Ask the question “What do you think of MedPAC?” to a physician, hospital executive, nurse, skilled nursing facility director, health care lobbyist, or Congressional staffer and you are likely to hear a wide range of opinions – admiration, vitriol, begrudging respect, and possibly receive a question in return, “What or who is MedPAC?” For those steeped inside Beltway Medicare payment and policy issues, MedPAC can be their “Dr. Phil” – the go-to voice of reason, expertise, and knowledge. For others, MedPAC is the enemy – its findings or recommendations to be debated, discounted, disparaged, and outright opposed. MedPAC also can serve as the canary in the coalmine conducting surveys and studies of providers, uncovering issues and new trends before they bubble up to the collective health policy consciousness. MedPAC certainly has its groupies and detractors; irrespective of its popularity or lack thereof, the work done by the commissioners and staff receives significant media and policymaker attention and increasingly influences the nature and scope of federal health care payment policy. Bottom line: pay attention to what is discussed at MedPAC’s meetings, read those red covered reports and scour the tables and charts – if you don’t, it may be at your peril.
MedPAC, created by the Balanced Budget Act of 1997, serves as an external, independent policy consultant/think tank that advises Congress, the Centers for Medicare and Medicaid Services (CMS), and the nation on Medicare payment policy. According to its website, MedPAC “is a nonpartisan legislative branch agency that provides the U.S. Congress with analysis and policy advice on the Medicare program.” Comprised of 17 commissioners, who are supported by a significant staff in Washington, DC, the Commission issues two reports a year in March and June. At the September Commission meeting, current MedPAC Chairman Glenn Hackbarth explained the difference between the two reports, “An important component of our March report is our recommendation on updates of the Medicare payment rates for the different payment systems for hospitals, physicians, home health agencies, et cetera. And then in June typically we cover a broad range of issues [and] in recent years often related to how new models of payment measuring quality of care and the like.” To support its work, the Commission holds public meetings to explore policy issues, discuss commission staff findings, and hear from the public about various policy and payment concerns and recommendations. MedPAC is regularly called upon by Congress to testify at hearings, comment on proposed legislation and/or regulation, offer insight and expertise to federal policymakers and their staff.
MedPAC’s policy research agenda is both broad and deep. The Commission lists its research areas as: hospitals, post-acute care, ambulatory care, delivery and payments reforms, physicians and other health professionals, private plans, beneficiaries and coverage, Medicare spending and financing, drugs, devices, and tests, quality, and regional issues. Given the scope of its work, anyone involved in the health care industry should know of MedPAC and understand its role in federal payment policy. Chairman Hackbarth opened the last Commission meeting by asserting, “Part of our charge from the Congress is to consider the budget implications of our recommendations for Medicare … [and as part of that charge we look at] a broad overview of what is happening not just in the Medicare program but in the broader health care system.” One need not look further than the table of contents from its June 2014 report to understand the MedPAC charge; the report included chapters on synchronizing Medicare policy across payment models; improving risk adjustment in the Medicare program; measuring quality of care in Medicare; and per beneficiary payments for primary care.
Once considered by some as more academic than pragmatic, increasingly, MedPAC is being viewed by federal policymakers as a helpful, balanced, and practical thought-leader in Medicare payment policy and health system delivery innovation/reform. I have observed this shift in MedPAC’s “popularity,” particularly among Congressional staff over the past six years as the nation has faced difficult financial challenges. It is quite common now for Members of Congress and their staff, particularly those on key committees of jurisdiction (House Ways and Means, House Energy and Commerce, and Senate Finance) to follow the Commission’s work and review and seriously consider its recommendations; these policymakers often take MedPAC ideas and suggestions and turn them into legislative proposals, which subsequently find their way into federal law. The most recent example of this is last week’s enactment of the IMPACT Act, which creates a requirement for uniform data to be collected among four types of post-acute care (PAC) settings – a policy, and now new federal law, which stemmed initially from a MedPAC recommendation. In fact the House Ways and Means Committee press release announcing the release of an IMPACT Act discussion draft cited MedPAC’s role in the policy and named previous law influenced by the Commission, “MedPAC first raised the need for a common PAC assessment tool in 2005. In the Deficit Reduction Act of 2005, [CMS] was first directed to test the concept of a common standardized assessment tool in the form of the [PAC] reform demonstration. MedPAC also included a recommendation to move forward with a common assessment tool in its March 2014 report.”
Despite its growing influence, not everyone on Capitol Hill or within the health policy sphere agrees with the Commission’s recommendations or counts themselves among its groupies. On some issues, Congressional staffers express skepticism or dissention, rejecting MedPAC recommendations outright or narrowing their scope to a pilot or demonstration, rather than adopting wide-spread change. Being a “good consumer” of MedPAC reports and recommendations increasingly is a job requirement – for both Congressional staff and those working in the health care industry, as providers or advocates.
Fortunately, MedPAC makes it easy to stay in the loop on its deliberations and discussions. You can join the MedPAC mailing list and receive reports, updates, meeting notices and agendas directly – and just in the last month the Commission joined the world of social media on Twitter – @medicarepayment. And, in case you missed the Commission’s last meeting, don’t worry – it next meets October 9 & 10 and agendas typically are posted a week in advance. MedPAC also posts its Payment Basics series, which provide individual walk-throughs of the various Medicare payment systems. MedPAC staffers also hold meetings with providers and others involved in health care delivery and consider public input and formal comment on their reports, meetings, and other work; as such, there is an opportunity to have your views and concerns within the Commission’s structure. MedPAC Chairman Hackbarth reminded attendees at the September Commission meeting that “this isn’t your only or best opportunity to provide input on our work. Your best opportunity is to work with our staff. Another one is to send letters to us, the Commissioners, and we are pretty good about reading those. A third is to post comments on our website.” With an estimated 10,000 people a day turning 65 and joining the Medicare program, coupled with ongoing federal budgetary and health system delivery challenges, for the foreseeable future, MedPAC will continue to play an influential role with the Congress and the nation’s health care system and as such, it seems advisable to heed Chairman Hackbarth’s advice to weigh-in with the Commission through all available means.
The views expressed are the author’s own, and should not be considered an endorsement of the agency.
Ilisa Halpern Paul, MPP, is president of the District Policy Group at Drinker Biddle, a bipartisan, boutique, full-service advocacy, public policy, and government relations group.