Like Al Pacino, MedPAC has been causing the birth of new ideas since the 1980s. MedPAC is an independent agency with the unenviable task of advising Congress about Medicare payment policy. These are not your average ideas — the June 15, 2023 report is packed into 503 pages, with 1,062 mentions of data. In fact, MedPAC is thinking about starting over on the use of “encounter data” — the documents submitted by doctors and hospitals showing the diagnoses of patients and what services they received. Encounter data is supposed to show the health condition of a Medicare-enrolled patient so a health plan will know how much it may have to pay for drugs and services, so the government knows how much to reimburse the health plan. Turns out, getting encounter data to be an accurate predictor of health care risk is not easy. So MedPAC is trying to start over, suggesting that MA payments could be based on a different set of data (see Chapter 4). Other experts are suggesting that health plans should just improve the accuracy and completeness of encounter data. This week, non-profit health plans suggested that CMS could use the encounter data it collects to fix the broken risk adjustment model to pay health plans more accurately. As we begin again to figure out how to glean what we need from existing health data, we are keeping a Dr. Oppenheimer quote in mind: “The optimist thinks this is the best of all possible worlds. The pessimist fears it is true.”
June 16, 2023 | 3 min read
June 16, 2023
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