Government

CMS grossly underfunded, says former acting chief

In a recent article, Kerry Weems also blames the AMA-convened RUC for the state of primary care services.

By Chris Silva — Posted July 3, 2009

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The Centers for Medicare & Medicaid Services might be in trouble if Congress passes significant health system reform later this year, as it's already short on resources to carry out its current responsibilities, according to a former agency official.

CMS does not have enough money on the operational side to pay Medicare bills in a reasonable fashion, Kerry Weems said in a June 18 Health Affairs article (link).

Weems was acting CMS administrator from June 2007 through January 2009. The agency is straining to perform its current duties because Congress and the executive branch perennially have deprived it of administrative resources, including funding needed to combat fraud and abuse, he said.

Lawmakers often frown on the "bureaucrats in CMS" and favor the budgets of the National Institutes of Health and the Centers for Disease Control and Prevention over the Medicare agency, Weems charged. "When the resources are limited, you can imagine which agencies win out."

Weems acknowledged that he was culpable in the past of underfunding CMS when he ran the budget office at the Dept. of Health and Human Services. "I plead guilty in this case," he said.

Weems does see some promise in how Medicare covers and pays for services. He praises the growing concept of coverage with evidence development, in which CMS agrees to pay for a new drug or medical device in return for physicians testing the product in the field.

Weems is not a fan, however, of how Medicare payments are influenced by the AMA/Specialty Society Relative Value Scale Update Committee. The RUC is convened by the American Medical Association to make recommendations on how to value certain Medicare services.

"I think there is a general consensus that the RUC has contributed to the poor state of primary care in the United States," Weems said.

The AMA responded to Weems' statements with a letter to Health Affairs from Rebecca J. Patchin, MD, chair of the AMA Board of Trustees. She noted that, in the past two years, CMS chose not to follow some committee advice that could have boosted primary care physicians. The agency, and not the RUC, make the ultimate decisions on how to set Medicare payments, she said.

"Under Kerry Weems' tenure as CMS administrator, the RUC sent recommendations for new ways to describe and pay for telephone calls, team conferences and management of care over a 90-day period for patients on blood-thinning medication," Dr. Patchin wrote. "CMS chose not to implement these recommendations that would have directly helped primary care physicians."

CMS had no comment on Weems' statements in Health Affairs.

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