2 new doctors join Medicare advisory panel

Washington -- The Medicare Payment Advisory Commission last month welcomed two new physicians to its ranks to replace another two doctors whose terms had expired.

Ronald D. Castellanos, MD, a urologic surgeon in Cape Coral, Fla., and Karen R. Borman, MD, a general surgeon and professor in Jackson, Miss., will serve on the panel for three years. The group of 17 MedPAC members makes recommendations to lawmakers on how to set reimbursement rates for the program. Commission reports often form the starting point for congressional legislation affecting doctors and other Medicare participants.

The nominations of the physicians, who join the three doctors who are continuing their service on the commission, was praised by American Medical Association President J. Edward Hill, MD. "Drs. Karen Borman and Ronald Castellanos are both highly regarded physicians who have served the profession well, and we look forward to working with them in their new role as MedPAC commissioners," he said in a statement.

AMNews recently spoke with Dr. Castellanos about his appointment.

Question: Why were you chosen to join the commission?

Answer: If you look at the 17 commission members, what you see is that they really have a diverse background. What [U.S. Comptroller General] David Walker does is go out and try to get people from a diverse background representing the medical community, academicians and consumers. Where I'm coming from is the practicing physician's viewpoint. I'm not associated with a large university, just like 85% of the physicians in the United States.

We're small businessmen, and we can't forget that, and I think they wanted to try to focus on that concept. I've also had experience with the Practicing Physicians Advisory Council, advising CMS on new proposed Medicare rules and regulations. So maybe they want to say, "Yeah, we make all these recommendations, but are we really appropriately addressing all the issues for all the doctors?"

I've been involved in organized medicine in my local community, in my state organizations and on the national level with my specialty. I'm not saying I've been around the block, but I've had some experience. I would hope that's what they were looking for when I was appointed.

Q: What particular concerns about Medicare payment do you hope to bring to the table?

A: I don't think there's any question that there's concern about the physician payment schedule and payment for all of the other health care providers. But in this position on this commission, you have to think more globally. You have to think of the whole system.

I've always been an advocate for the Medicare recipient, the patient. I want to make sure that they continue to have access to care. I want to make sure that the quality of care continues to increase. There are a lot of new issues as far as payments go, but I want to make sure that the Medicare recipient is not pushed out of the picture and out of the loop.

Q: So are reimbursements to physicians part of maintaining that access to care for patients?

A: I don't think you need to think of it just in terms of physician dollars. You need to make sure that the dollars spent are appropriately spent.

I come from a small business viewpoint. I have 10 physicians in my practice, I have a staff of 70 people and a big payroll. If I'm not in practice today, I can't take care of tomorrow's patients. I need to be in a [financially] equitable position so I can continue to provide care not just for patients today but tomorrow and in the future.

The little mom-and-pop shop, and by that I mean the one- and two-man practices, are getting squeezed. A lot of them are telling me that they cannot afford to take care of the Medicare patients anymore. So we need to make sure that this care is continued and that the patients have access to good quality care. We need to make sure that the Medicare payments keep up with the costs of providing the services.

But I don't want you to think that I'm here just to say that I'm going to raise doctors' salaries. I didn't say that at all. I said we need to look globally at the whole system.

Q: Are there any physician issues that you think have fallen off MedPAC's radar screen and that you want to get back on the agenda?

A: I need to get my feet wet first. There is a retreat in July where a lot of the issues are going to be discussed as far as what the goals of MedPAC are going to be over the next year or so.

You have to remember that I'm a little guy in a small community, and I'm honored to be chosen for such a group.

The people on the commission, some of them are the "Who's Who" of medical economics and medical decision-making in the United States. I'm just excited to be able to work with them, and I'm excited that MedPAC is interested in listening to one of the care providers.