MedPAC, MACPAC Issue June Reports to Congress

The Medicare Payment Advisory Commission today issued its June report to Congress, which includes the panel’s recent recommendation to reduce emergency department evaluation and management services payment rates by 30% for off-campus stand-alone EDs located within six miles of an on-campus hospital ED. The AHA in March urged MedPAC not to approve the recommendation, saying it was not based on any analysis of Medicare beneficiaries, Medicare costs or Medicare payments and would make Medicare’s record underpayment of outpatient departments and hospitals even worse. Medicare margins were a record-low negative 14.8% for hospital outpatient departments and negative 9.6% for hospitals overall in 2016, with the latter expected to reach negative 11% this year. The report also includes an AHA-supported recommendation to allow isolated rural hospitals located more than 35 miles from another ED to convert to stand-alone EDs that would be able to bill under the outpatient prospective payment system. These EDs also would be provided with annual payments to assist with their fixed costs. In addition, the report includes a mandated report on the Hospital Readmissions Reduction Program and recommends changes related to post-acute care payment, quality reporting programs, accountable care organizations and other areas. Meanwhile, the Medicaid and CHIP Payment and Access Commission today released its June report to Congress, which includes recommendations to change statutory provisions that prevent state Medicaid programs from paying the lowest price for certain drugs and clarify regulations on protecting the privacy of patients with substance use disorder to support integration of care.