MedPAC to CMS: Options to factor socioeconomics in star ratings not good enough
CMS has offered two interim approaches to address differences in plan performance due to the low-income or disability status of enrollees.
The Medicare Payment Advisory Commission and other organizations representing Medicare Advantage plans that serve low income and disabled populations say two options for interim relief on star quality ratings do not go far enough to address how socioeconomics affect scores.
The Centers for Medicare and Medicaid Services requested comments by December 10 ahead of potential changes to the Medicare Advantage star rating system to be released in February. CMS offered two interim approaches to address differences in plan performance due to the low-income or disability status of enrollees.
MedPAC prefers a Categorial Adjustment Index option, as opposed to an indirect standardization approach, MedPAC Chairman Francis J. Crosson said in a Dec. 2 letter to Acting CMS Administrator Andy Slavitt.
[Also: GAO: Quality incentives, penalties not improving US hospitals]
The Categorial Adjustment Index would be similar to a case-mix index, MedPAC said. It would use methodology to adjust Medicare Advantage patient experience measures based on a contract's distribution of enrollment by age, education, income status and other factors.
Indirect standardization computes an average measure of the subpopulation and plans are rated based on the relationship between the observed and expected results for the enrolled population, according to MedPAC.
MedPAC said that if two different methods for population-based differences are used in indirect standardization -- both a sampling of enrollees and the entire pool-- undo weight could be given to contracts that report based on all enrollees, Crosson said.
"In summary, given the agency's desire to implement an appropriate interim measure as it develops a more analytically rigorous long-term solution, we believe that of the two approaches discussed in the memorandum, the Categorical Index Adjustment is administratively less complicated but still addresses the concerns plans have raised," Crosson said.
[Also: MedPAC suggests converting rural hospitals to outpatient, emergency facilities]
Other trade groups voiced doubts about how effective either option would be in granting meaningful relief, according to Medicare Advantage News.
The Association for Community Affiliated Plans said more information from CMS was needed before it could make a determination of how well the two approaches adjust for socioeconomic status.
America's Health Insurance Plans also said it needed more detailed analysis of the potential impact of each approach, according to Medicare Advantage News.
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Regardless of which option CMS chooses, affected plans may not be able to preview their star ratings for the next year until significantly later in the year than they do now, the published report said.
If CMS adopts the Indirect Standardization option, it needs to be based on the current year's data, adding more uncertainties to the process for insurers, it said.
The reservations expressed in the comment letters could lead CMS not to adopt either option, Medicare Advantage News said. Last year, after receiving critical comments, CMS dropped a proposal to reduce the weighting of certain star measures for plans serving populations with low socioeconomic status.
Twitter: @SusanJMorse
