According to the draft recommendations of the Medical Insurance Payment Advisory Committee, hospitals, dialysis facilities, and long-term care hospitals may see an increase in medical insurance reimbursements in fiscal year 2023. Basic wages for professional nursing, home health, and inpatient rehabilitation facilities may fall by 5%. From 2022, there may not be any changes in the salaries of doctors, outpatient surgery centers, and shelters.
Post-acute care providers and stakeholders who may face a wage freeze said they are disappointed with MedPAC’s draft proposal. MedPAC’s own committee members agreed with most of the suggestions made by the staff. However, some members expressed concern about keeping doctors’ salaries flat in 2023. It is recommended that a formal vote be held at the meeting next month.
MedPAC staff recommends updating the hospital payment based on the amount determined by the current law, which is expected to be 2% by 2023.
MedPAC assesses the adequacy of payment by examining factors such as access to care, access to capital, and medical insurance payments. To guide their draft recommendations for 2023, the staff used 2020 data, which was marked by the COVID-19 public health emergency. However, MedPAC believes that most of the impact of PHE on the health system will be temporary and therefore should not be resolved by updating the fee schedule.
Although the commissioners largely supported the draft proposal, the commissioner, Brian DeBusk, CEO of medical device manufacturer DeRoyal Industries, encouraged MedPAC to watch Healthcare labor market close. In the future, hospitals may continue to pay more for nursing staff, which may affect the hospital salary index. He added that the medical device market should also be considered.
“Let’s make sure that these effects are included in the 2023 ratio. Because I do believe that if these effects are not included in 2022, next year will be catastrophic for hospitals,” Debsk said.
In contrast, Actuarial Commissioner Bruce Pyenson pointed out that during the COVID-19 pandemic, many health insurance beneficiaries died prematurely, which may lead to reduced demand for health insurance hospital services in the next few years. He said committee members should take this into consideration when planning to increase hospital payments.
For doctors, MedPAC’s draft proposal does not involve payment updates in 2023, except for performance-based adjustments or additional payments that providers can obtain from alternative payment models. The committee members are divided on whether they are willing to support this proposal.
The Medical Insurance Access and Chip Reauthorization Act of 2015 (MACRA) It is stipulated that the salary of doctors will be increased by 0% through the fee schedule, but the salary increase will be provided through the premium payment plan. This is effective in a low-inflation environment, but it may result in a severe underpayment of providers in 2023, said Lynn Barr, commissioner who leads Caravan Health, the company uses value-based care guidance providers.
Several committee members stated that they plan to vote for these recommendations next month, but hope to have a deeper understanding of the beneficiaries’ access to primary health care and its relationship to race and socio-demographic conditions.
The American Medical Association disagrees with MedPAC and believes that doctors need to reform wholesale payments.
AMA Chairman Dr. Gerald Harmon (Gerald Harmon) said in an e-mail statement: “The AMA seconds the concerns raised by several committee members that zero-percentage updates are unsustainable and can exacerbate health inequalities. Risks, and urge MedPAC to highlight these concerns in its report to Congress.”
MedPAC’s draft recommendations for outpatient surgery centers will eliminate the salary increase they receive in 2022.
Although the committee members generally support the update, DeBusk said he would like to see ASC’s salary increase to help encourage the industry’s growth. But Michael Chernew, chairman of MedPAC, countered that increasing the basic ASC payment would not necessarily lead to more ASC and plan savings. He said that instead, MedPAC could explore alternative payment models beyond the updated fee schedule.
MedPAC also drafted a proposal for HHS to require ASC to report cost data. This proposal has been Proposed every year It has been more than ten years, but it has never been implemented. The committee members once again support this idea.
“If ASC doesn’t show us their cost reports, it’s really difficult for us to show them positive updates,” said Harvard Medical School Commissioner David Grabowski.
On the other hand, according to MedPAC’s draft recommendations, the post-acute care environment may cut interest rates.
The basic salary of medical insurance in nursing homes may drop by 5%. MedPAC recommends that there is no change in the payment of nursing homes in 2022, but the profit rate of medical insurance has remained above 10% for 20 years. The staff said that these high profits indicate that the cuts are necessary.
The American Healthcare Association/National Assisted Living Center stated in an email that MedPAC’s recommendations for nursing homes could be devastating to facilities and should not take resources away from frontline combatants.
If MedPAC’s draft recommendations are adopted, the salaries of inpatient rehabilitation facilities may also be reduced by 5%. The provider supports this, but stated that the committee should discuss the differences between hospital-based and independent IRF more in the future.
The American Association of Medical Rehabilitation Providers is also disappointed with the proposal, especially considering the staffing challenges and increased resource costs currently facing the IRF.
MedPAC also recommends that hospice care rates remain unchanged in 2023 and remain at the level of 2022. MedPAC’s draft recommendations for outpatient dialysis clinics and long-term care hospitals will update the payments of these departments in accordance with current laws, which is equivalent to increasing both.
MedPAC is also considering suggesting that HHS add a statement modifier for doctors to indicate whether services are provided through audio-only telemedicine, and require hospice and family health agencies to report telemedicine visits. The committee members broadly supported these ideas.
The committee believes that any proposed changes will not affect access to care.