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The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare policy-related issues, released its 2022 data book related to health care spending on July 19. Ultimately, Congress and Medicare will likely rely on some of the data in the July 19 document to guide future policy direction.
Many of the data points focus on 2020, which represents the beginning of the pandemic. However, many of the data will still prove to be useful to policymakers.
Click here to look at PHA’s deep dive of the data book. Password: PHA2022
The following is a high-level overview of the topics that are covered:
Hospital Consolidation – Health care consolidation represents one of the most discussed health policy issues in Washington, and MedPAC issued the following observations in the data book:
- “Hospitals and physician groups have increasingly consolidated, in part to gain leverage over insurers in negotiating higher payment rates.”
- “By 2017, 57 percent of hospital markets were so concentrated that one health system in the market produced a majority of the market’s hospital discharges.”
- “Studies have found that prices paid by private payers tend to increase as provider consolidation increases.”
Accountable Care Organizations – MedPAC takes a look at the role of specialists in ACOs.
A-APMs & Physician Payments – MedPAC examines the progressive payment models that physicians utilize for A-APM payments.
Hospital Inpatient Services & the Pandemic – MedPAC’s data find that “IPPS hospitals’ all-payer margin remained strong in 2020 with the support of federal relief funds.”
Half of Inpatient Stays – Circulatory, musculoskeletal, respiratory and infections services represented half of all inpatient stays.
Physician Services: E&M – E&M represented 50.7 percent of physician fee schedule-allowed charges in 2020.
Emergency Visits & Level 5 MSK Procedures – All emergency visits and Level 5 musculoskeletal procedures represented the hospital outpatient services with the highest Medicare expenditures in 2020.
“Low value” Services – MedPAC breaks down the data for “low value” services that are defined by the Choosing Wisely campaign. Imaging for nonspecific low back pain represented the top data element.
Cardiovascular Testing & Procedures: “Low Value” Care – Per MedPAC, “cardiovascular testing and procedures, other surgical procedures and imaging accounted for most spending on low-value care in 2019.” CMS provided the breakdown on the types of tests and procedures.
Medicare Advantage – Medicare Advantage plans are playing a greater role in Medicare, and MedPAC provides an extensive breakdown.
CMS issued a call for stakeholders on Thursday to submit feedback on a re-design of the Medicare Advantage program. Medicare indicated that it would like to enhance market competition, prior authorization and network adequacy.
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