Latest News

June 2024 Report to Congress: Medicare and the Health Care Delivery System

Written on Jun 28, 2024

As part of its mandate from Congress, each June the Medicare Payment Advisory Commission (MedPAC), reports on improvements to Medicare payment systems and issues affecting the Medicare program, including changes to health care delivery and the market for health care services.  

The six chapters of the June 2024 report cover the following topics:  

  • Approaches for updating clinician payments and incentivizing participation in alternative payment models. The Commission considers two approaches for updating fee-for-service (FFS) Medicare’s physician fee schedule (PFS) payment rates and contemplates temporarily extending the bonus for participation in advanced alternative payment models (A–APMs). 

  • Provider networks and prior authorization in Medicare Advantage. The Commission discusses the use of provider networks and prior authorization in Medicare Advantage (MA) plans, CMS’s regulation of these tools, and the data that MA plans currently report in these areas. 

  • Assessing data sources for measuring health care utilization by Medicare Advantage enrollees: Encounter data and other sources. Using data from 2020 and 2021, the Commission assesses the relative completeness of MA encounter data and other data sources that contain information about MA enrollees’ use of services. 

  • Paying for software technologies in Medicare. The Commission reviews the Food and Drug Administration’s (FDA’s) process for clearing software as a medical device (SaMD), examines Medicare’s current coverage process and payments for medical device software under the payment systems for Part A and Part B services, and discusses issues that policymakers should keep in mind when considering paying for medical software in FFS Medicare. 

  • Considering ways to lower Medicare payments for select conditions in inpatient rehabilitation facilities. The Commission considers alternative approaches to lower FFS Medicare’s payment rates to inpatient rehabilitation facilities (IRFs) for beneficiaries with select conditions. 

  • Medicare’s Acute Hospital Care at Home. The Commission assesses the experience to date of hospitals and beneficiaries in the FFS Medicare Acute Hospital Care at Home (AHCAH) program and reviews considerations for Medicare policy. 

The full report is available for download from the MedPAC website

Related Upcoming Events