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Advising the Congress on Medicare issues
MedPAC > Meetings > October 5, 2023

October 5, 2023


MedPAC’s October 2023 public meeting was held virtually via video conference on the GoToWebinar platform.


10/05/2023 . 11:00 am - 1:00 pm

Considering current law updates to Medicare’s payment rates for clinician services

Staff Contacts:

ISSUE: Some stakeholders have raised concerns about the adequacy of future scheduled updates to clinician payments under Medicare’s physician fee schedule (PFS).

KEY POINTS: In recent years the Commission has largely determined that Medicare’s payment rates under the PFS are adequate to ensure that Medicare beneficiaries have access to clinician services. But during a period of higher cost growth, concerns have arisen that continuing to apply the updates specified in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 could negatively affect beneficiaries’ access to care in the future.

ACTION: Commissioners will consider whether there is a need for reforms to the method used to annually update payment rates under the PFS.

10/05/2023 . 2:00 pm - 3:25 pm

Examining staffing ratios and turnover rates in nursing facilities

Staff Contacts:

ISSUE: The effects of the coronavirus pandemic on nursing facility residents and staff have renewed and intensified long-standing concerns about the adequacy of nursing home staffing.

KEY POINTS: Staffing in nursing facilities, particularly registered nurse staffing and staffing stability, have been found to be associated with quality and patient safety measures. Federal staffing standards for nursing facilities, which care for both short-stay patients and residents of the nursing home, include minimum nursing coverage requirements but to date have not specified a minimum number of nurses per resident. Most states have more prescriptive minimum staffing requirements, but the specifics of these requirements vary widely.

ACTION: Commissioners will review and provide feedback on data describing nursing facility staffing variation.

10/05/2023 . 3:30 pm - 4:40 pm

An alternative method to establish Medicare payments for select conditions treated in inpatient rehabilitation facilities

Staff Contacts:

ISSUE: Given the overlap in the types of patients treated in different post-acute care settings, opportunities may exist for better aligning payments across settings.

KEY POINTS: The Commission maintains that Medicare should base payment rates on the resources needed to treat patients in the lowest-cost appropriate setting. This principle suggests that—for services that are safe and appropriate to provide in a lower-cost setting—Medicare should more closely align payment rates for inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs).

ACTION: Commissioners will begin to consider alternative methods to establish payments for select conditions treated in IRFs.

10/05/2023 . 4:45 pm - 5:45 pm

Workplan: Prices of generic drugs under Part D

Staff Contacts:

ISSUE: During this analytic cycle, the Commission will explore several aspects of generic drug prices in Medicare Part D.

KEY POINTS: Generic drugs account for most of the prescription medicines taken in Part D but make up a relatively small share of spending. Generic drugs often cost a fraction of the prices for their brand counterparts, and their prices tend to decline over time. However, studies have found that prices for generic drugs vary widely, depending in part on where they are purchased. Prices can also vary depending on the dosage form, strength, and route of administration. Further, studies have found that, for some generic drugs, prices paid by Part D plans are higher than the price an individual would pay if paying with cash rather than using their insurance.

ACTION: Commissioners will review the work planned on the prices of generic drugs under Part D.