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The Medicare Payment Advisory Commission yesterday discussed several potential changes to restructure the Part D benefit. These include eliminating the coverage-gap between the deductible and out-of-pocket cap; capping out-of-pocket spending for beneficiaries; and restructuring the catastrophic benefit by increasing plan liability, adding a drug manufacturer discount and decreasing Medicare reinsurance.
 
In a session on assessing the adequacy of payments for physician and other health professional services, staff presented separate updated analyses on the number and growth of primary care physicians and hospitalists, noting that beneficiaries continue to maintain adequate access to care. The analysis of primary care volume included encounters with clinicians and allowed charges as proposed new measures of access and spending, which the commissioners generally supported. Some members suggested that using qualitative research and other types of measurement would help in understanding access. The commission plans to discuss the pipeline for primary care physicians at its November meeting.
 
Among other , the commission discussed but did not reach consensus on the potential value of using avoidable hospitalizations and emergency department visits as population-based outcome measures for Medicare quality incentive programs. The commissioners also continued to discuss how to design a new payment system for post-acute care, with a focus on whether the new approach should require a prior hospital stay for all PAC patients; whether all patients should face a limit on the PAC days covered by Medicare; and possible copayment approaches.