Advocacy in Action - MedPAC and the Changing Tides

Carter L. Alleman, J.D.

The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997 to advise the U.S. Congress on issues affecting the Medicare program. MedPAC acts as Medicare’s unofficial policy department whereby its comments will influence future legislation and rulemaking regarding Medicare. A great deal of attention is paid to MedPAC when it discusses an issue and how that issue is being presented.

The Commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.

The Commission's seventeen members bring diverse expertise in the financing and delivery of health care services. Appointments are staggered; the terms of five or six Commissioners expire each year. The Commission is supported by an executive director and a staff of analysts who typically have backgrounds in economics, health policy, public health, or medicine.

MedPAC meets publicly to discuss policy issues and formulate its recommendations to Congress. During these meetings, Commissioners consider the results of staff research, presentations by policy experts, and comments from interested parties.

Recently, MedPAC has been discussing changes to the Quality Payment Program. At its October meeting, staff presented a policy option aimed at moving physicians toward Advanced Alternative Payment Models (A-APMs) by eliminating the Merit-based Incentive Payment System (MIPS) program and replacing it with a Voluntary Value Program (VVP), which requires participation in A-APMs or engagement in population-based measurement via “large” entities to avoid financial penalties.

At its November meeting, MedPAC discussed rebalancing the physician fee schedule toward primary care services. The driving argument is that primary care reimbursement is not matching the increases that is seen in specialty reimbursement. Several different measures were discussed including a budget neutral approach which would decrease specialty reimbursement and using those extra funds to increase for primary care.

Both these policy discussions are short sighted and show the lack of understanding when it comes to surgical care and reimbursement. The ACOS is working with the Alliance of Specialty Medicine and the Surgical Coalition to educate MedPAC on these issues in hopes that an understanding can be reached.