The Medicare Improvements for Patients and Providers Act of 2008

1. The Medicare Improvements for Patients and Providers Act of 2008 A Roadmap for Delivery System Reform

2. History • Prelude: MMSEA, 6-month doc fix, and plan for 2008 • Cancellation of Feb. mark-up and expanded bipartisan process • Separate paths – S. 3101 and S. 3118 • House takes up Senate bill – H.R. 6331 • Veto override and enactment

3. Key Points of Departure • Scope of “beneficiary provisions” • Mental health parity • Prevention • MSP asset tests • LIS barriers to enrollment • Offsets • Medicare Advantage Private Fee-for-Service

4. Value-Enhancing Provisions • Contract with consensus entity to set priorities and endorse valid measures • Extension and expansion of PQRI • Bonuses increased and authorized through 2010 • NQF endorsement required with limited exceptions • Adoption of MMSEA improvements: condition-specific measure groups and registry-based reporting • Group-level reporting for large practices • Posting on website of successful participants • Confidential feedback on MD resource use • Plan for transition to value-based purchasing of MD services due in early 2010*

5. Value-Enhancing Provisions (cont’d) • E-prescribing incentives with mandate • Access/Support for primary care • Increase work RVUs • Funding and pilot authority for medical home • Imaging • Accreditation requirement for advanced modalities • Test use of appropriateness criteria • Value-based purchasing of dialysis services • Report on health care disparities

6. What’s Next? • Additional steps toward delivery system reform likely next year and beyond • Consensus to focus on cost and quality • Value-based purchasing • Primary care • Health IT • “Systemness” • Episode-based payments • Etc. billy_wynne@finance-dem.senate.gov