September 5, 2024

09/05/2024 . 12:00 pm - 1:15 pm

Context for Medicare payment policy

Staff Contacts:

ISSUE: Each year in our March report to the Congress, we describe Medicare’s overall financial situation.

KEY POINTS: The “Context” chapter outlines the factors contributing to Medicare’s spending growth and other issues and is meant to serve as a backdrop for commissioners’ discussions and recommendations over the coming year.

ACTION: Commissioners will review and discuss the material.

09/05/2024 . 2:15 pm - 3:40 pm

Cost sharing for outpatient services at critical access hospitals

Staff Contacts:

ISSUES: To address small communities’ challenges with access to care, the Congress enacted the critical access hospital (CAH) program in 1997. The program provides cost-based Medicare payments to certain rural hospitals with 25 or fewer beds. The cost-based rates are far higher than traditional hospital payment rates and help CAHs remain financially viable. However, the Commission and others have shown that much of the higher payments to CAHs are funded through higher beneficiary cost-sharing liabilities.

KEY POINTS: For most fee-for-service Medicare outpatient services, CAH cost sharing is set at 20 percent of charges, instead of 20 percent of the allowed payment amount as in many other Medicare payment systems. As a result, beneficiaries who use CAHs typically face greater cost-sharing obligations than beneficiaries who use other outpatient settings. Because charges vary widely across different services and providers, the cost-sharing obligations of these beneficiaries also vary widely.

ACTION: Commissioners will review and discuss the material.

09/05/2024 . 3:45 pm - 5:15 pm

Medicare’s measurement of rural provider quality

Staff Contacts:

ISSUES: It is important for the Medicare program to measure the quality of care provided to beneficiaries by rural providers.

KEY POINTS: Rural communities across the U.S. are diverse. Some experience relatively higher levels of poverty and lower life expectancies, and others experience lower poverty and longer life expectancies than urban areas. Common challenges to measurement of rural provider quality are low population density and travel times for medical care.

ACTION: Commissioners will review and discuss the material.