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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
Reforming Medicare’s hospice benefit (1) The Congress should direct the Secretary to change the Medicare payment system for hospice to: * Have relatively higher payments per day at the beginning of the episode and relatively lower payments per day as the length of the episode increases, * Include a relatively higher payment for the costs associated with patient death at… Read more »	Post-acute care	February 2009
Reforming Medicare’s hospice benefit (2A) The Congress should direct the Secretary to: * Require that a hospice physician or advanced practice nurse visit the patient to determine continued eligibility prior to the 180th-day recertification and each subsequent recertification and attest that such visits took place, * Require that certifications and recertifications include a brief narrative describing the clinical basis for… Read more »	Beneficiaries and coverage Post-acute care	February 2009
Reforming Medicare’s hospice benefit (2B) The Secretary should direct the Office of Inspector General to investigate: * The prevalence of financial relationships between hospices and long-term care facilities such as nursing facilities and assisted living facilities that may represent a conflict of interest and influence admissions to hospice, * Differences in patterns of nursing home referrals to hospice, * The… Read more »	Post-acute care	February 2009
Reforming Medicare’s hospice benefit (3) The Secretary should collect additional data on hospice care and improve the quality of all data collected to facilitate the management of the hospice benefit. Additional data could be collected from claims as a condition of payment and from hospice cost reports.	Post-acute care	February 2009
Skilled nursing facility services The Congress should eliminate the update to payment rates for skilled nursing facility services for fiscal year 2010.	Post-acute care	February 2009
A path to bundled payment around a hospitalization (A) The Congress should require the Secretary to confidentially report readmission rates and resource use around hospitalization episodes to hospitals and physicians. Beginning in the third year, providers’ relative resource use should be publicly disclosed.	Hospital Physicians and other health professionals	June 2008
A path to bundled payment around a hospitalization (B) To encourage providers to collaborate and better coordinate care, the Congress should direct the Secretary to reduce payments to hospitals with relatively high readmission rates for select conditions and also allow shared accountability between physicians and hospitals. The Congress should also direct the Secretary to report within two years on the feasibility of broader approaches,… Read more »	Delivery system reforms Hospital Physicians and other health professionals Quality	June 2008
A path to bundled payment around a hospitalization (C) The Congress should require the Secretary to create a voluntary pilot program to test the feasibility of actual bundled payment for services around hospitalization episodes for select conditions. The pilot must have clear and explicit thresholds for determining whether it can be expanded into the full Medicare program or should be discontinued.	Delivery system reforms Hospital	June 2008
A revised prospective payment system for skilled nursing facilities (A) The Congress should require the Secretary to revise the skilled nursing facility prospective payment system by: * Adding a separate nontherapy ancillary component, * Replacing the therapy component with one that establishes payments based on predicted patient care needs, and * Adopting an outlier policy	Delivery system reforms Post-acute care	June 2008
A revised prospective payment system for skilled nursing facilities (B) The Secretary should direct skilled nursing facilities to report more accurate diagnostic and service-use information by requiring that: * Claims include detailed diagnosis information and dates of service, * Services furnished since admission to the skilled nursing facility be recorded separately in the patient assessment, and * Skilled nursing facilities report their nursing costs in… Read more »	Post-acute care	June 2008