Proposed Medicare commission could disregard funding realities

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I don’t know about you, Readers, but this push for an Independent Medicare Advisory Council (IMAC) makes me nervous.

If approved by Congress, this new body could make it more difficult for nursing homes to receive much-needed annual Medicare cost-of-living increases. That doesn’t strike me as a move in the right direction.

Basically, IMAC, which President Obama has largely endorsed, would replace the Medicare Payment Advisory Commission (MedPAC). The proposed five-member board would be authorized to regulate market-basket increases for nursing homes and other healthcare facilities.

That marks a sharp departure from the 17-member MedPAC, which has devolved into a toothless organization. Each year, it politely offers spending recommendations, and each year, Congress politely disregards its suggestions. That actually has been good for nursing homes because MedPAC has repeatedly recommended 0% market-basket increases for nursing homes.

Now imagine if those recommendations were the final word. That could happen under IMAC. The nursing home industry has lobbied aggressively year after year against MedPAC recommendations and has been successful in convincing Congress not to enact MedPAC’s suggestions. That would not be the case with IMAC, which would operate like the Federal Reserve—outside the influence of special interests.

Besides a say on the market-basket, IMAC could also offer broader recommendations to improve the quality or reduce the cost of medical care.

One silver lining in the proposal is that the president and Congress would have a check on IMAC’s suggestions. The president would have 30 days to approve or reject recommendations. Then the package would go to  Congress, which would have 30 days to take action to overrule the president’s decision.

But the whole idea still makes me uneasy. Thankfully, there is a chorus of opposition from healthcare groups along with some key federal lawmakers. It’s obvious why.

There is something unsettling about a somewhat insulated group of medical professionals making decisions about critical funding that affects the care to millions of vulnerable and sick people. As we know, nursing homes rely on Medicare to counter-balance insufficient Medicaid payments. Would this commission take this reality into account? MedPAC clearly hasn’t.

While the government might intend for IMAC to operate like the Fed, the two cannot really be compared. Manipulating Medicare funding is not the same as adjusting interest rates. It’s not immediately obvious when there is more or less money circulating throughout the U.S. economy. But it’s pretty easy to tell when a nursing home is short on staffing because it can’t afford to pay for needed help.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.