Medicare Payment Policy

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C H A p t e R11 Long-term care hospital services
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RepoRt to the CongRess Medicare Pay
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RepoRt to tHe CongRess Medicare Pay
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with the structure of the payment s
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table of contents Acknowledgments .
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executive summary
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of services—and pressure on feder
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current Medicare payments are adequ
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outpatient dialysis services Outpat
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some facilities are willing to acce
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coverage for conventional treatment
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of care for these conditions should
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Context for Medicare payment policy
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4 Context for Medicare payment poli
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FIguRe FIGURE 1-2 1-2 12% Out of po
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the level of health care spending a
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1-4 FIguRe 1-4 140 120 100 80 60 Do
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FIguRe 1-6 1-6 Growth rate (in perc
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FIGURE FIguRe Share of GDP (in perc
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Share of GDP (in percent) FIGURE 1-
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FIGURE FIguRe 1-10 1-10 8% African
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FIguRe 1-12 1-11 1800 1600 1400 120
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Americans than for other racial and
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References Agency for Healthcare Re
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Medicare Payment Advisory Commissio
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Assessing payment adequacy and upda
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The goal of Medicare payment policy
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may go up when payment rates go dow
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hospitals and that hospitals shift
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individual payment systems but also
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Hospital inpatient and outpatient s
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Hospital inpatient and outpatient s
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covered the fully allocated costs o
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3-1 3-1 FIguRe 100 80 60 40 Number
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Visits or claims per 1,000 benefici
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3-4 3-4 FIguRe 2012 dollars (in bil
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of physicians employed directly by
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FIguRe FIGURE Annual percent change
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FIGURE FIguRe Margin (in percent) 3
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FIGURE FIguRe Margin (in percent) 3
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tABLe 3-5 performance of efficient
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Act, the EHR Incentive Program also
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as Medicaid expands, the new insura
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ates for separately paid drugs resu
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endnotes 1 From 2002 to 2011, 479 h
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References Agency for Healthcare Re
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C H A p t e R4 physician and other
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physician and other health professi
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from the SGR system in its October
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4-1 4-1 FIguRe 40 35 30 25 20 15 10
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tABLe 4-1 Most aged Medicare benefi
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tABLe 4-2 Medicare beneficiaries ha
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payment adjustments for health prof
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tABLe 4-3 Year physicians primary c
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provider’s characteristics, geogr
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tABLe 4-4 type of service Change in
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tABLe 4-5 type of imaging Change in
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the patient-centered medical home T
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FIguRe FIGURE Cumulative percent ch
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References ABIM Foundation. 2012. C
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Ambulatory surgical center services
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Ambulatory surgical center services
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Background An ambulatory surgical c
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Differences in types of patients tr
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Differences in types of patients tr
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number of services grew from 2006 t
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tABLe 5-7 rapidly than nonowning ph
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Creating a value-based purchasing p
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Revisiting the ambulatory surgical
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endnotes 1 Because CMS updates paym
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Medicare Payment Advisory Commissio
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R e C o M M e n D A t I o n 6 The C
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128 Outpatient dialysis services: A
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tABLe 6-1 Characteristics of FFs di
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Physicians Association has publishe
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tABLe 6-3 Increasing number and cap
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Number of FFS dialysis beneficiarie
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FIguRe 6-3 Percent of dialysis bene
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and 2011, the proportion of adult h
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anticipated under the modernized pa
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endnotes 1 In this chapter, we use
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References ABIM Foundation. 2012. C
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C H A p t e R7 post-acute care prov
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encourages more 60-day episodes. Fu
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C H A p t e R8 skilled nursing faci
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skilled nursing facility services C
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adjust for differences in patients
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Description of beneficiaries who us
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snF prospective payment system and
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Number of SNFs FIguRe FIGURE 8-1 7-
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FIGURE FIguRe Percent 7-2 8-2 30 25
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and other SNF users were essentiall
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FIguRe FIGURE Program spending (in
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7-8 8-6 FIguRe 30 25 20 15 10 Medic
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(e.g., whether there is a requireme
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the Commission’s 2012 update reco
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tABLe 8-9 non-Medicare margins were
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found to be associated with one or
Page 210 and 211: Smith, V. K., K. Gifford, E. Ellis,
Page 212 and 213: R e C o M M e n D A t I o n s (The
Page 214 and 215: 188 Home health care services: Asse
Page 216 and 217: tABLe 9-1 use and growth of home he
Page 218 and 219: FIGURE FIguRe Number of new agencie
Page 220 and 221: tABLe 9-2 of services. The review a
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Page 224 and 225: tABLe 9-5 type of county Claims dat
Page 226 and 227: tABLe 9-6 state County are collecte
Page 228 and 229: tABLe 9-8 Medicare margins for free
Page 230 and 231: tABLe 9-11 provider characteristics
Page 232 and 233: tABLe 9-12 Medicare visits per full
Page 234 and 235: strengthening incentives for effect
Page 236 and 237: endnotes 1 The exceptions pertain t
Page 239 and 240: C H A p t e R10 Inpatient rehabilit
Page 241 and 242: Inpatient rehabilitation facility s
Page 243 and 244: FIguRe FIGURE 10-1 9-1 Note: IRF (i
Page 245 and 246: Medicare IRF classification require
Page 247 and 248: tABLe 10-2 type of IRF 2004 2005 20
Page 249 and 250: tABLe 10-4 number of IRF beds decre
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Page 253 and 254: unobserved factors regarding patien
Page 255 and 256: freestanding IRFs were about $4,340
Page 257 and 258: increase for changes in the outlier
Page 259: References Centers for Medicare & M
Page 263 and 264: Long-term care hospital services Ch
Page 265 and 266: Background Patients with chronic cr
Page 267 and 268: would have lower readmission rates
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Page 271 and 272: Chronically critically ill benefici
Page 273 and 274: tABLe 11-3 the top 25 Ms-LtC-DRgs m
Page 275 and 276: from year to year, over time we fou
Page 277 and 278: volume of patients on average and b
Page 279 and 280: endnotes 1 The Medicare, Medicaid,
Page 281 and 282: References Barnato, A. E., D. L. An
Page 283: Scheinhorn, D. J., M. S. Hassenpflu
Page 286 and 287: R e C o M M e n D A t I o n 12 The
Page 288 and 289: 262 Hospice services: Assessing pay
Page 290 and 291: tABLe 12-1 Category Description amo
Page 292 and 293: March 2009 Commission recommendatio
Page 294 and 295: tABLe 12-2 The second, more visible
Page 296 and 297: tABLe 12-3 We estimate that the sha
Page 298 and 299: FIguRe 12-1 12-1 250 200 150 100 Le
Page 300 and 301: tABLe 12-6 Characteristic shortest
Page 302 and 303: tABLe 12-8 In 2010, 10.1 percent of
Page 304 and 305: tABLe 12-9 Average Hospice costs pe
Page 306 and 307: tABLe 12-11 Hospice characteristic
Page 308 and 309: endnotes 1 If a beneficiary does no
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References Barnato, A. E., D. L. An
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the Medicare Advantage program: sta
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charges no premium (beyond the Medi
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tABLe 13-1 Medicare Advantage enrol
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tABLe 13-2 Access to Medicare Advan
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FIGURE FIguRe 13-2 13-2 MA bids in
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tABLe 13-4 Distribution of enrollme
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plan are updated using the new 2013
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measures, it is often the case that
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tABLe 13-8 plan performance on the
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tABLe 13-10 plans report a single r
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endnotes 1 Cost plans are technical
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References Centers for Medicare & M
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R e C o M M e n D A t I o n s 14-1
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314 Medicare Advantage special need
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Introduction Special needs plans (S
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previous Commission recommendations
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previous Commission recommendations
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to reduce hospital utilization for
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RAtIonALe 14-2 This recommendation
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RAtIonALe 14-3 Consistent with the
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endnotes 1 Employer plans are anoth
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C H A p t e R15 status report on pa
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334 Status report on Part D percent
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tABLe 15-1 parameters of the define
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Characteristics of Medicare benefic
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tABLe 15-5 pDp region state(s) of b
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FIguRe FIGURE 15-1 15-1 Enrollment
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tABLe 15-7 Virginia region, along w
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tABLe 15-8 stand-alone pDps with th
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gradual phase-out of the coverage g
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sponsors (i.e., the direct subsidy
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use of preferred pharmacy networks
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premiums) rather than lowering the
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tABLe 15-15 spending—using cost-s
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to formularies, benefit structure,
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with a difference of at least $12 i
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A p p e n D I X Commissioners' voti
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Chapter 5: Ambulatory surgical cent
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14-4 For dual-eligible special need
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The Hono orable Max Baucus Chairman
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ecommend that the Congress offset t
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problematic than access to speciali
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patients in hospitals, nursing faci
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Collecting data to improve payment
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a percentage of fee-schedule spendi
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Within the ACO program, incentives
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ates. Primary care physicians and o
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Appendix 17 Report to the Congress:
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19 Report to the Congress: Medicare
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• Along A with th he recommend da
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Acronyms
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gDR generic dispensing rate gI gast
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More about MedpAC
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Commissioners’ biographies scott
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Herb B. Kuhn is current president a
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Commission staff Mark e. Miller, ph
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Medicare Payment Policy

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