MedPAC Suggests Revamping Quality Measure Programs

The Medicare Payment Advisory Commission (MedPAC) submitted its mandated annual report to Congress last week, and once again called for a total revamping of Medicare’s hospital quality programs.
In June 2018, MedPAC called for replacing four existing quality programs with a single new program to be known as the Hospital Value Incentive Program (HVIP).
The existing quality programs – the Hospital Inpatient Quality Reporting Program (IQRP), Hospital Readmissions Reduction Program (HRRP), Hospital-Acquired Condition Reduction Program (HACRP), and Hospital Value-Based Purchasing (VBP) Program – adjust hospital payments based on how hospitals perform in meeting the programs’ measures.
MedPAC says the current programs are “complex” and often “duplicative” and could be streamlined. The proposed HVIP includes five CMS-administered measure domains: mortality, readmissions, Medicare spending per beneficiary (MSPB), patient experience, and hospital-acquired conditions.
“Payments under the HVIP would be financed by a payment withhold from each hospital’s base operating payments (e.g., 5 percent) and increased by the difference between the Commission’s update recommendation for acute care hospitals and the amount specified in current law,” MedPAC wrote.
MHA is still reviewing the details of MedPAC’s 500-plus page recommendations. However, in general, while hospitals have advocated for simplified quality reporting, MedPAC’s suggestion of using all-cause, all condition readmission and mortality measures raises concern. Hospitals have argued that condition-specific measures are more valuable because they allow a hospital to burrow down and target problem areas. Also, nationally, the validity and value of financial penalties for readmissions is increasingly being called into question.
Other MedPAC suggestions in its 2019 report call for reducing the FY 2019 Medicare base payment rate for inpatient rehabilitation facilities by 5%, increasing the FY2019 base rate for long-term hospitals by 2%, and reducing the calendar year 2019 Medicare base payment rate for home health agencies by 5%.