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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
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
Revising payment methods and monitoring quality of care in traditional Medicare (J) The Congress should combine prospective payment system operating and capital payment rates to create a single prospective rate for hospital inpatient care. This change would require a single set of payment adjustments- in particular, for indirect medical education and disproportionate share hospital payments- and a single payment update.	Delivery system reforms Hospital	March 2000
Revising payment methods and monitoring quality of care in traditional Medicare (K) The Commission recommends continuing the existing policy of adjusting per case payments through an expanded transfer policy when a short length of stay results from a portion of the patient’s care being provided in another setting.	Hospital Post-acute care	March 2000
Revising payment methods and monitoring quality of care in traditional Medicare (L) To address longstanding problems and current legal and regulatory developments, Congress should reform the disproportionate share adjustment to: include the costs of all poor patients in calculating low-income shares used to distribute disproportionate share payments, and use the same formula to distribute payments to all hospitals covered by prospective payment.	Hospital	March 2000
Revising payment methods and monitoring quality of care in traditional Medicare (M) To provide further protection for the primarily voluntary hospitals with mid-level low-income shares, the minimum value, or threshold, for the low-income share that a hospital must have before payment is made should be set to make 60 percent of hospitals eligible to receive disproportionate share payments.	Hospital	March 2000
Changing Medicare’s Payment Systems for Ambulatory Care Facilities (F) In implementing a prospective payment system for the hospital outpatientsetting, the Secretary should: Not use patient diagnosis to calculate relative weights or make payments, but rather should base payment for these services on the medical visit indicator coded using the Health Care Financing Administration Common Procedure Coding System.	Hospital	March 1999
Changing Medicare’s Payment Systems for Ambulatory Care Facilities (G) In implementing a prospective payment system for the hospital outpatient setting, the Secretary should: Closely monitor hospital outpatient service use to ensure that beneficiary access to appropriate care is not compromised.	Hospital	March 1999
Changing Medicare’s Payment Systems for Ambulatory Care Facilities (H) In implementing a prospective payment system for the hospital outpatient setting, the Secretary should: Re-evaluate the decision not to make additional payment adjustments under the new system, and should tie any proposed adjustments to patient characteristics. Any such facility-level adjustments that are proposed until such time as a patient level adjuster is available should reflect… Read more »	Hospital	March 1999
Changing Medicare’s Payment Systems for Ambulatory Care Facilities (I) In implementing a prospective payment system for the hospital outpatient setting, the Secretary should: Seek, and the Congress should pass, legislation to increase the rate of the beneficiary co-insurance buy-down. The cost of the faster buy-down should be financed by increases in program spending, rather than through additional reductions in payments to hospitals.	Hospital	March 1999
Providers Exempt from the Acute Care Prospective Payment System (A) To update and improve payments to providers exempt from the acute care prospective payment system, the Secretary should increase the market basket amount in the target amount update formula by 0.4 percentage points for fiscal year 2000.	Hospital	March 1999