Friday, April 21, 2017

Brief Blog: CMS MACs by Jurisdiction and by Contractor

CMS provides a website with detailed information on its Medicare Administrative Contractors (MACs) for traditional fee for service Parts A and B.   The website is here.

I recently needed to consolidate the information for a project, and provide the Excel spreadsheet in the cloud, here.  Dates and figures are current as of April 2017.

A snapshot summary is below - click to enlarge.   There are four numbered MACs (the old system), and eight lettered MACs, so there are twelve contracts.  However, four MACs (Novitas, NGS, Noridian, WPS) hold two contracts, so there are only eight MAC companies.

While I do not understand the full corporate structures, I believe that two pairs of MACs have some type of higher level joint ownership or umbrella corporation (Palmetto, CGS; and Novitas, FCSO).*  This would leave six MACs or sets of MACs that are unrelated.

Together, four multi-jurisdiction MACs, Novitas (24%), NGS (20%), Noridian (15%) and WPS (11%) have about 65% of Medicare beneficiaries.  A CMS MAC Map is here.

LCD Legislation Re-Introduced in New Congress

In both 2016 and 2017, legislation supported by AdvaMed has been introduced which would improve the clarity and independence of MAC LCD policymaking.  For the text of 2017's S.794 bill, see here.  For a 2017 press release, here.  For 2016 trade press, here.  For more detail, my blog here.

MolDX States & MACs

MolDX is a multi-MAC policy system for genomic test LCDs and pricing.   There are six MolDX jurisdictions (JE, JF, J5, J8, JM, J15) under four different MACs (Noridian, WPS, Palmetto, CGS.)   Therefore, MolDX spans 24 states and 41% of US claims (16.4M of 37M Medicare beneficiaries).  (Click to enlarge).


*  E.g. Celerian Group "is a consortium of companies" including MAC CGS and MAC Palmetto GBA, here.  Similarly, in a 2012 press release, "Diversified Service Options, a wholly owned subsidiary of Florida BCBS, acquired MAC [Novitas Solutions] from its parent company..." - here.


For economics nerds, the MACs have a Herfindahl or oligopoly index of 0.15.  The Herfindahl  index varies from 0 to 1, with 1 representing monopoly.  It is mostly driven by at least one company having a very large share (e.g. 1 company has 70% or 80%).  (Calculated by summing the squares of each participant's market share.)    Wikipedia.