On September 3 and 4, 2026, the Medicare Payment Advisory Commission (MedPAC) met for its first public meeting of the 2026-2027 cycle. During the meeting, Commissioners discussed several topics, including the workplan on ambulatory surgical centers (ASCs) for this cycle, the use of post-acute care (PAC) services by beneficiaries in fee-for-service (FFS) Medicare and Medicare Advantage (MA), and the accuracy of MA risk adjustment at the plan level. MedPAC staff shared that they are planning to discuss all of these topics during the Spring 2027 meetings as well, and that the June 2027 Report to Congress will likely include a chapter on MA risk adjustment at the plan level.
ASC WORKPLAN
The session began with MedPAC staff providing an overview of current knowledge and prior MedPAC work on ASCs, highlighting recent growth in ASC use and changes to the ASC-covered procedures list. Next, staff summarized their proposed workplan analysis, which aims to understand factors associated with geographic differences in ASC supply and assess the impact of ASC growth on FFS surgical volume.
Commissioners had a few clarifying questions. One Commissioner suggested capturing ASC size in both the number of operating rooms and the number of medical specialties practicing, which staff clarified they planned to do. Another Commissioner questioned why MA data will not be included in the analysis. Staff responded that while they hope to incorporate MA data in the future, they are currently unable to do so. Lastly, when asked whether there was a clear relationship in Medicare reimbursement for a procedure performed in an ASC versus a hospital outpatient department (HOPD), staff responded that, generally, ASCs are reimbursed at about 60% of HOPD reimbursement.
Some Commissioners had suggestions on the planned site visits and informational interviews laid out in the workplan. One suggestion was to ask ASC professionals about their plans to start offering additional procedures as they move onto the ASC covered procedures list. Another suggestion was to also interview rural providers about their barriers to starting an ASC.
Commissioners also had comments on additional analyses they would appreciate seeing. Those included analyses on the following:
- Potential decreased waiting time for procedures
- The change in case mix for ASCs and HOPDs
- The quality of procedures being performed in ASCs, more specifically if there is an increase in ER visits or hospital readmittance after a procedure in an ASC
- How ASCs may both increase access to procedures and increase rates of inappropriate care
Overall, Commissioners expressed excitement about the proposed workplan and are interested in understanding how ASCs have changed care delivery. MedPAC plans to revist it the work during its January 2027 public meeting for an interim update.
EXAMINING PAC BY BENEFICIARIES IN FFS MEDICARE AND MA
The session began with MedPAC staff providing a descriptive analysis of PAC use across FFS Medicare and MA in 2023, emphasizing that this is preliminary data and that results adjusted for beneficiary characteristics will be presented in spring 2027. Staff found that MA beneficiaries had slightly fewer Acute-Care Hospital (ACH) and PAC stays, and they were less likely to receive PAC services after hospitalization but typically had longer ACH stays. Staff also found that FFS Medicare beneficiaries were more likely to utilize multiple facilities and have longer stays.
Commissioners had questions and comments about the material presented. One Commissioner asked about other aspects of payment structure. Staff responded that they are currently looking into this and will share more in the spring 2027 meetings. However, staff did say they found that MA plans use a mix of strategies including per-visit and per-stay. Some Commissioners raised questions about what happens to beneficiaries when they are waiting for appeal on payment denials, specifically who is responsible for paying for the care, who is in charge of the care, and is there a window of time for appeals? Staff said they would look into these questions.
Multiple Commissioners discussed site-neutral payments, with differing views on its effectiveness. One Commissioner suggested including site-neutral as a variable in determining how MA plans deviate from FFS and what it would look like to move towards that model. A number of Commissioners raised concerns about this idea, stating that beneficiaries receive various levels of care in each facility and they have different incentives. For example, home-health is inclined to focus on collective health and ensure the beneficiary does not end up in the hospital or a facility; however, other PAC facilities typically focus on restoring functionality and discharging to the home. MedPAC staff expressed appreciation for this conversation but reiterated that they are looking more broadly at utilization of care, not specifically payment policies.
Commissioners also offered the following suggestions for additional analysis by MedPAC staff:
- Stratify data by dual-enrolled and non-dual-enrolled beneficiaries
- Examine the data by conditions to get better view of level of care provided
- Expand on beneficiaries admitted to PAC facilities from their community versus from the hospital
- Look into overall cost and length of care considering hospital stay, specifically if a longer hospital stay leads to shorter or longer PAC facility stay
- Conduct interviews with both hospital discharge planners and beneficiaries who were denied care
ACCURACY OF MA RISK ADJUSTMENT AT THE PLAN LEVEL
MedPAC staff began this session by sharing that the presentation is an expansion on the conversation Commissioners had at their March 2026 meeting, where they discussed their concerns with using FFS data to calibrate the risk model due to MA’s coding pattern and utilization differences. From their analysis, staff found current risk adjustment narrows the distribution of plan bids, indicating risk scores account for some variation. Staff then discussed the challenges with the current system, the policies that could improve accuracy, and plans for future work. They shared that there would be another session focused on risk adjustment in spring 2027, and that a chapter on the topic would likely be included in the June 2027 Report to Congress.
Commissioners had numerous comments on the policies proposed to improve the risk model’s accuracy and on MedPAC’s plans for future work. Commissioners overall agreed that the risk model should reflect MA characteristics to better predict annual spending; however, some voiced concern about the unintended consequences of recalibrating, specifically how plans currently invest excess revenue into supplemental benefits and lower premiums. A number of Commissioners expressed support for starting reforms with combating model input challenges, as they would improve accuracy more quickly. Commissioners encouraged greater use of objective utilization markers that are already available, including inpatient admissions and nursing home stays, to improve accuracy. A number of Commissioners also requested a high-cost risk pool for infrequent outliers to prevent skewed results and better assess their costs and needs. Other Commissioners also raised concerns about the prioritization of transparency and simplicity over accuracy, explaining the need for more complexity to better predict costs and provide better care for beneficiaries. Some Commissioners voiced skepticism about machine learning, at least until data quality issues are resolved, while others believed machine learning could improve the data quality concerns.
PUBLIC COMMENTS
At the conclusion of the session, MedPAC opened the floor for public comment. Shannon Woo, Director of Payment Policy at the American Hospital Association (AHA), flagged that prior authorization and the lack of quality niche providers already limit access to care for beneficiaries.