The Medicare Payment Advisory Commission is holding off on recommending how Congress or the CMS should address a perceived disadvantage some Medicare Advantage plans say they face with the agency's star rating system.
The decision came after panel members heard two presentations on the issue, one last month and one on Friday. Ultimately, panel members want to see what action the CMS takes, said MedPAC's Chairman Dr. Francis Crosson, following deliberations.
The MedPAC panel tuned into the matter following industry complaints.
“A concern has been raised by plans that primarily serve low-income populations, like those with special needs, or dual-eligibles, that they don't receive the same level of star ratings that other plans do, making them ineligible for bonuses,” said Carlos Zarabozo, a MedPAC staff member.
Since 2012, Medicare Advantage plans have been eligible for quality bonus payments. Plans are evaluated using a five-star rating system, and those that receive a star rating of four stars or higher receive a bonus payment.
Plans with low-income, high-needs patients say they handle more complex and costly needs, and therefore, need the bump.
During deliberations, one suggested strategy to avoid ratings inequality was to not compare such plans with those serving a more general population.
“One [idea] that I think does give necessary resources and instigates quality improvement … would be to allow like plans to compare with each other, as opposed to being blended in the broader stars pool,” said Dr. Craig Samitt, a MedPAC commissioner and global provider practice leader at consulting firm Oliver Wyman.
Some seemed to like the idea, but most felt it was better to wait for the CMS' action. Others worried that creating a separate stars system would open flood gates.
For instance, MedPAC Commissioner and former Congressman Bill Gradison asked what would happen if data were released that Medicare Advantage plans with beneficiaries who were predominantly age 85 or older had substantially different health outcomes than those plans that had members who were mostly under age 75? Would they get to have their own tier too?
Earlier this year, the CMS said it was considering reducing by 50% the weight of seven targeted measures for 2016 to help even out the playing field for plans with a high number of dual-eligible or low-income individuals, but after receiving negative comments, it didn't finalize that measure.
The agency did, however, say it will continue to look for ways to address the issue.
In the meantime, the CMS has made clear it will not stop terminating Advantage contracts for plans with high-needs populations if they continue to get low star ratings. The CMS has the statutory authority to boot a Medicare Advantage plan if it has fewer than three stars for three straight years.
“At this time, the CMS has not determined that contracts with significant dual-eligible enrollment face unique obstacles in achieving three-star ratings,” the agency said in its 2016 final rate notice for Medicare Advantage plans. “Plans subject to termination show a sustained below-average overall rating for at least three years, and there is no evidence to show that a low-rated plan cannot improve its performance to at least an average (i.e., three-star) level.”
