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.
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Structuring informed beneficiary choice (F)The Secretary should monitor the prevalence of aggressive marketing techniques or abuses, especially toward vulnerable populations, such as frail beneficiaries and those without functional literacy. |
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Changing Medicare’s Payment Systems for Ambulatory Care Facilities (A)In establishing ambulatory care prospective payment systems in general, the Secretary should: Define the unit of payment for ambulatory care facilities as the individual service, consisting of the primary service that is the reason for the encounter, the ancillary services and supplies integral to it, and limited follow-up care, but not the physicians’ services. The… Read more » |
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Changing Medicare’s Payment Systems for Ambulatory Care Facilities (B)In establishing ambulatory care prospective payment systems in general, the Secretary should: Use costs of individual services, not groups of services, to calculate the relative weights that apply to ambulatory care prospective payment systems. Relative weights should be calculated consistently across all ambulatory settings. |
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Changing Medicare’s Payment Systems for Ambulatory Care Facilities (C)In establishing ambulatory care prospective payment systems in general, the Secretary should: Evaluate payment amounts under both the hospital outpatient prospective payment system and the ambulatory surgical center prospective payment system together with practice expense payments for services provided in physicians’ offices under the revised Medicare Fee Schedule to ensure that unwarranted financial incentives that… Read more » |
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Changing Medicare’s Payment Systems for Ambulatory Care Facilities (D)In establishing ambulatory care prospective payment systems in general, the Secretary should: Study means of adjusting base prospective payment rates for patient characteristics such as age, frailty, comorbidities and coexisting conditions, and other measurable traits. |
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Changing Medicare’s Payment Systems for Ambulatory Care Facilities (E)In establishing ambulatory care prospective payment systems in general, the Secretary should: Seek legislation to develop and implement a single update mechanism that would link conversion factor updates to volume growth across all ambulatory care services. |
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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. |
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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. |
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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 » |
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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. |
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