At its October meeting, the Medicare Payment Advisory Commission (MedPAC) shared findings from its annual beneficiary and provider focus groups and examined trends associated with Medicare beneficiaries residing in nursing homes. MedPAC will include both topics in its spring 2025 reports to Congress.
The Commission conducted the beneficiary and provider focus group analysis to better understand those groups’ experiences with Medicare. MedPAC found that when selecting coverage, beneficiaries prioritized maintaining access to the same health care providers and considered prescription drug costs. Those who selected fee-for-service (FFS) Medicare attributed their decision to a broader network of clinicians, while those choosing Medicare Advantage (MA) prioritized lower premiums and lower prescription and out-of-pocket costs. Most Medicare beneficiaries reported timely access to primary care but longer wait times for specialty care.
The provider focus group reported the availability of more timely appointments for patients willing to see a nurse practitioner or physician assistant. Clinicians noted challenges such as an increasing share of MA enrollees and the plans’ burdensome prior authorization processes. Providers also expressed general concerns about MA plans’ aggressive coding practices designed to generate higher reimbursements for the plans without direct improvement in patient care. Many physicians reported being approached by a health system or private equity firm to acquire their practices, and those who declined these offers cited concerns about reduced decision-making authority and worsening patient care. Clinicians participating in accountable care organizations reported few benefits for their patients and minimal financial rewards for themselves.
The Commission also discussed challenges and opportunities to improve nursing home care for Medicare beneficiaries, acknowledging the population’s complex care needs, high medical costs, and quality-of-care concerns. Most nursing homes are freestanding for-profit entities in urban areas. MedPAC reported that Medicare Part A and Part B spending for long-stay nursing home residents is approximately twice that of other beneficiaries, citing higher medical risk scores. With Medicaid as the predominant payer for nursing home care, the Commission noted that a challenge to improving Medicare beneficiaries’ nursing home care is that Medicaid payments often do not cover the cost of care. The increased popularity of Institutional Special Needs Plans was noted, and MedPAC contemplated opportunities to improve care via managed care-based approaches. MedPAC also considered enhancing value-based purchasing arrangements, star ratings, and facility inspections.