Executive Summary
As part of its mandate from the Congress, each June the Commission reports on refinements to Medicare payment systems and issues affecting the Medicare program, including broader changes in health care delivery and the market for health care services. In the 10 chapters of this report, we consider:
- Rebalancing Medicare Advantage benchmark policy. The Commission evaluates the way benchmarks are set for Medicare Advantage (MA) plans and recommends a number of changes to MA benchmark policy. Our recommended approach would reduce MA benchmarks to capture some of the efficiencies generated by MA with relatively few disruptions to supplemental benefits.
- Streamlining CMS’s portfolio of alternative payment models. The Commission examines the performance of alternative payment models (APMs) over the last decade and recommends that Medicare move toward implementing a smaller, more harmonized portfolio of APMs.
- Private equity and Medicare. In response to a congressional request, the Commission identifies gaps in Medicare’s ability to collect information about private equity investments in health care and examines how such investments have affected Medicare
beneficiaries, providers, and MA plans. - The skilled nursing facility value-based purchasing program. As directed by the Protecting Access to Medicare Act of 2014, the Secretary of Health and Human Services began to implement a value-based purchasing program for skilled nursing facilities in October 2018. In this congressionally mandated report, the Commission finds that the current program is flawed and recommends that it be replaced with a value incentive program that follows the Commission’s principles for performance programs.
- Medicare beneficiaries’ access to care in rural areas. In this congressionally requested interim report, the Commission examines rural beneficiaries’ access to care, using Medicare claims data, survey data, and interviews with stakeholders. We also examine rural hospital closures, a trend that has become more prominent over the last decade and could affect access to care for beneficiaries living in rural areas.
- Revising Medicare’s indirect medical education payments to better reflect teaching hospitals’ costs. The Commission raises several concerns about Medicare’s current indirect medical education (IME) payment policy and recommends a new approach that would transition to empirically justified levels of IME payments while better aligning IME payments with the contemporary spectrum of settings in which residents train and patients receive hospital care.
- Medicare vaccine coverage and payment. The Commission recommends that the Congress move all preventive vaccine coverage to Part B without beneficiary cost sharing and improve the accuracy of Medicare’s Part B payment for preventive vaccines by modifying the current payment method and collecting data to enable further improvements in the future.
- Improving Medicare’s policies for separately payable drugs in the hospital outpatient prospective payment system. Medicare’s outpatient prospective payment system bundles multiple services into one payment to create incentives for providers to be judicious about the cost inputs of the services they provide. In certain circumstances, some items are not bundled but are paid separately. The Commission recommends several changes to the policies that govern which drugs are paid separately to strike a better balance between promoting access to high-cost innovative treatments and maintaining pressure on providers to be efficient.
- The impact of recent changes to Medicare’s clinical laboratory fee schedule payment rates. Beginning in 2018, Medicare sets clinical laboratory fee schedule (CLFS) payment rates based on the rates private payers pay for laboratory tests. In this mandated report, the Commission reviews the impact of the changes to the CLFS and explores possible modifications to the processes of collecting privatepayer data from laboratories.
- The relationship between clinician services and other Medicare services. In June 2017, the Commission published an initial congressionally mandated report on the relationship between the use of and expenditures for services provided by physicians and other health professionals and total service use and expenditures under Part A, Part B, and Part D of Medicare. In this final report, the Commission examines the relationship between clinician service use and nonclinician service use over the 2013 to 2018 period.