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 |
|---|---|---|
Skilled nursing facility servicesThe Congress should eliminate the market basket updates for 2018 and 2019 and direct the Secretary to revise the prospective payment system (PPS) for skilled nursing facilities. In 2020, the Secretary should report to the Congress on the impacts of the reformed PPS and make any additional adjustments to payments needed to more closely align… Read more » |
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March 2017 |
Skilled nursing facility servicesThe Congress should eliminate the market basket update for skilled nursing facilities for fiscal years 2017 and 2018 and direct the Secretary to revise the prospective payment system (PPS) for skilled nursing facilities. In 2019, the Secretary should report to the Congress on the effects of the reformed PPS and make any additional adjustments to… Read more » |
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March 2016 |
Medicare’s post-acute care: Trends and ways to rationalize paymentsThe Congress should direct the Secretary of Health and Human Services to eliminate the differences in payment rates between inpatient rehabilitation facilities (IRFs) and skilled nursing facilities for selected conditions. The reductions to IRF payments should be phased in over three years. IRFs should receive relief from regulations specifying the intensity and mix of services… Read more » |
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March 2015 |
Physician and other health professional servicesThe Congress should establish a prospective per beneficiary payment to replace the Primary Care Incentive Payment program (PCIP) after it expires at the end of 2015. The per beneficiary payment should equal the average per beneficiary payment under the PCIP and should be exempt from beneficiary cost sharing. Funding for the per beneficiary payment should… Read more » |
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March 2015 |
Reforming Medicare’s benefit designThe Congress should direct the Secretary to develop and implement a fee-for-service benefit design that would replace the current design and would include: an out-of-pocket maximum; deductible(s) for Part A and Part B services; replacing coinsurance with copayments that may vary by type of service and provider; secretarial authority to alter or eliminate cost sharing… Read more » |
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June 2012 |
Hospital inpatient and outpatient services (2)The Congress should direct the Secretary of Health and Human Services to reduce payment rates for evaluation and management office visits provided in hospital outpatient departments so that total payment rates for these visits are the same whether the service is provided in an outpatient department or a physician office. These changes should be phased… Read more » |
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March 2012 |
Hospital inpatient and outpatient services (3)The Secretary of Health and Human Services should conduct a study by January 2015 to examine whether access to ambulatory physician and other health professionals’ services for low-income patients would be impaired by setting outpatient evaluation and management payment rates equal to those paid in physician offices. If access will be impaired, the Secretary should… Read more » |
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March 2012 |
Moving forward from the sustainable growth rate (SGR) system (1)The Congress should repeal the sustainable growth rate (SGR) system and replace it with a 10-year path of statutory fee-schedule updates. This path is comprised of a freeze in current payment levels for primary care and, for all other services, annual payment reductions of 5.9 percent for three years, followed by a freeze. The Commission… Read more » |
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October 2011 |
Moving forward from the sustainable growth rate (SGR) system (2)The Congress should direct the Secretary to regularly collect data—including servicevolume and work time—to establish more accurate work and practice expense values. Tohelp assess whether Medicare’s fees are adequate for efficient care delivery, the datashould be collected from a cohort of efficient practices rather than a sample of all practices.The initial round of data collection… Read more » |
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October 2011 |
Moving forward from the sustainable growth rate (SGR) system (3)The Congress should direct the Secretary to identify overpriced fee-schedule services andreduce their relative value units (RVUs) accordingly. To fulfill this requirement, theSecretary could use the data collected under the process in recommendation 2. Thesereductions should be budget neutral within the fee schedule. Starting in 2015, the Congressshould specify that the RVU reductions achieve an… Read more » |
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October 2011 |