Medicare Payment Advisory Commission

But HHS being, you know, we are at the end of the day, healthcare providers, that's an important one for us.

CMS, CISIO, our team tracks MedPAC and MACPAC as well, just in case, you know, we want to see down the field a little bit and know what's coming.

And I think it's helpful to watch it all.

So, you know, that's one of the benefits that you have by partnering with a firm like us.

Ahead of the final 2027 Medicare Physician Fee Schedule, guest interviewer Cameron Sabat, a medical student at Georgetown University, sat down separately with the four health policy experts that you just heard.

Dr. Michael Chernew of Harvard Medical School, a former chair of the Medicare Payment Advisory Commission or MedPAC, Dr. Jonathan Ketcham of Arizona State University, Dr. Miranda Yaver of the University of Pittsburgh, and Dr. David Meltzer of the University of Chicago.

Medical Economics Senior Editor Richard Payerton connects those interviews to cover whether the 2027 drop in the conversion factor is really a cut, what a proposed pay cut for visits on the same day as a procedure would mean for older patients, and which payment model, if any, gets it right.

And if you're listening on the morning that this episode comes out, Thursday, October 29th, there's still time to join us this afternoon for Physicians Practice Practice Academy series.

The 2027 Medicare Physician Fee Schedule is highly anticipated and will be influential across U.S. healthcare.

It most likely won't settle the debate about how physicians should be paid and how much.

Michael Chernew is Harvard Professor of Healthcare Policy and former chair of MEDPAC, the Medicare Payment Advisory Commission.

You know, you've spent decades studying how we pay for healthcare.

Yep.

All right, so in D.C., there's an entity called MedPAC.

It's called the Medicare Advisory—never mind, doesn't matter.

Medicare Payment Advisory Commission.

Some letters.

and they've been doing a lot of work around 340B for, gosh, over a decade.

So Alicia, what has MedPAC's position been on 340B and how is it different from what CMS is proposing right now?

Yeah, so in 2016, MedPAC released an initial report to Congress where they recommended that Part B drugs be cut by 10% of ASP.

And, you know, it's a bit easier than provider risk because manufacturers, you know, they know their own data, so they should be able to kind of, to help support their claims.

Well, I don't think we can really have a full discussion without mentioning our friends over at MedPAC and what you think about that.

And I know MedPAC is near and dear to my heart personally.

Every time, you know, physician reimbursement time rolls around, We're talking September and we're writing those rules and we talk about what we learned at MedPAC and, you know, maybe certain policies should be implemented, some should not.

And I know you've got thoughts about these guys.

What role do you think MedPAC should play in shaping the next phase of Medicare payment policy?

So when I think about MedPAC, you know, obviously they're going to have an important influence on Medicare, right? They're going to advise Congress on Medicare payments and we're going to figure out, you know, if Medicare is paying providers enough and that's very valuable.

But I think what MedPAC also ends up doing is having quite an outsized influence on just the payers in the U.S. more broadly because Medicare is our most powerful payer, right? Covers so many patients.

It's like trying to, it's like the moment you have these programs, these government programs set up, whether it be 340B program, whether it be, you know, site neutral payments, or sorry, site selective payments, whether it be Medicare Advantage and the payments for... how sick you are, which is gamed to the tune of an extra $76 billion a year.

That's MedPAC's estimate.

It seems like everyone knows what's happening, but you can't actually do anything about it.

And in large part, that's because of the vested interests that are benefiting from it.

Here's the part I find most striking.

MedPAC, the independent commission that advises Congress on Medicare, has estimated that Medicare spends roughly $84 billion a year more on Medicare Advantage enrollees than it would if those same people were in original Medicare.

The insurance industry disputes that number.

But if it's even close, think about what it means.