Some in Congress want to boost MedPAC's power over pay

A Senate bill would place MedPAC in the executive branch, giving the panel independent authority over Medicare payment policy for physicians.

By Chris Silva, amednews staff. Posted June 15, 2009.

Washington -- Saying it's time to give the Medicare Payment Advisory Commission more power while shielding the panel from special interests, Sen. John Rockefeller (D, W.Va.) recently introduced legislation that would establish MedPAC as an independent executive agency.

MedPAC currently exists as a legislative entity that advises Congress on Medicare payment policies.

Payment advice
New MedPAC members named
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Topic: Medicare payment

However, the panel has no power to implement any of its recommendations, and Congress often takes its own path when it comes to setting rates.

MedPAC in recent years has recommended modest pay updates for doctors based on the costs of providing care, but lawmakers have mostly set aside the advice and instead approved freezes or smaller increases. That is something that needs to be changed if Congress is committed to reforming Medicare payment policies, Rockefeller said.

"Congress has proven itself to be inefficient and inconsistent in making decisions about provider reimbursement under Medicare," he said. "If we want serious improvements in our health care delivery system, then we need to reform MedPAC's current authority to include fully establishing and implementing Medicare reimbursement rules."

Under the Rockefeller bill, the panel would have independent authority to decide and implement payment policies, similar to how the Federal Reserve sets interest rates. Congress would increase its oversight of the commission and require Senate confirmation of commissioners.

The legislation also would re-christen the panel as the Medicare Payment and Access Commission.

President Obama has indicated a willingness to consider elements of the bill, which is called the MedPAC Reform Act of 2009. "I am open to ideas about giving special consideration to the recommendations of MedPAC, a commission created by a Republican Congress," Obama wrote in a June 2 letter to Sens. Edward Kennedy (D, Mass.) and Max Baucus (D, Mont.).

Kennedy chairs the Senate Health, Education, Labor and Pensions Committee, and Baucus chairs the Senate Finance Committee. Both are key players in the push to enact comprehensive health system reform.

Too much power?

Not all health policy experts are in agreement, however, that giving MedPAC a much more significant role in the pay-setting process is a good idea.

Gail Wilensky, PhD, served as the chair of MedPAC from 1997 to 2001. She's doubtful about Rockefeller's proposal.

"This is a good expert advisory group that I don't think is captured by special interests," said Wilensky, who is now a senior fellow at Project HOPE, an international health advocacy organization. "It was set up to advise Congress and be secondary to the Dept. of Health and Human Services and the administration. Why would Congress be willing to delegate broad decision-making powers to this non-delegate group?"

If Congress and the administration are serious about restructuring the Medicare payment system, it should give more powers and responsibility to the Centers for Medicare & Medicaid Services, Wilensky added. CMS deferred comment on the bill to the White House.

"Senator Rockefeller has done important thinking in this area, and the administration is looking forward to further discussions with him and other members of Congress about the best ways to ensure appropriate cost containment," said Linda Douglass, communications director for the Office of Health Reform.

Her office is a newly-created entity led by Nancy-Ann DeParle, former director of the Health Care Financing Administration, the predecessor to CMS.

Rockefeller said he was encouraged by Obama's letter. He is hopeful the bill will lead not only to a Medicare payment system overhaul, but also to the testing of new and innovative payment models for physicians.

"Congress should leave the reimbursement rules to the independent health care experts," he said. "By giving MedPAC independent authority to decide and implement reimbursement policies, we are giving the true experts the chance to weigh in on health care."

The print version of this content appeared in the June 22, 2009 issue of American Medical News.

ADDITIONAL INFORMATION:

Payment advice

Since the Medicare Payment Advisory Commission first suggested in 2001 that lawmakers do away with the formula that determines physician payment, the panel has made a payment update recommendation each year. With the exception of 2009, Congress has approved significantly smaller updates.

	Medicare formula	MedPAC recommendation	Actual update
2002	-4.8%	2.6%	-4.8%
2003	-4.4%	2.5%	1.6%
2004	-4.5%	2.5%	1.5%
2005	-3.3%	2.6%	1.5%
2006	-4.4%	2.7%	0.0%
2007	-5.0%	2.8%	0.0%
2008	-10.1%	1.7%	0.5%
2009	-15.1%	1.1%	1.1%
2010	-21.5%	1.1%	Not known

Note: 2010 figures are projected.

Source: American Medical Association research, MedPAC, Centers for Medicare & Medicaid Services

New MedPAC members named

Two new members, one of them a physician, have been appointed to the Medicare Payment Advisory Commission, the Government Accountability Office recently announced:

Robert A. Berenson, MD, senior fellow at the Urban Institute. From 1998 to 2000, Dr. Berenson served as director of the Center for Health Plans and Providers in the Centers for Medicare & Medicaid Services, overseeing payment policy and managed care contracting. He was the founder and medical director of the National Capital Preferred Provider Organization from 1986 to 1996, and he served as an assistant director of the White House Domestic Policy staff during the Carter administration. Dr. Berenson was appointed to a three-year term through 2012.
Herb B. Kuhn, independent health care consultant. Kuhn served in multiple roles at CMS during the George W. Bush administration, including deputy administrator from 2006 to 2009 and director of the Center for Medicare Management from 2004 to 2006. From 2000 to 2004, he served as corporate vice president for the Premier Hospital Alliance, serving 1,600 institutional members. Kuhn was appointed to complete the remaining year of health care consultant Jack Ebeler's three-year term that began in 2007. Ebeler resigned from MedPAC in March.

The remaining members of the commission, including five members who were reappointed this year, are:

Mitra Behroozi, JD, executive director of 1199 SEIU Benefit and Pension Funds.
John M. Bertko, adjunct staff member at RAND and a visiting scholar at the Brookings Institution.
Karen R. Borman, MD, professor of surgery at the University of Central Florida College of Medicine.
Peter W. Butler, executive vice president and chief operating officer of Rush University Medical Center in Chicago.
Ronald D. Castellanos, MD, urologist in Fort Myers, Fla.
Michael Chernew, PhD, professor of health care policy at Harvard Medical School in Boston.
Francis J. Crosson, MD (vice chair), associate executive director of the Permanente Medical Group.
Thomas M. Dean, MD, family physician in Wessington Springs, S.D.
Glenn M. Hackbarth, JD, MedPAC chair, independent health care consultant.
Jennie Chin Hansen, RN, president of AARP.
Nancy M. Kane, professor of management and associate dean of education at the Harvard School of Public Health in Boston.
George N. Miller, Jr., president and CEO of Community Mercy Health Partners and senior vice president of Catholic Health Partners in Springfield, Ohio.
Arnold Milstein, MD, MPH, medical director at the Pacific Business Group on Health.
William J. Scanlon, PhD, health policy consultant and senior policy advisor with Health Policy R&D.
Bruce Stuart, PhD, a professor and executive director of the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland, Baltimore.