Medicare Panel Considers One-Time Covid Pay Hikes for Providers


September 2, 2021 11:43 am

The Medicare Payment Advisory Commission could recommend that Congress provide immediate one-time or temporary payment rate increases to providers that suffered financially during the pandemic.

In the panel’s first meeting of its 2021-2022 cycle on Thursday, commission member Paul Ginsburg called for the recommendation and said it should be made along with the commission’s annual recommendations about Medicare payment updates.

“I think we’ll need to do both,” Ginsburg said, “because the pandemic’s effects have really been profound.” He said if the commission makes such a recommendation, it should be “implemented as soon as Congress can work them through.”

“I think we can accomplish more of value to the Congress by talking about what types of one-time adjustments appear to be justified by the data,” Ginsburg added. Commission members Amol Navathe and Stacie Dusetzina supported Ginsburg’s proposal.

The commission advises Congress on issues dealing with cost and quality in the Medicare program. Their recommendations are nonbinding, but Congress relies heavily on the panel’s expertise when making funding decisions.

Any commission recommendation for one-time payment hikes would follow billions of dollars in pandemic financial relief that physicians and clinicians have already received through the federal Provider Relief Fund, advance payment of Medicare billings, and the Paycheck Protection Program.

Covid Challenges

Ginsburg and commission Chairman Michael Chernew said any additional payment increases that Congress might approve would not be factored into data used to set subsequent provider payment rates.

Ginsburg made the proposal after commission staff discussed the difficulty the panel will face in making their annual payment update for 2023 based on program data from 2020—when Covid-19 drastically affected the type and amount of care sought by Medicare beneficiaries.

In 2020, Covid-19 impacted beneficiary mortality rates, caused a decline in volume of care sought by beneficiaries, created an increase in sicker, more acute patients, and created rising costs for providers, the staff said.

Commission Deputy Director James Mathews said there’s precedent for Congress to approve such a recommendation. In order to offset changes to billing codes, Mathews said Congress previously authorized a “separate bucket of dollars” that were allocated to physicians over three years that did not get figured into the determination of subsequent rate updates.

“This would definitely be atypical for us, no doubt about it,” Mathews said. “But we will keep it in mind as we start digging deeper into the data that we use for our assessment of payment adequacy.”

“There’s nothing we’re going to do that’s not going to be atypical,” Chernew said of the new cycle.