MedPAC recommends primary care, encounter data policy fixes

primary care
MedPAC has issued its regular June report to Congress recommending several policy changes that could make it easier for Medicare patients to seek primary care. (Getty/Milkos)

The Medicare Payment Advisory Commission (MedPAC) is urging Congress to adopt reforms to improve the quality of Medicare Advantage (MA) encounter data and boost beneficiaries’ access to primary care.

MedPAC issued its regular June report (PDF) to Congress late last week, and in it the group recommends several policy changes that could make it easier for Medicare patients to seek primary care. For one, it suggests that advanced practice registered nurses (APRNs) and physician assistants (PAs) be required to bill Medicare directly.

Doing so would eliminate the “incident to” billing codes, where a PA or APRN bills Medicare under the name of a supervising physician.

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Having these advanced practice providers bill under their own IDs would allow the Centers for Medicare & Medicaid Services (CMS) to more effectively track when they’re providing care, especially as they increase in number.

RELATED: Medicare Part D wasn’t built for costly specialty drugs. MedPAC wants to change that 

“Given the growing roles of NPs and PAs and their shift away from primary care, Medicare’s 'incident to' rules and lack of specialty data create several problems, including obscuring important information on the clinicians who treat beneficiaries and inhibiting Medicare’s ability to identify and support clinicians furnishing primary care,” MedPAC wrote.

In addition, current categories for specialty care don’t effectively capture services provided by PAs or APRNs, according to MedPAC. So Congress should also consider having the Department of Health and Human Services (HHS) reconfigure those categories to ensure that they can differentiate between types of providers.

The report notes that part of why APRNs and PAs are becoming so prominent in primary care is that there is a dearth of physicians entering that field. To ease the burden on these clinicians, MedPAC recommends Congress consider a Medicare-specific physician scholarship to encourage more doctors to become geriatricians.

This could be funded in several ways, including the savings from adopting MedPAC’s suggested overhaul to the Merit-based Incentive Payment System.

RELATED: Issues with encounter data hinder Medicare Advantage oversight, OIG says 

The report also includes recommendations aimed at boosting the quality of encounter data, or data on patient conditions that are supplied by hospitals and other providers. MedPAC suggests that legislators direct HHS to create thresholds for the completeness of encounter data. 

“Complete and accurate encounter data would be valuable to the Medicare program for a multitude of reasons,” MedPAC wrote. “However, encounter data currently lack completeness across providers and MA contracts, and the current system of feedback and incentives for improved encounter data submissions has shortcomings.” 

CMS is looking to grow its use of encounter data in MA risk adjustment, and is planning for encounter data to encompass half of what’s used for such calculations in plan year 2020. Insurers expressed concern as encounter data—which are supplied by hospitals and other providers—are often inaccurate or incomplete. 

In addition to suggesting the thresholds, MedPAC recommends that CMS withhold funds from MA plans to incentivize them to meet those benchmarks and issue refunds when they do. 

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