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Commission Recommendations

MedPAC makes recommendations to the Congress and to the Secretary of Health and Human Services on issues affecting the administration of the Medicare program. With its recommendations, the Commission strives to improve the delivery of care, while ensuring financial stability and maximizing value for the program. After extensive analysis and evaluation, our recommendations are discussed and voted on by Commissioners in our public meetings. Recommendations are typically published in two main reports, released in March and June of each year.

Recommendations	Topic(s)	Date
Assessing the design and impact of the hospital outpatient prospective payment system (A) The Secretary should monitor changes in practice patterns across ambulatory care settings to ensure that differences in payment do not lead to inappropriate shifts in site of care.	Ambulatory care settings Delivery system reforms Hospital	June 2000
Assessing the design and impact of the hospital outpatient prospective payment system (B) The Secretary should study the accuracy of and changes in coding practices with the implementation of the outpatient prospective payment system.	Hospital	June 2000
Assessing the design and impact of the hospital outpatient prospective payment system (C) The Congress should enact legislation to accelerate the rate of beneficiary coinsurance buy down under the outpatient prospective payment system and establish a date certain for achieving a coinsurance rate of 20 percent. This date should result in a time frame for implementation consistent with other Medicare payment policy changes.	Beneficiaries and coverage Hospital	June 2000
Assessing the design and impact of the hospital outpatient prospective payment system (D) The Secretary should carefully monitor implementation of the outpatient prospective payment system to ensure that: * It does not have unintended, adverse consequences on beneficiaries’ access to care, * It does not compromise the quality of care delivered, and * The annual reductions in beneficiary coinsurance as a share of total payment are realized.	Beneficiaries and coverage Hospital	June 2000
Financial performance and payment update for hospitals covered by prospective payment For fiscal year 2001, the Congress should increase the operating and capital payment rates for prospective payment system inpatient services by the rate of increase in the combined market basket plus 0.6 to 1.1 percentage points. If the current operating and capital market basket estimates hold, that level would results in an update between 3.5… Read more »	Hospital	June 2000
Improving Medicare’s payments for inpatient care and for teaching hospitals (A) The Secretary should improve the hospital inpatient prospective payment system by adopting, as soon as practicable, diagnosis related group (DRG) refinements that more fully capture differences in severity of illness among patients. At the same time, she should make the per discharge payment rates more accurate by basing the DRG relative weights on the national… Read more »	Hospital	June 2000
Improving Medicare’s payments for inpatient care and for teaching hospitals (B) The Congress should amend the law to change the method now used to finance outlier payments under the hospital inpatient prospective payment system. Projected outlier payments in each DRG should be financed through an offsetting adjustment to the relative weight for the category, rather than the current flat adjustment to the national average base payment… Read more »	Hospital	June 2000
Improving Medicare’s payments for inpatient care and for teaching hospitals (C) To avoid imposing extraordinary financial burdens on individual providers, the Congress should ensure that the case-mix measurement and outlier financing policies recommended earlier are implemented gradually over a period of several years. Further, the Congress should consider including protective policies, such as exemptions or hold-harmless provisions, for providers in circumstances in which vulnerable populations’ access… Read more »	Hospital	June 2000
Improving Medicare’s payments for inpatient care and for teaching hospitals (D) The Congress should give the Secretary explicit authority to adjust the hospital inpatient base payment amounts if anticipated coding improvements in response to refinements in case-mix measurement are expected to increase aggregate payments by a substantial amount during the forthcoming year. This adjustment should be separate from the annual update. Further, the Congress should require… Read more »	Hospital	June 2000
Improving Medicare’s payments for inpatient care and for teaching hospitals (E) The Congress should fold inpatient direct graduate medical education costs into prospective payment system payment rates through a revised teaching hospital adjustment. The new adjustment should be set such that the subsidy provided to teaching hospitals continues as under current long-run policy. This recommendation also should be implemented with a reasonable transition to limit the… Read more »	Hospital	June 2000