Medicare Payment Policy

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R e C o M M e n D A t I o n 3 The Congress should increase payment rates for the inpatient and outpatient prospective payment systems in 2014 by 1 percent. For inpatient services, the Congress should also require the Secretary of Health and Human Services to use the difference between the statutory update and the recommended 1 percent update to offset increases in payment rates due to documentation and coding changes and to recover past overpayments. COMMISSIONER VOTES: YES 16 • NO 0 • NOT VOTING 0 • ABSENT 1
Hospital inpatient and outpatient services Chapter summary From 2010 to 2011, Medicare payments per fee-for-service beneficiary for inpatient and outpatient services in acute care hospitals (ACHs) grew by 1.6 percent. The 4,800 ACHs paid under the Medicare prospective payment system and critical access payment system received $158 billion for roughly 10 million Medicare inpatient discharges and 181 million outpatient services. Assessment of payment adequacy To evaluate whether aggregate payments were adequate, we consider beneficiaries’ access to care, changes in the volume of services provided, hospitals’ access to capital, quality of care, and the relationship of Medicare’s payments to the average cost of caring for Medicare patients. In addition to examining the costs of the average provider, we compare Medicare payments with the costs of relatively efficient hospitals. Beneficiaries’ access to care—Access measures include the capacity of providers and changes in the volume of services over time. These measures were positive for the period reviewed. • Capacity and supply of providers—The number of hospitals and the range of services offered both continue to grow. • Volume of services—From 2004 to 2011, outpatient services per beneficiary grew 34 percent and inpatient admissions declined by 8 C H A p t e R 3 In this chapter • Are Medicare payments adequate in 2013? • How should Medicare payments change in 2014? Report to the Congress: Medicare Payment Policy | March 2013 41
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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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Page 20 and 21: some facilities are willing to acce
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Page 24 and 25: of care for these conditions should
Page 27: Context for Medicare payment policy
Page 30 and 31: 4 Context for Medicare payment poli
Page 32 and 33: FIguRe FIGURE 1-2 1-2 12% Out of po
Page 34 and 35: the level of health care spending a
Page 36 and 37: 1-4 FIguRe 1-4 140 120 100 80 60 Do
Page 38 and 39: FIguRe 1-6 1-6 Growth rate (in perc
Page 40 and 41: FIGURE FIguRe Share of GDP (in perc
Page 42 and 43: Share of GDP (in percent) FIGURE 1-
Page 44 and 45: FIGURE FIguRe 1-10 1-10 8% African
Page 46 and 47: FIguRe 1-12 1-11 1800 1600 1400 120
Page 48 and 49: Americans than for other racial and
Page 50 and 51: References Agency for Healthcare Re
Page 52 and 53: Medicare Payment Advisory Commissio
Page 55 and 56: Assessing payment adequacy and upda
Page 57 and 58: The goal of Medicare payment policy
Page 59 and 60: may go up when payment rates go dow
Page 61 and 62: hospitals and that hospitals shift
Page 63 and 64: individual payment systems but also
Page 65: Hospital inpatient and outpatient s
Page 69: covered the fully allocated costs o
Page 72 and 73: 3-1 3-1 FIguRe 100 80 60 40 Number
Page 74 and 75: Visits or claims per 1,000 benefici
Page 76 and 77: 3-4 3-4 FIguRe 2012 dollars (in bil
Page 78 and 79: of physicians employed directly by
Page 80 and 81: FIguRe FIGURE Annual percent change
Page 82 and 83: FIGURE FIguRe Margin (in percent) 3
Page 84 and 85: FIGURE FIguRe Margin (in percent) 3
Page 86 and 87: tABLe 3-5 performance of efficient
Page 88 and 89: Act, the EHR Incentive Program also
Page 90 and 91: as Medicaid expands, the new insura
Page 92 and 93: ates for separately paid drugs resu
Page 94 and 95: endnotes 1 From 2002 to 2011, 479 h
Page 96 and 97: References Agency for Healthcare Re
Page 99 and 100: C H A p t e R4 physician and other
Page 101 and 102: physician and other health professi
Page 103: from the SGR system in its October
Page 106 and 107: 4-1 4-1 FIguRe 40 35 30 25 20 15 10
Page 108 and 109: tABLe 4-1 Most aged Medicare benefi
Page 110 and 111: tABLe 4-2 Medicare beneficiaries ha
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Page 114 and 115: 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
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Smith, V. K., K. Gifford, E. Ellis,
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R e C o M M e n D A t I o n s (The
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188 Home health care services: Asse
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tABLe 9-1 use and growth of home he
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FIGURE FIguRe Number of new agencie
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tABLe 9-2 of services. The review a
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tABLe 9-4 Community-admitted home h
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tABLe 9-5 type of county Claims dat
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tABLe 9-6 state County are collecte
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tABLe 9-8 Medicare margins for free
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tABLe 9-11 provider characteristics
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tABLe 9-12 Medicare visits per full
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strengthening incentives for effect
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endnotes 1 The exceptions pertain t
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C H A p t e R10 Inpatient rehabilit
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Inpatient rehabilitation facility s
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FIguRe FIGURE 10-1 9-1 Note: IRF (i
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Medicare IRF classification require
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tABLe 10-2 type of IRF 2004 2005 20
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tABLe 10-4 number of IRF beds decre
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weight for compliant cases was 1.39
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unobserved factors regarding patien
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freestanding IRFs were about $4,340
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increase for changes in the outlier
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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 11 The
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Quality of care—LTCHs only recent
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FIguRe FIGURE 11-1 10-1 Source: Med
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short-stay outlier cases in long-te
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tABLe 11-1 growth in the number of
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Chronically critically ill benefici
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Quality measures for long-term care
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tABLe 11-4 type of LtCH per case pa
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temporary legislative relief from s
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16 We observed growth over time in
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Durairaj, L., J. C. Torner, E. A. C
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Hospice services C H A p t e R12
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Hospice services Chapter summary Th
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Background Medicare began offering
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March 2009 Commission recommendatio
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March 2009 Commission recommendatio
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number peaking in 2009). With rapid
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tABLe 12-4 Hospice use has increase
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tABLe 12-5 Characteristic insurers
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three settings, respectively) (Tabl
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measures, it is likely that the vas
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tABLe 12-10 Category percentage poi
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• additional wage index changes,
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elieve the cost report data provide
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C H A p t e R13 the Medicare Advant
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288 The Medicare Advantage program:
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The Medicare Advantage (MA) program
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enchmark. If a plan’s bid is abov
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tABLe 13-3 projected payments excee
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We broke the fourth quartile into t
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tABLe 13-5 Distribution of enrollme
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tABLe 13-6 examples of measures inc
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tABLe 13-7 Between 2011 and 2012, l
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tABLe 13-9 admission-weighted ratio
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ecommended that payments be brought
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eport HEDIS measures based on admin
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C H A p t e R14 Medicare Advantage
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Medicare Advantage special needs pl
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integrating Medicaid benefits. We f
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tABLe 14-1 Distribution of snp enro
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previous Commission recommendations
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tABLe 14-4 Readmission rates by typ
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There has been recent movement in t
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of the quality measures that only S
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Separate appeals and grievances pro
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References Government Accountabilit
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status report on part D Chapter sum
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controlling growth in drug spending
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tABLe 15-2 and pharmacists who part
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Characteristics of Medicare benefic
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tABLe 15-6 Distribution of enrollme
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FIGURE FIguRe Percent of all Part D
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3). Most regions continue to have m
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tABLe 15-9 • Reinsurance—Medica
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tABLe 15-11 toward the OOP threshol
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tABLe 15-12 Cost-sharing amounts fo
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tABLe 15-14 enrollees—by about $9
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Drug price index equal to 1.0 at th
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Voluntary switchers Each year, Part
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endnotes 1 PPACA eliminates the cov
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References Boards of Trustees, Fede
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Commissioners’ voting on recommen
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Chapter 12: Hospice services The Co
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A p p e n D I X Moving forward from
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well as the cost of temporary repri
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payments rates be frozen at their c
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than primary care physicians (class
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achieving a total estimated 10-year
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would be costly, too, and they are
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payment accuracy. For example, such
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Final regulations on the ACO progra
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statemen nt of MedPAC’s position
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Cumulative percent change 70 7 60 6
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390 Moving forward from the sustain
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Note: The availability and scoring
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Acronyms AAgR average annual growth
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op outpatient opD hospital outpatie
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Commission members glenn M. Hackbar
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a state society of the National Med
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on the Advocate Physician Partners
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425 eye street, nW • suite 701
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Medicare Payment Policy

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