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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
Updating payment rates in traditional Medicare The Congress should not establish a single overall expenditure target that determines payment updates for physicians’ services and ambulatory care facilities. Within existing statutory authority, the Secretary should not establish setting-specific expenditure targets.	Ambulatory care settings Physicians and other health professionals	March 2000
Improving the quality of care for beneficiaries with end-stage renal disease (A) The Secretary should determine clinical criteria for dialysis patients to receive increased frequency or duration of dialysis. The Secretary should then examine the feasibility of a multitiered composite rate that would allow different payments based on the frequency and duration of dialysis prescribed, as well as other factors related to adequacy of dialysis.	Ambulatory care settings Beneficiaries and coverage	June 1999
Improving the quality of care for beneficiaries with end-stage renal disease (B) MedPAC reiterates the recommendation made in its March 1998 and March 1999 reports calling for an increase in the composite rate.	Ambulatory care settings	June 1999
Improving the quality of care for beneficiaries with end-stage renal disease (C) The Secretary should determine clinical criteria for ESRD patients to be eligible for oral, enteral, or parenteral nutritional supplements. Coverage for these supplements should then be provided to eligible ESRD patients as a renal benefit apart from the composite rate.	Ambulatory care settings Beneficiaries and coverage	June 1999
Improving the quality of care for beneficiaries with end-stage renal disease (D) In fulfilling the requirements of the BBA regarding improving the quality of dialysis care, the Secretary should take into consideration the quality assessment and assurance efforts of renal organizations.	Ambulatory care settings Quality	June 1999
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 »	Ambulatory care settings	March 1999
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.	Ambulatory care settings	March 1999
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 »	Ambulatory care settings	March 1999
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