MedPAC Cites Concerns with GME Structure, Urges Focus on Out-of-Hospital Settings

Janice Simmons, for HealthLeaders Media , June 16, 2010

Overall, less than half of advanced imaging, ultrasound, and clinical lab tests were performed on the same day as an office visit, with about half of standard imaging studies performed on the same day as an office visit. Outpatient therapy services were not generally associated with a related office visit at all.

Pulling up short of making recommendations, MedPAC instead suggested that several options should be examined for these services:

  • Exclude therapeutic services such as physical therapy and radiation therapy from the IOAS exception.
  • Limit the in-office exception to physician practices that are clinically integrated.
  • Exclude from the exception diagnostic tests that are not usually provided during an office visit.
  • Reduce payment rates for diagnostic tests performed under the exception.

MedPAC also suggested that legislation be considered to give Medicare more flexibility with "innovative purchasing policies" to improve the delivery of healthcare services. Medicare currently has legislative limits that prohibit it from adopting such policies quickly, Miller said.

As one example, MedPAC found Medicare's ability to use policies such as reference pricing—in which a new item or service is paid at the same payment rate as clinically comparable items of services—has been limited due to lack of clear legal authority.

Also, in Medicare, no basic authority exists that says 'you can pay differentially on the basis of performance," Miller said. "Again, there are exceptions ... but there is not a broad authority that says Medicare's payment should vary on the basis of quality, outcomes."

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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