MedPAC Recommendations

1. MedPAC - Medical Payment Advisory Commission, bipartisan appointed by Congress

MedPAC, Report to Congress: Promoting Greater Efficiency in Medicare. June 2007

• 17.6% of Medicare hospital patients readmitted within 30 days in 2005 (p.107)
• 13.3% of Medicare hospital patients had "potentially preventable" (according to 3M software) readmissions within 30 days in 2005, costing $12 billion (p.107)
• So "76 percent of 30-day readmissions were flagged as potentially preventable." (p.108)
• The 3M software was not named, and is described as, "Researchers with 3M have also developed algorithms for a wide range of conditions that identify related readmissions within 7 days to 30 days of the initial admission. Florida is proposing to use this product for reporting purposes." (p.108)

• They only give four examples of preventable readmissions (p.109) so it is not possible to judge the general reliability of the software or what it would have taken to prevent all the readmissions:

1. diabetes after heart attack
2. angina after angioplasty (PTCA)
3. appendectomy after abdominal pain
4. angioplasty after arterial bypass graft (CABG)

• They note two other approaches which they did not use, (p.108)

1. "UnitedHealthcare counts all readmissions to the same major diagnostic category or for infections in disclosing readmission rates for hospitals in California.
2. "Physicians with the Geisinger Health System in Pennsylvania agreed not to be paid for certain readmissions within 90 days of nonemergency coronary artery bypass graft surgery. These types of readmissions include
   

1. acute myocardial infarction;
2. atrial fibrillation;
3. venous thrombosis;
4. infections due to an internal prosthetic device, implant, or graft; and
5. postoperative infections."

MedPAC, Report to the Congress: Reforming the Delivery System. June 2008

• "Congress should direct the Secretary to reduce payments to hospitals with relatively high readmission rates for select conditions" (p.8) unanimous vote by commission 16-0

MedPAC, Report to Congress, Medicare Payment Policy. March 2012

• "Congress should direct the Secretary to reduce payments to skilled nursing facilities with relatively high risk-adjusted rates of rehospitalization" (p.199).
  
• This will lessen their current "incentive to rehospitalize high-cost patients as a way to shift costs they would otherwise incur onto hospitals" (p.194).
• Rehospitalizations occur for many reasons (Mor et al. 2010). Some of these factors are within a SNF’s control; others are not. Influences at least partly within a facility’s control include:...
  • hospice use and the presence of advance directives (Grabowski et al. 2008, Mor and Grabowski 2008)." (pp.194-195)
  

MedPAC, Report to Congress, Medicare Payment Policy. March 2013

• "We have recommended readmission policies for hospitals (now in place) and SNFs [skilled nursing facilities], and we are working on similar policies for home health care and IRFs [inpatient rehabilitation facilities)" (p.153)

MedPAC, Medicare ACO Update, April 2013, Glass & Stensland

MedPAC, Report to Congress, Medicare & the Healthcare Delivery System. June 2013

MedPAC, Data Book. June 2013


MedPAC Report to Congress, Medicare Payment Policy, March 2014

• "About 46.7 percent of Medicare beneficiaries who died in 2012 used hospice, up from 45.2 percent in 2011 and 22.9 percent in 2000" (p.300)
  

2. See also Medicare Recommendations