January 11-12, 2024

01/11/2024 . 10:30 am - 11:10 am

Assessing payment adequacy and updating payments: Physician and other health professional services

Staff Contacts:

ISSUE: By law, each year the Commission reviews Medicare’s fee-for-service payment policies and makes payment update recommendations. For our March 2024 Report to the Congress, we consider whether payments to physicians and other health professionals are adequate and how they should be updated in 2025.

KEY POINTS: We assess beneficiaries’ access to clinician care, quality of care, and the relationship between Medicare’s payments and clinicians’ costs.

ACTION: Commissioners will review the findings and vote on the draft recommendation.

01/11/2024 . 11:15 am - 12:00 pm

Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services

Staff Contacts:

ISSUE: By law, each year the Commission reviews Medicare’s fee-for-service payment policies and makes payment update recommendations. For our March 2024 Report to the Congress, we consider whether Medicare inpatient and outpatient payments to general acute care hospitals are adequate and how they should be updated in 2025.

KEY POINTS: We examine beneficiaries’ access to hospital care, quality of care, hospitals’ access to capital, and the relationship between Medicare’s payments and hospitals’ costs.

ACTION: Commissioners will review the findings and vote on the draft recommendation

01/11/2024 . 1:15 pm - 1:40 pm

Assessing payment adequacy and updating payments: Outpatient dialysis services; hospice services; skilled nursing facility services; and home health agency services

Staff Contacts:

ISSUE: By law, each year the Commission reviews Medicare’s fee-for-service payment policies and makes recommendations. For our March 2024 Report to the Congress, we consider whether Medicare payments for outpatient dialysis services, hospice services, skilled nursing facilities, and home health agency services are adequate and how they should be updated in 2025.

KEY POINTS:   We examine beneficiaries’ access to care, quality of care, providers’ access to capital, and the relationship between Medicare’s payments and providers’ costs.

ACTION: Commissioners will review the findings and vote on the draft recommendations.

01/11/2024 . 1:45 pm - 2:45 pm

Assessing payment adequacy and updating payments: Inpatient rehabilitation facility services; and improving the accuracy of payments in the IRF prospective payment system

Staff Contacts:

ISSUE:   By law, each year the Commission reviews Medicare’s FFS payment policies and makes payment update recommendations. We consider whether payments to inpatient rehabilitation facilities (IRFs) are adequate and how they should be updated in 2025. The Commission has also been concerned about the accuracy of Medicare’s payments for IRF services.

KEY POINTS:  We examine beneficiaries’ access to IRF care, quality of care, IRFs’ access to capital, and the relationship between Medicare’s payments and IRFs’ costs. We also report findings from our ongoing analysis of differences in profitability across IRF case-mix groups.

ACTION:  Commissioners will review the payment adequacy findings and vote on the draft recommendation. Commissioners will also discuss recent findings that the current hospital-specific relative value method for setting payment weights has contributed to differences in profitability across case types.

01/11/2024 . 2:50 pm - 4:20 pm

Medicare Part D: Status report

Staff Contacts:

ISSUE:  Each year, MedPAC presents the annual status report of the Part D program.

KEY POINTS:  Staff will present the most recent available information on Part D enrollment, plan offerings, premiums, utilization, and other aspects of the program.

ACTION:  Commissioners will discuss the scope and substance of the material.

01/11/2024 . 4:25 pm - 5:25 pm

Ambulatory surgical centers: Status report

Staff Contacts:

ISSUE: Performing selected outpatient surgeries in ambulatory surgical centers (ASCs) instead of more costly hospital outpatient departments (HOPD) can be advantageous for beneficiaries, surgeons, and the Medicare program. Assessment of payment adequacy in this sector has been hampered by a lack of cost data for ASCs and concerns about available quality data.

KEY POINTS: Staff will provide a status report on ASC supply, volume of services provided to FFS beneficiaries, and Medicare spending.

ACTION: Commissioners will review and discuss the information.

01/12/2024 . 9:00 am - 10:55 am

The Medicare Advantage program: Status report

Staff Contacts:

ISSUE:  We present our annual update on the status of the Medicare Advantage (MA) program.

KEY POINTS:  We present the most recent information on MA enrollment and beneficiary access to plans, plan quality, plan rebates, market consolidation, plan coding practices, and Medicare payments to plans.

ACTION:  Commissioners will review and discuss the findings.

01/12/2024 . 11:00 am - 12:30 pm

Standardized benefits in Medicare Advantage plans: Policy options

Staff Contacts:

ISSUE:  MA plans differ in many respects, such as their cost sharing for Part A and Part B services, coverage of supplemental benefits, provider networks, use of prior authorization, and drug formularies. This complexity, combined with continued growth in the number of plans, makes it difficult for beneficiaries to compare plans and select the one that best meets their needs.

KEY POINTS:  The Commission has been exploring the possibility of standardizing two aspects of plans’ benefit designs—cost sharing for Part A and Part B services and coverage of supplemental dental, vision, and hearing benefits—to make it easier to compare plans.

ACTION:  Commissioners will discuss the material and provide guidance on future work.