The Medicare Payment Advisory Commission (MedPAC) has made 10 new recommendations to Congress regarding Medicare payment accuracy and financial incentives for medical imaging and other diagnostic testing, and quality improvement, targeting the worse performing Medicare providers for intensive technical assistance.

MedPAC – an advisory agency to Congress with a 17-member commission and an excellent staff headed by my former OMB colleague Mark Miller, Ph.D. – is highly influential on Medicare provider reimbursement, care delivery, and quality improvement issues.

Improving Medicare Payment Accuracy and Appropriate Use of Imaging and Diagnostic Services in Medicare

MedPAC is concerned about increased utilization of ancillary services in Medicare in recent years, particularly medical imaging and other diagnostic testing.  To address this, MedPAC made a series of recommendations intended to improve Medicare payment accuracy, reduce physician’s financial incentives to order more ancillary services, and strengthen clinical support tools to improve appropriate use of medical imaging and other diagnostic testing.

Specifically, MedPAC recommends that:

  1. The Centers for Medicare and Medicaid Services (CMS) should accelerate and expand efforts to package discrete services in the Medicare Part B physician fee schedule into larger units for payment.
  2. Congress should direct CMS to apply a multiple procedure payment reduction to the professional component of diagnostic imaging services provided by the same practitioner in the same session.
  3. Congress should direct CMS to reduce the physician work component of imaging and other diagnostic tests that are ordered and performed by the same practitioner.
  4. Congress should direct CMS to establish a prior authorization program for practitioners who order substantially more advanced diagnostic imaging services than their peers do.

Enhancing Medicare’s Technical Assistance to and Oversight of Poor Quality Providers

The clinical performance of physicians, hospitals, and other health care providers varies considerably in the U.S. and Medicare is no exception.  A small but troubling and easily identified subset of physicians and facilities provide consistently poor quality of care, with serious human and fiscal consequences.

Therefore, MedPAC wants Congress and the Centers for Medicare and Medicaid Services to pay far greater attention to the health care providers that consistently provide low quality of care and fail to follow evidenced-based medicine in caring for Medicare beneficiaries.

In its latest report to Congress, MedPAC makes a series of recommendations to fundamentally restructure Medicare’s Quality Improvement Organization (QIO) program with goal of giving poor performing Medicare providers targeted, comprehensive, and effective technical assistance to improve their quality of care:

  1. Congress should redesign the current Medicare Quality Improvement Organization program to allow CMS to provide funding for time-limited technical assistance directly to health care providers and communities.  Congress should require CMS to develop an accountability structure to ensure these funds are used appropriately.
  2. Congress should authorize CMS to define criteria to qualify technical assistance agents so that a variety of entities can compete to assist providers and to provide community-level quality improvement.  Congress should remove requirements that entities providing technical assistance be physician sponsored, serve a specific state, and have regulatory responsibilities.
  3. The Centers for Medicare and Medicaid Services should make low performing Medicare providers and community-level initiatives a high priority in allocating resources for technical assistance for quality improvement.
  4. CMS should regularly update the Medicare Conditions of Participation (CoPs) for hospitals and other providers so that the requirements incorporate and emphasize evidence-based methods of improving quality of care in Medicare Part A and Part B.
  5. Congress should require CMS to expand interventions that promote systemic remediation of quality problems for persistently low-performing Medicare providers.
  6. The Centers for Medicare and Medicaid Services should establish a public recognition program for high-performing Medicare providers that participate in collaboratives or learning networks, or otherwise act as mentors, to improve the quality of lower performing providers.

Learn More:

Further details on MedPAC’s recommendations, including background and data, are provided in Medicare and the Health Care Delivery System, the Commission’s June 2011 report to Congress.

CMS is in the midst of implementing the 10th Scope of Work for the Medicare Quality Improvement Organization program, including a nationwide re-procurement launched in the spring of 2011.  This CMS slide deck details the planned changes.

By State and focus, here is a list of the current Medicare Quality Improvement Organizations (QIOs) and a list of the current CMS recognized QIO-like entities.

For over 100 other posts related to Medicare in the Piper Report, visit here.