern, but “currently all of our indicators are positive enough” to maintain the status quo.

MedPAC also recommended reducing payments to home health authorities and inpatient rehabilitation facilities by 5% and adjusting and reducing the overall palliative care limit, which governs the payment a hospice can receive from Medicare health insurance during a given year, by 20% %.

In addition to the hospital upgrade, the recommendations are in line with current payments or less, so this would result in an overall saving on Medicare. If implemented, they would “add at least a few minutes to the life of Medicare’s medical fund,” Mathew said.

The proposed tariffs are likely to appeal to some supply groups and appeal to others after a year of intense financial volatility. However, previous research suggests that provider losses due to the pandemic were not as severe as originally feared.

The MedPAC report also looked at the status of the Medicare Advantage program, which is growing stronger unlike Medicare fees, the researchers said. MedPAC found that recruitment, beneficiary access to MA plans, and the discount levels used to fund additional benefits have all reached record levels in recent years. 43% of all Medicare beneficiaries are enrolled in Medicare. Medicare plans were privately administered last year.

However, Medicare contributed $ 317 billion to MA plans in 2020, which is significantly higher per capita than Medicare’s service fee. Despite historically low plan offers for 2021, MedPAC estimates that MA payments will account for around 101% to 104% of tariff spending this year.

As a result, some MA policies require “immediate improvement,” MedPAC said, noting that CMS can reduce overpayments due to coding practices for plans that result in overpaying and replace the bonus program. MA quality with various incentive programs in an amount that more precisely rewards the quality of care.

The report also includes a policy option for Medicare telemedicine after COVID-19. There is broad bipartisan support in the United States to permanently ease restrictions on long-code telemedicine, as the use of digital health care increased during the pandemic. However, the current flexibility would end with the end of the public health emergency without legislative action, and the exact form of the permanent reform is still under discussion in the Houses of Congress.

MedPAC proposes to extend Congressional Medicare coverage to all non-PHE beneficiaries for a temporary period of one to two years to give enrollees more time to review data on virtual care validity and its implications for billing costs. However, Medicare must pay the doctor’s fee for telemedicine services, and providers should not be allowed to reduce or forgo the beneficiary’s cost-sharing for protection against overuse, a primary concern of healthcare critics.

MedPAC also found that the Medicare Part D prescription benefit also continues to offer beneficiaries a wide variety of plans and access to prescription drugs, with little or no increase in premiums for many years, plus the government can do to contain expenses.

More than just Medicare payments to plans are made in the form of cost-based reinsurance rather than fixed dollar payments, minus the incentives from spending control plans. Although total Part D prices declined in 2019 due to increased use of generic drugs, the prices of therapeutic products, which are dominated by brand-name drugs, have continued to rise. Rising drug price inflation among high-cost participants could increase spending, warns MedPAC.

Therefore, the committee recommended a redesign of Part D benefits to limit direct costs, prioritize risk-based wage margins, and current program characteristics that distort market incentives.