March 6-7, 2025

03/06/2025 . 10:00 am - 11:30 am

Reforming physician fee schedule updates and improving the accuracy of relative payment rates

Staff Contacts:

ISSUE: For many years, the Commission has found that payments under fee-for-service Medicare’s physician fee schedule (PFS) have been adequate to ensure that beneficiaries’ access to clinician care is as good as, or better than, that of privately insured individuals. However, commissioners have voiced concerns about whether current-law updates to Medicare’s PFS will continue to be adequate, given inflation trends.

KEY POINTS: Coupling an increase in the annual update to the PFS with improvements to the accuracy of relative payment rates would help address the effects of misvalued services and help ensure that taxpayer and beneficiary funds are used judiciously.

ACTION: Commissioners will discuss the material and the Chair’s draft recommendations.

03/06/2025 . 11:40 am - 12:25 pm

Reducing beneficiary cost-sharing for outpatient services at critical access hospitals

Staff Contacts:

ISSUE: Most rural communities in the U.S. have low population density and experience longer travel times for services, both of which can pose challenges for delivery of and access to medical care. To help address these challenges, the Congress enacted the critical access hospital (CAH) program in 1997. The program provides cost-based Medicare payments to hospitals with 25 or fewer beds that are primarily in rural areas. The cost-based outpatient rates are far higher than payment rates to hospitals under the outpatient prospective payment system and help CAHs remain financially viable. However, beneficiary cost-sharing liability for most fee-for-service Medicare outpatient CAH services is higher than at other hospitals, because it is set at 20 percent of charges, rather than 20 percent of the Medicare payment amount.

KEY POINTS: MedPAC analysis has shown that outpatient cost-sharing obligations at CAHs averaged about half of total Medicare payments for those services in 2022 and varied widely due to differences in markups across CAHs and across services within CAHs.

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

03/06/2025 . 1:30 pm - 2:45 pm

Background: Medicare insurance agents

Staff Contacts:

ISSUE: Increasingly, beneficiaries have reported working with insurance agents (also referred to as brokers) to select their Medicare coverage.

KEY POINTS: Agents can play an important role in advising beneficiaries; but some stakeholders have voiced concern that, because agents receive compensation from insurers, they may have incentives to steer beneficiaries into particular plans.

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

03/06/2025 . 2:55 pm - 4:10 pm

Preliminary work on Medigap

Staff Contacts:

ISSUE: Beneficiaries selecting fee-for-service Medicare can obtain supplemental (Medigap) insurance to protect themselves against certain cost sharing and coinsurance.

KEY POINTS: Commissioners have requested background information on Medigap enrollment, federal and state requirements for Medigap policies, premiums, and loss ratios.

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

03/06/2025 . 4:15 pm - 5:15 pm

Mandated report: Payment for ground ambulance services

Staff Contacts:

ISSUE: The Bipartisan Budget Act (BBA) of 2018 required CMS to implement a ground ambulance data collection effort. In response, CMS has developed the Ground Ambulance Data Collection System (GADCS), which includes data collected from ground ambulance organizations, including information on the organizations’ characteristics, service areas, total time for ambulance responses, number of responses and transports (volume), service mix (emergency, non-emergency, basic life support, advanced life support), labor costs, facility costs, vehicle costs, equipment and supply costs, and revenues.

KEY POINTS: The BBA of 2018 requires MedPAC to analyze the GADCS data and submit a report on the adequacy of Medicare payments for ground ambulance services and geographic variations in the cost of furnishing those services. The report is due June 15, 2026.

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

03/07/2025 . 9:00 am - 10:10 am

Examining home health care use among Medicare Advantage enrollees

Staff Contacts:

ISSUE: Commissioners have expressed interest in understanding home health care use among Medicare Advantage (MA) enrollees, who now account for half of Medicare beneficiaries. Multiple studies have used Medicare’s home health Outcomes and Assessment Information Set (OASIS) data to examine home health use among MA enrollees, but it is difficult to draw conclusions from these studies because OASIS data contain no information on the number, length, or type of home health visits that beneficiaries receive.

KEY POINTS: The Commission has embarked on an analysis of home health care use among MA enrollees using OASIS data combined with MA encounter data, incorporating a large set of beneficiary characteristics and MA plan attributes.

ACTION: Commissioners will review and discuss the findings.

03/07/2025 . 10:15 am - 11:45 am

Institutional special needs plans

Staff Contacts:

ISSUE: In 2022, about 1.2 million beneficiaries lived in nursing homes, which provide services such as 24-hour medical and skilled nursing care, rehabilitation services, meals, and assistance with activities of daily living. As a group, the long-stay NH population has significant care needs and high medical costs, and there have been long-standing concerns about the quality of care they receive in NHs.

KEY POINTS: Institutional special needs plans (I–SNPs) are specialized Medicare Advantage plans for beneficiaries who live in nursing homes (NHs). These plans aim to improve quality and manage costs by providing more care in the NH setting and modifying how NHs are reimbursed.

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