Commission Recommendations

Revising payment methods and monitoring quality of care in traditional Medicare (C)

The Congress should require that HCFA establish a prospective payment system for home health goods and services that blends fixed episode payments and per-visit payments.

• Delivery system reforms
• Post-acute care

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (D)

The Secretary should use routinely collected data to refine the case-mix weights over time.

• Post-acute care

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (E)

The Secretary should use a home health agency wage index to adjust the prospective payment system rates for local wages.

• Post-acute care

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (F)

The Secretary should establish systems for routinely assessing the quality of post-acute care and should use the information these systems generate to: evaluate the effects of new payment systems on quality of care, focus quality assurance activities, facilitate continuous quality improvement, and promote informed patient decision making.

• Post-acute care
• Quality

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (G)

The Secretary should coordinate systems for monitoring post-acute care quality across all service settings to: assess important aspects of the care uniquely provided in a particular setting, compare certain processes and outcomes of care provided in alternative settings, and evaluate the quality of care furnished in multiple-provider episodes of post-acute care.

• Post-acute care
• Quality

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (H)

The Secretary should sponsor the development of post-acute care quality measures needed to monitor outcomes- such as beneficiary health and functional status- and the appropriate use of services.

• Post-acute care
• Quality

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (I)

The Secretary should review all post-acute care data collection requirements. Each item should have an explicit rationale, and only information needed for accurate billing, risk adjustment, or quality measurement should be required.

• Post-acute care
• Quality

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (J)

The Congress should combine prospective payment system operating and capital payment rates to create a single prospective rate for hospital inpatient care. This change would require a single set of payment adjustments- in particular, for indirect medical education and disproportionate share hospital payments- and a single payment update.

• Delivery system reforms
• Hospital

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (K)

The Commission recommends continuing the existing policy of adjusting per case payments through an expanded transfer policy when a short length of stay results from a portion of the patient’s care being provided in another setting.

• Hospital
• Post-acute care

March 2000

Revising payment methods and monitoring quality of care in traditional Medicare (L)

To address longstanding problems and current legal and regulatory developments, Congress should reform the disproportionate share adjustment to: include the costs of all poor patients in calculating low-income shares used to distribute disproportionate share payments, and use the same formula to distribute payments to all hospitals covered by prospective payment.

• Hospital

March 2000