MEDICARE MONITOR
MedPAC and Your ASC Recommendations from this regulatory agency can affect your business operations and your bottom line. BY KARA NEWBURY
I
f your ASC is Medicare-certified, you know that Centers for Medicare & Medicaid Services (CMS) sets poli- cies that your ASC must follow and de- termines what ASCs will be paid each year. You may have also seen ASCA mention another organization involved with Medicare payments: The Medicare Payment Advisory Commission (Med- PAC). What is MedPAC and how can the recommendations it makes impact your bottom line?
What is MedPAC? According to its web site, “MedPAC is an independent Congressional agency that was established by the Balanced Budget Act of 1997 (P.L. 105-33) to ad- vise the U.S. Congress on issues affecting the Medicare program.” This mandate is broad enough to allow MedPAC to evalu- ate most issues affecting Medicare, but MedPAC focuses on payments to private health plans participating in Medicare and all health care providers in Medicare’s tra- ditional fee-for-service (FFS) program. Medicare policymakers also rely on Med- PAC to evaluate access to care and the quality of care that Medicare beneficiaries receive.
Who Serves on MedPAC? The Comptroller General, the country’s chief fiscal watchdog and accountant, appoints 17 MedPAC commissioners. The law requires the commission to in- clude a mix of individuals with broad geographic representation who have expertise in the financing and delivery of health care services. Commission- ers have included physicians and other health professionals, employers, third- party payers, researchers with a variety of health-related expertise and represen- tatives of consumers and the elderly.
Despite the desire for diversity, how-
ever, the current group is dominated by individuals who work at hospitals and universities, primarily in large urban areas. There are currently no represen- tatives from the ASC industry. ASCA is developing a strategy to promote the nomination of an individual with expe- rience in the ASC industry.
What Does MedPAC Do? MedPAC holds public meetings sever- al times a year to discuss policy issues and formulate its recommendations to Congress. The bulk of MedPAC’s rec- ommendations are released in March and June of each year in two reports to Congress. MedPAC is also asked to testify before congressional commit- tees and prepare briefings for congres- sional staff. MedPAC submits formal comments to the US Department of Health & Human Services (HHS)— the regulatory body that oversees CMS—on proposed regulations that impact the Medicare program.
Why Should I Care? As previously mentioned, one of the primary functions of MedPAC each
30 ASC FOCUS NOVEMBER/DECEMBER 2013
year is to make payment recommen- dations to the Medicare program for the coming year. For 2014, MedPAC approved a recommendation that ASCs receive a zero percent increase in pay- ment rates at the same time that it recommended a 1 percent increase for hospital outpatient departments (HOPD) in 2014. MedPAC commis- sioners contend that since ASCs do not submit cost data, they have no way of knowing how much ASCs should be paid. ASCA has opposed cost re- porting due to the burden it would place on small ASCs and the inability to conduct a fair comparison of the costs of an ASC to an HOPD’s costs since HOPDs can include expenses that ASCs cannot. In addition, ASCA points out that CMS has received cost data from ASCs in the past and was un- able to use it effectively. Fortunately for ASCs, Congress is not required to follow MedPAC’s rec- ommendations, and the final decisions that Congress and HHS make often differ from the commission’s recom- mendations.
Site Neutrality Proposal Although Congress often ignores many of MedPAC’s recommendations, elected officials are paying close atten- tion to a proposal that the commission has developed to neutralize payments across health care settings. During this tough economic time, any proposals that could significantly cut spending are being taken seriously. In its June report, MedPAC included a chapter titled, “Medicare Payment Differences Across Ambulatory Set- tings.” This part of the report calls for the equalization of payment rates be- tween HOPDs and ASCs for certain procedures. The list includes nine oph-
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