The Medicare Payment Advisory Commission (MedPAC) recommended that Congress increase payment rates for acute inpatient and outpatient prospective payment systems in fiscal year 2009 by the projected rate of increase in the hospital market basket index, currently estimated at 3.0%, concurrent with the implementation of a quality incentive payment program. In addition, MedPAC recommended that Congress reduce the indirect medical education adjustment by 1 percentage point to 4.5% in fiscal year 2009. MedPAC recommended a freeze in payment rates for skilled nursing facilities, home health agencies and inpatient rehabilitation facilities. The commission also recommended long-term care hospitals get an update of market basket minus 1.5 percentage points for productivity growth, and physicians get a change in input prices minus 1.5 percentage points for productivity.