Each year MedPAC releases a June report advising Congress on issues affecting the Medicare program, including broader changes in health care delivery and the market for health care services. The latest June report focuses on making the Medicare program more consistent by reforming Medicare payment models, risk adjustment payments, primary care service payments, and select condition payments.
In the report, MedPAC examines three methods to improve how well risk adjustment predicts costs for the highest and lowest cost Medicare Advantage beneficiaries. However, each method would involve some degree of cost-based payment, which MedPAC says could lead to less incentive for plans to manage care and hold down cost and lead to more incentives to up-code claims.
This years’ report and recommendations highlight how difficult it is to develop a workable alternative to the current CMS payment system of FFS, MA and ACO’s. Exponentially more difficult will be the mechanism to any of the proposed new payment systems to specialties such as radiology.
The Commission can only make recommendations. It is up to Congress to enact those recommendations requiring statutory changes or CMS to adopt regulations to effect those recommendations requiring regulatory changes. It is not clear that any of these proposed changes recommended by MedPAC will be adopted anytime soon by either Congress or CMS, but they are an indication of the direction the Commission believes payment policy should be headed.
As always, ADVOCATE will keep you updated on this and other issues impacting radiology as they become available.
Kirk Reinitz, CPA