MEDICARE


History and Role of MedPAC Where do ASCs fit in BY ALEX TAIRA


On two mornings every month between Septem- ber and January, a long line of people waits


to enter a wood-paneled meet-


ing room in the Ronald Reagan Build- ing in downtown Washington, DC. Whether they are lobbyists, regulatory consultants or patient advocates, the people in line all have a special inter- est in health policy. They come to pack into tightly squeezed chairs that fill one half of the meeting room and lis- ten intently, while on the other side of the room, 17 appointees gather around a large, U-shaped table and discuss issues related to the Medicare program. These 17 appointees, and the staff that support them, make up the Medicare Payment Advisory Commission (MedPAC), and the discussions they have between Sep- tember and January each year inform the contents of a 500+ page report delivered to Congress every March. The report exhaustively examines all parts of the Medicare system and makes spe- cific recommendations to Congress on ways to constrain Medicare program spending while ensuring access to high-quality care.


beneficiary


Origins of the Commission MedPAC was established by Section 4022 of the Balanced Budget Act of 1997, a law better known for its cuts to Medicaid and the establishment of the Medicare Advantage program, at that point


called Medicare+Choice. The


act abolished two existing Medicare advisory committees—the Prospec- tive Payment Assessment Commission (ProPAC) and the Physician Payment Review Commission (PPRC)—while creating the new, overarching MedPAC. MedPAC is responsible for deliver-


ing two reports to Congress each year: one with reviews and recommenda- tions on specific Medicare payment


14 ASC FOCUS APRIL 2020 | ascfocus.org


policies and another on Medicare and its interactions with the larger health- care delivery system. The reports are delivered in March and June, respec- tively. In the report focused on pay- ment policy, the commission reviews aspects of the newly implemented Medicare+Choice program, as well as payment methodologies and benefi- ciary access to services, such as hos- pitals, physicians and skilled nursing facilities that continue to be paid on a fee-for-service basis.


The original 15 commission members—later expanded to 17— are selected by the comptroller gen- eral who is the director of the Gen- eral Accountability Office (GAO). The GAO is a congressional agency that audits various programs to ensure federal funds are used effi- ciently. Commissioners serve three-


year terms and should be individuals with “national recognition” for their work in a healthcare-related profes- sion. The act states that commis- sioners should come from a mix of backgrounds and a majority should be non-providers. Gail Wilensky, the chair of the abolished PPRC and for- mer administrator for the Health Care Financing Administration—today’s Centers for Medicare & Medicaid Services (CMS)—was selected as the first MedPAC chair, serving until 2001. The first MedPAC report was released in March 1998, with reports compiled in their current format beginning in 1999. MedPAC does not actually set Medicare policy. Instead, the commis- sion brings together a diverse group of health experts to assess the operation of an increasingly complicated Medi-


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