MedPAC, or the Medicare Payment Advisory Council, is an independent agency tasked with advising the United States Congress on topics and issues related to Medicare. More information about MedPAC can be found at 

https://www.medpac.gov/what-we-do/.

According to MedPAC, "The Centers for Medicare & Medicaid Services (CMS) determines the payment rate for each service based on the clinician work required to provide the service, expenses related to maintaining a practice, and professional liability insurance (PLI) costs

Additional, RVU's for malpractice insurance (MP RVU), is determined by:

1. Calculate a national average MP premium for each specialty,

2. Normalize specialty premiums to create a specialty-specific risk factor,

3. Calculate unadjusted MP RVUs for each service based on the volume of practitioners that perform a service, and

4. Adjust the RVUs for budget neutrality.

• Do you believe that the effects of malpractice insurance for providers is anecdotal or based on substantiated data?
• If providers are being reimbursed for malpractice insurance by CMS do you believe this continues to be a factor in providers closing practices, exiting the profession, narrowing margins, or being absorbed into larger health systems?
• Where the MP RVU is often the smallest part of the Medicare MPFS payment rate, do you believe the effects of malpractice insurance costs on the health system if perceived accurately by the general public or over exaggerated?