MedPAC pushes for higher rates, but only for hospi­tals and doc­tors

Modern Healthcare - - LATE NEWS - —Vir­gil Dickson

The Medi­care Pay­ment Ad­vi­sory Com­mis­sion has sug­gested hospi­tals and doc­tors get pay­ment bumps in 2018. Other sec­tors, in­clud­ing am­bu­la­tory surgery cen­ters, skilled-nurs­ing fa­cil­i­ties and in­pa­tient re­ha­bil­i­ta­tion fa­cil­i­ties, should get no in­creases, the group said.

MedPAC last week pro­posed a boost in Medi­care pay­ments for hos­pi­tal in­pa­tient and out­pa­tient ser­vices in 2018 as out­lined un­der cur­rent law. Acute-care hospi­tals and physi­cians both saw slight in­creases in their Medi­care vol­umes in 2015.

How­ever, MedPAC re­peated its sug­ges­tion from last year not to raise pay­ments for am­bu­la­tory surgery cen­ters in 2018, ar­gu­ing those fa­cil­i­ties ap­pear to be fi­nan­cially healthy at cur­rent rates, which hit $4.1 bil­lion for 3.4 mil­lion Medi­care ben­e­fi­cia­ries in 2015.

The in­dus­try, not sur­pris­ingly, shot back. “ASCs, just like other providers, need to be able to con­tinue to cover the in­creas­ing costs they in­cur,” said Steve Miller, chief op­er­at­ing of­fi­cer for the Am­bu­la­tory Surgery Cen­ter As­so­ci­a­tion, a lob­by­ing group. “Medi­care needs to keep ASC pay­ments com­pet­i­tive to en­sure that its ben­e­fi­cia­ries have con­tin­u­ing ac­cess to the high-qual­ity, cost­ef­fec­tive care that ASCs pro­vide.”

MedPAC sim­i­larly thought skilled­nurs­ing fa­cil­i­ties, hos­pices and long-term-care hospi­tals don’t need higher rates. The group sug­gested mod­est cuts for home-health agen­cies and in­pa­tient re­ha­bil­i­ta­tion fa­cil­i­ties since both groups of providers have profit mar­gins rang­ing from 18% to 41.5%. For in­pa­tient re­ha­bil­i­ta­tion fa­cil­i­ties specif­i­cally, MedPAC be­lieves Medi­care pay­ments sub­stan­tially ex­ceed the costs of care.

A for­mal vote on the pro­pos­als will take place in Jan­uary. If MedPAC se­cures ma­jor­ity votes from its com­mis­sion­ers, the rec­om­men­da­tions will be sent to Congress and HHS in March as part of its an­nual re­port.

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