Blog | Wednesday, March 16, 2011

QD: News Every Day--MedPAC recommends primary care pay raise

The Medicare Payment Advisory Commission (MedPAC) recommended a 1% raise for physician fee schedule services in 2012. MedPAC, the Congressional agency that advises Congress on issues affecting the Medicare program, released its report Tuesday. (A summary of the 384-page report is here.)

In addition, MedPAC advised Congress to raise payment rates for:
--acute care hospital inpatient and outpatient prospective payments by 1%. Congress should also adjusts inpatient pay rates in future years to fully recover all overpayments due to documentation and coding improvements;
--ambulatory surgical centers by 0.5%, while requiring them to submit cost and quality data;
--outpatient dialysis payments by 1%; and
--hospice rates by 1%

MedPAC recommended no rate increases for long-term care hospitals, inpatient rehabilitation facilities, home health care services or skilled nursing facilities. The number of home health agencies has increased to an all-time high and Medicare’s payments have exceeded their costs by nearly 18% for the tenth consecutive year, the report said. Also, the commission found that Medicare payments for skilled nursing facilities appears to pay providers relatively more for patients who need therapy than for patients with complex care needs.

MedPAC is made up of primary care and specialty physicians, lawyers, nurses and business experts. Its vice chair is Robert Berenson, MD, a Fellow of the American College of Physicians. It recommends Medicare payment rates for 10 Medicare fee-for-service payment systems.

The commission also reviews the status of the Medicare Advantage, which saw 2010 enrollment increase to 11.4 million beneficiaries, or 24% percent of all Medicare beneficiaries). Enrollment in HMOs grew by 7%.

And, the Commission’s report also outlines Medicare's Part D program. The centers for Medicare and Medicaid Services estimates the average monthly premium in 2011 will be $30, a $1 increase over the 2010 average.

IOM identifies immediate health priorities
A new report from the Institute of Medicine singles out 12 indicators as immediate, major health concerns that should be monitored and 24 objectives that warrant priority attention as part of its master plan for improving the health of the American population over the next decade.

The 12 recommended indicators include measures of access to care, quality of health care services, healthy behaviors, injury, physical environment, social environments, chronic disease, mental health, responsible sexual behavior, substance abuse, tobacco use, and healthy births.

Areas to increase include:
--the proportion of children developmentally ready for school, and educational achievement of adolescents and young adults,
--the proportion of people with health insurance, a usual primary care provider and who get appropriate evidence-based clinical preventive services,
--health literacy,
--condom use,
--sleep, and

Areas to decrease include:
--cancer deaths,
--air pollution,
--teen pregnancies,
--central-line-associated bloodstream infections,
--coronary heart disease deaths and hypertension,
--fatal and nonfatal injuries,
--major depressive episodes,
--low birth weight rates
--the proportion of obese children and adolescents,
--consumption of calories from solid fats and added sugars,
--binge drinking of alcohol and past-month use of illicit substances, and
--tobacco use by adults, and starting smoking by children.

From Leading Health Indicators for Healthy People 2020: Letter Report, Institute of MedicineHealthy People 2020, the U.S. Department of Health and Human Services' plan, covers 42 topics and nearly 600 objectives, expanding on the 10 leading health indicators that served as priorities for Healthy People 2010. IN 1990, there had been 15 topic areas and 226 objectives.

The recommendations on what should be the priorities for the latest version of this decadal health plan reflect the consensus of a committee comprising population health experts, epidemiologists, health statisticians, and others. Indicators provide yardsticks that health experts and policymakers can use to measure progress, and objectives set out clear, concrete goals for improvements.

The report suggests specific measures for three topics: social determinants of health; health-related quality of life and well-being; and lesbian, gay, bisexual, and transgender health.