MedPAC discusses potential IME, outpatient drug, SNF payment changes

The Medicare Payment Advisory Commission today discussed a draft recommendation that Congress require the Centers for Medicare & Medicaid Services to transition to an indirect medical education adjustment that considers both inpatient and outpatient care.

The proposed adjustment would be budget neutral at first, but could eventually lead to an increase in IME payments. It also would be redistributive.

In a session on separately payable drugs in the hospital outpatient prospective payment system, the commission generally supported a draft recommendation directing the Health and Human Services Secretary to apply the pass-through drug policy only to drugs and biologics that function as supplies to a service and are clinically superior to their packaged analogs. It also generally supported a draft recommendation that the non-pass-through separately payable drug policy apply only to drugs and biologics that are the reason for a visit and meet a defined cost threshold.

Commissioners also discussed a draft recommendation that the Secretary “implement a more coordinated portfolio of fewer alternative payment models that support the strategic objectives of reducing spending and improving quality.” Commissioners discussed how the Center for Medicare and Medicaid Innovation could achieve more coordination and what metrics CMMI should use in determining which models to terminate to streamline the number of APMs. MedPAC will take a formal vote on the recommendation in April and publish an accompanying chapter in June.

In another session, MedPAC discussed draft recommendations to eliminate the Skilled Nursing Facility Value-Based Purchasing program and replace it with a proposal that incorporates social risk factors in performance evaluations and distributes the entire withhold rather than only 60%; and to finalize development of and start collecting patient experience measures for SNFs.