The Medicare Payment Advisory Commission this week recommended that Congress provide a 2 percent market-basket update for the hospital inpatient and outpatient prospective payment systems in 2020, and replace the current hospital quality programs in 2020 with a new Hospital Value Incentive Program. The difference between the update recommendation and the amount specified in current law would be used to increase payments in the new value incentive program. The HVIP would include a small set of population-based outcome, patient experience and value measures; score all hospitals based on the same absolute and prospectively set performance targets; and account for differences in patient’s social risk factors by distributing payment adjustments through peer grouping.  

In comments submitted this week, AHA urged the commission to defer a final recommendation on the HVIP, citing significant concerns with the program’s design.
In other action this week, MedPAC recommended that:

  • the Health and Human Services Secretary increase the fiscal year 2019 Medicare base payment rates for long-term care hospitals by 2 percent in 2020;
  • Congress reduce the FY 2019 Medicare base payment rate for inpatient rehabilitation facilities by 5 percent in 2020;
  • Congress eliminate the FY 2020 update to the Medicare base payment rates for skilled nursing facilities, and HHS revise the SNF PPS and annually recalibrate the relative weights of the case mix groups to maintain alignment of payments and costs;
  • Congress increase the calendar year 2019 Medicare payment rates for physician and other health professional services by the amount specified in current law; require advanced practice nurses and physician assistants to bill the Medicare program directly, eliminating “incident to” billing for services they provide; and HHS refine Medicare’s specialty designations for APRNs and PAs;
  • Congress reduce CY 2019 Medicare base payment rate for home health agencies by 5 percent;
  • Congress eliminate the CY 2020 update to the Medicare conversion factor for ambulatory surgical centers, and HHS require ASCs to report cost data; and
  • Congress reduce the FY 2019 Medicare base payment rates for hospice providers by 2 percent.

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