MedPAC, GNYHA Members Discuss Quality, Value Payment Programs

August 13, 2018

GNYHA hosted a meeting last week at which Medicare Payment Advisory Commission (MedPAC) staff and senior clinical quality leaders from GNYHA member hospitals discussed proposed changes to Medicare’s hospital quality and value payment programs. MedPAC is an independent, nonpartisan Congressional agency established by Federal statute to advise Congress on programs and policies that affect the Medicare program.

MedPAC’s proposed changes would modify and align the existing Hospital Readmissions Reduction, Hospital-Acquired Conditions, and Value-Based Purchasing programs into a single program—the Hospital Value Incentive Program (HVIP). The four HVIP measures would be of equal weight and consist of 1) all-condition risk-adjusted mortality, 2) Medicare spending per beneficiary, 3) all-cause 30-day readmission, and 4) patients’ overall rating of the hospital based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS®).

The changes detailed in MedPAC’s June 2018 Report to the Congress promote the Commission’s principles for measuring quality in the Medicare program: measures should be patient-oriented and encourage coordination across providers; include outcome measures with clear, prospectively set targets that adjust for relevant patient risk factors; and reduce burden and complexity for providers. The new program would also incorporate “peer group” payment adjustments (based on share of “dual eligibles”) that have the potential to decrease existing disparities and make payment adjustments more equitable. GNHYA and clinical quality leaders support program changes that promote reductions in redundancy and burden.

MedPAC staff were also encouraged to consider supporting the elimination of the hospital meaningful use program’s reporting requirements. GNYHA members encouraged changes that increase the accuracy and fairness of measurements across the range of hospitals. GNYHA members voiced specific concerns about hospitals’ ability to significantly impact overall HCAHPS® scores, hospital readmissions beyond seven days, and Medicare spending during the 30 days post-hospitalization.

GNYHA will continue engaging with MedPAC, the Centers for Medicare & Medicaid Services (CMS), and Congress to advocate for more equitable, fair, and clinically useful quality incentive payment measures for our members. MedPAC will deliberate the HVIP proposal in future meetings, which may result in sending specific recommendations to Congress and CMS in early 2019.