Public Health & & Policy > Medicare– Comparing MA strategies with fee-for-service quality called “a hornet's nest”
by Cheryl Clark, Contributing Writer, MedPage Today March 11, 2024
The techniques utilized to compare quality in between one Medicare Advantage (MA) strategy and another are so seriously problematic that the system requires an overhaul, members of the Medicare Payment Advisory Commission (MedPAC) recommended recently.
A commission evaluation has actually identified the program “is pricey and not a great basis for evaluating quality,” MedPAC primary policy expert Ledia Tabor, MPH, informed the commission throughout a discussion Thursday. It does not promote using high-value care, nor supply recipients with significant info about regional strategy quality, she stated.
It's likewise essential due to the fact that presently, the quality program– based upon a first-class rankings system– pays higher-rated MA strategies bonus offers of some $15 billion a year from the Medicare trust funds. Almost every strategy gets a high rating. According to the Centers for Medicare & & Medicaid Services (CMS), the typical rating for 2024 strategies is 4.04 stars, and just a couple of lots MA strategies got less than 3 stars. Since this year, 52% of recipients are now registered in MA strategies.
The commissioners' conversation about how to alter the system followed Tabor discussed a huge part of the issue. Medicare utilizes more than 100 metrics in those star scores for each strategy under agreement. Those procedures are assessed at the agreement level– nationally– even when an agreement covers as numerous as 2.6 million enrollees across the country.
The commission has consistently, in 2010, 2018, and 2020, advised that strategies be examined at regional market-area levels because there is a lot local variation, with various suppliers and various strategy networks.
What a recipient would like to know “is the MA rating for my physician. I do not truly appreciate the aggregate strategy number. I need to know my medical professional, my health center, how does MA carry out in my neighborhood?” stated commissioner Lynn Barr, MPH.
Commissioner Brian Miller, MD, MBA, kept in mind that “we most likely should not have a ‘Lake Wobegon impact' where the typical MA strategy is 4.5 stars in numerous counties.” He included that there likewise must be a method to rate quality of look after fee-for-service (FFS) recipients to compare them with MA strategies. Miller stated he is considering methods to save the score system, although he quipped that it “still might require to head out back and satisfy its last death.”
The commissioners made their remarks after Tabor's discussion of an alternative method of determining MA quality of care: risk-adjusted rates of ambulatory care-sensitive (ACS) hospitalizations within each strategy's market locations. These are hospitalizations for conditions that preventive techniques– such as prompt sees to a medical care supplier or expert, or particular screenings– may have prevented.
The MedPAC analysis, based upon 2021 MA encounter MedPAR (Medicare Provider Analysis and Review) information, revealed large variation in ratings,
