The Medicare Payment Advisory Commission in a recent report to Congress highlighted four cost-saving recommendations MedPAC has made that health plans should be aware of, although they have yet to be implemented.
According to MedPAC’s report, Congress should:
- Fully account for coding intensity in Medicare Advantage plans, which could lead to a 2% reduction in payments
- Establish thresholds for the accuracy and completeness of MA encounter data, and withhold funds or apply refunds to MA plans based on reaching those thresholds
- Implement a MA value incentive program in place of the current MA quality bonus program, which could reduce payments by 2%
- Replace the current MA benchmark policy with a new one that equally blends per capita fee-for-service spending with price-standardized per capita FFS spending in the US, yielding a 2% reduction in payments. 1,2
Rapid growth in MA plan enrollment continues, the MedPAC report noted. Enrollment totaled 26.9 million in 2021, more than doubling what it was in 2010, at 11.3 million.1 Further, MA enrollment jumped 10% between 2020 and 2021, and MA enrollees comprise 46% of the total Medicare population.1
The Better Medicare Alliance pushed back against the report, arguing that the MacPAC report didn’t take into account data that demonstrates how MA adds value through higher-quality care and lower spending.1,3 The alliance cited studies that demonstrate the greater level of care MA plans provide, including reducing unneeded hospital stays and increasing screenings.1,3
The current coding intensity for MA plans is due to the greater percentage of MA beneficiaries who have chronic illnesses, the alliance argued.1,3 “It is appropriate and unsurprising that Medicare Advantage coding and risk score trends would reflect the truth of this increasingly diverse, at-risk, and medically complex patient population.”1,3
To stay up to date on the latest from RAM Technologies, follow us on LinkedIn
References
- Waddill, Kelsey. MedPAC Releases Medicare Advantage Recommendations, BMA Reacts. Health Payer Intelligence. March 22, 2022. https://healthpayerintelligence.com/news/medpac-releases-medicare-advantage-recommendations-bma-reacts
- Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. March 2022. https://www.medpac.gov/wp-content/uploads/2022/03/Mar22_MedPAC_ReportToCongress_SEC.pdf
- Better Medicare Alliance. Better Medicare Alliance Responds to MedPAC Report to Congress. March 15, 2022. https://bettermedicarealliance.org/news/better-medicare-alliance-responds-to-medpac-report-to-congress/
