Thomas Hutchinson Quoted in “In Final Notice, MAOs Get Partial Win on Encounter Data; Benchmark Caps Remain”

AIS Health

Thomas E. Hutchinson, a Strategic Advisor for EBG Advisors, Inc., in the firm’s Baltimore office, was quoted in AIS Health, in “In Final Notice, MAOs Get Partial Win on Encounter Data; Benchmark Caps Remain.”

Following is an excerpt:

As expected, the final 2018 payment notice and Call Letter for Medicare Advantage and Part D plans posted April 3 contained no drastic alterations to the MA program and few deviations from policies proposed 60 days earlier in the Advance Notice. But one significant change that gave MA plans a bit of relief was a partial retreat on the percent of encounter data used in risk scores, although industry experts are quick to remind plan sponsors that encounter data aren’t going away and that CMS will continue its efforts to make sure plans are submitting accurate data. Meanwhile, plans were disappointed with CMS’s conclusion that it does not have the authority to eliminate the Affordable Care Act’s ceiling on payment rates (aka benchmark caps) and the apparent return of the ACA-established health insurer fee that was temporarily set aside for 2017. …

CMS in the Advance Notice asked for feedback on the idea of a “uniform industry-wide adjustment” to the EDS data to account for the differences, but it abandoned that idea in the final notice. Tom Hutchinson, a strategic advisor with the EBG Advisors unit of the health care law firm Epstein Becker & Green and a former top CMS official who also spoke at the National Medicare Advantage Summit, said the problem with such an adjuster is that it would have essentially given “everybody a break” when certain plans were struggling with their scores and others had no issues. “So instead of doing an across-the-board adjuster, going back…to 15% in a sense is a plan-specific adjuster. If you’ve been really good at getting your encounter data in, you’re not getting much of a plus on that. If you haven’t done all that good, that’s actually a fairly decent adjuster.”