MEDICARE


care program, and neither Congress nor CMS is required to implement MedPAC’s recommendations. MedPAC’s inability to effect change has caused many to question whether the agency needs new, or additional, rules and powers. In 2009, Senator John Rockefeller (D-WV) introduced the MedPAC Reform Act of 2009, a piece of legislation that would have made MedPAC an independent executive agency with the power to set Medicare payment rates. Ultimately, his effort was unsuccessful, but a simi- lar proposal was enacted in 2010 as part of the Affordable Care Act (ACA). The Independent Payment Advisory Board (IPAB) was supposed to be a new, 15-member executive-branch agency with the power to implement changes that would rein in Medicare spending growth. Infamous for being described as a “death panel” in debates over the ACA, no person was ever appointed to the IPAB and the board was ultimately repealed in 2018.


MedPAC and ASCs In a final rule effective January 1, 2008, CMS established a new, ASC- specific payment system. Under the new system, ASCs would be paid their own rates separate from hospi- tal outpatient departments (HOPD) for roughly 3,400 outpatient surgery procedures. Until this change, Med- PAC had only mentioned ASCs in its reports tangentially when discuss- ing payments for physician services or HOPDs. However, MedPAC’s March 2009 report included ASCs in Chapter 2B, “Physician services and ambulatory surgery centers,” as well as in a standalone recommendation unanimously approved by the com- missioners. The commission recom- mended that Congress update pay- ments for calendar year 2010 for ASCs by 0.6 percent, but perhaps more importantly, included a rec- ommendation that Congress should require ASCs to submit cost data to


MedPAC is responsible for delivering two reports to Congress each year: one with reviews and recommendations on specific Medicare payment policies and another on Medicare and its interactions with the larger healthcare delivery system.”


—Alex Taira, ASCA


the Secretary of Health and Human Services (HHS). The March 2010 MedPAC report created a new chap- ter devoted to ASC payment analysis with a recommendation identical to 2009’s report.


In its March 2012 report, Med-


PAC included a new recommenda- tion that Congress direct the HHS secretary to implement a value-based payment system for ASCs no later than 2016. MedPAC would note in later reports that CMS does not actu- ally have the statutory authority to implement such a system. MedPAC’s March 2013 report


marked a change in the commis- sion’s recommendations for ASC pay- ments. From 2009 to 2012, MedPAC had recommended small increases— either 0.5 or 0.6 percent—for ASC payments. The 2013 report, however, recommended that Congress elimi- nate updates for ASC payments under Medicare and require ASCs to submit cost data. Since that year, all seven of


MedPAC’s March reports have recom- mended that Congress eliminate the payment update for ASCs and require centers to submit cost data. As noted above, MedPAC does not


have the power to compel changes in Medicare payment policy and Congress has consistently refrained from passing legislation implementing MedPAC rec- ommendations regarding ASCs. ASCA representatives have met with MedPAC staff and commissioners several times to discuss the challenges involved in cost reporting. Furthermore, ASCA has nom- inated, and will continue to nominate, representatives to serve on the commis- sion to give ASCs a voice in the discus- sions where MedPAC’s ASC payment recommendations are being formed. Eleven of the 17 current commissioners work in academia or at health systems as their primary occupation.


To learn more about MedPAC, write Alex Taira, ASCA’s regulatory policy and research manager at ataira@ascassociation.org.


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