Medicare Payment Policy

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R e C o M M e n D A t I o n 11 The Secretary should eliminate the update to the payment rates for long-term care hospitals for fiscal year 2014. COMMISSIONER VOTES: YES 16 • NO 0 • NOT VOTING 0 • ABSENT 1
Long-term care hospital services Chapter summary Long-term care hospitals (LTCHs) furnish care to beneficiaries who need hospital-level care for relatively extended periods. To qualify as an LTCH for Medicare payment, a facility must meet Medicare’s conditions of participation for acute care hospitals, and its Medicare patients must have an average length of stay greater than 25 days. In 2011, Medicare spent $5.4 billion on care furnished in 424 LTCHs nationwide. About 123,000 beneficiaries had almost 140,000 LTCH stays. On average, Medicare accounts for about two-thirds of LTCHs’ discharges. Assessment of payment adequacy Beneficiaries’ access to care—We have no direct measures of beneficiaries’ access to LTCH services. Instead, we consider the capacity and supply of LTCH providers and changes over time in the volume of services they furnish. • Capacity and supply of providers—In spite of the moratorium imposed by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) and subsequent amendments, the number of LTCHs filing Medicare cost reports increased 9.3 percent between 2008 and 2011. • Volume of services—Controlling for growth in the number of fee-forservice beneficiaries, we found that the number of LTCH cases rose 2.8 percent between 2010 and 2011, suggesting that access to care increased during this period. C H A p t e R 11 In this chapter • Are Medicare payments adequate in 2013? • How should Medicare payments change in 2014? Report to the Congress: Medicare Payment Policy | March 2013 237
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RepoRt to the CongRess Medicare Pay
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RepoRt to tHe CongRess Medicare Pay
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with the structure of the payment s
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table of contents Acknowledgments .
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executive summary
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of services—and pressure on feder
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current Medicare payments are adequ
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outpatient dialysis services Outpat
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some facilities are willing to acce
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coverage for conventional treatment
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of care for these conditions should
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Context for Medicare payment policy
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4 Context for Medicare payment poli
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FIguRe FIGURE 1-2 1-2 12% Out of po
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the level of health care spending a
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1-4 FIguRe 1-4 140 120 100 80 60 Do
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FIguRe 1-6 1-6 Growth rate (in perc
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FIGURE FIguRe Share of GDP (in perc
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Share of GDP (in percent) FIGURE 1-
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FIGURE FIguRe 1-10 1-10 8% African
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FIguRe 1-12 1-11 1800 1600 1400 120
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Americans than for other racial and
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References Agency for Healthcare Re
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Medicare Payment Advisory Commissio
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Assessing payment adequacy and upda
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The goal of Medicare payment policy
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may go up when payment rates go dow
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hospitals and that hospitals shift
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individual payment systems but also
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Hospital inpatient and outpatient s
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Hospital inpatient and outpatient s
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covered the fully allocated costs o
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3-1 3-1 FIguRe 100 80 60 40 Number
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Visits or claims per 1,000 benefici
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3-4 3-4 FIguRe 2012 dollars (in bil
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of physicians employed directly by
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FIguRe FIGURE Annual percent change
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FIGURE FIguRe Margin (in percent) 3
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FIGURE FIguRe Margin (in percent) 3
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tABLe 3-5 performance of efficient
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Act, the EHR Incentive Program also
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as Medicaid expands, the new insura
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ates for separately paid drugs resu
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endnotes 1 From 2002 to 2011, 479 h
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References Agency for Healthcare Re
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C H A p t e R4 physician and other
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physician and other health professi
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from the SGR system in its October
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4-1 4-1 FIguRe 40 35 30 25 20 15 10
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tABLe 4-1 Most aged Medicare benefi
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tABLe 4-2 Medicare beneficiaries ha
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payment adjustments for health prof
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tABLe 4-3 Year physicians primary c
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provider’s characteristics, geogr
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tABLe 4-4 type of service Change in
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tABLe 4-5 type of imaging Change in
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the patient-centered medical home T
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FIguRe FIGURE Cumulative percent ch
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References ABIM Foundation. 2012. C
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Ambulatory surgical center services
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Ambulatory surgical center services
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Background An ambulatory surgical c
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Differences in types of patients tr
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Differences in types of patients tr
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number of services grew from 2006 t
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tABLe 5-7 rapidly than nonowning ph
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Creating a value-based purchasing p
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Revisiting the ambulatory surgical
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endnotes 1 Because CMS updates paym
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Medicare Payment Advisory Commissio
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R e C o M M e n D A t I o n 6 The C
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128 Outpatient dialysis services: A
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tABLe 6-1 Characteristics of FFs di
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Physicians Association has publishe
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tABLe 6-3 Increasing number and cap
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Number of FFS dialysis beneficiarie
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FIguRe 6-3 Percent of dialysis bene
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and 2011, the proportion of adult h
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anticipated under the modernized pa
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endnotes 1 In this chapter, we use
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References ABIM Foundation. 2012. C
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C H A p t e R7 post-acute care prov
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encourages more 60-day episodes. Fu
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C H A p t e R8 skilled nursing faci
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skilled nursing facility services C
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adjust for differences in patients
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Description of beneficiaries who us
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snF prospective payment system and
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Number of SNFs FIguRe FIGURE 8-1 7-
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FIGURE FIguRe Percent 7-2 8-2 30 25
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and other SNF users were essentiall
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FIguRe FIGURE Program spending (in
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7-8 8-6 FIguRe 30 25 20 15 10 Medic
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(e.g., whether there is a requireme
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the Commission’s 2012 update reco
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tABLe 8-9 non-Medicare margins were
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found to be associated with one or
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Smith, V. K., K. Gifford, E. Ellis,
Page 212 and 213: R e C o M M e n D A t I o n s (The
Page 214 and 215: 188 Home health care services: Asse
Page 216 and 217: tABLe 9-1 use and growth of home he
Page 218 and 219: FIGURE FIguRe Number of new agencie
Page 220 and 221: tABLe 9-2 of services. The review a
Page 222 and 223: tABLe 9-4 Community-admitted home h
Page 224 and 225: tABLe 9-5 type of county Claims dat
Page 226 and 227: tABLe 9-6 state County are collecte
Page 228 and 229: tABLe 9-8 Medicare margins for free
Page 230 and 231: tABLe 9-11 provider characteristics
Page 232 and 233: tABLe 9-12 Medicare visits per full
Page 234 and 235: strengthening incentives for effect
Page 236 and 237: endnotes 1 The exceptions pertain t
Page 239 and 240: C H A p t e R10 Inpatient rehabilit
Page 241 and 242: Inpatient rehabilitation facility s
Page 243 and 244: FIguRe FIGURE 10-1 9-1 Note: IRF (i
Page 245 and 246: Medicare IRF classification require
Page 247 and 248: tABLe 10-2 type of IRF 2004 2005 20
Page 249 and 250: tABLe 10-4 number of IRF beds decre
Page 251 and 252: weight for compliant cases was 1.39
Page 253 and 254: unobserved factors regarding patien
Page 255 and 256: freestanding IRFs were about $4,340
Page 257 and 258: increase for changes in the outlier
Page 259: References Centers for Medicare & M
Page 264 and 265: Quality of care—LTCHs only recent
Page 266 and 267: FIguRe FIGURE 11-1 10-1 Source: Med
Page 268 and 269: short-stay outlier cases in long-te
Page 270 and 271: tABLe 11-1 growth in the number of
Page 272 and 273: Chronically critically ill benefici
Page 274 and 275: Quality measures for long-term care
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Page 278 and 279: temporary legislative relief from s
Page 280 and 281: 16 We observed growth over time in
Page 282 and 283: Durairaj, L., J. C. Torner, E. A. C
Page 285 and 286: Hospice services C H A p t e R12
Page 287 and 288: Hospice services Chapter summary Th
Page 289 and 290: Background Medicare began offering
Page 291 and 292: March 2009 Commission recommendatio
Page 293 and 294: March 2009 Commission recommendatio
Page 295 and 296: number peaking in 2009). With rapid
Page 297 and 298: tABLe 12-4 Hospice use has increase
Page 299 and 300: tABLe 12-5 Characteristic insurers
Page 301 and 302: three settings, respectively) (Tabl
Page 303 and 304: measures, it is likely that the vas
Page 305 and 306: tABLe 12-10 Category percentage poi
Page 307 and 308: • additional wage index changes,
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Page 311: C H A p t e R13 the Medicare Advant
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288 The Medicare Advantage program:
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The Medicare Advantage (MA) program
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enchmark. If a plan’s bid is abov
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tABLe 13-3 projected payments excee
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We broke the fourth quartile into t
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tABLe 13-5 Distribution of enrollme
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tABLe 13-6 examples of measures inc
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tABLe 13-7 Between 2011 and 2012, l
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tABLe 13-9 admission-weighted ratio
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ecommended that payments be brought
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eport HEDIS measures based on admin
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C H A p t e R14 Medicare Advantage
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Medicare Advantage special needs pl
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integrating Medicaid benefits. We f
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tABLe 14-1 Distribution of snp enro
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previous Commission recommendations
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tABLe 14-4 Readmission rates by typ
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There has been recent movement in t
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of the quality measures that only S
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Separate appeals and grievances pro
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References Government Accountabilit
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status report on part D Chapter sum
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controlling growth in drug spending
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tABLe 15-2 and pharmacists who part
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Characteristics of Medicare benefic
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tABLe 15-6 Distribution of enrollme
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FIGURE FIguRe Percent of all Part D
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3). Most regions continue to have m
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tABLe 15-9 • Reinsurance—Medica
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tABLe 15-11 toward the OOP threshol
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tABLe 15-12 Cost-sharing amounts fo
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tABLe 15-14 enrollees—by about $9
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Drug price index equal to 1.0 at th
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Voluntary switchers Each year, Part
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endnotes 1 PPACA eliminates the cov
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References Boards of Trustees, Fede
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Commissioners’ voting on recommen
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Chapter 12: Hospice services The Co
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A p p e n D I X Moving forward from
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well as the cost of temporary repri
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payments rates be frozen at their c
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than primary care physicians (class
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achieving a total estimated 10-year
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would be costly, too, and they are
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payment accuracy. For example, such
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Final regulations on the ACO progra
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statemen nt of MedPAC’s position
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Cumulative percent change 70 7 60 6
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390 Moving forward from the sustain
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Note: The availability and scoring
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Acronyms AAgR average annual growth
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op outpatient opD hospital outpatie
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Commission members glenn M. Hackbar
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a state society of the National Med
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on the Advocate Physician Partners
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425 eye street, nW • suite 701
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Medicare Payment Policy

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