Medicare beneficiaries can receive care in various hospital settings, depending on the severity and type of their illness or injury. Care may be provided during an inpatient hospital stay or through a visit to an outpatient department. Medicare generally pays for inpatient and outpatient care using separate prospective payment systems, in which hospitals receive a fixed payment for much of the care provided to a patient. Some hospitals – notably critical access hospitals – are paid on a cost basis. The Commission analyzes trends in care and spending in hospitals and makes recommendations to the Congress and the Secretary of Health and Human Services.