Mark Miller, PhD, Executive Director of Medicare Payment Advisory Commission (MedPAC), was one of the keynote speakers at VNAA’s Sept. 18-19 Public Policy Leadership Conference (PPLC) in Washington, D.C. Dr. Miller spoke about MedPAC's role, trends in Medicare spending and long-term financing challenges. Finally, Dr. Miller indicated that recent reports of the Institute of Medicine suggest significant geographic variation in utilization--which is particularly evident in post-acute care.
Home Health: MedPAC has recommended accelerated and deep rebasing adjustments, case-mix revisions, per-episode beneficiary copayment and continued use of program integrity measures. Key indicators for home health on which these recommendations are based include:
- Rapid entry of new providers
- Substantial increase in number of episodes
- Decline in the number of visits per episode
- Over a decade of double digit Medicare margins
- Significant geographic variation in utilization
- Evidence of fraud and abuse
Hospice: MedPAC has recommended modest updates to the payment rates, focused medical review of hospices with many long-stay patients and long term revisions to the payment system. Key indicators for hospice on which these recommendations are based include:
- Substantial increase in number of hospices, due almost entirely to growth in for-profit providers
- Substantial increase in average length of stay, especially among long stay patients
- Higher profit margins among hospice providers with longer stay patients
- Reports from industry experts of hospices enrolling patients who do not meet eligibility criteria
Dr. Miller concluded his presentation by addressing opportunities for home health and hospice in delivery system reform including bundled payment for care improvement, Accountable Care Organizations, Independence at Home, other medical home models and demonstrations to coordinate care for beneficiaries receiving both Medicare and Medicaid. For more information, or to see Dr. Miller’s entire PowerPoint presentation, click here.