Specialists balk at giving MedPAC regulatory power

Washington -- Several medical specialty organizations have urged key lawmakers not to pursue legislation that would give the Medicare Payment Advisory Commission authority to set Medicare rates instead of just advise Congress on them.

The Alliance of Specialty Medicine said in a July 6 letter that a bill by Sen. John Rockefeller (D, W.Va.) to make MedPAC an independent executive agency would set a dangerous precedent. It would place too much control over health care decisions into the hands of a handful of unelected officials, said the 10 specialty organizations making up the alliance.

"Given the critical impact that these decisions have on beneficiary access to quality care, we strongly believe that Congress should continue to exert strong oversight over these critical programs and not inappropriately relegate these critical duties to MedPAC," said the groups, which include the American Assn. of Neurological Surgeons, the American Gastroenterological Assn. and the American Urological Assn.

The letter was sent to Rockefeller and Rep. Jim Cooper (D, Tenn.), who has sponsored companion legislation in the House. Senate Finance Committee leaders Max Baucus (D, Mont.) and Charles Grassley (R, Iowa), who are working on a national health system reform bill, also received copies.

The specialists said potential unintended consequences could occur if MedPAC gains the power to set payment rates, including restrictions on Medicare patients' access to important specialty care services.

MedPAC currently exists as a legislative entity that advises Congress on Medicare payment policies. The panel has no power to implement any of its recommendations, and Congress often makes its own decisions when it comes to setting payment rates.

In recent years, MedPAC has called for modest pay updates for doctors based on the costs of providing care. But lawmakers mostly have not followed the advice and instead approved freezes or smaller increases.

Rockefeller's bill would give MedPAC independent authority to decide and implement payment policies with some oversight by Congress, similar to how the Federal Reserve sets interest rates. The legislation also would rename the panel the Medicare Payment and Access Commission.

President Obama indicated a willingness to consider elements of the bill shortly after it was introduced, saying he is "open to ideas about giving special consideration to the recommendations of MedPAC."

But specialists worry that MedPAC's new authority might go unchecked if the bill were to become law, on its own or as part of a comprehensive reform package. They said their opposition has nothing to do with conclusions by MedPAC in recent years that Medicare undervalues some primary care services and overvalues some specialty services when it comes to payment rates.

"If you could consider anything worse than Congress being in charge of health care, it would be some independent party you couldn't vote out of office, and that's the possibility you see here with MedPAC," said Troy Tippett, MD, president of the American Assn. of Neurological Surgeons. "So it really has nothing to do with primary care versus the specialties, it has to do with our concern of who's controlling health care."

The specialty organizations also are concerned that MedPAC does not have the clinical expertise or research capacity to determine how Medicare would work best for patients.

But supporters disagree. They say the current process involves far less clinical expertise and must be changed if Congress and the administration are serious about restructuring the Medicare payment system.

"In general, we believe it is in the best interest to put the decisions in the hands of the experts and not politicians," said John Spragens, a spokesman for Cooper. "If we're going to further strengthen the health reform process, the best way to do it is to empower MedPAC so they have the capability to do more than publish two reports that sit on a bookshelf for the rest of the year."