MedPAC supports changes to the development of MA plan payment benchmarks

“The Medicare Payment Advisory Commission [..] was largely in favor of creating a new payment approach that calculates MA [Medicare Advantage] payments based on a blend of local and national spending as opposed to the current methodology, which sets benchmarks on a county-by-county basis. [..] the meeting underscored the panel’s desire to make reforms to the MA payment structure. MedPAC data show that MA plan payments are on average 2% higher than traditional Medicare. [..] MA plans submit a bid that details the estimated revenue the plan will need to cover the basic Medicare benefit in Parts A and B. … Read More

Taming The Paper Tiger

“If health care is going to spend less, some inputs will need to be paid less. This post explores the possibility of saving money by reducing the administrative costs of health care. Reducing administrative costs is attractive for several reasons. Administrative costs are high, perhaps a quarter of health spending, so reductions in administrative costs could yield a good deal of savings. Further, the goal of medical care is clinical care, so reducing administrative staff likely has a smaller effect on quantity and quality of care than would reductions in clinical staff. Finally, excess administrative hassles adversely affect peoples’ ability … Read More

The Mismatch of Telehealth and Fee-for-Service Payment

“the “virtual check in” code introduced in the 2019 MPFS [Medicare Physician Fee Schedule] initiated payment for short communications with patients to avoid unneeded office visits. During the PHE [Public Health Emergency], restrictions on both telehealth visits and non-visit-based communications were loosened further, importantly permitting telehealth services to originate from the patient’s home instead of a medical facility. The Centers for Medicare and Medicaid Services also agreed to pay for routine phone calls between patients and their practitioners. Medicare initially set the rate for a 5- to 10-minute call comparable to a virtual check in—about $15—pegging the fee to relative … Read More