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

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.

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."