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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

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.

  • Ambulatory care settings

March 1999

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.

  • Ambulatory care settings

March 1999

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

Changing Medicare’s Payment Systems for Ambulatory Care Facilities (J)

In changing the prospective payment system for ambulatory surgical centers, the Secretary should: Carefully monitor changes in service provision between the ambulatory surgical center and physician office setting that may occur after HCFA’s loosening of numerical guidelines for determining ambulatory surgical center list eligibility.

  • Ambulatory care settings

March 1999

Continuing Reform of Medicare Payments to Physicians (A)

To refine practice expense relative value units for the Medicare Fee Schedule, the Secretary of Health and Human Services should: Determine whether a clinical consensus exists about the appropriate settings in which services should be provided. For services that should not be provided in physicians’ offices, the Secretary should set both the office and facility… Read more »

  • Physicians and other health professionals

March 1999

Continuing Reform of Medicare Payments to Physicians (B)

To refine practice expense relative value units for the Medicare Fee Schedule, the Secretary of Health and Human Services should: Use a service-by-service approach to decide which services are subject to a site-of-service differential.

  • Physicians and other health professionals

March 1999

Continuing Reform of Medicare Payments to Physicians (C)

To refine practice expense relative value units for the Medicare Fee Schedule, the Secretary of Health and Human Services should: Include in the refinement process participants with expertise in payment methods, survey research, and accounting: representatives from the physician community; and payers other than Medicare.

  • Physicians and other health professionals

March 1999