Lawmakers grilled Medicare Payment Advisory Commission (MedPAC) Chairman Glenn Hackbarth on March 6, 2007, asking why the commission recommends two possible paths for altering physician payments, rather than one clear recommendation. At a hearing of the Health subcommittee of the Energy and Commerce committee, Rep. Diana Degette (D-Colo.) said, "We thought we created you to make a recommendation." She asked Hackbarth if he could pick one option. He explained that the commission was split on whether expenditure targets are useful in Medicare. She and other Democrats said the recommendations are not detailed enough.
Rep. Steve Buyer (R-Ind.) defended the commission, saying MedPAC has been given an "impossible task," which is to decide prices for the entire health care industry. He added that he has deep concerns about any payment system that is not driven by customer satisfaction. "Patient evaluation must be a huge component of this," he said.
Hackbarth said the traditional Medicare program should stay in place, but private options should be available for beneficiaries. He emphasized that the government should not pay more for private Medicare plans than traditional fee-for-service Medicare. He also said that there needs to be some system of geographic adjustment and those changes should be budget neutral on a state by state basis.
Rep. Michael Burgess (R-Texas) said there should be more quality reporting mechanisms available to doctors that should not be punitive.
Just a few hours later, Hackbarth appeared before the House Ways and Means Health Subcommittee to answer questions on the commission's recommendations on the sustainable growth rate (SGR). He said that cuts in the rate could lead to reduced care and that changing the formula will take time. Chairman Pete Stark (D-Calif.) asked whether adjustments to physician payments could improve quality and control volume. He also asked how much CMS can do administratively to resolve problems in the system. Hackbarth said the agency could improve pricing accuracy, noting that Medicare pays too much for some services provided by hospitals and physicians. Rewarding coordination of care would require legislative changes.
He added that pay for performance is complex for physicians. "It's important to move ahead with pay for performance for physicians but to do so carefully," he said. More measures are not necessarily better, he said, emphasizing the importance of a good benefit to cost ratio when choosing measures.
Rep. Phil English (R-Penn.) said that if MedPAC could not agree on the issue, there might be resistance from stakeholders as well. He asked how to limit the risk of rationing. Hackbarth said that decision makers must understand the effectiveness of different treatments, assessing whether the added benefit is equal to the added cost before paying for new treatments. "That's a luxury that's going to be increasingly difficult" for the program to afford, he said.
Source: CCH Washington Bureau, March 6, 2007.
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