Geographic Adjustment in Medicare Payment Phase II: Implications for Access, Quality, and Efficiency (2012) / Chapter Skim
Currently Skimming:
1 Introduction and Overview
1 Introduction and Overview
Pages 13-22
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and the U.S. Congress addressing geographic adjustments in Medicare payment.
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The committee agreed on the importance of focusing its deliberations on issues that reflected geographic variation and Medicare payment policy. Specifically, the committee sought empirical evidence of geographic differences in access to appropriate levels of care for Medicare beneficiaries, quality of care provided to beneficiaries, and provider supply and distribution.
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health care marketplace, the committee will also evaluate and consider · T he effect of the adjustment factors on the level and distribution of the health care workforce and resources, including o Recruitment and retention taking into account mobility between metropolitan and nonmetropolitan areas; o Ability of hospitals and other facilities to maintain an adequate and skilled work force; and o Patient access to providers and needed medical technologies; · The effect of adjustment factors on population health and quality of care; and · The effect of the adjustment factors on the ability of providers to furnish efficient, high-value care. A first report will address the issues surrounding the adjustment factors themselves, and then a second report that evaluates the possible effects of the adjustment factors will follow.
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.3 Based primarily on data availability, the committee's assessment of the supply and distribution of primary care and specialty services was focused on physicians, nurse practitioners, and physician assistants. Other members of the health care workforce, including dentists, pharmacists, physical therapists, technicians, and medical assistants, were not included in the evidence review even though they may bill Medicare and are considered as part of the Medicare workforce.
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. The primary care bonus payments became effective January 2011, and CMS requires that primary care services account for at least 60 percent of the practitioner's Part B allowed charges (CMS, 2012b)
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· Finally, what additional policies could either augment or replace existing policies to improve access to appropriate levels of health care services? 4 Medicare beneficiaries make up 15 percent of the population nationwide.
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Because geographic adjustment is part of a multipayer and heterogeneous delivery system environment, the committee's report is not limited to Medicare payment policies; it also considers the important role of other federal agencies and private organizations in training, recruiting, and retaining qualified practitioners across the country to provide quality care for Medicare beneficiaries. RESULTS OF IMPACT ANALYSES FROM PHASE I RECOMMENDATIONS The impact analyses were designed to determine the impact of the proposed changes in the hospital wage index and geographic practice cost indexes, and the direction and extent of their effects on provider payments.
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In approaching this report, the committee sought to identify vulnerable geographic areas, such as HPSAs, that might experience a disproportionate impact if the Phase I recommendations were implemented. After reviewing the findings from each component of the impact analyses, the committee discussed whether other existing policies could mitigate potential adverse effects of payment reductions.
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. MedPAC (Medicare Payment Advisory Commission)
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