Medicare Payment Policy

FIguRe FIGURE
Cumulative percent change
4–6 4-4
80
70
60
50
40
Volume growth has raised...
Volume growth has caused spending
to increase faster than input
prices and updates, 2000–2011
Spending per beneficiary
MEI
Updates
An overarching issue affecting our deliberations is the
SGR system. The Commission laid out its findings,
principles, and recommendations for moving forward from
the SGR system in its October 2011 letter to the Congress
(see Appendix B, pp. 371–392). Repeal of the SGR should
follow Updates the Commission’s principles—eliminating the link
between cumulative fee-schedule expenditures and annual
conversion-factor MEI updates, protecting beneficiary access to
care, and having the Congress replace the SGR in a way
that is Spending fiscally per responsible.
FFS beneficiary
30
Although our latest access survey does not show
significant deterioration at the national level, the
20
Commission is nonetheless concerned about access. The
balance between supply and demand is tight in many
10
markets and problems could surface, particularly in
0
-10
primary care. The Medicare population is increasing as
Column1 Spending per beneficiary
members of the baby-boom generation become eligible
for Medicare, 2000 a large cohort of 0 physicians is nearing 0
MEI
0
2000 2002 2004 2006 2008 2010 retirement age, 2001 and SGR fatigue 9.9 is increasing. We do not 2.4 5
predict abrupt 2002 changes in the national 12.0 access picture, but 5.4 -0.04
Note: MEI (Medicare Economic Index). The MEI measures the changes in the
market basket of input prices for physician and other health professional
we cannot rule 2003 them out either. 19.0 7.9 1.7
services.
For these reasons,
2004
the Commission
31.2
reiterates the urgent
10.4 3.2
Source: 2012 annual report of the Boards of the Medicare trust funds and Office
of the Actuary 2012.
need to repeal 2005 the SGR as detailed 36.9 in the set of parameters 12.4
for how the SGR 2006 could be repealed 42.8 in our October 2011 14.4
4.7
4.9
improvement in a few measures and slight declines in a
Note: Note and Source in InDesign.
few others. Between the periods 2008 through 2009 and
2010 through 2011, 12 indicators improved, 20 indicators
were statistically unchanged, and 6 indicators worsened.
letter to the Congress. 2007 Deferring 45.7 repeal for one or two 16.2
years will not 2008 provide the Congress 51.0 with a better set of 18.4
choices. On the contrary, delaying action makes the cost
2009 57.5 20.3
of repeal that much larger, given the projected continuing
2010 63.7 22.1
increases in volume and intensity. A second argument
4.9
5.5
6.6
8.0
With a few exceptions, the increases and decreases were against deferring repeal of the SGR is that the array of
modest. Input prices for physicians and other health
professionals Notes are projected about to be this 2.3 percent graph: in 2014
new payment models to choose from is unlikely to change
materially in the near term. ■
(including a • productivity Data is in adjustment). the datasheet. Make updates in the datasheet.
• I had to force return the items on the x-axis. They will reflow if I update the data.
• I had to manually draw tick marks and axis lines because they kept resetting when I changed any data
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default when you change the data.
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98 Physician and other health professional services: Assessing payment adequacy and updating payments