; and and inserting a semicolon; (2) in subclause (V), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following new subclause: (VI) subparagraph (P) shall not be taken into account in applying clause (ii)(II). . (c) Report Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the Medicare physician fee schedule and patient access, including— (1) an analysis of the number of health care providers furnishing specified services (as defined in section 1848(c)(2)(P) of the Social Security Act, as added by subsection (a)) in a nonfacility setting under the Medicare program over the 20 year period ending on such date of enactment, including a description of any changes in volume of such services furnished under such program and the availability of such services under such program and a description of wait-times, decreased hours, other factors that could impede a patient’s access to such services (such as increased cost sharing); (2) an analysis of any change in the proportion of services payable under such schedule furnished in nonfacility settings compared to the proportion of such services furnished at other sites of service over such period, including an analysis of the impact of any such change on health system consolidation, underserved and rural populations, quality of care of Medicare beneficiaries, and increased cost to the Medicare program; (3) an analysis of whether significant annual changes in provider reimbursement are a cause of any change described in paragraph (2), disruptions in patient access to services, and increased cost sharing; and (4) taking into account the analyses described in paragraphs (1) through (3), recommendations for improving Medicare patient access to specified services (as defined in section 1848(c)(2)(P) of the Social Security Act, as added by subsection (a)) and minimizing health system consolidation.