In its June 2012 report to Congress, the Medicare Payment Advisory Commission (MedPAC) focused on three areas: Medicare benefit design, care coordination for fee-for-service (FFS) Medicare and care coordination for those dually-eligible for Medicare and Medicaid.
Some of the commission's recommendations for benefit design include capping out-of-pocket beneficiary spending; implementing deductibles for Part A and Part B services; replacing coinsurance with copayments to enable beneficiaries to better anticipate their medical costs; and adding cost-sharing for supplemental insurance, which cover deductibles, coinsurance and copayments.
"Medicare's benefit package under FFS has remained substantially unchanged since 1965," wrote the commission in the report. "During that time, insurance products in the private sector have undergone numerous changes, medical technology has evolved radically, and Medicare payment systems have changed as well. The commission has been considering ways to reform the traditional benefit package so that it gives beneficiaries better protection against high out-of-pocket (OOP) spending and creates incentives for them to make better decisions about their use of discretionary care."
MedPAC's recommendations as related to care coordination in FFS Medicare include creating a per-beneficiary payment for care coordination; adding or modifying codes to allow providers to bill for selected care coordination activities; and developing payment policies to reward coordinated care and penalize fragmented care.
And for dual-eligibles, MedPAC recommends improving the Medicare Advantage (MA) risk adjustment to more accurately predict risk across all MA enrollees and paying providers for the Program of All-Inclusive Care for the Elderly (PACE) based on the MA payment system for setting benchmarks and quality bonuses.
MedPAC's report and its focus on care coordination was welcomed by some but not overwhelmingly applauded.
In a statement, the American Medical Association said it was "very pleased" with the report and its focus on care coordination and in particular, the committee's recommendations about paying for care coordination services that are not currently covered by the program. "We are especially pleased the report stresses the need for Medicare to recognize and pay for care coordination services that physicians are already conducting, including telephone calls, patient education and medication management," said Peter Carmel, MD, AMA's then-president.
But others, including Paul Keckley, the executive director of Deloitte Center for Health Solutions, were not so impressed. He chalked up the report as another attempt to answer unknowns. "No one really knows what's going to happen with our healthcare system," he said. "Everyone builds models and reports on assumptions."
"As I read the report - it's interesting but does it tell me what's going to happen? Not anymore clearly than many other reports," he said. "I think [MedPAC] is zeroing in on the right things but we don't have these things quantified and Congress isn't always listening to these reports."
[See also: MedPAC advises 1 percent pay increase for doctors, hospitals]
[See also: MedPAC finds access to Medicare physicians holding steady ]