Doctors' Medicare panel disbanded after 18 years

Washington -- A federal advisory panel that provided physicians one way to tell the federal government about Medicare administrative issues was quietly eliminated by a provision tucked away in the health system reform law enacted earlier this year.

The Practicing Physicians Advisory Council, a 15-member board that met quarterly with federal officials to discuss matters pertaining specifically to Medicare fee for service, was officially disbanded on March 23. A provision in the health reform law repealed the section of the Social Security Act that created the council in 1992.

Council members were informed of the dismantling in an April 16 letter from Health and Human Services Secretary Kathleen Sebelius. The secretary announced that because PPAC was being discontinued, the council's June meeting would not take place.

"I want to personally thank you for your active participation as a member of the PPAC," Sebelius wrote. "I greatly appreciate your dedication and contributions pertaining to practicing physician Medicare fee-for-service program issues."

PPAC's final meeting was March 8, during which officials with the Centers for Medicare & Medicaid Services praised the group for its leadership and suggested that the imminent passage of reform legislation, with its emphasis on boosting Medicare quality and value, would enhance the council's role.

"PPAC has been critical in the past couple years, and it's going to be more critical going forward," Jonathan Blum, director of the CMS Center for Medicare Management and the Center for Drug and Health Plan Choice, said at the meeting.

Items touched on at the final meeting included fraud and abuse, payment accuracy and electronic medical records.

The legislative language in the reform law eliminating PPAC did not give a detailed explanation for why lawmakers wanted it gone. But the title of the provision reads, "Focusing CMS Resources On Potentially Overvalued Codes." One of the responsibilities of the Medicare agency is to make necessary revisions to the amount it pays for particular service codes to reflect changes in medical practice, a process during which it seeks the advice of all types of physicians through a separate, AMA-convened committee.

Disappointed members

PPAC members said they hoped they could have kept working with CMS on fee-for-service administrative issues that are important to physicians, and they were disappointed to hear the council was ending.

"It sent out the message that our input was not wanted or desired, and that's very disheartening," said Joseph Giaimo, DO, a Florida pulmonary care physician and board member of the American Osteopathic Assn. "It's disconcerting, because the philosophy of the health reform bill is to move forward in a timely fashion with innovative ideas. A lot of provisions in the new bill are about streamlining health services, and that's what PPAC was about."

Arthur D. Snow Jr., MD, a council member and family physician in Shawnee Mission, Kan., said PPAC's elimination came as a bit of surprise. Still, he said the members had some inkling that the March 8 meeting would be the last when a new person was not named to replace outgoing Chair Vincent Bufalino, MD, a clinical cardiologist and president and CEO of Midwest Heart Specialists in the Chicago area.

Dr. Snow acknowledged that the public forum for practicing physicians to engage the federal government did not always have the desired effect.

"CMS has talked in circles, and it seemed like at times they weren't listening to our concerns. But hopefully we've given them some good input," he said. "We're just disappointed that this valuable tool is no longer available for physicians to communicate to CMS."

Other options available to doctors

Sebelius and CMS officials stressed that physicians still have numerous ways besides PPAC to keep communicating with the agency, including feedback groups, regular conference calls and public comments on Medicare regulations.

The American Medical Association noted that its direct mode of contact with the agency relays physicians' interests to those who need to consider them.

"It's unfortunate that this physician advisory committee has been dissolved, but it's important to note that AMA and its partners in organized medicine communicate with CMS officials on a regular basis to ensure that the voice and concerns of the physician community are heard loud and clear," said AMA President J. James Rohack, MD.

For example, Dr. Rohack pointed out that the administration recently followed the AMA's counsel by removing the cost of physician-administered drugs from the calculation of the Medicare physician payment formula, a move that decreased the projected cost of a pay overhaul. The AMA also was able to convince the administration to make important changes to Medicare's recovery audit contractor program, and to push back deadlines for physicians to adopt new Medicare electronic transaction standards and code sets.

And even though PPAC is not going to be around, some of those familiar with the group said its message will not be forgotten. One of them is William Rogers, MD, director of the Physicians Regulatory Issues Team, a group that works to reduce the regulatory burden on physicians who participate in Medicare.

"I think they did a wonderful job, although sometimes their concerns were not immediately aligned with those of CMS," said Dr. Rogers, who is also an emergency physician at Georgetown University Hospital in Washington, D.C. "Their role was to make sure it was understood what life was like in the physician's office."

Dr. Giaimo said he plans to stay involved in physician advocacy work, something that he took very seriously as a PPAC member. "I took time away from my family and practice to represent my profession with concerns that we all have."