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Advising the Congress on Medicare issues
MedPAC > Recommendations

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

Physician and other health professional services

For calendar year 2019, the Congress should increase the calendar year 2018 payment rates for physician and other health professional services by the amount specified in current law.

  • Physicians and other health professionals

March 2018

Physician and other health professional services

The Congress should increase payment rates for physician and other health professional services by the amount specified in current law for calendar year 2018.

  • Physicians and other health professionals

March 2017

Physician and other health professional services

The Congress should increase payment rates for physician and other health professional services by the amount specified in current law for calendar year 2017.

  • Physicians and other health professionals

March 2016

Physician and other health professional services

The Congress should establish a prospective per beneficiary payment to replace the Primary Care Incentive Payment program (PCIP) after it expires at the end of 2015. The per beneficiary payment should equal the average per beneficiary payment under the PCIP and should be exempt from beneficiary cost sharing. Funding for the per beneficiary payment should… Read more »

  • Delivery system reforms
  • Physicians and other health professionals

March 2015

Mandated report: Geographic adjustment of payments for the work of physicians and other health professionals

Medicare payments for work under the fee schedule for physicians and other health professionals should be geographically adjusted. The adjustment should reflect geographic differences across labor markets for physicians and other health professionals. The Congress should allow the geographic practice cost index (GPCI) floor to expire per current law and, because of uncertainty in the… Read more »

  • Physicians and other health professionals
  • Regional issues

June 2013

Mandated report: Improving Medicare’s payment system for outpatient therapy services (2)

To avoid caps without exceptions, the Congress should: reduce the therapy cap for physical therapy and speech-language pathology services combined and the separate cap for occupational therapy to $1,270 in 2013. These caps should be updated each year by the Medicare Economic Index. direct the Secretary to implement a manual review process for requests to… Read more »

  • Ambulatory care settings
  • Beneficiaries and coverage
  • Physicians and other health professionals

June 2013

Hospital inpatient and outpatient services (2)

The Congress should direct the Secretary of Health and Human Services to reduce payment rates for evaluation and management office visits provided in hospital outpatient departments so that total payment rates for these visits are the same whether the service is provided in an outpatient department or a physician office. These changes should be phased… Read more »

  • Delivery system reforms
  • Physicians and other health professionals

March 2012

Moving forward from the sustainable growth rate (SGR) system (1)

The Congress should repeal the sustainable growth rate (SGR) system and replace it with a 10-year path of statutory fee-schedule updates. This path is comprised of a freeze in current payment levels for primary care and, for all other services, annual payment reductions of 5.9 percent for three years, followed by a freeze. The Commission… Read more »

  • Delivery system reforms
  • Physicians and other health professionals

October 2011

Moving forward from the sustainable growth rate (SGR) system (2)

The Congress should direct the Secretary to regularly collect data—including servicevolume and work time—to establish more accurate work and practice expense values. Tohelp assess whether Medicare’s fees are adequate for efficient care delivery, the datashould be collected from a cohort of efficient practices rather than a sample of all practices.The initial round of data collection… Read more »

  • Delivery system reforms
  • Physicians and other health professionals

October 2011

Moving forward from the sustainable growth rate (SGR) system (3)

The Congress should direct the Secretary to identify overpriced fee-schedule services andreduce their relative value units (RVUs) accordingly. To fulfill this requirement, theSecretary could use the data collected under the process in recommendation 2. Thesereductions should be budget neutral within the fee schedule. Starting in 2015, the Congressshould specify that the RVU reductions achieve an… Read more »

  • Delivery system reforms
  • Physicians and other health professionals

October 2011