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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) Publication

Revising payment methods and monitoring quality of care in traditional Medicare (G)

The Secretary should coordinate systems for monitoring post-acute care quality across all service settings to: assess important aspects of the care uniquely provided in a particular setting, compare certain processes and outcomes of care provided in alternative settings, and evaluate the quality of care furnished in multiple-provider episodes of post-acute care.

  • Post-acute care
  • Quality

March 2000 - Chapter 3

Revising payment methods and monitoring quality of care in traditional Medicare (H)

The Secretary should sponsor the development of post-acute care quality measures needed to monitor outcomes- such as beneficiary health and functional status- and the appropriate use of services.

  • Post-acute care
  • Quality

March 2000 - Chapter 3

Revising payment methods and monitoring quality of care in traditional Medicare (I)

The Secretary should review all post-acute care data collection requirements. Each item should have an explicit rationale, and only information needed for accurate billing, risk adjustment, or quality measurement should be required.

  • Post-acute care
  • Quality

March 2000 - Chapter 3

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 - Chapter 3

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 - Chapter 3

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 - Chapter 3

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 - Chapter 3

Revising payment methods and monitoring quality of care in traditional Medicare (N)

HCFA should continue to work with the medical community in developing guidelines for evaluation and management services, minimizing their complexity, and exploring alternative approaches to promote accurate coding of these services.

  • Physicians and other health professionals

March 2000 - Chapter 3

Revising payment methods and monitoring quality of care in traditional Medicare (O)

HCFA should pilot-test documentation guidelines for evaluation and management services before their implementation, and/or pilot test any alternative method. The agency should continue to work with the medical community in developing the pilot tests, and should ensure adequate time for physician education.

  • Physicians and other health professionals

March 2000 - Chapter 3

Revising payment methods and monitoring quality of care in traditional Medicare (P)

HCFA should disclose coding edits to physicians and should seek review of the appropriateness of those edits by the medical community.

  • Physicians and other health professionals

March 2000 - Chapter 3