Policy Options to Sustain Medicare for the Future
This table provides information about potential budget effects for the options included in this report. In general, the estimates in the table and text are from official and publicly available government sources, including publications from the Congressional Budget Office (CBO), the Medicare Payment Advisory Commission (MedPAC), the Office of Management and Budget (OMB), and the Department of Health and Human Services Office of Inspector General (HHS OIG). In a few cases, estimates from other sources are presented and noted accordingly. Estimates may differ in terms of the budget window and the year of implementation because they were drawn from different sources and published in different years. Some of these options have potential to achieve savings but do not have estimates from the official and publicly available government sources we relied on; in such cases, we note that estimates are “not available.” Some estimates were produced before subsequent changes in law, including provisions in the 2010 Affordable Care Act (ACA) and the American Taxpayer Relief Act of 2012.
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Daniel Budnitz et al. 2011. “Emergency Hospitalizations for Adverse Drug Events in Older Adults,” New England Journal of Medicine, November 24, 2011.
Centers for Medicare & Medicaid Services (CMS). 2012. Competitive Bidding Update—One Year Implementation Update, April 17, 2012.
Congressional Budget Office (CBO). 2010. Effects of Using Generic Drugs on Medicare’s Prescription Drug Spending, September 2010.
Congressional Budget Office (CBO). 2011a. Cost Estimate, H.R. 5, Health Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011, March 10, 2011 and May 23, 2011.
Congressional Budget Office (CBO). 2011b. Cost Estimate, S. 27: Preserve Access to Affordable Generics Act, November 2011.
Congressional Budget Office (CBO). 2011c. Long-Term Analysis of a Budget Proposal by Chairman Ryan, April 5, 2011.
Congressional Budget Office (CBO). 2011d. Reducing the Deficit: Spending and Revenue Options, March 2011.
Congressional Budget Office (CBO). 2012a. Cost Estimate, H.R. 452: Medicare Decisions Accountability Act of 2011, March 2012.
Congressional Budget Office (CBO). 2012b. Estimate of the Effects of Medicare, Medicaid, and Other Mandatory Health Provisions Included in the President’s Budget Request for Fiscal Year 2013, March 2012.
Congressional Budget Office (CBO). 2012c. The Long-Term Budgetary Impact of Paths for Federal Revenues and Spending Specified by Chairman Ryan, March 2012.
Congressional Budget Office (CBO). 2012d. Medicare Baseline, March 2012.
Congressional Budget Office (CBO). 2012e. Medicare’s Payments to Physicians: The Budgetary Impact of Alternative Policies Relative to CBO’s March 2012 Baseline, July 2012.
Congressional Budget Office (CBO). 2012f. Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services, November 2012.
Congressional Budget Office (CBO). 2012g. Raising the Ages of Eligibility for Medicare and Social Security. January 2012.
Congressional Budget Office (CBO). 2012h. Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget, June 2012.
Government Accountability Office (GAO). 2012. Medicare: High-Expenditure Part B Drugs, October 12, 2012.
The Heritage Foundation. 2011. The Second Stage of Medicare Reform: Moving to a Premium Support Program, November 2011.
HHS Office of Inspector General (OIG). 2009. Inappropriate Medicare Payments for Chiropractic Services, May 2009.
HHS Office of Inspector General (OIG). 2011. Letter to Senator Herb Kohl, October 6, 2011.
HHS Office of Inspector General (OIG). 2012a. Comparison of Fourth-Quarter 2011 Average Sales Prices and Average Manufacturer Prices: Impact on Medicare Reimbursement for Second Quarter 2012, August 2012.
HHS Office of Inspector General (OIG). 2012b. Surety Bonds Remain an Unused Tool to Protect Medicare from Home Health Overpayments, September 27, 2012.
Medicare Payment Advisory Commission (MedPAC). 2010. Report to the Congress: Medicare Payment Policy, March 2010.
Medicare Payment Advisory Commission (MedPAC). 2011a. Moving Forward from the Sustainable Growth Rate (SGR) System, October 2011.
Medicare Payment Advisory Commission (MedPAC). 2011b. Report to the Congress: Medicare Payment Policy, March 2011.
Medicare Payment Advisory Commission (MedPAC). 2012a. Report to the Congress: Medicare and the Health Care Delivery System, June 2012.
Medicare Payment Advisory Commission (MedPAC). 2012b. Report to the Congress: Medicare Payment Policy, March 2012.
Medicare Payment Advisory Commission (MedPAC). 2012c. Staff presentation by Dan Zabinski and Ariel Winter, “Addressing Medicare Payment Differences Across Settings: Ambulatory Care Services,” October 4, 2012.
National Commission on Fiscal Responsibility and Reform. 2010. The Moment of Truth: Report of the National Commission on Fiscal Responsibility and Reform, December 2010.
Office of Management and Budget (OMB). 2012a. Fiscal Year 2013 Budget of the U.S. Government, February 2012.
Office of Management and Budget (OMB). 2012b. Fiscal Year 2013 Budget of the U.S. Government: Cuts, Consolidations, and Savings, February 2012.
ACA Affordable Care Act (see also PPACA)
ACE acute care episode
ACO accountable care organization
AHRQ Agency for Healthcare Research and Quality
ALS amyotrophic lateral sclerosis
ARC Actuarial Research Corporation
ASC ambulatory surgical center
ASP average sales price
AMP average manufacturer price
ATRA American Taxpayer Relief Act of 2012
AWP average wholesale price
BBA Balanced Budget Act of 1997
CAD coronary artery disease
CAH critical access hospitals
CAHPS Consumer Assessment of Healthcare Providers and Systems (survey)
CBO Congressional Budget Office
CCA Commonwealth Care Alliance
C-CPI chained consumer price index
CEA cost effectiveness analysis
CED coverage with evidence development
CHF congestive heart failure
CHIP Children’s Health Insurance Program
CMMI Center for Medicare & Medicaid Innovation
CMS Centers for Medicare & Medicaid Services
COLA cost of living adjustment
COPD chronic obstructive pulmonary disease
CPI consumer price index
CPI-U consumer price index for urban consumers
CPS Current Population Survey
CPT Current Procedural Terminology
CRS Congressional Research Service
CT computed tomography
CTA computed tomography angiography
DME durable medical equipment
DMEPOS durable medical equipment, prosthetics, orthotics, and supplies
DRG diagnosis related group
DSH disproportionate share hospital
D-SNP dual eligible special needs plan
EHR electronic health record
ESRD end stage renal disease
FDA Food and Drug Administration
FEHBP Federal Employees Health Benefits Program
FPL federal poverty level
FTC Federal Trade Commission
FY Fiscal Year
GAO Government Accountability Office
GDP gross domestic product
GME graduate medical education
GRACE Geriatric Resources for Assessment and Care of Elders
HCFAC Health Care Fraud and Abuse Control (program)
HEALTH Act Help Efficient, Accessible, Low-Cost, Timely Healthcare Act
HHA home health agency
HHS (Department of) Health and Human Services
HI Hospital Insurance (trust fund)
HIT health information technology
HITECH Health Information Technology for Economic and Clinical Health (Act)
HIPAA Health Insurance Portability and Accountability Act of 1996
HMO health maintenance organization
HSA hospital service area
ICU intensive care unit
IME indirect medical education
INTERACT Interventions to Reduce Acute Care Transitions
IOAS in-office ancillary services
IOM Institute of Medicine
IPAB Independent Payment Advisory Board
IRF inpatient rehabilitation facility
LCA least costly alternative
LCD Local Coverage Decision
LIS Low-Income Subsidy
LTCH long-term care hospital
LTSS long term services and supports
MA Medicare Advantage
MAC Medicare Administrative Contractor
MCBS Medicare Current Beneficiary Survey
MEDCAC Medicare Evidence Development and Coverage Advisory Committee
MEDIC Medicare drug integrity contractor
MedPAC Medicare Payment Advisory Commission
MEI Medicare Economic Index
MIP Medicare Integrity Program
MMA Medicare Modernization Act of 2003
MPRR multiple procedure payment reduction
MRA magnetic resonance angiography
MRI magnetic resonance imaging
MTM medication therapy management
NASI National Academy of Social Insurance
NBI MEDIC National Benefit Integrity Medicare Drug Integrity Contractor
NCD National Coverage Decision
NCHC National Coalition on Health Care
NCHS National Center for Health Statistics
NIH National Institutes of Health
NSC National Supplier Clearinghouse
OACT Office of the (Medicare) Actuary
OIG (HHS) Office of Inspector General
OMB Office of Management and Budget
ONC Office of the National Coordinator (for Health Information Technology)
OPD outpatient department
OPM Office of Personnel Management
PACE Program of All-inclusive Care for the Elderly
PCORI Patient Centered Outcomes Research Institute
PDP prescription drug plan
PE practice expense
PEN parenteral and enteral nutrition
PET positron emission tomography
PL Public Law
PPACA Patient Protection and Affordable Care Act (see also ACA)
PPO preferred provider organization
PPS prospective payment system
QIO Quality Improvement Organization
RAC Recovery Audit Contractor
RBRVS Resource-Based Relative Value Scale
RTI Research Triangle Institute
RUC Relative (Value) Update Committee
RVU relative value unit
SDM shared decision making
SGR Sustainable Growth Rate
SMI Supplementary Medicare Insurance (trust fund)
SNF skilled nursing facility
SNP special needs plan
SOW scope of work
SSDI Social Security Disability Insurance
TEFRA Tax Equity and Fiscal Responsibility Act of 1982
VBID value-based insurance design
VBP value-based purchasing
ZPIC Zone Program Integrity ContractorSection 5: Medicare Program Administration