Medicare Payment Policy

table of contents
Acknowledgments ......................................................................................... v
executive summary ........................................................................................xi
Chapters
1 Context for Medicare payment policy ................................................................ 3
Introduction .............................................................................................. 5
Growth in health care spending .............................................................................. 5
Growth in Medicare spending................................................................................ 8
Health care and the federal budget ...........................................................................14
Changes in the Medicare-eligible population ..................................................................17
Effects of growth in health care spending on individuals and families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Variation in health care spending suggests inefficiencies .........................................................20
Conclusion..............................................................................................22
2 Assessing payment adequacy and updating payments in fee-for-service Medicare ...............29
Are Medicare payments adequate in 2013? ....................................................................31
What cost changes are expected in 2014? .....................................................................35
How should Medicare payments change in 2014?...............................................................35
Payment adequacy in context ...............................................................................36
3 Hospital inpatient and outpatient services ..........................................................41
Background .............................................................................................45
Are Medicare payments adequate in 2013? ....................................................................46
How should Medicare payments change in 2014?...............................................................66
4 physician and other health professional services ...................................................75
Background .............................................................................................79
Repeal of the SGR: Urgent and should protect access, break the link between updates and expenditures,
and be fiscally responsible .................................................................................79
Are Medicare fee-schedule payments adequate in 2013? .........................................................83
How should Medicare payments change in 2014? ..............................................................96
5 Ambulatory surgical center services................................................................105
Background ............................................................................................107
Are Medicare payments adequate in 2013? ...................................................................108
How should Medicare payments change in 2014?..............................................................116
6 outpatient dialysis services.........................................................................127
Background ............................................................................................129
Are Medicare payments adequate in 2013? ...................................................................133
How should Medicare payments change in 2014?..............................................................142
7 post-acute care providers: shortcomings in Medicare’s fee-for-service
highlight the need for broad reforms ..............................................................151
Shortcomings in how Medicare defines and pays for PAC services ................................................151
Broad reforms that would move Medicare beyond PAC silos .....................................................152
8 skilled nursing facility services .....................................................................157
Background ............................................................................................161
Are Medicare payments adequate in 2013? ...................................................................165
Report to the Congress: Medicare Payment Policy | March 2013
vii